The accommodative rock demonstrated

This is a video of me performing an exercise called 'accommodative rock' or a version thereof. You need a tiny letter chart to hold in your hand and another big letter chart on the wall in front of you. The exercise simply consists of alternately reading a letter from the paper in your hand and then a letter from the chart on the wall.


That sounds pretty easy and straight forward but with a history of strabismus (surgery), it isn't. Both stimuli require very different responses from both they accommodative as vergence systems. It's taken me years to just be able to produce these responses correctly but achieving both states isn't enough. You need to be able to 'rock' back and forth between them in an automatic, fluent motion without losing too much time, juice or concentration! Ideally it should not require one's full attention merely to execute the physical movements. My goal is to be able to do it well and without effort. Have a look at my current level when executing the accommodative rock.

What can we say about this aside from the fact that I need to work on my decorating and directing skills?

- I gradually move the handheld paper to the right. Maybe because I get tired, maybe because it's easier to view it that way or both. That compensating behavior has to go.

- Wandering OS. The left eye is my inferior, 'lazier' eye. To remedy this lack of speed and control it could be appropriate to execute this exercise also while patching one eye. This way I strengthen each eye individually as well as the team.
To specifically stimulate my left eye or the brain activity associated with it, I already apply a blurry filter on the right lens of my glasses each morning until I get tired. I prefer 'blurred out' patching over full occlusion because it still allows sunlight to enter both eyes.

- The far away target needs to be on the same height as your face, not up. On this occasion my webcam was blocking the view but normally it'd be straight ahead to stimulate near and far viewing at the same height. The shift to superior gaze is an extra hurdle we want to keep for later.

- Needs to be executed more slowly to solidify skills.

- You can't see this in the video but when looking at the nearby letter chart I get double vision midway of the exercise. In this case the misalignment was vertical. The print is very small and requires very precise eye movements. Halfway I was already tiring and my accuracy was getting sloppy. This kind of motor imperfections will ultimately be eliminated entirely.  I know this because I've seen things improve again and again over the last three and a half years. Refine, refine and more refining.One day I'll simply wake up with a rock solid gaze.

Also watch:
- Instructional video with more information on how to execute the 'accommodative rock'
- You want more evidence? I'll give you some evidence right here!

Also read
- VT and eye movements

Matan Drumer on living with and overcoming Convergence Insufficiency

Previously I wrote about how lately my situation more resembles a Convergence Insufficiency profile rather than a manifest strabismus profile. Most of the time my eyes are grossly aligned and I'm aware of both images although I do have some remaining surround suppression. My cyclopean eye is also still somewhat positioned to the right side of my head. Traditionally I used to be an alternating esotrope with a dominant right eye but after some surgeries the situation has gotten a lot more complex. For the moment the issue most impeding me from being more functional and productive is the inability to comfortably converge causing me to have double vision while reading and making it a highly stressful activity.  I've been in this VT game for a while now and I am not worried that in time with the proper lifestyle this will improve and can be remediated.

Looking through both eyes but being unable to sustain convergence... That sounds like the situation my VT friend Matan Drumer (31) experienced before entering VT. Matan entered VT  at the age of 27 after figuring out CI was the thing keeping him from reading properly and advancing academically. It's impressive he was able to pinpoint the problem and take constructive action towards a solution. That's always the first step. He engaged in an intensive year of visual training followed by another year and a half of less intensive training. The changes he describes are profound and encouraging!

How did his life improve?
1. Before starting Visual Training he used to be tired all the time. This is not the case anymore.
2. He could not pass his driving test. He would lose concentration because of the abnormally high amount of physical exertion needed to coordinate his eyes and see. Using his mirrors correctly and figuring out his relative position to other vehicles seemed impossible. Joining traffic and changing lanes was very risky. He felt like a gambler while driving. No longer.
3. Previously studying had not seemed sustainable and he was forced to pause his studies. After his reading improved by ameliorating eye teaming, he was able to resume them.
4. He feels a lot more comfortable in social situations now. He feels like he can be more open en relaxed around people because he feels more in control of his body and can anticipate and read others' intentions better.

He emphasized that improved ocular motor and muscle control is only the start of a series of amazing changes. Once he learned to operate his eyes and eye muscles correctly and effortlessly, the perceptual changes were intense and overpowering. He feels most people, even practitioners in this field, often don't really understand how visual improvement goes beyond motor and perceptual changes and into the functional and social realm. 'It feels like an awakening.'

Nowadays he still experiences (visual) ups and downs. There are days when Matan feels really sharp and it's easy to read. He confided that it feels like taking a drug. 'It's as if everything is "flowing". My reactions are fast. My thinking is quick. It's really cool.' On the bad days things are harder but never as hard as they have been before VT. I once asked Susan Barry the same question about ups and downs. She said 'I still have good and bad vision days. Only now the bad days are good and the good days are very good.' 

