Yoga Bharati
A Systematic Review of the Therapeutic Effects of Yoga for Refractive Errors and Other Vision Disorders
Institutional Report
2014 Yoga Bharati Vision 2020 Project Initiative
Yoga Bharati, 7630 Kirwin Lane, Cupertino, CA, 95014. In technical collaboration with
Yogaksema-Stress & Lifestyle Clinic, Bengaluru, India 775, Double Road, Indiranagar, bangaluru, 560038 Author Savita Joshi, Director, Therapy Services, Yoga Bharati Advisory Ashwini Surpur, Director, Yoga Bharati.
Review Committee Anil Surpur, President, Yoga Bharati Naveen Visweswaraiah-Consultant Physician in Integrative Medicine
Š Copyright 2014 Yoga Bharati Powered by HealthMinds
Yoga Bharati
Executive Summary Our Aim
Look around you. We are wired to a media-rich, networked world of infinite possibility. Visually connected to computers, tablets, phones and television sets – peering into an abyss of electronic screens and digital content for hours can pose a serious problem for the eyes. Computer Vision Syndrome [CVS] and has become a common problem for our generation. The cost associated with all that surfing, e-reading, texting, e-mailing, blogging, chatting, tweeting and computer game playing that we do 24*7 days on our e-notebooks, tablets and smart phones IS damage to our eyes and puts us at a risk for early myopia (or nearsightedness). Among our five physical senses, the most dominant and highly developed sense is vision. In fact, 80% to 90% of the information that we gather comes to us through our eyes. Thus, vision is our primary means of relationship with the world around us. Therefore, loss of vision is a condition that compromises the quality of life of individuals significantly. In this whitepaper, YogaBharati presents a yoga module developed by our experts to alleviate vision disorders, our accomplishments so far as well as what we aim for as we look to the future
Our Approach
Yoga Bharati offers a Yoga module (not Yoga the cult, but as a Science!) for children aged 5-13 years who have one of these following eye disorders: Refractive Errors, Short sightedness, Astigmatism, Farsightedness and Crossed/Lazy eyes. Research has shown that eye muscles, viz. intrinsic muscles (ciliary muscles) and the extrinsic muscles (superior rectus, inferior rectus, lateral rectus, medial rectus, inferior oblique and superior oblique) relax by stretching and expansion much like other muscles in the body. Therefore, induction of specific stretching and relaxation exercises can have a curative effect on vision issues. We imbibed these research principles into a yogic workshop, which lasted for three months. We undertook a series of assessments before and after the yoga for vision workshops. In order to determine the improvement in the vision among the study subjects, we noted down the diagnosis from an initial eye-check up before the workshop and a follow up eye checkup after a year. We also conducted a vision test, using a Snellen chart. The guardians of each participant were required to fill up a form containing the reported personal stressors, sleep patterns, appetite, eating habits, food allergies, bowel movements, pain in the eyes, watery eyes and headaches and other subjective questions attempted to determine if the child is happy, does he/she make friends quickly, participation and patience level. Tremendous imporvements in the vision of the participants were achieved as a result of these three workshops.
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Yoga Bharati Our Observation Our results from the pilot study of the interventions of a ‘Yoga Based Lifestyle on Vision Disorders’ provided an interesting insight in children with specific vision disorders. We found that the study participants showed significant improvement in their vision after 3 months of yoga therapy. With just one element of the lifestyle program, i.e., yoga therapy, the observed results have been positive. Among the total study participants, 10-20% participants (Based on the Pre-assessment and post assessment forms filled out by the guardians of each participant) reported improvement in the following areas; eyesight, eye pain, burning sensation in the eye, headaches, sleeping pattern, food allergies, and even appetite. Subjective analysis of the any improvement of the participant’s social skills was also performed. We noticed an improvement in social skills among 40% of the workshop participants (Based on the Pre-assessment and post assessment forms filled out by the guardians of each participant).
Looking Ahead
Based on the encouraging results, Yoga Bharati has developed a quarterly plan for conducting these workshops on Lifestyle Intervention Programs for Natural Vision Improvement. Within a year, we plan to conduct similar Lifestyle Intervention Programs to improve vision for adults as well. In addition to workshops designed to correct refractive errors of the eye, we are also looking to conduct workshops and take an integrative healing approach to other eye abnormalities.
