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

Some are color blind. I am stereo blind.

Archive for the ‘double vision’ Category

Schools Need Binocular Vision Screening

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I read about an appeal to write my congressman from the “Let Them See Clearly Campaign” to add binocular vision screening to a bill, as posted in a DIY Vision Therapy Group I belong to on Facebook.

I emailed a rather lengthy letter to my House Representative about three weeks ago, using the campaign’s information, and adding my own research and brief personal story. I haven’t heard back, but hope to. It seems to me that adding binocular vision screening to this bill would be a good fit.  Here’s why (Although I just learned after posting that the writers want to create a separate bill*):

To the Honorable ….

re. H.R 3535 the “Alice Cogswell and Anne Sullivan Macy Act” in Committee

Dear …..

H.R 3535 should add screening for binocular vision (BV) impairment to the vision screening protocol to identify students with visual disabilities.* BV is tested via an assessment of eye focusing, eye teaming, and eye movement abilities (accommodation, binocular vision, ocular motility.)**

Under the “Categories of Disability Under IDEA” (Individuals with Disabilities Education Act), “Visual Impairment Including Blindness means an impairment in vision that, even with correction, adversely affects a child’s educational performance.”(1)

The Visual Impairment definition further states: “Most of us are familiar with visual impairments such as near-sightedness and far-sightedness. Less familiar visual impairments include: strabismus, where the eyes look in different directions and do not focus simultaneously on a single point…” (2)

Strabismus (Esotropia and Exotropia) is just one of many Binocular Vision impairments. More common ailments are:

Convergence Insufficiency, where the eyes fail to team together to see things up close. “Convergence is the coordinated movement and focus of our two eyes inward on close objects, including phones, tablets, computers, and books.”

Amblyopia or “lazy eye” where the brain suppresses the image from one eye because the image is different than that of the other eye.

Diplopia or double vision

Esophoria or exophoria, where the suppression of one eye is intermittent.

Strabismus, as either Esotropia (“crossed eyes”) or Exotropia (“wall eyes”), occurs when the suppression of one eye is well established.(3)

Undiagnosed Binocular Vision Impairments are increasingly triggered in children by our convergent-based technology, which requires turned-in eye-teaming on phones, tablets and computers, with little outdoor play to aid binocular vision development. (4)

Unfortunately, at the same time, children in school are being misdiagnosed in IEP’s when binocular vision problems inhibit learning. These children can and should receive an early diagnosis and, hence, the opportunity to pursue certified optometric vision therapy and/or recommendations from an Opthalmalogist to normalize visual processing and improve learning ability and quality of life.

Furthermore, IEPs must include accommodations necessary to aid the child undergoing optometric vision therapy as advised by their Doctor of Developmental Optometry, in order to not undo progress made under vision therapy. This may include not forcing the child to read, for example, until her unstable convergence issues are resolved.

-13 to 20% of the population have impaired binocular vision that is 75% curable according to a double blind study by NEI (5)

-Studies by ADHD and vision experts show 20 -25% are misdiagnosed and have binocular vision impairments (6)

-Autism.com says studies show that 21 to 50% of autistic children also have binocular vision impairments. (7)

“Binocular vision impairments are more common than you may think. Just one type of binocular impairment, amblyopia (“lazy eye”), affects approximately 3% of the population. At least 12% of the population has some type of problem with binocular vision.” (8)

As an adult with alternating esotropia, a form of strabismus (crossed-eyes), I can’t begin to tell you how much better my quality of life would have been if my condition had been diagnosed and treated while I was a child in the 1960s. My parents gladly spent money to straighten my teeth, not realizing that all their harping about my feet turning out and my poor posture was due to my eyes not teaming to create a visual center-line for my posture and gait. This of course made gym class excruciating, as I was always the last to be picked for any team (imagine trying to catch a fly ball without any sense of depth) and also made socialization difficult as other children did not know if I was looking at them or something else.

Instead of learning how to use both eyes together, in early childhood my brain spent extra energy suppressing the vision of one eye or the other to avoid double vision. While my early well-established suppression allowed me to read without difficulty in 1st grade, it has lasted for a lifetime.

The extra energy expended by the brain to suppress vision and live and move by monocular depth cues, instead of fusing vision from both eyes to see palpable space and distance, limits one’s ability to: multitask on any level (how many jobs require this?); drive well during demanding depth needs (e.g. driving multiple sized vehicles on the job); work in food service, landscaping, auto-mechanics, carpentry, etc.; participate in sports or recreation (eg. yoga, dance, catching or hitting a ball); or watch 3D movies (the latter is impossible.)

Please, please, make screening for binocular vision issues a goal, so that 12% of the population can benefit from early vision therapy intervention to avoid the everyday pitfalls this hidden, subtile disability creates, which must be endured for one’s entire life.

Lynda Rimke
*For reference:
Subtitle A—General Provisions
Sec. 201. Identifying students with visual disabilities.

