Session 80: Large rope circles projected on the wall

After almost four years of me doing Vision Therapy, our VT office finally got around to repairing an old projector they had in storage. It's pretty cool. Now we can finally do polarized quoits vectograms on a bigger scale by projecting them on some kind of grey screen on the wall. My Vision Therapist named Sofie was doing the exercise simultaneously with me. Funnily enough her ocular movement ranges at that distance (2 to 3 meters) were similar to mine. Keeping my circles singled out is going pretty well then but I didn't see any depth or changes in circle size (SILO - Small In Large Out). Damn it!

This brings me back to the goals I stated in July 2014. Easy convergence, more agile accommodation, sensory fusion and possibly stereo vision. That's what I hope to achieve by July 2015. That's all still on the table. Let time to its job. On a positive note, I have already reached the 75 kilograms weight target. One goal down, four to go.

I'm also working on procuring Rapid Alternating Occlusion Goggles which are supposed to help with decreasing remaining fields of suppression and stimulate sensory fusion. Movement seems to be the key to 'blowing open' the magnocellular pathways, even when that movement is so rapid one does not consciously perceive it anymore. Read some papers about it, talked to the optometrist who invented it, ... I am very excited about the research papers but I'd like to SEE it for myself. More about this later!

Session 79: A short Aperture Rule update.

Recently a VT friend of mine named Pasquale asked me how I had progressed in executing the Aperture Rule ever since I wrote 'Doing time' two years ago. Last week I asked my Vision Therapist whether I could try the AR again to verify.

Two years ago I only recently started having single vision some of the time. Back then I was able to execute the AR up to level 4 (of a total of 12) both with the exo and eso settings.

Right now I am able to execute the AR successfully up to level 7 using either the exo or eso aperture. Not too shabby! Certainly when considering my Vision Therapist said that even people with 'normal vision' often have trouble going beyond level 9 or 10.  

Good. This is where binocular vision problems come to die a slow and painful death. 

The story of Ilaria Invitto: 'Vision Wars in Medical School'

"Am I wrong when refusing to surrender to my visual limitations? Am I condemned to live a life suspended in uncertainty while continueously fighting these limitations?" - Ilaria Invitto

My name is Ilaria Invitto. I'm 23 years old and I live in Battipaglia, Italy. I was only three months old when my strabismus presented itself. It suddenly appeared after a night during which I suffered from strong respiratory problems due to bronchitis. I've undergone strabismus surgery when I was six but that hasn't really resolved my vision problems on a functional level.

Ilaria and her mother

During high school I experienced the need to cover one eye with my hand while reading. I also lived through periods when I was unable to read, suffered from headaches and had to rest excessively. I knew it had to do with my strabismus but wasn't sure how exactly. I didn't know that I was lacking stereopsis. I didn't even know what stereopsis was!

Ilaria and her sister Serena

MICHAEL: That sounds all too familiar. I only discovered how much I'd been missing as a young adult too. Do you feel as if your strabismus has put the brakes on your performance and stopped you from living up to your true potential?

ILARIA: It's as if you've taken the words right out of my mouth! I feel there's been a considerable lack of productivity compared to my potential.  I know I have a good memory and I am quick to learn. Still, there's always been something wrong ever since I was a child. It is as if there's a 'fire wall' between me and the world. Something preventing me from interacting and learning freely.

https://www.facebook.com/AskaDoctorofOptometry

MICHAEL: I completely identify. The mounting academic load led my partially developed vision to gradually disintegrate and break down, particularly during my University years. What has been your experience as you got older?

ILARIA: Currently I am pursuing a degree in 'Medicina e Chirurgia'. That is the Italian equivalent of Med school. To enter this branch of study one has to pass a demanding entry exam. Receiving the news that I had passed the test was the happiest moment of my life! It was also around that time I met my boyfriend. Things were good. I had a fairly normal life. My vision still didn't give me as much trouble as it does now. Everything seemed to be okay until I started to become unable to read and study. That was after my first year of Med school. That's when the real 'war' started.

