Wide-eyed Wonder: an artist's musings on three-dimensional vision

Some are color blind. I am stereo blind.

My diagnostic impasse

with 4 comments

"Bottom of Imperfect Impass" creative property of climber Gabriel Deal

Alternating esotropics are the most difficult to treat. (Period.)

My vision therapist stated this twice during my second eye exam with what sounded like a touch of resignation.

This is because 1. we have clear vision out of each eye and 2. the more established our system of alternation is, the more difficult it is to work against it.

My vision therapist contacted two colleagues this week and conducted further testing during my third office visit today. After the testing, she told me that degree of alternating esotropia I have is best not to treat, according to her own instincts and best practices, and the advice of her colleagues.

Apparently, the danger is that I could see double, with no guarantee of breaking through the double vision to gain stereoscopic vision. This is the same reasoning I received during my only other vision therapy eye exam back in 1981.

I certainly respect her professionalism and unwillingness to risk the creation of dyplopia. The Hyppocratic Oath to “cause no harm” is an ideal I desire in any medical professional who tries to help me.

And I deeply appreciate the extra care she has taken to confirm my diagnosis. She has gone the extra mile because this is my second time around, with 30 years of wishing for a binocular solution in between.

She also offered to contact Sue Barry’s vision therapist on the chance that there may exist some crack in the impasse my particular diagnosis presents. However, I am not terribly hopeful for an answer in that direction, as Sue Barry went into her vision therapy with several other vision problems that I do not have.

The malware that my brain has created “fixed” these other problems so that I can read without experiencing eye problems, other than fatigue. I also drive without fear, but this could be mere bull-headedness on my part!

Perhaps another vision therapist would consider taking the risk of giving me binocular fusion exercises, but before I make that decision, I will need to better understand the kind of dyplopia or double vision I might get stuck with, and what clinical evidence or case studies back up this belief.

In the mean time, I intend to further define and publish information about my particular kind of stereoblindness and my methods of coping with it, for the benefit of others. Over 30 years of burying my stereoblindess and hiding it from others has helped no one.

I will also seek out everything my vision therapist can in good conscience offer to improve my vision in spite of the malware, especially so that I can drive more safely and teach art classes and communicate more effectively. What I emailed last week still holds true:

“Beyond pursuing fusion, I would love for you to expound on the connection between peripheral vision and gross motor movements. I am also all for building as much peripheral awareness as I can.

Are there ways to encourage better peripheral eye teaming? Optic flow has been a huge clue, for example.

My goal is to immerse myself in better seeing, with whatever tools I can get and use between office visits!”

And stereoscopic, 3D, binocular vision will remain at the top of my bucket list!

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Written by Lynda Rimke

December 21, 2010 at 6:06 pm

4 Responses

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  1. Dear Lynda,
    I just read your post about your diagnostic impasse. I understand what your therapist is saying. I went into vision therapy with a poorly adapted visual system. My angle of strabismus varied with viewing distance and direction. Is that the case for you? I think, perhaps, this variation in strabismic angle made it hard for my brain to come up with a single solution for viewing the world. I never came up with a single stable relationship between the two eyes, even a strabismic one.

    My view of the world, especially when attempting to look precisely at small targets such as objects at a distance or words on a page, was jittery and jerky. I had a great deal of trouble and fear around driving. If I tried to fixate on anything for a long period of time, sometimes the whole scene would start to grain out. This could occur when driving down a straight highway and was obviously very upsetting. As a result of some tests I recently underwent with a vision scientist/physician, I’ve learned that a lot of these problems may have resulted from a “manifest latent nystagmus” an oscillating movement of the eyes that is found in people with infantile esotropia.

    So, my poor adaptation to my strabismus may have disposed me to adopt and embrace new ways of seeing when I began vision therapy. I did not experience double vision during my therapy, though others have temporarily and then moved past it.

    That being said, I think another reason that I was able to move from alternating fixation to fusion was the way my optometrist paced my therapy. I started with gross antisuppression and gross fusion at the same time. In fact, I began working with polarized vectograms (a fusion exercise) from the very first day of therapy. As I learned to break suppression, I was learning to fuse or stimulating my latent fusion abilities at the same time. This may have prevented double vision. Moreover, as I learned to fuse, I no longer needed to suppress so the suppression was reduced. This approach is slightly different from some other approaches to vision therapy and reflects the thinking of Frederick Brock. I have a copy of a series of lectures by Dr. Brock that I’ve recently scanned into PDF format. If you like, I could email or snail mail them to you and your therapist. There are also some good documents about Brocks’ approach to strabismus therapy written by Nat Flax and Israel Greenwalk available through the OEP.

    Working on greater peripheral awareness is very important. Many people with esotropia probably fuse the broad contours of the landscape and this may provide a way to maintain a stable relationship between the two eyes. As you get better at taking in the visual periphery, you may better align the eyes. This is why the first fusion exercises for an esotrope should involve large, undetailed stereo targets that are moving. They stimulate the peripheral visual system, stimulate gross eye alignment, and may provide the best chance for gross fusion.

    When you try the Brock string, is there any viewing distance where you can get the X around the bead? If so, that’s an area, called the centration point, where you are displaying binocular behavior and you can work to develop fusion at that point and then beyond it. For me, my centration point was initially about an inch from my nose. I could “get” the X better in dim light where suppression is less.