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Contents
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INSTITUTIONAL REPORT
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1. Yoga for Vision
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1.1 World Blindness Overview
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1.2 Relevance of use of Yoga Therapy for Vision Problems
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1.3 Expected Clinical Evidence & Performance Outcome from Eye Exercises described in Yoga
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1.4 Evidence Based Yoga Therapy 2. Pilot Study conducted by Yoga Bharati to Alleviate Vision Disorders
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2.1 Structure of the Vision Yoga Workshop
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2.2 Interventions to Prevent Progression of Refractive Errors
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2.3 Assessments Undertaken
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2.4. Results from the Pilot Study
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3. Case stories from the Vision Yoga Workshops
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3.1 A Case Study # 101
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3.2 A Case Study #102
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4. Clinical & Research Road Map for Yoga Bharati 4.1 A clinical Road Map for Practice of Yoga therapy for Vision 4.2 A Research Road Map for Yoga for Vision 5. Summary References
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Institutional Report
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1. Yoga for Vision 1.1 World Blindness Overview The term “blindness” can have many connotations and is mostly associated with complete loss of sight with no perception of light. The definition cited by the National Federation of the Blind states that central visual acuity (vision) must be 20/200 (6/60) or less in the better eye (if the perception of light is unequal in both eyes) with the best possible correction or that the visual field must be 20 degrees or less7. (Simply put, a legally blind individual requires to be at a distance of 20 feet or 6.1 m from an object to visualize it—with vision correction—with the same measure of clarity as a person with perfect vision could from 200 feet or 61 m). According to World Health Organization (WHO), as of 2014, globally there are 285 million visually impaired people. Out of them, 39 million are blind and 246 million have low vision8. Experts in vision and eye health surmise that eighty percent of the visual impairments can be cured or avoided8! A whopping 63% of the global population of children below age 15 is visually impaired due to refractive errors (most commonly, nearsightedness or myopia and farsightedness or hyperopia)8.
Fig.1 Geographical Distribution of Global Blindness. Adapted from Global Initiative for the Elimination of Avoidable Blindness : action plan 2006-2011.
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Interestingly, the Visual Acuity Impairment Study sponsored by the National Eye Institute rates lazy eye or amblyopia to be the chief cause of vision loss in the age group between 20-70 years. In this regards, lazy eye surpasses other major eye disorders, including, diabetic retinopathy, glaucoma, macular degeneration, and cataract. The American Optometric Association recommends an early correction for lazy eyes as the chance for a complete recovery reduces noticeably with age. If lazy eyes are not corrected at an early age, it may lead to permanent vision reduction or even blindness in the affected.
Yoga Bharati Visual impairment is not distributed uniformly throughout the world. More than 90% of the world’s visually impaired live in developing countries. Blindness is most prevalent in developing countries where malnutrition, inadequate health and education services, poor water quality and a lack of sanitation leads to a high incidence of eye disease. Worldwide, for each blind person, an average of 3.4 people has low vision, with country and regional variation ranging from 2.4 to 5.59.
1.1.1 Causes of Blindness International studies indicate that vision loss is associated with higher prevalence of chronic health conditions, death, falls and injuries, depression, and social isolation10,11,12. Globally, the causes of visual impairment are uncorrected refractive errors (myopia, hypermetropia, astigmatism) 43%, un-operated cataract, 33% and glaucoma, 2%8.
According to the International Classification of Diseases -10 (Update and Revision 2006), there are four levels of visual functions: 1. Normal vision, 2. Moderate visual impairment, 3. Severe visual impairment and 4. Blindness. ”Low vision” is a term used by WHO to describe moderate visual impairment combined with severe visual impairment. Thus, we understand visual impairment as low vision taken together with blindness8.
1.1.2 Insights on Vision Our eyes are the body’s most highly developed sensory organs. Vision, is the means by which our brain perceives the world and gathers information from the world in order to interact with it. In a nanosecond, our eyes work with our brain to tell us the size, shape, colour and texture of an object. The eyes work together to perceive depth, enabling us to judge distance and the size of objects to help us move around them. Not only do both eyes work together, they also work with the brain, muscles and nerves to produce complicated visual images and messages. In order to see things clearly (whether near or at a distance) one of the most amazing things that our eyes does is the ability (called accommodation) to change its focal length. Now, there are six muscles (superior Rectus, inferior rectus, lateral rectus, medial rectus, inferior oblique and superior oblique) that surrounds each of our eyeballs! These muscles work to move the eye up and down, side to side, and to rotate the eye.
Fig 1. The anatomy of the human eye.
The simple act of opening our eyes and seeing a single, clear image is something that we take for granted. This seemingly automated mechanism of how our eye functions depends on the flawless synchronization of multiple areas of the vision system. Normally light rays from the object pass through the eye to reach the retina. This in turn causes nerve messages to be sent from the cells of the retina down the optic nerve to the vision centers in the brain. The brain processes the information it receives, so that in turn, we can see.
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1.1.3 Refractory errors and their impact on quality of life The global initiative to eliminate avoidable blindness by the year 2020 has included Refractory Error as one of its five priority eye diseases, following epidemiological studies that have highlighted the escalating estimates of Refractory Error prevalence13. According to World Health Organization, Refractive error (or Ametropia) occurs when the parallel rays of light entering the non-accommodating eye do not focus on the retina, resulting in a blurred image. The main types of refractive errors are myopia (nearsightedness), hyperopia (farsightedness), presbyopia (loss of near vision with age), and astigmatism.
Myopia
Myopia or near sightedness causes light rays to focus at a point in front of the retina, rather than directly on its surface. This results in blurred vision. Myopia occurs when the eyeball becomes too long and prevents incoming light from focusing directly on the retina. It may also be caused by an abnormal shape of the cornea or lens.
Fig 2. Myopia- When light rays enter, they come to a focus before reaching their destination, which is the retina at the back wall of the eye.
Hyperopia
Hyperopia is also known as “farsightedness” or “hypermetropia”. It is an ocular condition in which the refracting power of the eye causes light rays entering the eye to have a focal point that is behind the retina, rather than directly on it. Hyperopia is mainly caused by the eye being "too short", meaning the distance between the cornea and the retina is not great enough.