Under these circumstances the problem with Med School is the amount of reading. I suddenly couldn't study or read a book anymore at all, the headaches got worse and my eyes always felt strained and painful. I didn't understand why I couldn't study anymore. I didn't understand why I felt so numb, slow and ... old! From that period on I started to suffer from anxiety, panic attacks and depression.

This will be my fourth year of medical school attendance. Sadly however, in terms of exams, I am still working towards finishing up the second year. Studying Medicine normally takes six years in Italy so I'm still far from obtaining my degree. I'm very worried about my future...

MICHAEL: 'Numb, slow and old.' It's almost uncanny how I've used the exact same words in attempts to convey my situation to other people. Although it's hard for others to understand a twenty something with a burn out due to badly treated binocular vision problems/strabismus. Fortunately I discovered Fixing My Gaze on the internet. How did you break the dead lock?

ILARIA: After a class on the anatomy of the eye, I talked to my teacher Mrs Stefania Lucia Nori (University of Salerno) about my troubles. She's an ophthalmologist. She recommended for me to read Susan Barry's Fixing My Gaze. I discovered a whole new world. I can tell you that Fixing my Gaze, in a sense, saved my life! Even if the book wasn't able to provide an instant resolution of the problem, at least now I understood what was going on.

MICHAEL: What did you do with this new information?

ILARIA: Because of the perpetual and accute eye strain and headaches I started looking for ways to improve my vision. An ophtalmologist told me to look into a program called Revital Vision. It's a computer program containing eye exercises. A supervising orthoptist is to guide the patient through the program and track progress. The advantage would be that I didn't have to travel long distances to complete this treatment. One of the problems with Revital Vision however was that it was supposed to be a treatment for amblyopia. I'm strabismic but don't really have severe amblyopia. I've done these computer exercises at home for two or three months. I was very desperate, confused and was under a lot of pressure from my parents. I did those exercises in front of the computer with my good, fixating eye covered in order to enhance function of the deviating eye. Because of this fairly random treatment, I started to alternate between eyes frequently and experienced occasional double vision. I still remember when I used to see my teacher with two heads in the classroom at university! They said it was a good sign because my right eye was "waking up". Nevertheless, my headaches and the eye pain were getting worse whatever they might have said.  In my opinion they didn't know what they were doing. That's when I decided that it might be worthwhile to travel long distances in order to get some proper advice. I even think that the changes induced by this treatment slowed down the actual Vision Therapy I participated in later on.

...

I started Vision Therapy in April, 2014.  My Vision Therapist's name is Angelo Caniglia.  He works in "Ottica Pisani", an optical shop/optometric center owned by an optometrist named Sabino Pisani. It is located in Castellanza, near Milan. Some famous athletes have been treated there for vision problems, such as for instance the football player Rino Gattuso.

A major issue for me is the traveling distance. I live in the south of Italy, near Naples. My optometrist is located in the north of Italy, near Milan. That's 900 kms from where I live. I have to travel 1800 kms using high speed trains to see my Vision Therapist. Originally I had to do it all in one day which was beyond exhausting. Luckily, recently my boyfriend moved to Milan for his job. That allows me to spread the commute which makes it more bearable. That was a happy coincidence!

MICHAEL: That's an insane amount of traveling. I hope it's worth it!

ILARIA: Ever since I've seen sort of a hologram in the quoits vectogram, I totally trust my Vision Therapist. It was such an exciting and touching spectacle to see the stick in my hand passing through the circle. My Vision Therapist always explains why we are doing something and answers all my questions in a comprehensive fashion. I very much appreciate that.

MICHAEL: Wow, the floating circles are a very nice first step considering you only started VT in April. That's awesome.

