Hope for an amblyope

We have a new intern in our office, a fourth year optometry student who, as I am fond of saying to the therapy patients, is just a minute away from becoming an eye doctor. As I was introducing her to the various activities that we use in therapy, she disclosed that she is not binocular. In other words, she does not see in three dimensions because her eyes do not team properly together. She is also an amblyope. One eye has an acuity that is at least two lines on the Snellen Eye Chart worse the other eye. This is probably why she is not binocular - she opted to pay attention to the information coming into her brain from just one eye - actually, she did not do this on purpose, it just happened and therefore she does not experience double vision. You need two eyes to point to the same place in space AT THE SAME time in order to experience three-D vision. Since we deal with binocular dysfunctions a lot in VT (vision therapy), she and I began to talk about what her goals were for this rotation. Binocularity has been an abstract concept for her, not ever having experienced it and she hopes to understand it better. As I showed her patient histories that demonstrated how we can stimulate the emergence of binocularity in patients with similar conditions as her own, she became more and more intrigued with the possibility that she, like "Stereo Sue" Barry, could actually achieve a different visual outcome. That was last Monday. I only work on Mondays and Saturdays so when I saw her today she greeted me with the news that she is beginning to be able to do very simple binocular tasks. Later this morning, she was wearing a patch over her better eye to make the amblyopic eye work. I love when people unexpectedly gain hope for what they thought was a forever condition to change. I'll keep you posted.

3-D Vision Therapy

Some people whose eyes do not team properly don't see in three dimensions. In other words, they may lack stereo vision (stereopsis). The cause may be an eye turn (strabismus), the suppression of one eye, or some other condition to be identified by an optometrist. Until recently the experts believed that unless the condition was addressed in a young person, either by vision therapy and/or surgery, it would become "hard-wired" in the brain. In other words, no one even held out hope for an adult to obtain stereopsis. That began to change with the experience of psychologist, Dr. Sue Barry, now nicknamed "Stereo Sue." Check out how she explains what happened to her on her website, www.fixingmygaze.com, or in her book by the same title. You can also watch her on You Tube:

http://www.youtube.com/watch?v=m2YqVLARZOM

http://www.youtube.com/watch?v=P9afrMMsh2w

http://www.youtube.com/watch?v=aUzJogvB0Hc

http://www.youtube.com/watch?v=CP8SsUl5wb0

http://www.youtube.com/watch?v=_c010cP8sKo

In the vision therapy context, I have worked with quite a few adults who had never experienced seeing in 3-D. When it begins to emerge, the delight they express is amazing- in spite of the headache that seems to accompany the adjustment to true binocularity. It takes time but to enrich the way the world looks is a reward that is truly worth the investment of time, money, and discomfort.

What if your 3-D glasses didn't work?

Did you put on a pair of 3-D glasses to watch the special Super Bowl commercials yesterday? At least 4% of you probably did not notice any difference in the picture after you put on the glasses. This is the percentage of the American population that has a strabismus or an eye-turn. Even more people have difficulty teaming their eyes together whose conditions may involve a convergence insufficiency, convergency excess, or other problem that involves binocular function and would also have found the commercials less impressive than they had been led to believe. Other people probably were able to appreciate the added depth and detail in the commercials with the 3-D glasses at first, but then their eyes began to hurt or the special effects seemed to fade away. Still others, who have amblyopia, commonly called a lazy eye, tend to suppress the information gathered by the weaker eye, so they would also have had difficulty using the 3-D glasses.

3-D glasses work by providing the right eye with different visual information than the left eye so that a more complex image will be perceived when the two pictures are combined in the retina. ( See http://www.3dglassesonline.com/how-do-3d-glasses-work/ for a discussion of how 3-D glasses work.) For them to work requires that the individual has good binocular vision. Strabismus, eye teaming disorders, and amblyopia all correlate with reduced or absent binocularity. People who have these conditions usually have difficulty with depth perception. Some of these conditions also impair the individual's ability to read efficiently because, with a convergence insufficiency, for instance, the words may seem to be unstable on the page. They may also get headaches or report seeing double when they read.

Fortunately, with appropriate diagosis and vision therapy, these conditions can be helped. New research demonstrates that convergence insufficiencies can be addressed with a program of in-office vision therapy. Children who have been diagnosed with other binocular disfunctions have the best prognoses but even adults can be assisted to gain ground as has been demonstrated by the experience of Sue Barry, dubbed "Stereo Sue". (See ttp://www.newyorker.com/archive/2006/06/19/060619fa_fact_sacks for her story.)

What is my point? If you or someone at your Super Bowl party was unimpressed by the 3-D glasses because they didn't seem to change anything about the picture, or if anyone found wearing the glasses uncomfortable or intolerable, it probably means that they need to schedule a comprehensive eye exam with a developmental optometrist who specializes in binocular vision and who also is a vision therapy provider. Then, if there is a diagnosis that can be helped by vision therapy, know that the benefit of seeing in stereo is worth the investment of time, money, frustration, and effort.