On the topic of stereo vision Matan is less clear. He thinks he had some stereo vision before VT or at least some of the time. He has always viewed the world with both eyes but that might have made bad eye coordination all the more confusing. He is however positive that VT has enhanced his stereo vision and his ability to navigate space allowing him to get his driver's license.

Naturally I was curious about what exercises he had done to accomplish all that. He talked a little bit about the famous Eccentric Circles and the Aperture Rule. Incidentally I myself have rediscovered the Aperture Rule this week and am enjoying the exercise much more as 'perfect execution' (who are we kidding :)) gets closer and closer. Knowingly he added that in many cases the 'how' you do a VT exercise is more important than the 'what'. I couldn't agree more.

Experiences and stories like these will certainly keep me going for another year as I eliminate my residual CI. As ocular motor skills keep improving, all these great improvements Matan is talking about might be just around the corner!

Syntonics report

By the end of last year I had learned about this supplementary light therapy called syntonics that can be used along with VT to enhance results. The paper was very convincing so I wanted to try it. As it turned out that is easier said than done... My own optometrist was of the opinion that it was only to be used for anti-suppressant purposes and given my double vision that was not what I needed. 'It will only worsen the double vision.' This statement is wrong on a number of levels.
- I did have double vision and hence have broken through my suppression to some extent already. But now that I had gained sufficient control over my eye movements as to align them most of the time, visual processing is the next step in sealing the deal. Granted, I do have conscious input for my inferior eye indicating a lack of complete suppression. On the other hand, this input is not of premium quality and isn't properly contributing to a single unified stereo percept of the world so I sure can use some anti-suppressant to make that traditionally amblyopic eye truly part of the team.
- True, syntonic therapy does work stimulating and anti-suppressant but nothing is as simple as that when it comes to the brain... It will enhance a number of abilities, one of which is less suppression, in order to advance towards the goal of better binocular vision. Even better, some optometrists say syntonics is at the heart of their treatment of patients with double vision!

Even when the paper in question was presented to him he did not change his opinion. As often times has been the case on this long and winding VT road, I had to rely on my gut feeling and reasonable judgement once more. I have to admit I was pretty upset because of being 'sabotaged' again after being fooled by ophthalmologists for twenty years... Being pragmatic, I decided to leave it at that and find another way. Most manufacturers of these appliances ask for a professionals consent when purchasing and I wanted some more information on how to use it myself. Heather, having had a really positive experience with syntonics, suggested I'd contact her own optometrist Brad Habermehl. So I did... We e-mailed, we Skyped and we moved towards a practical solution.

Initially I had wanted to buy the Syntonizer by Bernell but apparently it was out of order so Dr Habermehl decided to make some calls in order to find another solution. Worryingly, he wasn't able to find a syntonics device even though he applied himself to the task for some weeks. Speaking of an unsaturated market! Meanwhile on my end I had found a Belgian company named Optomatters which sells similar units called Color Boy. Surprisingly that extraordinarily nice optometrist still hadn't grown tired of me and took it upon himself to take a look at the website and reassuringly advised me on what kind of colour filters to buy with it. "I am as excited about this purchase as you are."-, he concluded. What an awesome guy!

 This whole process must have taken us a month or three... Although once ordered it arrived real quick at my doorstep. I was as excited as a kid on Christmas day about my ugly and surprisingly heavy lamp. It's insane if you think about it... We weren't able to find a syntonics device in the US which sounds very unlikely given its leadership in the field of visual rehabilitation. So of all countries in the world, I found a supplier in my own little weird country. Dr Habermehl still wasn't referring my e-mails to spam and advised me on how to use it.

OK, here we go! 

It would be great to do 20 minutes in the morning and 20 minutes in the evening consecutively for the next 30 days. Consecutively is the key! Do not miss more than 2 days in a row or we will need to start over. If the 20 minutes twice a day does not work then you can do 40 minutes straight. Start with: 

Alpha Omega for the first week consecutively (Dark red colour filter)

Mu Delta for the second week consecutively (Light green)

Alpha Delta for the third week consecutively (Light red or orange)

Mu Upsilon for the fourth week consecutively (Dark green)

Be ready to experience some mood changes: anger, hyper, anxious, tired just to name a few. Continue doing vision therapy while you are doing your syntonics plan. Stay motivated and keep me informed! Dr. Brad. 

I had my gear and my instructions so I started cracking. During the first week I was exceptionally tired, but to me it was a sign something was changing. I had to sleep even more and had some trouble dealing. From the second week on, things were getting somewhat better and somehow I felt like my ocular reflexes are swifter. Overall I my tracking, saccades and accommodation have gotten better during and after syntonics. I had the feeling it was a disproportionate improvement, by which I mean more than just the continuation of VT. This isn't a controlled study but I am convinced it has been very useful. It isn't a miracle treatment, at least not for me or at least not yet, but I'm glad I managed to do it after all. After those initial four weeks, I continue using it according to a different regimen. I  use each of the four filters for three minutes daily amounting to 12 minutes which are added to my VT routine.