    I am describing what worked for me and my particular visual system. Everyone is different and vision therapy must be tailored to the individual. Your vision therapist and you know you the best, and you and your vision therapist are right to explore things slowly and carefully. Your determination to keep exploring your vision is more important than you know.

    You can also email me at
    stereosue@gmail.com

    Best,
    Sue Barry

    Sue Barry

    December 29, 2010 at 11:06 am

    • Sue, your long, thoughtful and compassionate comment made my day! Thanks for taking the time to give me a huge shot in the arm! I have been in a bit of a wilderness concerning what to do next, other than get on with my life as I have. Every google search has given me dozens of “almost leads” … and yet I keep searching. So I’m not giving up just yet!

      My vision therapist knows yours, and is going to call her! So I’m trying to let her take the lead for as long as she is willing. I’m sure her notes concerning my kind of alternating esotropia and Theresa’s notes concerning yours will be the topic of discussion. Hooray!

      I will also copy paste your comment for her to consider. To be honest, I truly respect my VT. She also battled alternating esotropia when in college (excessive reading during optometry school) and regained her stereopsis, so she has really wanted to help and already taken a great deal of time concerning my diagnosis.

      But the rub is the standard protocol that is so much of the world of medicine, that errs on the side of caution. I feel this is especially true for vision therapists, because the whole field is so opposed by so many, particularly a handful of opthomologists … the stuff I’ve read from the opposition makes me crazy!

      Because my alternation is so well established, it may be a harder system to override. But I do feel that stereopsis would take hold, simply because that is the original and most efficient design as you have said in your book. (My dog truly is bone-headed, and a frisbee catching machine. Stereopsis can’t be that hard!)

      As far as the Brock String goes, I do get an X around the bead at about 5″ and 10″, but I haven’t had much chance! I made a button string just to check before my second appointment. After not doing well with the polarized quoit rings on my second appointment, I begged for the string . My VT watched my eyes very closely, and wasn’t happy enough with what she saw to give me the string again. I feel like a petulant child! I want that string!! But I’m resisting the temptation to make one and practice at home, until I talk with her again.

      And YES, I would love to have anything you’ve got on Brock. I read in your book how you were able to research his writings, and was hoping to do the same myself. What you’ve quoted from him just makes so much sense! I will email you so you have my email for the Brock pdf.

      Did you see Traci commented today about 10 minutes after you? So touching. We are a bit of a long lost “sisterhood”! She found me through your facebook page. That made my day all over again!

      Thanks for everything!

      Lynda Rimke

      December 29, 2010 at 8:38 pm

  2. Hi Lynda!
    The best way to explain my feelings as I write this post would be similar to those of someone finding their long-lost sister … I’ve finally found someone just like me, struggling with the same vision difficulties and wanting so badly to find answers!

    I recently finished reading Sue Barry’s “Fixing My Gaze,” which inspired me to seek out my “sisters with strabismus” and encouraged me to fight for a 3-dimensional view that I’ve lacked my entire life. I found your name and blog on Stereo Sue’s Facebook page, and I’ve spent the past two days reading your posts (I haven’t been very productive at work, I’ll admit!). I’ll give a quick synopsis of my “story,” in the hopes that we can become e-friends and join in the quest to gain binocular vision.

    Thirty years ago (yes, I’m 30), I was born with crossed eyes (my left eye was drastically turned inward) When I was 4 years old, I had my first (and only) cosmetic surgery to align my eyes. The surgeon did a fantastic job with the alignment, but I have never been able to fuse the two images into one … I’ve always seen double. I quickly learned to suppress my right eye so that I could function in life … I did everything a “normal kid” could do (I even played softball, although I couldn’t catch a fly ball!). However, the lack of depth perception and the double vision that is especially apparent at night) continue to pose “frustrations,” as I’m sure you can relate! I’ve sought out several opinions from Opthalmologists and Optometrists over the years, but I always leave hopeless … I’ve always been told that it’s too late in life to train my eyes to work together. But, after reading Sue’s story and hearing of other success stories, I’m not ready to give up!

    Reading your latest blog post about the “double vision that you might get stuck with,” I’ll say this … As someone with constant double vision, I’d always rather see two images and use both of my eyes, vs. seeing the world through only one! And, I’m now more confident than ever that I can achieve binocular vision … I just need to find the proper resources and Dr.s to help me achieve it! (My biggest frustration is that there are so few vision specialists who understand Strabismus and binocular vision … in Sue’s book, she says that 5 – 10% of kids experience some type of crossed eyes or vision problems throughout their lives, so why aren’t there better resources and knowledgeable Dr.s out there?!)

    I could talk about this forever, and I hope to continue the conversation with you … thank you for starting this blog as a place to share stories and provide encouragement and inspiration for those “like us!” You now have my e-mail address, so please feel free to reach out that way as well.

    Sincerely,
    Traci

    Traci

    December 29, 2010 at 12:05 pm

    • Traci, thanks so much for commenting and letting me know you’re out there, with many of the same issues. I was just surfing again to no avail to find more info on alternating strabismus and diplopia … to no avail. But when I do find more, I will post. There is such a blackout, and I’m with you … there are too many with this condition needing as much good info as they can get!

      Sue Barry also left a wonderful thought-filled comment minutes before yours. Be sure to read it. What a blessing!

      I hope and pray you find a good therapist. Isn’t Sue Barry’s book an inspiration? Let’s keep pressing on.

      Lynda Rimke

      December 29, 2010 at 8:10 pm


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