Vision therapy - week 3

Well, I'm still no good with the cheiroscope. I have trouble fusing two images, even when both eyes are "turned on" or not suppressing. My brain keeps saying, "But there are two eyes!!! And two different things!!!" Seeing two different things and fusing them into one is an alien concept to me.

Also, I have been becoming more and more motion sick. If I drive for half an hour or longer, I get nauseous. My vision therapist says it's a good sign, though, so I've decided to be happy about it.

This week was a little special because I met with the optometrist to ask him if I had anomalous retinal correspondence (ARC). I won't try to explain what that is, because I have trouble understanding it myself. But it is something that complicates vision therapy and takes a long time to correct, if it can be.

The optometrist didn't think that I had it, because it's not very common. And after reading about it some more, I thought that I probably didn't have it either. However, he didn't really have the diagnostic tools to tell me either way, so we're just assuming I don't. The moral of the story is: don't get paranoid and self diagnose.

Later, I also tested myself for it, with this test involving a camera flash after image in both eyes, and I think I'm fine. But I digress...

This week was also special because it very snowy, the roads were terrible, and I spun out, 360 degrees, on the highway on the way to my vision therapy appointment appointment. Luckily I didn't hit anyone or fall off the highway and end up upside down.

Anyway, I learned some fun stuff this week. Here are some highlights:

Red/green stoplight
My vision therapist made the instrument for this activity out of a manila folder, some red/green pieces of plastic, and some staples. It looked like this:

The top square is transparent red plastic, the middle square is empty (just a hole), and the bottom square is transparent green plastic. You place this stoplight thing on a window, and look at it using red/green glasses. If you are using both eyes, the red and the green square should remain transparent. If you are suppressing, one of the squares will turn black.

When I looked at it, I was having trouble seeing the stoplight without any black squares. I was seeing this a lot:
I was using both eyes (and overconverging, I think) but I was having trouble bringing those images together and making them overlap. When I try to make things overlap in my central vision, suppression kicks in and one eye takes over. Arggg, central suppression zone. I like to give a voice to my brain, so this is what I felt like it was saying:

"Okay, I'll use both eyes, but only to see things in the periphery. If you want to fixate on something centrally, though, I'm only going to let you use one eye."

Anyway, enough about stoplights. I also did some fun stuff with arrows on a piece of paper. It's very similar to using a Brock string, and I've seen it called "Tondel arrows" on other vision therapy websites.

(picture from bernell.com)

You have to make the little pairs of arrows touch each other. It's a fun time.

Anyway, that's enough about week three!

Vision therapy - week 2

I forgot to mention that last week, when playing around with the Brock string with both eyes, I crossed my eyes to look at the bead. When my vision therapist saw this, she said "WHOAAAAA! You exotrope, you!" I had a similar reaction when I crossed my eyes for a different optometrist who offered vision therapy. Apparently the ability to cross my eyes is a good sign. It shows that I have some conscious control over my eye muscles. Who knew? I just thought it was a fun trick to make my face look funny.

Anyhow. Even though my homework was to use the Brock string with one eye, I still wanted to to play with it with both eyes, and trying to see the X. I found that I could easily see a Y or a V, depending on where I put the bead:

I could not see the X, though. Or the backwards V. So I tried what the vision therapist suggested, and tapped the bead with my finger. That shook the string around too, and helped quite a bit. I could now see the X (and the backwards V), but some of the strings were flashing and flickering in and out. The dotted lines represent the flickering strings:

I think they are flickering like that because each eye keeps trying to "take over" and suppress the other eye. I wish they would quit fighting like that.

Anyway... my second week of vision therapy.

Denise checked the tracking in my left eye. Still jumpy.

Then we played some "ball games", as she called them. I patched my right eye and put a strong base out prism on my left eye. I then hit a ball hanging from the ceiling back and forth with the vision therapist. Then I took the prism off my eye and hit the ball around again. It was a strange experience. I kept missing the ball, but then acclimated to the prism. Then I took off the prism and couldn't hit the ball again! I didn't quite understand the purpose of this exercise, though: something about brains and hands and eyes.

Then she brought out this device called a cheiroscope.

This is how it works. You look through the eye pieces and the image on the card appears to be on the paper. You then trace the image on the paper using a pencil. The image on the card appears to be on the paper because your eyes are fusing the two images together.

When I tried to use the cheiroscope, I saw two separate images. I saw a mirror with an image on it and, next to it, a blank piece of paper. We tried putting prisms on this eye or that eye, but nothing was working. Arrghh!

At this point, time was about up, but before I left, the vision therapist showed me one last thing. She showed me these nifty anti-suppression cards to be used with red/green glasses. You can only see all the cards if you are using both eyes. If you suppress one eye, half of the cards disappear. They either go blank or turn black.