ILARIA: Yes, it's not all good though. A few weeks back my therapist told me he thinks it would probably be better for me to give up the idea of central stereopsis. He'd suggest to reactivate the suppression in the right eye and develop only peripheral stereopsis. He says that there is no coherence between the surgically altered posture of my eyes and the perception of my right eye. For instance, the position of my eyes looks like exophoria but the underlying neurology reacts like an esotrope's. He's worried about the possibility of developing constant double vision. He also doesn't want to give me false hope as he doesn't know for certain whether he might be able to resolve my problems completely. I think it might be an attempt to manage my expectations because either way it's not going to be easy.

MICHAEL: Yeah, the physical re-positioning of the eyes through surgery can result in a mismatch with how your vision developed neurologically. That creates an entirely new host of problems. I understand that your Vision Therapist wants to be cautious... Although I'm not sure how one is to develop peripheral stereopsis without it leading to central stereopsis anyway? It sounds like a good idea to make sure your eyes move well enough before throwing suppression out completely, develop peripheral stereopsis and then zone in on central stereopsis. To me that sounds like a better game plan than stopping with a job half done.

ILARIA: I used to believe in the impossible. I'd do whatever it takes to achieve the goals I set for myself. Maybe I was wrong... He says that peripheral binocularity should help a lot with reading... but I'm scared! I thought that one day I would be able to see in three dimensions, but now what?

These days I'm suffering from severe headaches because I'm studying more in order to pass my upcoming exams. I don't know what to think. I only know that I want my life back! I've heard acquiring stereopsis is possible for people with surgically altered eyes. I can't accept that it might be impossible for me!

Notice the lack of reflection
in the right eye

MICHAEL: I think your Vision Therapist underestimates how much you want this. Good luck with your exams by the way! I know how it is to sacrifice your health for a passing grade. Don't hurt yourself too much though because in the long run it's not worth it. Focus on your vision and the rest will straighten itself out all by itself.

ILARIA: You say "don't hurt yourself" but I have to! I want to fight against my terrible headaches and the other symptoms, because I totally reject the possibility of renouncing my greatest passion. I'm too much in love with medicine!

MICHAEL: I've fought that fight against my own body too. It's a fight you can't win without losing. I'm not suggesting you should renounce or give up, just postpone for a little while to come back even stronger.

ILARIA: I've seen my first vision improvements but the road is long. Literally and figuratively, considering the long train rides. Lately I'm feeling the exhaustion of the travel which slows down my progress and sometimes even makes me regress. I guess progress doesn't happen in a straight line.

MICHAEL: Yes, I'm afraid so. I just try to do what I have to do to solve the vision issue while avoiding and dismantling any potential secondary social or monetary problems. How are you coping with that?

ILARIA: It's hard to stay in that kind of  'reasonable problem solving mode'. One of the things that makes it particularly hard is the fact that my parents don't understand my vision problems and think I'm just being lazy. Often times I feel very anxious about this... or angry.

MICHAEL: It's very hard to be patient with people when they accuse you of being lazy while you are in fact maxed out by trying too hard. That always makes me furious. Fortunately I've always been able to control myself quite well. That reminds me. I've watched the Godfather recently. One of the Sicilian bodyguards warned Michael Corleone for women from the south of Italy. Allegedly they can be more dangerous than shotguns. Fact or fiction?

ILARIA: Hahaha. That might be true when being angry. Maybe the Corleone bodyguards have a point there.

However, to get back to your question. A specific activity that helps me cope with my vision problem is singing. I'm in a Vocal Ensemble and choral music is vital to me. I'm very passionate and I was soothed by singing in the choir during many bad times. It's the only thing on which I can focus without using these damn eyes!

una publicación de Ilaria Invitto.

MICHAEL: That's beautiful! I'm glad you are able to vent your frustrations and emotions in such a graceful way.

ILARIA: Yes, I need to upload some Italian or Latin songs now that I think of it.

MICHAEL: Italian does lend itself very well to singing indeed. I look forward to those videos and I wish you the best of luck with everything you're doing and with Vision Therapy in particular! Let me know how it goes. Arrivederci, Ilaria!