Mark B, strabismic pilot with eyes on the skies

Around a year ago I met Mark B. through our DIY Vision Therapy Facebook group. Every so often he'd post a picture of a little airplane or an air field on his Facebook profile. I thought he must really like planes but since he was strabismic he probably doesn't fly them himself. Turns out I was wrong!

MICHAEL: Hi Mark, where do you live and how old are you?

MARK: I live in the Brittish midlands, in Redditch more specifically. That's just south of Birmingham. I'm 39 years old and will turn 40 this year.

MICHAEL: When did you develop strabismus? 

MARK: As far as I know it's congenital, although the term "strabismus" is relatively new to me. Growing up it was simply a "lazy eye" which was "treated" with eye patches. The patching was a regiment of forced reading with one eye. I don't think the patching did anything to align my eyes and improve the strabismus as such. At the time I didn't really know why I was doing it either. However, clearly the patching helped me keep vision in both eyes (avoiding amblyopia which is another relatively new term for me) so I'm grateful for that!

MICHAEL: So just to be sure... You never had eye muscle surgery, right?

MARK: No, the patching happened around the age of 5 or 6. Then, I can't remember exactly, maybe around 6 or 7 I had a few hospital visits and had lots of tests. They wanted to do eye muscle surgery but I was horrified and refused!  Over time I learned to control my eyes so they looked straight(ish). On the other hand, I also learned to suppress vision in one eye and developed a distinct head-tilt. I'm glad I never went in for the surgery. My parents were cool with backing out of it and never made a fuss about it.

MICHAEL: Clever kid, good for you! Did you have a hard time academically? What did you study?

MARK: I do remember when I was very young, reading was very difficult for me. I had above average intelligence and a very inquisitive nature but I struggled to read words as they jumbled all together. I would lose my place when moving to the next line. Over time, my reading got better as I learned (as I now realise) to suppress the image from one eye. At school I studied Science and went on to study Physics at university.

MICHAEL: Cool, what kind of work do you do currently? 

MARK: I'm currently working for a water company. It's a great job. It takes me to a lot of different places and I meet a lot of interesting people.  I work as a planning and scheduling manager - I've got groups of people dotted around the place who organise crews to go and respond to customer issues and make sure we maintain the pipes and overflows so we don't cause pollution. There's a lot to keep me busy!

MICHAEL: Sounds like an interesting and useful job! Water is important. How then did you get involved in aviation?

MARK: I started flying a few years ago - just a lesson a month which was very slow going. I've always liked planes and the idea of flying. It was my wife who suggested I should start flying lessons. I never really believed I could afford it or have the ability. I trained for a few years and got my private pilot's licence last year.

MICHAEL: That's awesome! What a supportive wife you have! Did you have to pass some sort of vision exam to obtain your licence?

MARK: To get a private pilot's licence you need a class 2 medical which involves a reasonably thorough medical examination by an aviation doctor including a "routine eye exam" (basically medical history, no "abnormal" eye conditions, a reasonable level of visual acuity and colour vision although the latter only restricts night-flying).

Last autumn I got the crazy idea of pursuing a career path in aviation (commercial work or instructing) but for that I would need a class 1 medical (thorough examination including very detailed ophthalmology exam, cardiogram, audiogram, blood tests etc.).

I spent a day at Gatwick airport doing this but failed due to strabismus. The guidelines for a pass on the vision exam are:: -

(1) At 6 metres:
2.0 prism dioptres in hyperphoria,
10.0 prism dioptres in esophoria,
8.0 prism dioptres in exophoria;
and
(2) At 33 centimetres:
1.0 prism dioptre in hyperphoria,
8.0 prism dioptres in esophoria,
12.0 prism dioptres in exophoria
 should be assessed as unfit.

MICHAEL: I guess they placed prisms in front of your eyes to elicit certain reactions and those were your limits or something...

MARK: I failed due to 8 dioptres hypertropia . My eye positioning was not fixed and would change all the time, even during the measurements. My eyes were just out of my control! They also said it would be very unlikely that I would ever be issued with a class 1 certificate. Nonetheless, at this point I was allowed to renew my class 2 medical (fit to fly - hooray!). That was when I finished my private pilot licence course in Feb 2014.

MICHAEL: It's too bad you were assessed as unfit for a class 1 certificate! Nonetheless, you seem to be endowed with an analytical mind and can do attitude. A problem needs a solution, right? How did you discover VT?

MARK: I think I learned about VT just by searching the web for 'strabismus cures'. I did a bit of research. I went looking for real evidence on websites that they genuinely viewed Vision Therapy as a serious and effective branch of optometry.  I have also seen some websites advertising VT as some kind of miracle cure or pseudoscience which put me off... Anyway, I found several good websites and eventually I also found your blog!

MICHAEL: I always love to hear that people find my blog! Did you ever read Fixing My Gaze? 