Figure 3. Hyperopia- In such cases, the image forms just behind the retina, which means a hyperopic sees things better far away than close up. 4
Yoga Bharati Refractive error is associated with decreased visual functioning as well as other aspects of quality of living for individuals. Research demonstrates that refractive error has a negative impact on 1. Psychological well-being 2. Depressive symptoms 3. Self-esteem 4. Career choice 5. Lost educational & employment opportunities 6. Reduced social interaction and naturally 7. Ocular health Interventions that correct myopia and hypermetropia could improve participation in the daily life people with uncorrected refractive errors14,15,16. Thus, quality of life measures targeted to improve defects in vision and perception contribute significantly to the quality of living and the well-being of the individuals.
Interventions to correct refractive errors
Description
Corrective Glasses/Spectacles
Corrective glasses help the eye and addresses far, intermediate and near vision problems.
Contact lenses
Medical devices worn to correct vision, or for cosmetic or therapeutic reasons
Photorefractive Keratectomy (PRK)
PRK was the first type of laser eye surgery developed for vision correction, i.e. myopia, hyperopia and astigmatism. In PRK the cornea's entire epithelial (outer) layer is removed to expose the area and no flap is created.
Laser-assisted in situ Keratomileusis (LASIK)
Most popular laser eye procedure today used to correct refractive errors. LASIK patients generally have less discomfort, and their vision stabilizes more quickly
Laser-assisted Subepithelial Keratectomy (LASEK)
It is a variation of PRK, involves lifting the epithelial layer of the cornea and then replacing it on the eye's surface at the end of the procedure.
Epipolis Laser In Situ Keratomileusis (Epi-LASIK)
It involves cutting a very thin flap of tissue from the epithelium that covers the cornea. After the laser treatment, the epithelial flap is gently repositioned back on the eye and a special contact lens is placed on the eye to assist with the healing process.
Overnight corneal reshaping/ Corneal Refractive Therapy (CRT)
It is the fitting of specially designed gas permeable contact lenses used to reshape the cornea and improve a patient’s vision.
Table 1. List of interventions available to correct refractive errors
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1.2 Relevance of use of Yoga Therapy for vision problems Yoga has been a part of traditional Indian spiritual practice for around 5000 years17. Research in Yoga is indeed a multidisciplinary venture and has adopted tools from various disciplines such as biology, medicine, psychology, psychiatry and sociology. The practice of yoga includes specific postures, cleansing practices, regulated breathing and meditation. Yoga practice has been associated with better self-rated relaxation as well as with physiological relaxation. Evidence-based approaches to yoga recognizes the allopathic medical definitions of diseases as well as disorders and correlates it with descriptions provided in Ayurvedic and Naturopathic literature and uses the yoga sutras to treat them.
1.3 Expected Clinical Evidence & Performance outcome from eye exercises described in Yoga 1. Improved eyesight 2. Improved concentration 3. Improves peripheral vision 4. Reduces chances of having diseases of the eyes 5. Calms the mind 6. Helps relieve eye strain from prolonged time at computers 7. Relieves dry eyes 8. Improves clairvoyance and ability to visualize
1.4 Evidence based Yoga Therapy In a recent study carried out to understand the effect of Yoga therapy on visual discomfort in computer users, it was observed that a combination of yoga practices reduced symptoms of visual strain in the yoga group as against the control group18. Specific yoga practices have been known to bring about psychological changes suggestive of ‘an intermediate state of balance between rest and alertness’. This description is based on simultaneous decrease in heart rate and oxygen consumption along with a reduction in peripheral cutaneous blood flow. The visual cleansing practices (tratakas) have been shown to facilitate visual perceptual sensitivity in terms of a decrease in optical illusion4. A relaxed state attained with the practice of mindful meditation has been associated with better visual perceptual sensitivity19. A certain set of yoga practices has been correlated with definite changes in perception, awareness and cognition. Visual perception in a group of college students was also significantly increased following a ten-day training session in asanas (physical postures), pranayamas (voluntary regulation of breathing), tratakas (visual focusing exercises), meditations and classes on the theory of yoga2. A combination of yoga practices reduced symptoms of visual strain in persons with progressive myopia1. Extensive studies done by the American Optometry Association in 1986 found that eye exercises for these eye muscles can significantly improve the vision. We see a lot of eye problems in later life are due to a loss of tone in the eye muscles. These muscles become rigid, and this loss of elasticity reduces the ability of the lens of the eye to focus at different distances. It also causes the eyesight to become weaker. These exercises tone the eye muscles up and keep them elastic.
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Eye exercises have a great role to play in various opthalmological conditions, such as, eye strain (or, Asthenopia). An eye strain is both similar and common to the strain developed in our leg after a long, forced and arduous walk! Eye strain can be divided into accommodative strain (due to strain on ciliary muscles) and muscular strain (due to weakness of extra ocular muscles).
