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!

I'm back!

After 7 months, I have returned. My personal life became kind of crazy for a while (a serious car accident, among other things) and I kind of forgot about vision therapy. At that time, seeing out of one eye was good enough for me. But everything is okay now! I'm back in vision therapy, and I have even more ideas and inventions floating around in my head than before.

If you tried to email me, I'm sorry that I didn't answer. I will slowly try to go through my old emails and see what I missed. Thanks :)

To prove that I am really back, here is a picture of me doing one of my first back-in-vision-therapy homework assignments: wear the red/green glasses and track the red/green ball as it floats around your face. Thankfully, I'm finding that I can still flat fuse red/green stuff like that. It seems that I haven't lost any of the talents that I gained from the first round of vision therapy, but I sure do feel a little rusty.

Just a little

I saw a little depth at my last vision therapy appointment. For the first time! Just a little! But still... it happened! Here's the story...

In Effective Strabismus Therapy, Dr. Israel Greenwald talks a lot about working with strabismus patients to achieve red/green luster while looking at a white wall. The patient wears red/green glasses, stands up close and stares at a big empty while wall, and tries to make the colors intermix and become inseparable. To help achieve this, he recommends that the patient wear high plus lenses (+15 to +20). These high plus lenses are basically superpowered magnifying glasses that make everything blurry. This removes all figure/ground distinctions and allows for easier fusion.

I asked my vision therapist if we could get some high plus lenses and she said 'Sure!' She called in an order to the lab, and I thought everything would be fine. It turns out, though, that it's very hard to find a place that even makes plus lenses that strong. The strongest that I have seen available for order on the internet are +12. (+12 is actually very strong though and would probably work, but that's not part of the story.)

So last Friday, I brought up the topic of plus lenses again and my vision therapist had an idea. There were lots of contacts in the office, so why not try high plus contacts? That way, there wouldn't even be a chance to "peek around" the glasses and ruin the blurring between figure and ground. They weren't any +20, but there were some +6 available. (or maybe they were +4, I can't remember).

So I said yes, even though I was kind of terrified. (You remember what happened last time someone got all up in my eyes.) And it turns out, contacts are really hard to get in! I did the usual - hold your eyelids down like they are trying to escape - type of thing, but then I would involuntarily try to shut my eye so hard that my eyelids would turn inside out and block the contact anyway. It was both funny and gross.

20 minutes later, when they were finally in, I got to experience the world as myope (near sighted person). I actually found it quite nice. My eyes couldn't focus on anything and thus didn't try - it felt rather relaxing. It also blurred out everything past my nose, leaving me encapsulated in a blurry womb. I've always been an anxious and shy person, wondering what people are thinking about me (are they looking at my crooked eye??), and for once, I couldn't see anybody's faces. I just had to assume that everyone was smiling at me. I wouldn't want to live with uncorrected blurry vision, of course, but it was nice to take a vacation in blurry land for a while.

So we tried some red/green luster with the white wall, and the extra plus seemed to help (more plus would have been better, though). While, the contacts were in, we also tried some other things. I had some vague memories of reading that dim light can help fusion and help break suppression, and something about contrast levels.... and something about ARC and peripheral fusion... and something about something else... So we decided to try out some polarized vectograms while I was wearing the plus contacts, just for fun, and.... something happened!

First, I was looking at this "figure 8" vectogram:

I was looking at this one the previous week, and while rocking side to side, I noticed that one of the little triangles was moving with me. It only did it for a second, and I couldn't really get it to happen again, but I knew that this vectogram was doing something funny to my brain. So, while wearing the blurry contacts, I decided to start with this one.

I put the polarized glasses on and started to rock side to side like last time. And suddenly little triangles started popping off the screen! They didn't stay popped out for very long, but it happened more than a few times, especially (for some reason) on the triangles on the left hand side of the picture.

It reminded me of those pop-up story books - the kind where you pull a tab and little paper figures extend off the page. It was as if someone was pulling a tab behind the vectogram and making the triangles pop out. At one point, I even saw a wave of depth undulate across the vectogram and then disappear. It was pretty neat.

Excited, I tried another vectogram - the one my vision therapist calls "creepy clown."

Again, something happened! Nothing really popped off of the screen, like those little triangles did in the figure 8 vectogram.. It was more like... the screen fell away and I was looking through a portal into another dimension... A dimension of scary living devil clowns!

The area with the most depth was that area between creepy clown's legs, where you can see his two legs, his hand, and the stool. It's was very depthy in there. And yes, I do appreciate how creepy it is to have one of my first experiences with depth involve looking between a clown's legs. Some optometrist out there sure has a sick sense of humor.

Also, every time the screen fell away and got depthy, I got the strange sensation that someone was punching me in the stomach. That was pretty neat, too.

So that's the story. It wasn't in "real life", and it was blurry and unstable. But it HAPPENED. Up until this point, I have been secretly fearing that maybe I was born without those special binocular neurons. Maybe I became strabismic because my brain was missing some pieces... Now I know that's not the case. I just need to keep practicing.

What is "fusion"?

I'm writing this entry to describe my experience with "fusion" in vision therapy. I'm putting "fusion" in quotes, because I'm still not quite sure if what I am experiencing is fusion, or even what the definition of fusion really is. I know that, basically, fusion means two eyes making one picture. But what I've seen and noticed seems much more complex, and involves brain processes that I can't even begin to understand. In any case, this is what I have noticed about fusion so far...