My homework for next week:

try to make the X with the Brock string
try to use the cheiroscope
practice more eye tracking with my left eye
play more "ball games" at home
play around with the anti-suppression training cards

Suppression

Before I go on further, I want to talk about suppression. It seems to me that it can come in all shapes and sizes. From reading about Stereo Sue (an esotrope) and some other vision therapy blogs by esotropes, it sounded like their suppressed eyes were really "turned off." You either see out of one eye or another. And before my third surgery, that's how I remember seeing too. My eye turn was really dramatic, with one eye wandering way over to the corner of my eye. I either saw out of my right eye or my left eye.

Since my third surgery, I seem to have developed a more panoramic view, with a central suppression zone. Here's an illustration that I found somewhere on the internet a while ago:

I get the input from the periphery of both eyes, but one eye needs to "take over" for the stuff in the middle. The other eye's input about the middle is suppressed, because it's overlapping and confusing.

It took me a few weeks in vision therapy to even realize this. I was so efficiently suppressed that I had no idea that it was happening. If you would have asked me earlier, I would have told you, no, I don't really have that suppression stuff. I thought that I had a panoramic view with the images from each eye being pasted next to each other. If I did have some suppression, I thought it was just a sliver in the middle. Now, I realized that it's quite a bit bigger than a sliver.

Vision therapy - week 1

I started vision therapy on November 19, 2010. It's now December 18th, so it's a little hazy, but I will try to remember what I can. Before that appointment, though, I needed to have a separate appointment with the optometrist so that he could check me out. I had to fill out all of this paperwork asking questions about my "child" and their vision problems. I asked the receptionist, "Am I my own child?" and she said yes. Apparently so few adults come in asking for vision therapy that they haven't bothered to make a separate form for them.

Anyway, back to the vision therapy appointment. The vision therapist does all of the vision therapy, not the optometrist, so that's who I work with. She's a nice lady named Denise.

One of the first things she did was test my eye tracking. She was looking for what they call "smooth pursuits." When your eyes follow an object, it should follow it in a smooth motion. She patched my left eye, and asked me to follow a pencil with the my right eye. Everything looked good; my allow followed it smoothly in all directions.

She then patched by right eye and tested my left. My left eye is the weaker eye and the eye that is often turned out. Usually my right eye fixates and tracks and my left eye hangs out and takes it easy. Anyway, so she patches my right eye (the good eye) and asks me to follow a pencil with my left. And when my left eye tries to follow the pencil, it does a bad job! It follows the pencil in a jumpy, choppy motion. If I paid attention, I could see this effect for myself too. The pencil looked like it was under a strobe light. How strange! How have I gone my whole life without noticing this?

Another thing that came up was the fact that I position my body strangely because of my eyes. This was something that I had noticed myself before, and something that I read about in Stereo Sue's book. Because I use mostly my right eye, I'm always positioning myself off center of what I am looking at. That way, I can get things directly in front of my right eye. I have a hard time seeing things that are centered in front of me; I don't know which eye to use. I prefer things slightly to the side. Take a look at the following illustration:


Here I am, looking at a "thing." My left eye is being suppressed, and my body has turned so that my right eye easily faces the object that I am looking at.

This works okay, but it can lead to some confusing situations. If I'm talking to two people standing next to each other, they have hard time telling who I am looking at.

To address this issue, my vision therapist suggested that I use a balance board when I'm doing my vision therapy exercises. If I position my body weirdly, I'll become aware of it because I'll tip over.

Anyway, back to the exercises. The first one was called a Hart chart. It was a chart of letters on the wall. I held a miniature version of it a few inches away from my face. I had to read a line of the tiny chart in my hand, then, keeping my place, read the next line on the big chart on the wall. Then back to the tiny chart, then back to the big chart. Focus near, focus far. On a balance board. With one eye patched.

Then I did a similar thing with some beads on a string (a Brock string). I held it up to my nose and looked at the near bead. Then looked at the far bead. Then the near bead. Then the middle bead. And on and on. Also patched and on the balance board.

Then another bead exercise. Slowly slide the bead up and down the string while watching it.

And that was it. My homework was to do those same exercises at home: eye tracking, Hart chart, bead jump, and bead slide. Most of them patched and on a balance board. So that's what I did and that's the end of the story!

My strabismus surgeries

I developed strabismus, a misalignment of the eyes, at a very young age. My mother has always told me that I was "born cross-eyed." When I was little, my parents noticed that my eye (or eyes) turned in, a condition known as esotropia.


Why were my eyes doing that? The theory is that my eyes were slightly misaligned, for whatever reason, and that this caused double vision and visual confusion. To cope with this confusing world view, my brain needed to turn off the input from one eye. It turned one eye inward, thus making the input from that eye easier to ignore. With one eye suppressed, I could have a single, stable picture of the world.