I realize, after all the trouble I had to go through to even try syntonics, I haven't done the best job of keeping a day to day journal with more detailed impressions. Fortunately, a strabismic friend of mine named Andrew bought exactly the same unit and is following the same instructions. He is reporting on his personal experience with syntonics in more detail on http://vtwithsyntonics.blogspot.com/. I hope both of our efforts will help you understand and learn more about Syntonics as an addition to Vision Therapy.

VisionHelp Podcast: Introduction to Visual Neuroscience and Vision Therapy

An Introduction to Visual Neuroscience and the Science of Vision Therapy

The program features interviews from Dr. Dan Fortenbacher O.D. FCOVD, Dr. Carl Hillier O.D. FCOVD and Dr. Leonard Press O.D. FAAO FCOVD. These three doctors specialize in the field of Developmental Optometry and practice Office-Based Optometric Vision Therapy.

More on: http://visionhelp.libsyn.com/webpage/category/Science

How to rehabilitate a lazy eye while promoting binocularity?

According to my research traditional amblyopia treatment (patching the dominant eye) is not beneficial for eye teaming and what it might do for the acuity in a lazy eye it will destroy on the binocular front. Moreover, improvements in acuity will often only be of a temporary nature and be lost once patching treatment is stopped because the visual system will go back to its old ways and mostly ignore that particular eye's input. Patching is as ineffective as it is impractical.

So what's to be done? 
If you want to promote integrating the amblyopic  eye into the visual system, you have to use it while putting the dominant eye in a disadvantage BUT NOT FULLY OCCLUDING IT. This in combination with other exercise will promote eye coordination because both eyes are opened. Allowing light to enter both eyes is very important.

More advanced techniques of treating amblyopia allow patients, especially children, to have faster and better results with little or no eye patching. One technique illustrated below called 'piercing a straw' works on eye-hand coordination while using various prism glasses. This is only one of many techniques based on the latest neuroscience that could be used to integrate a lazy eye into the visual system with minimal patching. 



Source: Wow vision therapy - Dr Fortenbacher

Once someone understands the underlying principles of the visual system and binocular vision the possibilities of practicing those are endless. Amblyopia is caused by a disruption in binocular vision in infancy and/or early toddlerhood. The latest research shows that the brain of an amblyopic person functions as though  they are only a "one-eyed" person. The goal is to properly integrate the inferior eye in the visual system of the brain and with a tad of creativity necessity can be combined with pleasure.  



This video is produced by Dr. Fortenbacher and his Wow Vision Therapy practice. Check him out on www.wowvision.net or http://www.facebook.com/wowvisiontherapy. He does an excellent job explaining his work in an accessible fashion.

A while later another video was published on the Wow Vision Therapy facebook page showing the same little girl experience 3D vision for the very first time in her life. It's just awesome. At session 17, Caroline's treatment has effectively "removed the brakes from her strabismic flat vision". Office-based optometric vision therapy has stimulated the development of her visual brain enough to enable her to experience "stereopsis" for the first time in her life in a 3-D movie. Prior to her treatment, Caroline came to us with a unilateral strabismus, right esotropia and amblyopia. She suppressed her right eye and was stereo blind. While vision therapy is not simply about looking at 3-D movies, this example is showing how Caroline is able to transfer her developing binocular vision ability into seeing the depth in a 3-D movie. Therefore, Caroline is enjoying seeing images popping off the screen of a 3-D movie as the reward of having binocular vision.




Since possibilities are infinite, I came up with my own modest way of stimulating my inferior eye. Every so often I put a RYSER FILTER on my glasses blurring my dominant right eye and consequently forcing my inferior eye in a more prominent position. Although my inferior eye is also quite good, otherwise I wouldn't be having double vision, applying the filter on my glasses feels kind of funny. It's a lot more tiring to function this way, so even though I have double vision the right eye still mostly runs the bingo. Doing this I try to insert some balance into my visual brain and produce equitable binocular vision over time. I only do this for a limited amount of time because it is just too exhausting after a while and forcing doesn't help. Vision therapy takes time and patience, especially with adults.

More info on monocular fixation in a binocular field:
- http://visionhelp.wordpress.com/2013/02/16/advanced-amblyopia-treatment-for-faster-and-better-outcomes/
- http://www.mainosmemos.com/2013/12/what-is-lazy-eye.html
- https://pinterest.com/caprockeyedoc/monocular-fixation-in-a-binocular-field-activities/
- http://strabby.wordpress.com/2011/05/04/my-new-bff-mfbf-15/
- http://www.acbo.org.au/news-views/articles/171