Eye exercises are instrumental in reducing the general tension in the eye muscles. Eye tension produces an increase in the nerve impulses in the eye muscles. The nerve impulse travels along the optic nerve and bombard the brain, causing a general feeling of tension and anxiety. In the effort of clear vision, the blinking phenomenon also renews the tear film, which leads to redistribution of a fresh layer across exposed cornea and hence clearing of vision. Vision Yoga is a holistic method of treating eye disorders, which is a part of the Vedic tradition as given in the Chakshushopnishad-Upanishad of the eyes and Netradwayam- Ayurvedic treatment of eye disorders.
The pioneer in natural vision improvement was New York ophthalmologist, William H Bates (1860-1931). In the years he worked as assistant surgeon at the New York Eye Infirmary Dr. Bates examined thousands of eyes. He discovered not only that eyesight changes all the time, but contrary to the conventional belief, which exists even today, that it was the muscles around the eye which are involved with focusing rather than the lens inside the eye.
2. Pilot Study conducted by Yoga Bharati to Alleviate Vision Disorders Meister Eckhart, a thirteenth-centur y Christian mystic who once declared, "The eye with which I see God is the same eye with which God sees me."
Yoga Bharati was established in 2002 under the aegis of Shri N.V Raghuram, the spiritual founder and Chairman of Yoga Bharati. Attainment of well-being in the five dimensions of human existence (also called as the pancha koshas)- namely the physical, the pranic (vita-sheath), the emotional, intellectual and the spiritual levels- is the main aim of this august yoga institution. Yoga Bharati strives to translate yoga research into lifestyle modifications for people from any cultural backgrounds in order to help them understand and adapt to the philosophy of yoga as a socially relevant science. Yoga Bharati offers a Yoga module (not Yoga the cult, but as a Science!) for children aged 5-13 years who have one of these following eye disorders: Refractive Errors, Short sightedness, Astigmatism, Farsightedness and Crossed/Lazy eyes. Yoga Bharati started a much anticipated workshop related to vision with an open house on October 2nd, 2013. 2nd October is also the birth anniversary of India’s Father if the Nation, Mahatma Gandhi. What better day to begin the fight against vision illness than Gandhi Jayanti. The first workshop commenced on October 9th, 2013 and the second workshop followed up on February 12th, 2014. We also conducted a third workshop on May 7th, 2014. Forth workshop was conducted from October 2014 to February 2015 across three regions.
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Yoga Bharati Parents of participating children were given a two hour long induction training on Yoga therapy concepts and a background on yoga for vision model. In a nutshell, the induction training imparted the rationale behind the yoga for vision workshop and how it works. Parents were explained that Yoga is certainly not a miracle nor is it just a magic pill! Yoga is a lifestyle change and a way of life, which when adapted in our day to day life brings good health as a primary positive benefit. The three-month workshops that were conducted as a preparatory phase helped the children learn principles of yoga and techniques of self-management of healthy lifestyle and eye care. The 27 children enrolled into our pilot study signed the Informed Consent forms and completed the Pre-assessment forms and submitted their recent eye prescriptions as well. Classes continued for twelve weeks I each workshop and the participants were taught specific eye practices along with regular yoga poses and breathing techniques. We were delighted to see that the twelve week preparatory sessions were enough to jump start natural vision healing.
2.1 Structure of the Vision Yoga Workshop Patient Population: Children and adolescents ranging from 5 to 13 years of age received three months of yoga therapy. We screened for the following eye disorders: Short sightedness, Astigmatism, Farsightedness and Crossed/Lazy eyes among the study participants. Our inclusion criteria for the study population having the above mentioned eye disorders led us to include 27 subjects for our workshops conducted on yoga therapies for Vision Management.
Rationale & Aim for Yoga therapy for Vision: The major reasons for treating refractive errors are to improve patient’s visual acuity, visual function and visual comfort. Evidence based on yoga therapy reported in peer-reviewed literature is currently insufficient to recommend yoga intervention to prevent progression of refractive errors. Thus, the clinical objectives of this pilot study was to prevent progression of refractive errors in addition to correct the overall side effects of poor vision, viz. headache, low self-esteem, pain or burning sensation in the eyes and watery eyes.
Design of the Workshop • Semi private group classes were conducted once a week for duration of three months or twelve weeks. Additionally, one virtual session over the phone per week was conducted during this time period. • Basic clinical evaluation in these workshops is for the following cases, refractive errors, intraocular pressure, field of vision, and tests for dry eyes. • Each organized group class consists of the following series of yoga practices and games; 1. Suryanamaskars or Sun Salutations 2. Asanas or yogic postures 3. Pranayamas and breathing techniques 4. Chanting 5. Palming 6. Eye ball strengthening practices 7. Blinking/self massage
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Yoga Bharati 8. Tratakas – Gazing practices 9. Peripheral vision stimulating practice 10. Energetic yogic games to keep the session interesting 11. Yoga nidra or Deep relaxation techniques 12. Bhramari – humming bee breathing 13. Meditation 14. Field trips to health stores, outdoor parks, and lake areas. • Each class is sixty minutes long. • Apart from the classes, the children will be given a set of 10 minute audio recording so that they can practice twice daily at home.