MARK: I did, it is a fantastic book! I really like the way it relates to Sue as the person and how she feels and relates to the world rather than Sue solely as the objective scientist. Definitely gave me hope despite years of dogmatic medical opinion that there is nothing that can be done with strabismus apart from cosmetic changes through surgery!

MICHAEL: When you first found out about VT you experimented a bit on your own, right? 

MARK: I did try some VT stuff before I started formal VT appointments but this caused me a lot of frustration. I think I was over stretching myself and trying to work on alignment and fixation without considering the basics like muscle control, attention and posture.

MICHAEL: Here are some of your group updates from around that time: 

January 21st, 2014

"Had an interesting couple of days. I'm experimenting with different things myself at the moment before handing over money to somebody who says I will never see in stereo.

The anaglyph Tetris is going okay but it's hard work. I'm still not fusing both images into one so it's like trying to guess how many columns to move the piece to land it. Interesting though, I thought my left eye wandered upward but it moves slightly to the right as well! I know it's helping me overcome suppression but it is hard!

I'm having much more fun trying to view 3D anaglyph (blue/red) photos, I'm finding that if I relax my eyes and un-tilt my head (I have a head tilt), I get fleeting moments of 3D vision. I tried to explain to my wife that it's like suddenly looking through a piece of glass in front of your face and everything looks beyond or in front of that piece of glass. Everything looks a lot clearer and sharper as well. Those fleeting moments are quickly lost but will hopefully build up.

I'm getting brief moments of stereo vision in every day life as well. They're few and far between but getting more frequent. This is going to take some serious time but I believe I will get there!"

March 26th, 2014

"Last week I felt I was getting somewhere. I worked on some crossed eyes stereograms for a couple of weeks and started to see in 3D in the real world but it was short-lived! I just went back to flat images and vague 'shadows' of the eye that tends to suppress. I'm going to sort out formal Vision Therapy in the next few weeks... I can't do this on my own!"

MICHAEL: How did you find your behavioral optometrist? You seem to be having very good experiences with the practice you are going to.

MARK: I looked on Google. They are surprisingly hard to find! I think I ended up on the BABO (British Association of Behavioural Optometrists) website www.babo.co.uk. Fortunately I found a behavioral optometrist around 40 miles away which isn't too far. I went with Keith Holland and associates in Cheltenham as it looked really professional and they seemed to genuinely care about what they did. The vision therapist has been working in this field for many years and really takes time to make sure we spend our time productively and focus on the right areas (no pun intended). I really cannot praise them enough and really look forward to our sessions! It is difficult to gauge my own progress as I am, by my very being, subjective but I have really improved my visual range (i.e. movement range of the eyes), ability to focus on specific points and stereopsis when viewing stereograms. I see the Vision Therapist every month and I think I'm due for a review with the optometrist every six months. I have a long way to go but I've definitely got some momentum going here!

MICHAEL: Yeah, you also went in with some fleeting moments of stereopsis which is a nice starting point! I would sign up for that any day! Here are some more group updates you posted after you officially started VT. I always liked your updates as they are so positive and excited.

August 27th, 2014

"Well, I finally had my first appointment with a behavioural optometrist today. I was warned that I might get permanent diplopia (double vision) if VT breaks my suppression but I can't fuse images. That's just something that could happen. The alternative is living with the strabismus which I don't want to do. I should get some news next week about starting proper vision training!"

September 15th, 2014

"I started vision therapy today!!! It went really well. The therapist said that a lot of people in my position (i.e. late thirties) find out about VT and start a program having done a lot of research and having a good idea of what it is about. As it was the first session, we covered lots of different things.

One thing that surprised me was that there was emphasis on balance and perception of surroundings. It had something to do with re-wiring the brain and creating new neural pathways in order to accept 3D vision. For instance, for one exercise I wore a pair of prism glasses which gave me instant double vision (no suppression). I had to look at my hands in front of me (there were four of them) and we went through each one (numbered 1,2,3 and 4!) to make me believe each hand was real. I'm not entirely sure what the purpose of this was but I will ask next time - possibly starting anti-suppression?

Anyway, I've got an eye-patch and my own brock string with a timetable of daily exercises for next time. I'm working on balance (walking in a straight line with legs crossing in front of each other), eye stretching (patching one eye and fixating to the far ranges of the unpatched eye) to strengthen the muscles and to "convince" the brain that it would be good to start looking in places where I currently cannot, and a brock string. I'm trying to get the "V" shape. I'm sort of struggling so far but I will persevere! There was one brief super exciting moment where we had a go at a polarised stereo pair plate and I could "see" one circle "in front" of the other. I've had brief flashes of 3D before but this was quite controlled. Apparently neurons going into overload and building new pathways when that happens! Looking forward to more of that! Next session in four weeks!!!"

