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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 52
| Issue : 1 | Page : 5-11 |
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Immediate effects of eye yogic exercises on morphoscopic visual acuity
Tommaso Bianchi1, Raffaella Bellen2
1 Yoga Teachers Trainer of the School for Yoga Teachers of Metamorfosys Association, Via XXX Ottobre 19, Trieste, Italy
2 Psychologist, Director of the School for Yoga Teachers of Metamorfosys Association, Via XXX Ottobre 19, Trieste, Italy
| Date of Submission | 28-Mar-2020 |
| Date of Acceptance | 23-Apr-2020 |
| Date of Web Publication | 11-Jun-2020 |
Correspondence Address:
Tommaso Bianchi
Via Della Tesa 20, 34138 Trieste
Italy
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ym.ym_5_20
Background: Various studies have been carried out on what yoga can do for eyesight improvement and for eye health. Numerous of them tested both subjective and objective parameters in different optical fields (myopia, presbyopia, resistance to optical illusions, etc.). The majority of them have tested long-term yoga training. In literature, we found no evidence of the immediate effects of yoga exercises on visual abilities.
Aims: In this study, we tested some yoga exercises directly involving eyes in the improvement of morphoscopic visual acuity.
Methods: Twenty participants have been examined for morphoscopic visual acuity on Snellen chart. After this, they have been invited to perform some yoga eyes exercise for 6 min overall. The exercises included ocular motility, focusing, concentration/purification (trātaka), and relaxation (palming). Finally, they have been subjected again to the Snellen chart examination. Each eye has been examined separately.
Results: The results of the first and the second Snellen chart examination were compared, resulting in a visual acuity medium improvement of 2.28%. The differences between second and first examination ranged from −22.22% to +24.44%.
Conclusions: In literature, we found some critical analyses of the effects of eye yoga exercises on eyesight. Some studies deny every form of improvement in this field. However, the results of our study and the evidence found in literature testify the effectiveness of improvements. Some more studies would be useful to determine the efficacy of yoga training – both short- and long-term – on visual abilities, on refractive errors, on presbyopia, and on most serious eye pathologies.
Keywords: Eye exercises, morphoscopic visual acuity, palming, Snellen chart, trātaka, yoga
How to cite this article:
Bianchi T, Bellen R. Immediate effects of eye yogic exercises on morphoscopic visual acuity. Yoga Mimamsa 2020;52:5-11 |
| Introduction | |  |
Thousands of studies have been published about the therapeutic effects of yoga practice. In particular āsana, but also prāṇāyāma, ṣaṭkarman, concentration and meditation have been tested. Contraction, stretching, and relaxation of muscle bends of every body area, that the āsana involve, perform a fundamental role in achieving and in maintaining both physical and, in a psychosomatic optic, psychological health. However, some body areas have received more attention by the researchers. In the case of eyes, for example, the amount of studies dedicated to them is not as wide as for other body areas. The present study is born from this observation. In fact, it aims to identify any immediate beneficial effects of some simple ocular exercises handed down by yoga tradition. Moreover, the literature survey we made before starting with our study showed that yoga has been really tested by some researchers, but only with regard to long-term effects. The immediate effects of eye yoga exercises, as far as we know, are absent in the research landscape.
| Methods | | |
The study was planned as follows: Twenty participants underwent an examination of morphoscopic visual acuity on the Snellen charts; immediately after, they performed some eye yoga exercises; after the exercises, they underwent a second examination of visual acuity. Each eye has been tested separately, before and after the exercises. The version of the Snellen charts used comprised eight rows (2, 4, 5, 6, 7, 7, 7, and 7 letters each). They have been placed 6 m (20 feet) from the observer. The chart was changed for the second examination.
The administered exercises were the following: looking up and down (30 s); looking right and left (30 s); looking up-right and left-down (30 s); looking up-left and right-down (30 s); following the right index finger approaching and moving away from the tip of the nose (30 s); following both index fingers moving away laterally and rejoining at the center (30 s); performing a complete rotation of both eyes in one direction (30 s) and the other (30 s); trāṭaka – fixing a black dot without blinking (60 s); and palming (60 s). It was, therefore, a mix of exercises of ocular motility, focusing, concentration/purification, and relaxation. During the first reading, the exercises, and the second reading, the participants have been invited to sit on the same chair, keeping head, neck, and the rest of the body motionless.
