The modern, effective treatment of cataract is to remove it from the lens capsule, or, if necessary, remove the whole lens itself. From about the age of fifty onwards the ligaments which hold the crystal lens in place become weaker. The lens can therefore be quite easily removed from the eye by rupturing the ligaments, especially if they have been ‘prepared’ by appropriate weakener-enzymes. Special forceps or a ‘freezing probe’ then lift the lens out of the eye. Usually the surgeon will supply counter-pressure to facilitate this operation. Another technique makes an opening in the eye and tears out the lens capsule. The hard nucleus of the lens may be ‘broken up’ whilst it is still in the eye, and the debris then washed out.

Once the nucleus has been removed the cortex, which is softer, naturally disintegrates so that it too may be washed out.

Once the inner lens has been removed the surgeon will decide whether to replace it with an artificial lens, or not to replace it at all.

Occlusion of the Arterioles

Blockage, as opposed to hardening and shrinking, of the blood vessels in the retina or the optic nerve causes much more abrupt signs of vision-loss. Depending upon which part of the system is affected, loss may be partial or it may be total. Recovery takes place over a period of months, and is likely only to be partial. If an artery is blocked, recovery is unlikely unless the blood can find an alternative route. (Arteries convey blood from the heart to the body, veins convey blood from the body back to the heart.) Such a condition is miserable to observe because even with early treatment a successful outcome is rare. Patients become easily despondent and sometimes seek fringe treatments which, while temporarily boosting morale, produce no long-term improvement. The blockage of a vessel in the eye is also generally a symptom or signal of a much deeper degeneracy in the blood circulation system, and a general physical check-up must always follow an eye diagnosis. Many otherwise seemingly healthy adults in their fifties suddenly suffer this form of loss of sight, and within a matter of days their mental attitude towards life is changed and they realize that their physical zenith is well and truly passed.

Blockage of the arterioles is perhaps the most common retinal problem among the normal- or average-sighted. Its incidence is low enough. However, there are other even rarer conditions, such as periphlebitis and blood dyscrasia. For the purposes of this account they can be passed over, but something should be said about sickle cell anaemia. This is an inherited abnormality of the haemoglobin molecule concerned with sulphur linkages. An estimated ten per cent of black people in the United States, and an estimated eight per cent of black people in Britain, are born with a sickle cell anaemia trait. That is to say, they are carriers of the disease. Between 20 and 25 per cent of these have the disease itself, which also affects a small minority of Mediterranean people. The haemoglobin makes the red blood cell an abnormal (sickle) shape and unable to function as an efficient carrier of oxygen. Those afflicted are likely to develop acute and even chronic retinal abnormalities for which, sadly, there is at the present time no cure. Money for medical research is administered very largely by white people in white foundations, and this provides one unpleasantly cogent explanation as to why so little has been done, until relatively recently, to overcome an ‘outsider’ disease.

Retinal Degeneration

Retinal failure is not invariably explicable in terms of blood deficiencies or defects. There are many other conditions, some of cause unknown. For want of a better name they are called degenerations. The suffix `-pathy’ is sometimes added, giving retinopathy. (Similarly some diseases of the cornea are called keratopathy.) Retinopathic conditions are generally progressive, developing over very long periods of time. Retinitis pigmentosa is one such condition, resulting in loss of visual field and eventual blindness. Night blindness may be the first symptom, although the practitioner, looking at the retina through an ophthalmoscope, easily recognizes the signs long before the patient realizes there is anything seriously wrong with his or her eyes. The doctor sees areas of pigment surrounding narrowing blood vessels. Retinitis pigmentosa can be either hereditary or acquired, and it is sometimes associated with other systematic abnormalities. Much is unknown about this disease, which can have tragic consequences even among the young, and so not surprisingly many different treatments are offered. In this and some other progressive diseases there are usually periods of apparent improvement, of temporary remission, generally governed by the patient’s mood. The promise of treatment and the build-up of expectations, especially if the treatment is to be undertaken abroad, lifts the patient’s spirits, and this alone is sometimes enough to affect the progress of the condition beneficially, regardless of any efficacy that the proposed treatment may have. The same kind of expectant aura, with the same kind of short-term relief, is also sometimes derived from acupuncture, hypnosis and other fringe medicines.

As far as retinitis pigmentosa is concerned, however, almost every known approach to aetiology and treatment has been attempted and eventually proved of no great value. Perhaps tomorrow there will be better news. Meanwhile the disease does exemplify another aspect of the medical world. The patients who have this condition, and more especially the parents of child sufferers, have combined to form a strong society with sufficient funds to establish research programmes and collect data from the society’s members. Patients and their relatives as a group are in effect saying to doctors: ‘We have the financial and social means, you produce the result.’

The blood coat that lies between the retina and the sclera (outer tunic) is known as the choroids. The retina is in contact with its smallest branches (capillaries), and the retinal cells are separated from the capillaries by membranes and a potential space, which can become a real space filled with fluid either from the choroid or from the vitreous. As has already been explained, the usual cause of retinal detachment from the choroidal membrane is due to fluids from the vitreous flowing through tears in the retina. But the choroid itself can separate from the sclera (choroidal detachment), in which case fluid can enter the potential spaces of the retina from the very back of the eye. This indeed sometimes happens after either cataract or glaucoma-filtering operations, but does not necessarily lead to very great visual impairment.