September 19th, 2014

"Almost a week later and I'm starting to really break things down. The brock string is great. It shows you how things really are. It gives instant feedback on whether both eyes are "switched on" and if you're really fusing/fixating on an object (rather than your brain telling you not to worry about it!). Doing big eye muscle stretching exercises every day. I think they're helping. I can "fix" a bead on the string after doing stretches. It's just going to take some serious repetition and practice. Onwards and upwards!"

October 14th, 2014

"I had my second VT session on Monday and we covered loads! I tried brock string with red/green glasses which really helped. It seems to help break the suppression as the two images are clearly different colours. I've now added those to my VT pack. We did some more balance work with prisms to alter my view point. We're working on centering my brain and body. My VT is big on looking at vision as a holistic sum of many parts, not just the eyes!

Did some more work on the polarised tranaglyph. I'm sort of seeing depth but really struggling without another reference point to compare it to. I've been given some homework to work on hand/eye coordination and estimating depth by threading a straw with a cocktail stick and to keep with the brock string.

A final thing we did was called the "Van Orden Star" which is a bit like a stereogram lensed viewer where you join opposite sides by drawing with a pencil to where you think they meet. I think it gives an objective visual representation of how you see the world (how your eyes are positioned, that is). One side seemed higher than the other which would make sense. We're going to do it again in a few months to see how I've improved (!).

In every day life, I'm suppressing less by fixating on objects with my eyes more rather than turning my head. This is bringing on some diplopia but it is completely within my control and is useful feedback on where my eyes are pointing and how far I am off. I'm sure my brain would prefer I didn't do this but it's tough.  It's going to have to adapt I'm afraid! I am getting regular flashes of "depth" also - very briefly but more often. I just need to keep pushing myself. Onwards and upwards. This VT stuff really does work."

ANDREW: Apparently you have some 3D vision and it's gradually getting stronger and stronger. It doesn't seem that you just suddenly *got* it. Some people mention 'layers of depth' in regard to object array auto stereograms without really seeing depth in every day life. It seems like it's a sort of low-level stereopsis. With higher-level stereopsis, I'd imagine that you would see depth exactly as you would Y and X dimensions. 

MARK: Yes, the depth I see is something I've discussed a lot with my Vision Therapist. I refer to it as relative depth as I can differentiate between different depth planes in a very real way. They seem nearer or further away. Nonetheless I really struggle with tying that up with their absolute position in space. I think judging absolute positions of objects and the environment by stereoscopic depth perception is a learned skill which most people learn throughout infancy. For us strabismics, however, it's another step in the Vision Therapy chain of neural learning.

ANDREW: Do you have still have strabismus, i.e. a perceptible misalignment?

MARK: I still have strabismus but I have a greater degree of control. The reduced suppression helps. I can line everything up that I need for stereopsis (fixation on an object, in focus, no suppression, awareness of peripheral vision etc.). It can be an enormous effort but it's like any other form of learning. Repetition is the key and progress, however slow, will be made!
  
MICHAEL: Things seem to be moving in the right direction for you! That was October last year. How have things progressed since then?

MARK: Ever since I started formal Vision Therapy I've been making leaps and bounds of progress. It's been hard for me to judge as things don't happen quickly but I have regained a lot of muscle control and I have a better degree of stereopsis. For example, when I was first assessed, I was shown a stereoacuity test "the fly" which was just a polarized stereogram of a fly. I was asked what I could see and, with my alternating suppressing ways I answered that I could see two slightly different images - it depended on which eye I looked with. I had completely forgotten about this when I was shown it again a few weeks ago when I saw a fly with different levels of depth, it was very clear but I didn't know what the big deal was! These things creep up on you, I think I had been doing a lot of stereogram tests and failed to appreciate the progress I was making! For me, the results are not dramatic and immediate but do build up over time. I'm amazed at how little understood and acknowledged VT is in the medical community given that they estimate that 10% of the adult population has stereo-blindness due to vision alignment problems. Every time I have had an eye test they tell me that my vision is perfect, 20/20 and that I have nothing to worry about and nothing can be done except for surgery!

MICHAEL: How does Vision Therapy fit into your aviation activities and plans?

MARK: I am currently doing some more flying courses (flying on instruments, night flying) to keep the flying going while I go through Vision Therapy. Flying will always be fun even if I don't ever work in aviation. Nevertheless, I do plan to go back to Gatwick sometime and get my class 1 certificate and who knows where I'll go from there. I do intend to keep working my full time job for the time being but the eventual aim is to get a full commercial licence and train to be an instructor. I think I'll retire as a flight instructor in the Scottish highlands, taking people on pleasure flights. In comparison to my current job, flying is so much simpler but much more exciting and with a better view!

MICHAEL: That sounds like a great plan. It's good to have plans and goals to aspire to. It will certainly keep you motivated. Thanks for taking the time and good luck with everything you do, Mark! Onwards and upwards!