Before performing the visual acuity tests and the exercises, the participants were invited to answer to a questionnaire. The questionnaire investigated the eye health conditions of the participants, the yoga habits, the familiarity or not with the proposed exercises, the presence or not of other pathologies, the reading and computer working habits, and the activities performed immediately before performing of the test with a particular reference to the use of the eyes.
The test has been performed in a little more than 2 months, in various hours of the day, but always in the same conditions of luminosity.
| Results | | |
The group was composed of three males and 17 females, aged between 27 and 66 years, as reported in [Table 1]. The letters of the Snellen charts have been turned in percentage values. Hence, it has been possible to assign a value to each reading for each eye, before and after performing the exercises. The variation of the percentage values resulting from the difference between the second and the first morphoscopic visual acuity examination is reported in [Table 1], too. The personal medium improvement values between the right and left eyes ranged from −13.33% to +17.78%. General improvement media was +2.28%. Only three participants declared no problem to the right eye, and six participants declared nonproblem to the left eye [Table 2]. Almost all the participants were yoga practitioner (17 on 20), but only six had a familiarity with the eye yoga exercises proposed. Only one participant had no familiarity with meditation practice [Table 3]. Eighteen of twenty participants had no cardiac problem and 14 of 20 had good blood pressure. The rest complained low pressure (four participants) or high pressure (two participants). None of the participants suffered from diabetes, and no one had undergone eye or brain surgery. The health parameters are summarized in [Table 4]. The majority of participants had not tired the eyesight before test and more than an half of them (14 on 20) used to work at computer; more than an half of them (14 on 20 again) used to read paper texts [Table 5] and [Table 6].
| Discussion | | |
In literature, we find various studies affirming that a yoga practice contributes to eyesight improvement and eye health. Telles, Maharana, Balrana, & Balkrishna (2011) and Vani, Nagarathna, Nagendra, & Telles (1997), for example, demonstrated that yoga improves the resistance to some optical illusions. In particular, Telles et al. (2011) showed how some exercises of kapalabhati and breath awareness reduced the Müller–Lyer optical illusion. Vani et al. (1997) showed how a structured yoga practice (90 min of asana, 30 min of satkarman, 60 min of pranayama, 60 min of meditation, 90 min of devotional sessions, and 60 min of study of yoga theory) may determine a major resistance to the optical illusion of continuity generated by an intermittent luminous source. Other studies have compared different methods in treating some visual disorders. Bansal (2014) compared an ayurvedic treatment (Saptamrita Lauha) and a yoga therapy (Jala Neti, Nadi Sodhana, Sitali Pranayama, and Trāṭaka) in persons affected by myopia, concluding the second being more effective in reducing some subjective symptoms such as pain in the eye, watering of the eye, eye strain, and heaviness of the eye. Gopinathan, Dhiman, & Manjusha (2012) compared some eye exercises taken from the Bates method and trāṭaka in the treatment of ametropia and presbyopia. The authors concluded: ”In Snellen's chart reading one line improvement was noted. There was moderate improvement in the clarity of vision, contrast sensitivity, and fineness of objects. Though the degree of this improvement was almost similar in both the groups, a better relief was appreciated by patients of Trāṭaka Yoga Kriya group. It is an encouraging finding that a nonpharmacological, low-cost, relaxation technique can improve the quality of vision, by which it indirectly checks the progression of the disease condition. Both these techniques act as an adjuvant therapy, hence one should adopt pharmacological interventions (medical management), life style, and diet modifications to get a better result” (Gopinathan et al., 2012, p. 545). About yoga and myopia, there are also the studies of Harnoorkar (2016) and Lolage & Jadhav (2013). Harnoorkar compared an ayurvedic treatment and yoga therapy (including eyes movement 10 min, trāṭaka 1–3 min, palming 1 min, every day for 8 weeks) in the visual acuity of myopic patients and concluded that both the remedies, and mostly their combination, generate an improvement in visual acuity and in some subjective symptoms such as watering of the eyes, burning sensation, redness of the eyes, and eye strain. Lolage & Jadhav (2013) reported an improvement of the degree of myopia in a group of 15 girls, aged between 11 and 15 years, subjected to a yoga program (including Om stawan, anuloma viloma, kapalabhati, brahmari, ujjay, trāṭaka, palming, and yoganidra for 60 min a day in 1 month), and compared to a control group. The comparison between an ayurvedic treatment and yoga training has been the object of the study of Pramodini & Peiris (2013), too. The authors compared the two methods, and their combination, in patients affected by presbyopia, concluding that the combination of both the methods leads to better results.