First, I have noticed that fusion is not just one process. There seem to be several "types" of fusion that I have come across, and even within these "types", lines get blurred and things get murky. These types may even exists on a continuum. However, I will try my best to explain what I have experienced. Here are the three types of fusion that I have come up with:

1. Cut and paste
 This is the easiest kind of fusion for me. The images from each eye are selectively cut and pasted together into one image through some brain photoshoppery. An example of this would be the anti-suppression playing cards that I love so much.

When viewed through red/green(blue) glasses, these are the images that the brain must combine:

How does the brain do this? In my subjective experience, it feels as if my visual system is using scissors and glue to make a sort of collage.

Of course, it doesn't look like that. But it feels as if that's the process that my brain is going through - choosing the important elements from each eye, and deciding which to use in the final "collage." If the brain did not go through such a process of defining importance and cherry picking input, then what would stop the brain from making an image such as this?

The brain would not make the above picture, and one would never see the cards all blank like that. I dare you to try! The brain looks for meaningful input, and assembles everything together accordingly. That is why, when making anti-suppression activities, I am always writing letters on everything. I have learned from the playing cards that the brain cannot ignore letters.

For me, this type of fusion becomes more difficult as finer and more precise "brain cuts" and "brain pastes" are required. For example, fuse - by convergence or divergence - the image below:

What you should see is something like this:

This is quite hard for me to do, and I believe I know the reason why. Look at all of the places where the lines are in conflict (in pink). This would require some very creative cutting and pasting.

In fact, this comes close to requiring the brain to create a completely new image (rather than a collage), which brings me to the next kind of fusion.

2. Transmutation
In this type of fusion, something new is created that neither eye can see alone. This is not a composite of two images, as is the case with cut and paste fusion. Two images are combined in such a way that they create a new, unique third image.This is certainly not a collage. It's a new painting!

An example would be the "luster" effect. By convergence or divergence, fuse the two images below:

What you should see is one grid in the middle, with the red square and the yellow square magically transmuted into a new color. This new color was not perceived by either eye, it was created in the brain. (I imagine it will be glowing like it's fresh out of a nuclear reactor.)

This type of fusion is exceedingly difficult for me, and I'm not sure that I have properly achieved it. When I try to do luster activities, I tend to get flashing, alternating between colors, rather than the creation of a new color. I also imagine that stereoscopic vision requires a great deal of transmutational fusion, and thus it is very important that I get better at it! I can't be satisfied with merely cutting and pasting; my brain needs to learn how to blend and create.

3. Stereopsis
What happens here? I'll let you know when I see it. I've heard that salads, tomatoes, horse skeletons, steering wheels, and coat sleeves all start jumping out to say hello. It sounds pretty awesome.

My left eye - a VT update

(I've lost track of the weeks. They're just flying by!)

The theme for my vision therapy lately has been "back to basics." My vision therapist and I were talking, and we decided that we skipped over some important stuff in the beginning. With new patients, she normally starts out with a lot of monocular patched activities, tracking, pursuits, body bilaterality, and so on. But in my case, I was very eager and kept being like, "Wow! Is that a cheiroscope? I read about that. Can I take that home?" And so we got a little ahead of ourselves.

As I've been progressing and starting to really get a feel for my eyes, I've been realizing the importance of those beginning foundational activities. I'm becoming very aware of how unequal my eyes are, and I can see how much of a hindrance that can be. Therefore, for the past few weeks, we've been going back to those basic beginning activities.

Specifically, I've been working on my left eye - the amblyopic and frequently turned eye. Here is what I have noticed about it:

1. It is terrible at pursuits, especially going from right to left. It prefers a quick succession of saccades, or what Dr. Len Press told us are "catch-up ballistic saccades." My eye thinks that it's tricking me with these saccades, and that I won't notice that they aren't real pursuits. You're wrong, eye!

2. It has trouble knowing where it's pointing. I sometimes think that I am using the center of my eye to track something, but really I have stopped moving my eye (because the object has moved to a place where it's hard to move my eye smoothly) and I'm just seeing it my peripheral vision. My eye feels like that is "good enough" and doesn't realize that it's not even tracking anymore.

3. It doesn't like to initiate movement or be the leader. It just wants to follow what my right eye is doing.

4. It has trouble maintaining a stable gaze. When I try to fixate on something for more than just a second, my eye jitters around the target. I've witnessed this using the MIT and seeing the Haidinger brush dance around the target that I was (trying to) fixate on.

5. It's even nystagmus-y on occasion. Sometimes when I wake up in the morning and my right eye is occluded by the pillow, I will look at the alarm clock with my left eye and the image of the clock will jerk back and forth over and over.

(and I'm sure I'll discover more as time goes on)

Amazingly, I had no awareness of any of this until very recently. How could I not notice all these years?

Now that I have noticed, I have been busy working away on my monocular skills with activities like:

tracking / pursuits with the monster
word searches with progressively smaller letters
marsden ball tracking
MIT mazes
tracking while keeping something in a circular afterimage
and so on...

And of course I've been throwing in some physiological diplopia and antisuppression exercises, because life would be boring with without them.