2.2 Interventions to prevent progression of refractive errors A. Table listing the interventions for In-Class Sessions
Class Sessions & Virtual Sessiona
Duration (in minute)
Physical Practices (focused on improving blood circulation in the upper body, shoulders, neck, head, arms) & Suryanamaskars
15min
Eye Palming Exercise
2-3 min
Ciliary /optic muscle strengthening practices ( such as, eye ball movements, vertical, horizontal, diagonal, and circular movements.) and Trataka (i.e. gazing exercise, either one of Vama/Dakshina/Nasikagra/Bhrumadhya)
10min
Note: Palming exercises are performed before each switch Eye Palming Exercise
2-3 min
Peripheral vision practice (either, pirate vision practice 1, melissa practice, sunning practice or even pirate vision practice 2)
10 min
Facial Massage (Self massage)
5 min
Pranayama – Any two breathing techniques, such as Kapalabhati, Ujjayi, Sadanta (cooling pranayama) and Bhramari.
5 min
Note: Brahmari is performed at the end Guided deep relaxation technique while performing eye palming exercise
10 min
Total Time Taken
60 min
Source: YogaBharati Yoga Workshop for Vision Schedule
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B. Table listing interventions for Virtual class Sessions Upper body parts warming up and Eye Palming exercise
10min
Eye ball strengthening practice
5 min
Eye Focusing Practice
5min
Palming relaxation practice during deep relaxation
10 min
Total Time Taken
30 min
Source: YogaBharati Yoga Workshop for Vision Schedule
Specific yoga practices can effectively reduce or eliminate refractive errors and decrease your need for glasses or contact lenses. These specialized techniques that were taught in the workshop are described as follows: • Suryanamaskars or Sun Salutations (in Sanskrit, action, deed) are set of 10 postures that adresses the entire body brings about awareness, blood circulation and voluntary control over autonomic nervous system. Suryanamaskar practice also improves spinal flexibility and improveds immunity. These are only few of many other obvious benefits. • Blinking Practice is a natural preserver of healthy vision. Blinking cleanses and lubricates eyes. Stand or sit straight. Blink eyes about 10-15 times every minute or about once every 5 sec. Having proper relaxation in the only muscle that controls the eyelids it can promote relaxation throughout the body. • Self Massage is a practice to relieve tension in the facial muscles, around the eyes, eyebrow ridge, temples, cheek bone, jaws, around and behind the ears and neck regions. Massage is conducted in a small circular motion. Self massage creates a very nourishing effects into the muscles and deep tissue areas. • Peripheral vision stimulating practices are to stimulate and improve ability to see objects and movements outside of the direct line of vision. Peripheral vision is the work of the rods, nerve cells located largely outside the macula (the center) of the retina. The rods are also responsible for night vision and low-light vision but are insensitive to color as opposed to central vision. • Deep relaxation technique is a form of biofeedback to the body to bring in complete stress relief to the body, breath and mind. Relaxation response brings in nervous system back into balance. It is a mentally active process rather than deep sleep state. Children are given simple techniques that they can relate to day to day situations. • Bhramari is a breathing technique that is derived from black Indian bee called Bhramari. The sound resembles the typical humming sound of this bee, and hence the name. Bhramari pranayama calms the nerves and reduces tension and anxiety. Also helps to reduce anger and frustrations. • Kriyas (in Sanskrit, action, deed) are yogic purification processes. These are cleansing techniques meant to strengthen the nerves which connect the eyes to the brain. Kriyas help in reducing tension between the different eye muscles, calm the mind and slow down breathing. These effects therefore control the physiological responses of tension and anxiety- increased heart rate and hyperventilation. • Shatkarmas (or six cleansing techniques) play a very important from the point of view of physical and mental health. There are six main groups: Neti, Dhauti, Nauli, Basti, Kapalbhati & Tratakas. Among these, Neti, Kapalbhati and Tratakas play an important role in regulating vision.
• Neti, is a type of nasal irrigation that exerts a relaxing and irrigating effect upon the eyes by stimulating the tear ducts and glands. According to the ‘Hatha Yoga Pradipika -Neti cleanses the cranium and bestows clairvoyance. It also destroys all diseases which manifest above the throat. Cleansing practices such as Nasal washes are also known to relieve pressure from the sinuses. • Kapalbhati (kapal is cranium/forehead & bhati is light or splendor) is a technique which invigorates the entire brain and awakens the dormant centers which are responsible for subtle perception. While normal breathing is characterized by active inhalation (suggestive of active contraction of the inspiratory muscles, such as the diaphragm and external intercostals) and passive expiration, Kapalbhati reverses this process. The forced and longer exhalation and passive inspiration improves the oxygenation of blood in the body which helps in better nourishment of all the structures of eyeball along with nerves 20,21. • Trataka is an eye muscle strengthening exercise that includes a combination of focusing and defocusing our gaze. It is one among the six kriyas in Hatha Yoga. In trataka, the simple act of holding the image in the mind for an extended period of time results in ‘blanking out’ of visual perception. In the wake of this suspension, the central nervous system begins to function in isolation. In Trataka Yoga Kriya, the functional efficiency of extra ocular and intra ocular muscles increases by forcing them to work and enhances the metabolism of rods and cones through the mechanism of dark and light adaptation. • Asanas are the physical postures practiced in yoga. Through the practice of asanas, we develop the habit of discipline and the ability to concentrate, both of which are necessary for the relaxation of mind. Relaxation of the mind improves blood circulation, which in turn, can enhance visual perception. • Pranayama or breathing exercises increase para–sympathetic tone, decrease sympathetic activity, improve cardio–vascular and respiratory functions, decrease the effect of stress and strain on the body and improve physical & mental health 22. Pranayama & meditation reduce stress and enhance pranic energy in the eyes. Also, pranayama balances pitta dosha and improves eye power. • Chanting helps calm and bring down the sympathetic tone. At Yoga Bharati we use monosyllables such as ‘AAA’, ‘UUU’, ‘MMM’ and ‘AUM’ sounds. Monosyllables are neutral sounds leave us with no thoughts and feelings behind but still bringing deep rest at the cell levels. • Energetic yogic games help child to let go all the barriers, open up and express. Kids love to play. Learning and fun can go hand in hand. They also keep the class interest.