Although Pandey, Aranha, Samuel, & Kumar (2015), in their reviews of studies about myopia treatment, conclude that the studies reviewed do not present the characteristics of generalizability and do not guarantee the effectiveness of the methods used, other researchers have investigated other aspects of the sense of sight improvement generated by yoga. For example, Telles again (Telles, Naveen, Dash, Deginal, & Manjunath, 2006) reported a considerable reduction of ”dry eyes,” the major symptom of computer vision syndrome (CVS), after a yoga training including asana (15 min), pranayama (10 min), exercises for the joints (10 min), trāṭaka (10 min), and guided relaxation (15 min), for 5 days a week for 2 months. The study involved 291 individuals (146 yoga group and 145 control group). On yoga (and Ayurveda) in CVS, there is also the study of Musale, Suryawanshi, & Suryawanshi (2015), which concludes about the effectiveness of trāṭaka, palming, blinking, and splashing in the reduction of the symptoms of the syndrome.
Other studies investigated aspects such as the effects of yoga exercises on visual reaction time (Gosewade, Shende, & Kashalikar, 2013; Madanmohan et al., 1992); others discussed the role of some yoga asana on intraocular pressure (Schirrmacher, 2015; Bhartiya, & Ichhpujiani, 2014; Bskaran et al., 2006; Bertschinger, Mendrinos, & Dosso, 2007), a recognized etiologic factor of glaucoma; on the same topic, more recently, the study of Gupta, & Aparna (2019) has demonstrated the value of yoga ocular exercises in the reduction of intraocular pressure; other studies again compared the effectiveness of different sports, including yoga, in ocular physiology and in eyesight improvement (Wylegala, 2016; Shmakov, & Kozyreva, 2014). There are also studies that tested methods of eye exercises other than yogic (Rawstron, Burley, & Elder, 2005; Di Noto, Uta, & DeSouza, 2013; Lin et al., 2013a; Lin et al., 2013b; Krezpota et al., 2015; Kang et al., 2016). However, although few, there are also critical voices: in 2013, Elliott published a paper in which the author attributed every possible myopia improvement deriving from ocular exercises (in particular Bates method) to placebo effect, in addition, in 2018, the significant study of Tiwari, Shaik, Aparna, & Brundavanam reported as not effective on myopia neither Bates method nor Trāṭaka Yoga Kriya, placing itself in stark contrast to the cited literature which put forward different hypotheses.
The present study investigated a topic which was absent in the survey of the literature we made: the immediate effect on morphoscopic visual acuity of a group of yoga exercises engaging eyes. The studies we examined are all about long-term yoga training, minimum 1 month, whereas ours showed the effectiveness of a 6 min only training. The reason of the general improvement media in morphoscopic visual acuity (+2.28%) detected by the test may be attributed principally to the effect of relaxation on extrinsic eye muscles the exercises induced, but also the ciliate muscle may be involved. As known, the ciliate muscle acts on the crystalline lens of the eye determining the degree of convexity. The degree of convexity of the crystalline lens is responsible for focusing images at different distances. The nearer is the image to focus, more convex becomes the crystalline lens. Therefore, the relaxation of the ciliate muscle may have caused the lower convexity of the lens needed for remote focusing of the letters on the Snellen charts. It is plausible that a practice of the exercises protracted in the time can make definitive such temporary effect. The effect of relaxation has not to be attributed to the palming only. Also, the ocular motility exercises may have contributing in inducing such an effect. In fact, according to the principles of progressive relaxation of Jacobson, releasing of a muscle after a prolonged contraction, or training, induces just a relaxation deeper that the one I can reach by relaxing only the same muscle. Also, trāṭaka may have contributed to the general effect of relaxation. Bates (1920) teaches that fixing the black color is one of the best methods to relax eyes: the absence of light (that may overstimulate the retina) in black color, in fact, allows the eye to rest. Moreover, the surplus of tearing, generated by fixing without blinking that trāṭaka involves, may cause a major hydration and cleansing of the cornea, providing a clearer vision. In addition, both trāṭaka and palming (more the latter than the former), by reducing the light stimulus, may have contributed to the relaxation of the sphincter muscle of the iris, too.