** https://covd.site-ym.com/?page=Exam

(1) http://www.parentcenterhub.org/repository/categories/

(2) http://www.parentcenterhub.org/repository/visualimpairment/

(3) http://www.covd.org/?page=VisionConditions

(4) https://nei.nih.gov/sites/default/files/nei-pdfs/VisionResearch2012.pdf p50 “spending time in bright outdoor light appears to be important for normal eye development…In 1972, approximately 25 percent of the U.S. population, 12–54 years of age, were nearsighted, compared to 42 percent 30 years later”

The Binocular Vision Dysfunction Pandemic http://c.ymcdn.com/sites/www.covd.org/resource/resmgr/ovd41-1/editorial_binocularpandemic.pdf

(5) https://nei.nih.gov/news/pressreleases/101308

(6) http://www.add-adhd.org/vision_therapy_FAQ.html

(7) https://www.autism.com/treating_vision

(8) http://www.children-special-needs.org/questions.html

For further reading:

American Academy of Optometry Binocular Vision, Perception, and Pediatric Optometry Position Paper on Optometric Care of the Struggling Student For parents, educators, and other professionals August 2013



* Let Them See Clearly Campaign LTSCC just commented on my Facebook share today: After meeting the HR 3535 writers from the American Federation for the Blind, they thought that though HR 3535 should pass that BVD needs its own bill. They said it was a statement piece that the extras may bog down my efforts and never pass. I do think a BVD on its own would be best and will talk to my legislation writer and my rep contacts about options. Thanks for the blog. HR 3535 should pass and will help with BVD along with a comprehensive bill. Working on that. :) Thx for your help

I replied: Let’s hope for the best. I’m going to add your comment to my post. Thanks.

And then, later: I’ve been thinking about this. I’m not happy they think comprehensive screening isn’t part of the bill. I mean, come on, how hard is it to add a simple cover uncover test and use a pen light? https://www.youtube.com/watch?v=ZErvGS1EqyM

And just now: Ok, I remember— those two tests only discover well-established strabismus and not other binocular vision issues such as convergence insufficiency, which is far more common. Maybe a full bill just for Binocular Vision Disorders is the better idea … if it ever gets written!



My diagnostic impasse

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"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!

Written by Lynda Rimke

December 21, 2010 at 6:06 pm

Avoiding fusion confusion

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My second eye appointment is not for another week. I feel I am getting ahead of myself with any attempt to fuse small images around my center-occluded glasses, and so have not worked at this for the last couple of days. After reading more of Fixing my Gaze, I am swearing off fusion until I try it in my vision therapist’s office.

The uncertainty about making myself see double, even for a split second is rooted in what Cynthia said when she was examining me last week: “You don’t want to see double!”

“Of course I don’t want to see double!—” I replied “but I have to see double as a result of turning ‘on’ both eyes, don’t I?”

The question was also on Sue Barry’s mind at the beginning of her therapy:

“If I turned on the input from both eyes, I asked Dr. Ruggerio, wouldn’t I see double? Isn’t this why I suppressed in the first place? This concern is why it is so important to undertake vision therapy with an optometrist highly trained in binocular vision. To prevent this situation, Dr. Ruggerio gave me several procedures that taught me how to aim both eyes precisely at the same place in space at the same time. As I mastered this skill, something remarkable happened. I learned to fuse images from two eyes and achieved what I thought was impossible: I began to see in stereoscopic depth.” (Fixing My Gaze, p.88)

I must be patient. I have not begun therapy yet, and should not be trying to accomplish stereopsis in an uncontrolled way, via my own experiments. Haven’t I done this all my life, anyway? Where has it gotten me? It will only result in flying saucers, which are not of any use and only feed my need to suppress two-eyed input. Instead, I must wait for the precise exercises that will train my eyes switch on only when they team correctly.

November 29

I have created a new game to play with my center-occluded glasses. The edges of the occlusion sometimes fuzzily split a shining thing in the dark early morning distance, a reflection in the window, or a slight opening in the curtain about 12 feet from where I sit on the couch, with feet up and a dog or two on my lap.

When I look just right, softening my gaze with the reflection on either side of the occlusion, a second reflection floats into being, and shimmers and hovers with the first. They look like two flying saucers, and I chirp “Good brain!” My brain is unlearning the “auto off switch” for one image or the other. But it is hard to keep them flying for more than a second or two.

I startle and inhale when, in what seems like a millisecond, the saucers fuze into one. “Oh! Was that fusion? Let me SEE” and one eye takes over, then I switch to the other and compare that fleeting image with the one-eyed versions. I am not sure, really.

It’s all over. I try again once or twice more in the early morning darkness, sipping coffee by the fire. I can get the saucers to fly, but not fuze. It becomes too tiring all too soon. The refection resumes it’s solidity in the front window, an input from one eye only.

Heather posted a similar experience on her blog, One-eyed Girl. I wonder if she is also going about this the wrong way, and merely activating her suppression, or is she “holding onto binocular vision”?

My binocular vision is still very weak. When I wake I can conjure up two door knobs on my closet door. One is very faint and elusive, it stays for a moment, drifts away and then I see one door knob again. This is my brain’s ability to hold onto binocular vision. Fusion; seeing those two door knobs as one is my ultimate goal (I can suppress one door knob and get one, but my goal is the ability to merge the two). The brains ability to take two images and make them one is a magnificent process that we take for granted every day. Unfortunately (and fortunately), I am expert at suppressing, it has been the way I have kept my visual world in order my entire life.

Written by Lynda Rimke

December 2, 2010 at 11:19 am