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No wonder reading feels so weird – Adult VT, Week 7

5/31/2019

Thank you to COVD for this piece.
COVD Link: https://covdblog.wordpress.com/2016/08/09/adult-vt-week-7/
August is Children’s Vision & Learning Month, and did you know that adults with undiagnosed vision problems who struggle with learning can benefit from vision therapy as well?

Difficulties while reading, working, and learning to play the cello caused this adult patient to seek a comprehensive vision exam with a developmental optometrist found with COVD’s Locate a Doctor tool. After a diagnosis of convergence insufficiency, he was prescribed glasses with prisms and a course of vision therapy. Follow his journey below as he retrains his brain and eyes to work together.

Week 1 – Week 2 – Week 3 – Week 4 – Week 5 – Week 6

Things are really starting to happen for my vision! It’s so incredible but it also makes so much sense that such individually-tailored and directed exercises would start to really make an impact.
I can now control my eyes enough to read one word at a time and keep moving in a left-to-right direction, which was really challenging when I had no idea I was skipping and re-reading and jumping all over the place. No wonder I have to read things over… I guess I just learned to go fast enough that it made up for it. Fast but sloppy!

This week we started to work on my eccentric fixation (not looking at things with the center of my vision) and it explained even more of the visual symptoms I experience. This was the most validating thing we did so far and it really reassured me that I’m not making this all up! I’m so glad I spoke up and tried to explain how things look so my optometrist and vision therapist team would know what to test.

A surprisingly-challenging maze when you’re using one eye that’s off-center!

Many mysteries were solved when I was asked to navigate mazes on the Macular Integrity Tester (which my ingenuitive vision therapist made herself before they were commercially available! I’m so impressed!) Covering one eye, I had to move the “brush” (a sort of “x marks the spot” of the center of my visual field) through the maze. I was surprised to find that my right and left eyes acted totally differently and correlated so exactly with what I experience.

My right eye was first and it was relatively easy to navigate the maze. After I stopped hitting dead ends and finished, my vision therapist asked me how it had felt to go in the different directions. Left was the easiest and this correlated to moving from the end of one line of text to the start of the next one, which I confirmed is not difficult for me, so it makes sense that the necessary skill is easier to do.

The left eye was even more revealing. While it had been easy to keep the brush in the center of the maze path for my right eye, I could hardly keep it off the upper and right boundaries for the left one. This made so much sense because when we discovered my eccentric fixation, I had needed to look down and left of a target to aim the brush at it. It was also very hard to move downward and I was completely unable to even keep my awareness of the brush for the bottom part of the maze. Since we hold what we’re reading lower than our faces, this trouble lower down relates to my overall reading difficulty.

So this is what the mazes revealed: my right, weaker eye, had an easier time moving because its fixation isn’t as far away from the center of my vision. While my left eye is dominant and stronger, it must have started fixating eccentrically before the right eye started being turned off. Eccentric fixation was my brain’s first attempt to fix the double vision I experienced as a child, and because it would have been even more extreme due to my convergence insufficiency, my brain then learned to turn off my right eye for close work. What I ended up with is one eye that’s strong at focusing but off-center, and one eye that’s weaker at focusing and gets turned off close up. No wonder reading feels weird!

Today was the first day we started working on binocularity, meaning my eyes working together, now that my right eye was starting to get more caught up with my left. We did an activity called Squichels which is really fun to say but less fun to do–what a weird experience! I put on these bizarre glasses with giant prisms on them that forced apart what my two eyes were seeing. It was really disorienting and I definitely had a few moments of feeling seasick.

Wearing these glasses, I was asked questions about things on the table in front of me. How many did I see? Which one was higher or lower? Can I reach out and touch the doubled object? It was fascinating, disorienting, and mysterious, and I’m definitely excited to see how this new part of my therapy will play out!
Could you or your child be struggling with a vision condition like this VT patient? Locate a Doctor in your area and schedule a comprehensive vision exam today to find out during this month’s Vision & Learning Month!

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Amblyopia is a Binocular Problem

5/20/2019

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Thank you to COVD for this piece. COVD Link:
https://covdblog.wordpress.com/2017/06/27/amblyopia-is-a-binocular-problem/

Amblyopia is defined as a visual developmental disorder that arises after selective disruption of visual input early in life. The diagnosis of amblyopia typically focuses on the presence of a selective disruptor (the amblyogenic factors of strabismus and/or anisometropia) in young children which results in a visual disorder (reduced visual acuity) of the amblyopic eye. Visual acuity becomes the “yardstick” by which treatment progress is measured. However, amblyopic eyes almost always have deficits in many visual functions which can also be measured, such as fixation, accommodation and eye movements, just to name a few.

Although the clinical presentation of amblyopia focuses on one eye, it is a binocular problem.Between the presence of an amblyogenic factor (the cause) and the reduced visual function (the effect) lies the neurological process ofsuppression. The dominant eye dominates and suppresses the amblyopic eye. Think of big brother bullying his younger sibling, until the younger brother is cowering in the corner.**

A recent review article supports this view of amblyopia as a binocular problem by focusing on deficits in the non-amblyopic eye. Most of these deficits are subtle and can only be measured in a laboratory, but they enhance our understanding of how amblyopia happens in a developing visual system.