In our study, many aspects remain unclear. It would be desirable that these aspects could be investigated in further researches. For example, the study lacked a control group. In fact, an improvement in the second visual acuity test would be possible also without performing the exercises. The mere adaptation of the participants to the new situation could however have led to a better result in the second reading. Furthermore, 17 out of 20 participants were familiar with the practice of yoga. This condition may have influenced the tests, in particular the second one, as the participants were more accustomed, compared to the general population, to quickly reach a meditative and/or relaxing state. This hypothesis is confirmed by the fact that the familiarity with the proposed exercises (3 participants out of 20) gave a better result (+4.08%, participants 6, 8, and 19) than the medium recorded one. Also, the hardly explainable +3.33% medium improvement registered in the three males of the group (participants 12, 15, and 18) should be object of further investigations. Another element on which to focus any future research is the type of eye disorder complained of by the participants. In our study, we found that an astigmatic (participant 20) showed a significant worsening in the second reading (−22.22% in the right eye and −4.44% in the left eye). In addition, participant 12 presented a worsening in her astigmatic eye, the left one (−6.67%), in front of an improvement (+4.44%) of a healthy right eye. These data could lead to conclude that the exercises are not effective for astigmatic, but only for myopic and farsighted participants. Notwithstanding, participant 5, astigmatic too, showed an improvement in both eyes (+8.89% in the right one and even 20.00% in the left one). The discrepancy of the data suggests that, also in this case, a comparison among homogeneous groups (e.g., myopic vs. astigmatic) could lead to interesting results. Finally, we detected a significant difference in the medium improvement between the right eye (+3.78%) and the left one (+0.78%). A possible explanation of this finding could be that the reading of the left eye have benefited from the memory effect, deriving from the fact that the Snellen charts have been changed only between the first and the second readings and not between the right and left eyes. The participants could have memorized the chart and could have started immediately with a better reading of the left eye. However, this did not happen. The total number of letters correctly recognized by the right eye was higher than those recognized by the left eye, both at the first (622 right vs. 600 left) and at the second readings (656 right vs. 607 left). Therefore, the memory effect does not seem to have played a determining role in the difference found in the two eyes. Furthermore, the hypothesis that all the participants presented a left eye weaker than the right one does not seem plausible. Perhaps, it is more reasonable to think that the left eye was disturbed by being covered by a hand, whereas the right one read and forced to read immediately after the hand was removed.
With regard to the age of the participants involved, it should be noted that they were adults. The range was 27–66 years, with an average of 44.30 years and with a prevalence of 40–49 years (50% of participants). Both boys and the elderly were excluded from the study, i.e., those age groups in which the major and minor improvements of a physical, sensorial, or mental training are respectively manifested. From this point of view, the tested sample is equidistant from an extreme youth and from an extreme old age and therefore particularly significant in the detection of actually medium values.
| Conclusions | | |
The matter of this study is still an object of dispute. As we have seen, some authors do not confirm – or agree with – the positive findings reported by others. However, the amount of studies that testify an actual improvement of eyesight, following the practice of yoga in general and of yogic eye exercises in particular, suggest that this field of research deserves to be further investigated. In addition, the specific contribution of the present study is that of investigating, next to long-term effects of eye yogic exercises on vision, also the immediate ones. The finding of a percentage value of +2.28% in morphoscopic visual acuity after only 6 min of exercises is worthy of attention. Moreover, the limits highlighted in the present study can be considered as aspects to be overcome in subsequent investigations.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.[28]
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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