2.3 Assessments Undertaken Initial eye check-up and a follow-up after a year will be required from the family eye doctor to record any changes in the ocula health. Thus, eye tests undergone within the last four weeks before the beginning of our workshop and a year later were required. Amongst other objectives, we hoped to see improvements in the objective measurements such as improved eyesight, as judged by using Snellen chart (explained on the left) and subjective measurements such as better focus, memory, concentration and control over emotions. Objective aims of this pilot study included an assessment of vision by using Snellen chart, Intra-ocular pressure and field of vision, reported personal stressors, sleep patterns, appetite, eating habits, food allergies, bowel movements, pain in the eyes, watery eyes and headaches. Besides the clinical objectives listed above, subjective analyses were also performed. Subjective analysis were based on quetions attempted to determine if the child is happy, does he she make friends quickly, participation and patience level.
2.4. Results from the Pilot Study Our results from the pilot study to see the effect of Yoga Based Life Style on Vision Disorder provided an interesting insight in children with specific vision disorders. This pilot study is the first study in the world to investigate the effect of the practice of yoga therapy for vision in a group of children and adolescents. We found that the study participants showed significant improvement in their vision after 3 months of yoga therapy.
We conducted vision tests to determine the improvement in the vision among the study subjects. Initial vision evaluation was done using a Snellen chart (shown on the below). Based on the children’s visual ability, they were asked to read the smallest line they could. Distances chosen were 5 ft, 10 ft, 15 ft and 20 ft. Children were asked to read the same lines at the same distances during pre- evaluation and post assessment. We maintained uniformity to ascertain if there were any changes observed before and after the vision yoga workshops.
Yoga Bharati
Clinical Results
Improved Vision
20%
Headache Relief
10%
Easing Burning Eye/ Eye Strain
10%
Reduction in allergy symptoms
20%
Improved Sleep
20%
Improved Appetite
10%
Subjective Results
Improvement in social skills & participation
40%
Table 3. Results from the Pilot Study
3. Case stories from the Vision Yoga Workshops 3.1 A Case Study # 101 Demographic Data: Rohit [name changed to protect his privacy] joined us on October 9th, 2013. He was only 7 years old and weighed 45lbs. His height was taken as 4’2”. Clinical Vision Data: Four years back, he was diagnosed with long sightedness. His optical power at the time was + 3.75 on both eyes. Observation: Rohit diligently completed all the three vision workshops offered by YogaBharati. We were happy to see that Rohit’s mom was very committed to actively participate in our yoga sessions and special field trips that were planned during the workshop. Rohit was as enthusiastic as well and was able to learn and grasp the yoga practices and specialized techniques that were taught at the vision workshops. Performance in Clinical Outcome: After three months of yoga therapy intervention his mother reported that his power went down to + 3.0 (R) and + 3.25 (L). Rohit’s vision checkup was conducted independently by his ophthalmologist. Progress in Scholastic Performance & Quality of Life: The yoga intervention showed an all around improvement in Rohit’s case. Gradually, we observed Rohit’s social skills improving, he started taking an interest in many activities and began to open up and communicate better. With his confidence levels increasing, the vision yoga workshops have encouraged him to make lifestyle changes that oriented him towards better health. Conclusion: At YogaBharati, we believe in holistic therapy. We noticed that Rohit is a healthy eater and loves his green raw vegetables. All we had to do was add more fresh carrots and leafy vegetables to his diet to boost the good minerals and vitamins.
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3.2 A Case Study #102 Demographic Data: Seven year old Sneha [name changed to protect her privacy] weighed 48 lbs and her height was recorded at 3’5”. Clinical Vision Data: Three months before the workshop, she was told by her optometrist that she has slight short sightedness and astigmatism. Observation: Sneha was an assiduous participant who never remained absent for any of our group class or even the virtual classes. The results were a reward of her persistence. Performance in Clinical Outcome: After three months into the workshop, Sneha reported that her vision has improved and her eye strain has reduced to negligible proportions. Progress in Quality of Life: At the pre assessment, Sneha’s parents had complained to us about their child’s teeth grinding (medical term, Bruxism), especially during night. Post assessment, after the completion of the twelve week vision workshop, we learnt that night time teeth grinding have stopped completely and the headaches have reduced considerably.