The article considers possible mechanisms for deficits in the non-amblyopic eye. Are they caused by occlusion (patching) therapy? slowed maturation of visual functions? atypical development of the binocular cells in the brain’s cortex? or an adaptive mechanism to equate the sensitivity of the two eyes? The authors conclude that while there isn’t enough evidence to rule out any of these mechanisms, binocular mechanisms are clearly in play. The idea that the brain is attempting “to equate the sensitivity of the two eyes in order to mitigate the effects of amblyopia on the developing visual system” is very compelling.

What does this mean for treatment? Traditionally, amblyopia is treated by patching the non-amblyopic eye. Let’s go back to the big brother bullying little brother paradigm. Patching essentially removes big brother from the room and sends little brother to the gym to get stronger. But eventually, you have to take the patch off, and the amblyopic person has to learn to integrate the information from both eyes. This requires reducing the suppression.

New binocular treatments are becoming available which separate the visual information channels to each eye and then decrease the contrast of the information being presented to the non-amblyopic eye. At what point, will the non-amblyopic eye stop the suppression and allow the amblyopic eye to participate in a binocular view of the world? Can big brother’s volume be turned down to a point where little brother can be heard?

This review article suggests that the amblyopic brain has already initiated this approach to treatment! The deficits in the non-amblyopic eye are an expression of having turned down the volume from the non-amblyopic eye, or at least an attempt to do so. The development of binocular-based treatments that follow the same approach that the amblyopic brain has already undertaken seems very promising. The evidence that amblyopia is a binocular problem requiring binocular treatment is growing. What exactly is this “binocular treatment”? Learn the answer at COVD.org!

** Thank you to Pilar Vergara, who uses this analogy in her book,Crossed and Lazy Eyes — Myths, Misconceptions and Truth.

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Science and Splash: “My Eyes Couldn’t Rest for a Minute”

5/9/2019

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Today’s guest blog post was written by Carrie Hall, an optometric vision therapist at Washington Vision Therapy Center in Yakima,WA and edited by Benjamin Winters, OD, FCOVD, the clinical director of that clinic.

“I’m getting annoyed. I just feel like I didn’t get a break; everywhere I looked, things were distorted. My eyes couldn’t rest for a minute unless I closed them. Even faces, I’m trying to listen to what you were saying, but you know, I wasn’t there anymore.”

Many of us who work with children who are struggling in school might find the above sentiment familiar. Familiar not in the sense that children are able to express their concerns so clearly. But familiar in that as we look at their slightly overwhelmed, slightly vacant, slightly tired-seeming faces, we know that this is exactly what they’re feeling.

Believe it or not, the quote at the beginning of the story is not from a child with a vision problem, it is from a teacher who has just experienced what is like to have a vision problem. This teacher and 3 other teachers were subjected to simulated vision problems and then given some school work to do. The video, created by COVD member Dr. Chris Schell and Dr. Richard Maharaj captures what it is like for children that struggle with vision problems. Even more, they show that despite these vision problems, the teachers could easily pass a vision screening using the 20/20 Snellen acuity chart; thereby, demonstrating how poorly we are able to catch these problems with the vision screening done in most schools.

The truth is that many of the children that we work with simply lack the capacity to voice this frustration. They have no idea that their eyes cannot “rest for a minute,” as they have never consciously experienced what that sensation would be like. They don’t know what normal vision feels like! All they know is their parents’ frowns as they peruse report cards. They know they sure do try to sit still and concentrate each time the teacher tells them to. And they know they try so very, very hard to ignore it when their younger siblings can read the books they themselves struggle with.

It takes some contrast to truly experience how difficult it is to accomplish tasks with a visual impairment. If you weren’t born with amblyopia (a lazy eye) or convergence insufficiency, it is nearly impossible to describe how difficult school or work can become. Just the simple task of reading becomes immensely challenging and exhausting when one’s eyes are not working together as the video so brilliantly demonstrates.

The glaring truth of how very unfair it is to try to ask a child to read with a broken visual system becomes evident in this video: we see the looks on these teachers faces as they attempt to do simple tasks, such as reading and understanding children’s books. Dr. Schell elaborates, “the look on a parent’s face when they experience a moment of double vision or blurriness in one eye and how that interferes with function is priceless. The parent “gets it” for the first time.” Just like these teachers, the parents realize that their child’s slagging performance or poor behavior is utterly logical for the situation that they have been in. They experience the unfairness of it all first-hand and finally realize that they have completely misjudged their child. Often, they are overwhelmed with guilt. They feel it is their fault for not realizing what was really going on.

The simple truth of the matter is, it’s not their fault. They didn’t know.

It only takes one creative teacher searching for how to make concepts stick to realize that fixing the vision is the answer for multitudes of her students, from now till forever. It only takes one end-of-her-rope mom, worn to the bone by late-night procrastination marathons to see this video and know how to change the course of her child’s life. And it only takes one vision therapist, or optometrist, or student, or parent, to share this video with hundreds of people who desperately need to know that they are not doomed to the state they have always lived in. That there really is another way of seeing the world.

If you feel you or your child are struggling with a life-altering developmental vision problem, please contact a developmental optometrist near you by going to covd.org .

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No wonder reading feels so weird – Adult VT, Week 7

Amblyopia is a Binocular Problem

Science and Splash: “My Eyes Couldn’t Rest for a Minute”

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