But the retina is not the only tissue to be supplied with nutrients by the choroid. It also feeds the ciliary body, just in front of the equator of the eye, and the muscle it contains, with nourishment and oxygen.

Inflammation of the choroid and its feed-tissues can be seen in the form of various reactions using an ophthalmoscope or slit-lamp bio-microscope. The circulation of blood in the choroid can furthermore be studied by using fluorescein. Fluorescein is injected into the blood system, and its traces are then photographed (an `angio-fluorogram’) . A similar but more sophisticated technique for examining the back of the eye is the use of tracer elements that have irradiated molecules in them, the response being measured on radio-active receptors which produce an exact mathematical quantification.

With these technological aids we can see and record abnormalities in the choroidal blood system. Some of these abnormalities, or diseases, are blood-borne. That is to say, the disease of the eye may turn out to be a symptom of a disease of the blood, and this could be microbiological or macrobiological. More simply, the blood may contain the wrong nutrients, or certain metabolic hormones may be absent. Or there may be a circulatory problem connected with heart disease. Every tissue of the eye depends upon the blood it gets from the choroid, and therefore any irregularity in that supply is likely to show up as a degeneration in one part of the eye or other. Another possibility is the presence of cancer cells in the blood, carried to the eye, or part of a generalized cancer change in the body. And so on. Indeed, disease in any part of the body can affect the eye, and so the list is inexhaustible. It is for this reason that ophthalmologists are required to have a sound general medical background.

Therefore, this exercise is a good way to measure your rental state, as well as your eyesight. When you shield tour eyes, the transition from a shimmering, gray state to leep blackness indicates the change from actively seeing o a totally relaxed, restful state.

Only the eyes can experience the sensation of blackness. The feeling produced by this darkness can be of a deep mental rest or of a pleasing sense of mental emptiness, somewhat like diving deep into your inner center, from which essential energy emanates. This can be a deeply relaxing and joyful experience. Do the shielding exercise as often as possible.

Simple Biofeedback

Shielding is a surprisingly simple form of biofeedback. This technique, widely used in research and performance sports, involves expensive instruments which change body signals into acoustic or optical signals.

You don’t need any mechanical devices in order to use shielding as a method of biofeedback, and it doesn’t cost anything. It provides an excellent way to gauge the degree of tension or relaxation at any time of the day or night.

This exercise deeply relaxes the eyes. After a phase of complete darkness and total relaxation, the vision often becomes surprisingly clear. Colors and contrasts are more lively, and the total field of vision seems clearer, somewhat like the air after a thunderstorm.

If you use shielding regularly, particularly after periods of intense work, you will discover a distinct difference in the quality of darkness when you cover your eyes with your hands.

How to Use Shielding

You can do this exercise sitting down or lying down. Assume a comfortable position where nothing will interfere with your breathing. Breathe freely in a relaxed fashion. Recommended time: one to twenty minutes.

• Rub the palms of your hands together so that they are warm and charged with energy. Warm, relaxed hands release healing, negatively-charged ions and are very invigorating. Your closed eyes will directly absorb the energy created this way.
• Close your eyes. Gently place the palms of your hands over your closed eyes. Rest your fingers on your forehead with the palms of your hands resting on your cheek bones. The palms create a small dome over the closed eyelids. Place the center of your palms over the pupils, without any pressure. Make sure that no light penetrates through your hands.
• If you are sitting down, rest your elbows on a table or on your knees. If your are lying down, place a thick pillow under your elbows. Either of these will create a very comfortable position for your hands.
• Relax your whole body. Take a few deep sighs—be vocal. Allow your eyes to sink deep behind your closed lids, as if resting in a hammock with your head hanging over t edge or into a small, soft lining behind your eye sockets like sinking into a pillow when you lie on your back.
• Be aware of what is happening beneath your close eyes in the darkness. Do you see anything shimmering, do you see lightening, fog, or patterns? Is the quality of darkness equal or is something moving? Is the darkness me intense in some places?
• Inhale and exhale deeply. Allow every thought, emotion, and image that appears in the darkness to dissolve every time you exhale.
• When inhaling, feel the warmth, the protection, and the touch of your hands through your eyelids and in your eyeballs.
• Become deeply absorbed in this process, for at least ten to twenty breaths. When exhaling, observe how the shimmering, pulling sensations; the patterns you see; and the fog enter the darkness and dissolve. When inhaling, allow the energy from your hands to flow into your eyes, filling your eye sockets like a bathtub.
• Keep your eyes closed and conclude the exercise by removing your hands from your eyes. Allow your eyes to become accustomed to light again before you open them.
• Stretch and bend as if you have just awakened from a nap. Look around. Are your eyes more relaxed and refreshed? Are they interested in what is around you? Has your sense of vision changed in any way?

Important Tips for People Who Wear Glasses or Contact Lenses

Remove your glasses or contact lenses before starting the shielding exercises.

Relax the area around your eyes before starting these exercises. Do short tapping massages with the tips of your fingers.

Afterwards, look around without your glasses or lenses. Compare your visual impressions with what they were before.