4.Conclusion: Clinical & Research Road map for Yoga Bharati 4.1 A clinical road map for practice of Yoga therapy for vision These preliminary results from the pilot study suggest that yoga therapy exerts a positive impact on natural vision healing. Although the study described herein is a small pilot study, similar sessions can be executed for children as well as adults. Our study findings are limited by several factors, including the inherent limitations of a small sample size and an absence of a control group. A cross sectional study performed using evidence-based interventions, including, yoga postures, regulated breathing, exercises for the joints, visual cleansing exercises and guided relaxation will be carried out by Yoga Bharati in the near future to estimate the effectiveness of these lifestyle intervention programs on natural vision improvement. Based on the encouraging results, Yoga Bharati has developed a quarterly plan for conducting these workshops on Lifestyle Intervention Programs for Natural Vision Improvement.
2014 October
November
2015 December
January
February
Fall Quarter
March
April
Spring Quarter
Fall Quarter
May
Spring Quarter
Table 3. Schedule of Planned YogaBharati workshops
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June
Yoga Bharati
Yoga Bharati just completed winter workshop in the fall quarter, October 2014 to February 2015. Our Spring Quarter begins next year April through June, 2015. Upcoming Fifth workshop will include: • Evidence based and innovative eye practices and yogic exercises. • Evidence based herbs, functional foods, vitamins and supplements and manipulative therapies such as Chiropractic, Ayurveda, among many others. • Recommendations for lifestyle changes with respect to food, eating habits, reading habits and ambient lighting • Two compulsory structured group classes. (Note: We also have a provision for a few one- on-one classes with the instructor and the child to help the child respond better and pick up speed or cover sessions missed out upon, if any. Younger kids are allowed to come with their parents. We insist upon mandatory attendance.)
4.2 A research roadmap for Yoga for vision The scope of the Lifestyle Intervention Program mentioned in the Whitepaper goes well beyond allergies affecting eyes and vision (such as, refractive errors). In the near future, we have plans to develop programs for correcting double vision, crossed eyes and strabismus (squint vision) through our integrative and holistic approach. Within a year, we plan to conduct similar Lifestyle Intervention Programs to improve vision for adults as well. Clinical groups will clearly demarcated in our future workshops, for example, an equal distribution of male and female subject group among the participants. Newer assessment techniques, for example, measuring the dryness of the eye by semi-quantitative estimation of the superficial lipid layer or the tear breakup time, or even critical flicker frequency will be performed for our future research endeavors. Personality traits using the Yatabe Guilford Personality Test and a detailed questionnaire sheet will be incorporated into our checklist as well. Inferential statistics performed on the study results will include repeated measures analyses of variance (ANOVA) and the standard mean, median and average tests, along with Post Hoc analysis to ensure our data strength and quality. In addition to workshops designed to correct refractive errors of the eye, we are also looking to conduct workshops and take an integrative healing approach to other eye abnormalities such as incipient Glaucoma and Macular Degeneration. As most of the techniques used are applicable to Nasal allergies, and simply stress management.
5. Summary Yoga Bharati presents a holistic yoga module developed by our experts to alleviate vision disorders. We have conducted pilot studies for young children with vision problems which have yielded encouraging results. As can be expected of most physiological interventions, the results are variable, although positive. The most salient feature of these interventions is that they are non-invasive and have no undesirable extra effects. Yoga Bharati has designed and planned new Yoga workshops that can accommodate and address participants’ health issues in a personalized manner. Our goal is to offer health solutions for problems like vision disorders, sleep disorders and allergies. We present our vision for the development of the yoga modules as lifestyle intervention programs to resolve chronic health problems. 14
Yoga Bharati
References 1. Nagendra HR, Vaidehi S, N. R. Integrated approach of yoga therapy for ophthalmic disorders. (1984). 2. Shirley Telles, R Nagarathna, H. R. N. Improvement In Visual Perception Following Yoga Training. J. Indian Psychol. 13, 30–32 (1995). 3. Telles, S., Nagarathna, R., Vani, P. R. & Nagendra, H. R. A combination of focusing and defocusing through yoga reduces optical illusion more than focusing alone. Indian J. Physiol. Pharmacol. 41, 179–82 (1997). 4. Vani, P. R., Nagarathna, R., Nagendra, H. R. & Telles, S. Progressive increase in critical flicker fusion frequency following yoga training. Indian J. Physiol. Pharmacol. 41, 71–4 (1997). 