My parents were concerned about their cross-eyed baby, understandably, and I ended up having two eye surgeries to try to correct this misalignment. Initially it appeared to work, and I looked normal. However, as the years progressed, my eyes started wandering out in the opposite direction. One eye faced forward, while one eye looked off to the side, a condition known as exotropia.


This eye turn became more and more dramatic. My wandering eye was way out to the side, so much so that my classmates often thought that I was looking at them out of the corner of my eye, when I was really watching the teacher. I even remember one of my aunts telling me, "Josh, quit looking at me like a gargoyle."

It was around age 13 that my parents finally decided to sign me up for a third surgery. I was scared, but also excited at the prospect of finally looking "normal." I remember the day of the surgery quite well. This may be silly, but these were the three things that terrified me the most: the IV needle, being naked and barely covered by a hospital gown, and the post-anesthesia throw ups. The thought of KNIVES going into my EYES, or going BLIND, didn't really cross my mind. I'd had this surgery twice before and trusted the eye doctor. It was needles, nakedness, and throwing up that really scared me. In any case, the surgery seemed to go well. I did have to endure an IV and being naked in a hospital gown, but I did not throw up.

The eye surgeon wanted me to come to her office immediately after the surgery to tighten up the stitches, which I hear leads to a more precise alignment. On the way there, my parents stopped and got me some ginger ale to drink, which made me happy. I love ginger ale. Anyway, when I got to the office, I sat down in the exam chair and my parents sat a few feet away from me, under a Snellen chart. The eye doctor proceeded to put some numbing drops in my eyes, and then started tugging at the stitches in the corner of my right eye, trying to tighten them. Tug tug tug...

Suddenly, there was a pop, and my eye went sideways toward my nose. The room looked funny, but I felt an odd sense of relief, as if some strained muscle, somewhere inside of my body, had just relaxed. I also had a vague sense of "this is probably not good" but I was so groggy from the anesthesia that I really didn't know what to think.

However, the eye doctor looked panicked. The stitches from the surgery had just broken loose, and my eye had detached from one of it's muscles.

See how that lateral rectus muscle up there is cut in half? That's what happened!

In the midst of all this, I thought "hmmm... I'm thirsty" and tried to take another drink of my ginger ale. What else was there to do? However, one of the doctor's assistants nervously reached out and pulled it away from my mouth in a gesture that I took to mean, "Let's not fill your stomach up just yet. You may be having surgery again sooner than you think."

The doctor stepped out of the room and had a secret discussion with her assistants. When she returned, she explained to me and my parents that she had done over 900 eye surgeries, and that this had never happened to her before. She wasn't really sure what to do, but it boiled down to two options:

1. Immediately return to the hospital for another surgery on that eye.
2. Perform the surgery again immediately, in the office, while I was awake.

I chose option number 2 because, as I have told you, I was more scared of IVs and hospital gowns than... anything in the world, apparently.

So the eye doctor added more numbing drops to my eye, propped it open with some sort of gadget, pointed a blinding light at it, and began her work. She asked me to look over at the left wall and keep looking there.

I sat like that for two hours, staring at that wall. I remember blood dripping down my cheek and drying there, and I remember hallucinating from staring at the bright wall for so long. I didn't feel any pain at the point, or anything at all, really. My parents were quite traumatized however, from having to witness surprise eye surgery.

After the eye doctor finished, she sent me home with some sunglasses and a prescription for a whole bunch of icky eye medicines. She told me and my parents to call her if we needed too. As it turned out, we did need to call her. The whites of my eyes had turned a solid red color and I looked like a vampire. I felt like a vampire, too, and even the smallest amount of light caused me excruciating pain. After I had turned off all the lights in the house, unplugged the Christmas tree, and stuffed pillows under my door, my parents called the eye doctor, who called in some pain medicine for me.

After the surgery, I had strong double vision for a few weeks, followed by periods of lingering double vision where people had two heads. My eye also began wandering outwards, backsliding into it's pre-surgery strabismic ways. The surgery had reduced the degree of my eye turn, but, alas, it was still there and still noticeable. If I wanted it straighter, I was told that I could try again with a fourth surgery in the future.

Meet my eyes

Hello. My name is Josh, and I'm currently undergoing vision therapy to correct my strabismus, or misalignment of the eyes. I was inspired by Stereo Sue to pursue vision therapy, and I wanted to share my story.

Meet my eyes!


The one on the right (your left) is looking forward, while the one on the left (your right) is wandering outward.

I can also switch them so that the left is pointing ahead and the right is pointing outward, but I'll let you use your imagination.

More to come later...