Learn to Be the Boss of Your Own Eyes

A first grader came to his 15th in-office session of vision therapy today. His parents brought him to the developmental optometrist in the first place because they noticed one eye shifting in whenever he got tired. They feared he would be teased for having crossed eyes and wanted to try to avoid surgery. Not only did the doctor concur that he has a strabismus- an eye turn, she discovered that he did not use both eyes as a team. Like many other children, he suppressed the vision in one eye to avoid seeing two images when his eyes were not aligned at the same time on the same visual image in space. This unconscious strategy made him unaware of any visual problem. He had good grades, was a good athlete, and had no intrinsic use for coming to see me every week. It has taken all sorts of monocular, and binocular activities disguised as games to coax him to begin to experience binocularity. Last week it started to make sense TO HIM. I asked him to watch a bead approaching his nose on a long string (the Brock String - magic to many patients but key to learning to use two eyes together). Whenever the bead got within about six inches of his nose, his left eye swooped in towards his nose and he reported seeing two balls. Had his eyes continued to be teamed on the in-coming bead it would have remained single. Finally he was able to connect the feeling of that eye moving in with the sensation of double vision. "You need to be the boss of your own eye," I suggested, "but it keeps saying: 'I don't have to obey you - I can do anything I want.'" That apparently was enough motivation to make the child take charge. Today I could push the bead within two inches of his nose without the eye wigging out and he could switch between that bead and another bead about eight feet away on the same string without any problems at all except that it made him very tired. By next week he should be able to do more repetitions without fatiguing. As long as he is the boss of his own eyes, he will make them mind. Of course, this activity correlates with the ability to read for extended periods of time without fatigue, double vision, headaches, or the words wiggling on the page. It also solves the cosmetic problem that his parents were so (justifiably) worried about.  I can't wait for his re-evaluation appointment with the doctor who will be thrilled at the emerging binocularity and independent control of his eye movements both when using one eye and two.

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.