5. muscle power, dexterity skill and visual perceptions in community home girls trained in yoga or sports and in regular school girls.pdf. 6. improvement in spatial and temporal measures of visual perception following yoga training.pdf. 7. Blindness Statistics | National Federation of the Blind. at <https://nfb.org/blindness-statistics> 8. WHO | Visual impairment and blindness. at <http://www.who.int/mediacentre/factsheets/fs282/en/> 9. Vision 2020-WHO Factsheet. at <http://www.icoph.org/downloads/whofactsheet.pdf> 10. Lee, D. J., Gómez-Marín, O., Lam, B. L. & Zheng, D. D. Visual acuity impairment and mortality in US adults. Arch. Ophthalmol. 120, 1544–50 (2002). 11. Ivers, R. Q., Norton, R., Cumming, R. G., Butler, M. & Campbell, A. J. Visual impairment and risk of hip fracture. Am. J. Epidemiol. 152, 633–9 (2000). 12. Jones, G. C., Rovner, B. W., Crews, J. E. & Danielson, M. L. Effects of depressive symptoms on health behavior practices among older adults with vision loss. Rehabil. Psychol. 54, 164–72 (2009). 13. WHO | Blindness: Vision 2020 - The Global Initiative for the Elimination of Avoidable Blindness. at <http://www.who.int/mediacentre/factsheets/fs213/en/> 14. Berry, S., Mangione, C. M., Lindblad, A. S. & McDonnell, P. J. Development of the National Eye Institute refractive error correction quality of life questionnaire: focus groups. Ophthalmology 110, 2285–91 (2003). 15. Pesudovs, K., Garamendi, E. & Elliott, D. B. The Quality of Life Impact of Refractive Correction (QIRC) Questionnaire: development and validation. Optom. Vis. Sci. 81, 769–77 (2004). 16. Owsley, C. et al. Effect of refractive error correction on health-related quality of life and depression in older nursing home residents. Arch. Ophthalmol. 125, 1471–7 (2007). 17. The Yoga Tradition: Its History, Literature, Philosophy and Practice: Georg Feuerstein, Ken Wilber: 9781890772185: Amazon.com: Books. at <http://www.amazon.com/The-Yoga-Tradition-Literature-Philosophy/dp/1890772186> 18. Telles, S., Naveen, K. V, Dash, M., Deginal, R. & Manjunath, N. K. Effect of yoga on self-rated visual discomfort in computer users. Head Face Med. 2, 46 (2006). 19. Brown, D., Forte, M. & Dysart, M. Differences in visual sensitivity among mindfulness meditators and non-meditators. Percept. Mot. Skills 58, 727–33 (1984). 20. Gosewade, N. B., Shende, V. S. & Kashalikar, S. J. Effect of Various Eye Exercise Techniques along with Pranayama on Visual Reaction Time: A Case Control Study. J. Clin. Diagn. Res. 7, 1870–3 (2013). 21. Udupa, K. N. & Singh, R. H. The scientific basis of yoga. JAMA 220, 1365 (1972). 22. G.K. Pal, S. V. & M. Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res 120, 115–121 (2004). 15
Project Vision
A PROJECT ON NATURAL VISION IMPROVEMENT
(7 to13 years)
For children with Myopia, Hyperopia, Astigmatism and Cross/Lazy eyes ► Two classes per week one in person class and one virtual class per week ► Daily and weekly practice kits provided. ► Lifestyle recommendations given on evidence based herbs,
functional foods and food supplements. ► Recommendations list for passive therapies such as Ayurveda are given. ► Detailed child’s pre and post health assessments will be conducted. ► Exciting field trips (with outdoor Yoga) ► Workshop material inclusions - T-shirts, Jala Neti pots, Eye wash cups a personalizes files to organize workshop materials for children.
Two workshops a year Fall and Spring For more information, Contact:- Call 408 341 YOGA or Send an Email:- workshop@yogabharati.org
Author
Savita Joshi
Advisory
Director,Therapy Services, Yoga Bharati.
Ashwini Surpur Director, Education, Yoga Bharati.
Advisory
Anil Surpur
Consultant
Dr. Naveen Visweswaraiah
President, Yoga Bharati
Consultant Physician, Integrative Medicine
About Yoga for Vision Disorders Conducted by Yoga Bharati in technical collaboration with Yogaksema India, Yoga for Vision disorders report is an independent study conducted on the children ages 5-13 years in the South Bay Area, CA, USA. Study was conducted based on three main ideas, Yoga is effective in bringing about functional changes in vision. Functional changes can in turn affect structural changes. Secondly stress plays a very important role in any ailment, once the underlying stress situation is addressed, total health can be brought about and achieved. Thirdly it is based on the plasticity of the brain, visualization and imagination can bring about drastic changes.Sage Patanjali, father of Yoga, said hundreds of years ago, Imagine an elephant and you will get the strength of it. Habits can be created and re created. Vision - Institutional report is an educative manual for yoga teachers, yoga researchers, optometrist, ophthalmologists, holistic practitioners. Report gives the insights on hope and scope of yoga and other complimentary and alternative therapies are available and possible on vision therapy. Report goes in very systematically starting from building the case as to why this project is necessary and need of the hour. Next anatomy are physiology are explained. Pathology of vision disorders are addressed in systematic manner. Project vision is a very broad subject and area, report and the project itself has been narrowed down in addressing four major areas, Short sightedness, Long sightedness, Astigmatism and Cross or Lazy eyes. cope of this report is not limited to what is brought about in here, but it is only a starting point and can be taken further to add many more features to it. Project vision which includes yoga as only one part and in corporating other CAM (Complimentary and Alternative Modalities) will be offered in the upcoming workshops.
Yoga Bharati,
Yoga Bharati
7630 Kirwin Lane, Cupertino, CA, 95014. In technical collaboration with
Yogaksema - Stress and Lifestyle Clinic 775, Double Road, Near Cauvery School, Indiranagar, Bangaluru-560038