Friday, December 2, 2011

A great experience

My vision therapist set up something really cool for me. She has another adult strabismic in therapy and she set up a time for us to meet and do a 2 hour block of vision therapy together. This other patient, let's call her... Tara, has had 8 surgeries, has been both an esotrope and an exotrope (currently eso), is a pretty severe amblyope in one eye, and  has double vision 100 percent of the time. My vision therapist thought it would be good if we got together, because she said we both "speak the same language" and might be able to help each other.

Finally, this Friday, we got a chance to meet and play around with some red/green stuff! It was great. It turns out that Tara's double vision allows her to "cheat" on most red/green exercises, and so far it has been very difficult for her to get any fusion or overlapping of the two doubled images that she sees. The images just don't want to overlap and make a combined picture, and she doesn't know how to move her eyes to move the doubled images over top of each other.

I started to get so interested in what was going on with Tara's double vision that I spent almost the whole time asking her questions and trying different things with her. One of the toys at the VT office was this ancient looking device that looks like two flashlights connected to box, with one flashlight projecting a red circle and one flashlight projecting a green dot.

When my vision therapist pointed the flashlights at the wall and put the green dot inside the red circle, Tara could not see the green dot inside the red circle. She saw the green dot to the left and under the red circle. When we were doing other red/green activities, she also mentioned that she saw double images that were vertically displaced.

From what I've read and heard, I seem to remember that vertical misalignment is harder to treat than an exo or eso deviations. If one eye is wandering out horizontally, then it is possible to learn how to pull it in. But if one eye is wandering up, it can be difficult to learn how to pull it down. Or so I've heard. I've also heard that if the vertical deviation isn't too extreme, the brain can compensate and fuse the images, but if it's too far, then it can be really hard.

I thought that maybe if she used a vertical prism, she would have more luck with fusion. I'm not sure if it's frowned upon to use prisms to help with vertical deviations, or if you're just supposed to "deal with it" until you suddenly have the eye strength to do it yourself, but I wanted to try it. So I ran and grabbed the box of loose prisms and found that a 6 prism diopter base down over one eye (or base up over the other eye) allowed her to see the dot in the circle. One image, no vertical displacement. Cool!!!!

We also did some other stuff and I tried out some ideas for physical diplopia practice. And then the three of us started brainstorming and came up with a neat idea for an exercise we want to develop involving black, red, and green felt and Nerf guns (details to come later). It was really fun and inspiring experience all around! I'm more inspired to do my own homework now, and it even made me consider maybe going to optometry school some day. Vision therapy is just so fun!


  1. I'm a vision therapist and I look forward to all you posts. My husband is an optometrist.
    Glad you're considering optometry!

  2. Josh, this post is reminding me of a discussion that is taking place on the adult strabismic patients' forum about prism and hypertropia here

  3. That's great that you got to do therapy with another adult. I wish I had that chance as I rarely ever see anyone born in the last millennium at my optometrist's office. How does "Tara" live with 100% double vision? Doesn't that make it impossible to do just about anything?

  4. Hi Josh,
    I found your blog as I was looking up ARC, as my optemetrist suggested it might be my problem.  I am 37 and suffered a stroke in Nov 2011 that left me with double vision and a "twist" to the image of my right eye.  I have done some vision therapy and can now get my two images to overlap sometimes. Circles are fun to play with, no edges so I can fuse them.  I have a few "sweet spots," but double in the periphery.  For now we fog one image with a piece of scotch tape unitl my eyes settle down and we knkow what we are left with.  My right image is not stable and moves around a lot so we are waiting for some stabilization, then we can move forward.  Thanks for the information on ARC, very helpful insight on what I am dealing with.

  5. Thanks for sharing your vision therapy exercises. I cut short my own vision therapy short 9 years ago when we took an overseas assignment.

    I have recently decided to try to work on improving my amblyopic vision once again. I have limited materials and have forgotten some of the techniques. Your detailed descriptions and inventive ideas are very helpful.

    I was disappointed not to be able to download Solkan Solitaire to our Windows laptop, nor our MAC using Parallels, but that is another matter.

    What has been of interest is your shared exercise of looking in the mirror whilst wearing polaroid lenses, and your time spent with Tara.

    When I first tried looking in the mirror with the polaroid lenses, my eyes alternated for a few seconds, first one lens would black out then the other, but with a little effort both eyes came into view. The problem is that the the two eyes are vertically displaced, the weaker left eye being lower, fuzzier, and somewhat enlarged.

    I have always had trouble with the Brock string because I see one strong string coming from the right and to my nose and one fainter string that is lower, comes from the left and past my right ear. When I had mentioned this vertical displacement to my therapist many years ago she was somewhat mystified.  

    My question to you is: Do you have further information on vertical misalignment, or reading references? Do you know anything about Tara's treatment and progress?

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