Book Review: The Mind's Eye by Oliver Sacks

Oliver Sacks' books are impressive and this one is no exception. He's always willing to go that extra mile in trying to understand the experience of people who are confronted with all kinds of neurological anomalies. One of my favourite Oliver Sacks quotes is very truthful and at the same time marvelously reveals his curious and compassionate attitude towards his patients.

"Classical fables have archetypal figures — heroes, victims, martyrs, warriors. Neurological patients are all of these. ... They are travelers to unimaginable lands — lands of which otherwise we should have no idea or conception." 

In this book Oliver Sacks delves deeper into the phenomena of alexia (loss of the ability to read), posterior cortical atrophy, aphasia (inability to speak), prosopagnosia (face or object blindness), stereo blindness (inability to see depth), his own experience with eye cancer and unilateral blindness and finally various accounts of complete blindness and mental imagery. I am intrigued by all of those conditions and the very diverse ways of neurological adaptation to them. Especially the gift of mental imagery based on visual memories and input from other senses some blind people develop, allowing them to do all sorts of unexpected things, is very inspiring. I personally on the other hand only have first hand experience with stereo blindness making this a rather biased review towards that topic. It is also in this book that he tells us the story of how he met Susan Barry and how they marveled at her discovery of stereo vision later in life which is discussed in more detail in her own book 'Fixing my gaze'. For many strabismic people, including myself, the book 'Fixing my gaze' was a turning point in their lives and propelled them into a stereo frenzy. Aside from Susan Barry's journey from zero to stereo, the chapter also describes Sacks his own experience as a 'stereophile' joining the NY stereoscopic society and experiences of various other people losing and gaining stereopsis and how it affected them. One of these stories confirms everything I've learned so far from many earlier readings but nonetheless it still didn't fail to amaze me.

One has to lose the use of an eye for a substantial period to find how life is altered in its absence. Paul Romano, a sixty-eight-year-old retired pediatric ophthalmologist, recounted his own story in the Binocular Vision & Strabismus Quarterly. He had suffered a massive ocular hemorrhage, which caused him to lose nearly all sight in one eye. After a single day of monocular vision, he noted, “I see items but I often don’t recognize them: I have lost my physical localization memory.… My office is a mess.… Now that I have been reduced to a two-dimensional world I don’t know where anything is.”

The next day he wrote, “Things are not the same at all monocularly as they were binocularly.… Cutting meat on the plate—it is difficult to see fat and gristle that you want to cut away.… I just don’t recognize it as fat and gristle when it only has two dimensions.” After almost a month, though Dr. Romano was becoming less clumsy, he still had a sense of great loss:

Although driving at normal speed replaces the loss of depth perception with motion stereopsis, I have lost my spatial orientation. There is no longer the feeling I used to have of knowing exactly where I am in space and the world. North was over here before—now I don’t know where it is.… I am sure my dead reckoning is gone.

His conclusion, after thirty-five days, was that “even though I adapt better to monocularity every day, I can’t see spending the rest of my life in this way.… Binocular stereoscopic depth perception is not just a visual phenomenon. It is a way of life.… Life in a two-dimensional world is very different from that in a three-dimensional world and very inferior.” As the weeks passed, Dr. Romano became more at home in his monocular world, but it was with enormous relief that, after nine months, he finally recovered his stereo vision.

A reoccurring theme in all things neuroscience is the importance of stimulation and experience which is especially relevant in figuring out treatments such as Vision Therapy for neurological conditions.

"Our face cells (neurons used to recognize faces), already present at birth, need experience to develop fully. It is similar to many other capacities. From stereo vision to linguistic powers, some predisposition or potential is built in genetically but requires stimulation, practice, environmental richness and nourishment if it is to develop fully. Natural selection may bring about the initial predisposition but experience and experiential selection are needed to bring our cognitive and perceptual capacities to their full realization."

Speaking of which... I recently listened to 'The woman who changed her brain' by Barbara Arrowsmith Young who developed and tested many cognitive exercises to treat herself and thousands of others with severe neurological deficits and learning disabilities. Her book and program of brain exercises are wonderful examples of what neuroplastic treatment can offer if only educators and doctors start learning about them!

Online Eye Exercises to Improve Learning and Visual Attention

1. The following website contains some simple but effective exercises to improve visual information processing skills such as perception, tracking, focusing and eye teaming.

http://www.eyecanlearn.com/

NOTE: These activities are offered as a fun way to help sharpen "learning-related" visual skills that are critical for success in school. If a child has deficits in visual information processing, these simple exercises alone are not sufficient to correct a problem. Please do not confuse these exercises with vision therapy. Vision therapy involves a much wider scope of remediation procedures involving the use of lenses, prisms, filters, and instrumentation in a closely sequenced program prescribed by developmental optometrists. However, if your child has difficulty with these activities, it could indicate there is a problem with his/her vision system, and you may want to contact a developmental optometrist for further evaluation. A developmental optometrists can run specialized tests to determine if your child has developed adequate visual skills for reading, learning, and visual attention. Developmental optometrists are sometimes called behavioral optometrists because of their role in evaluating how vision affects behavior and performance.

2.  This site has some more cool and free visual attention exercises. More varied kinds of brain exercise are available for paying customers, but I have only tried the free ones.

https://brainhq.positscience.com/pscweb-free/start#

The attention exercises are quite VT like but what sets them apart is that they automatically increases or decrease difficulty depending on your performance which is great! I'd really recommend anyone to try them. Posit Science is a company co-founded by neuroscientist Michael Merzenich and was mentioned in the book 'The brain that changes itself'.

On dealing with double vision and the limitations of current ophthalmology practices concerning strabismus

Even among people with strabismus, the ones with intractable double vision are quite rare. Most strabismics unconsciously suppress the image of one eye and often, but not always, alternate between both eyes. I also used to see like that but because of extreme studying habits slowly broke through my suppression. So I went to an ophthalmologist who suggested, as they almost always do, surgery. This exacerbated the problem since it does absolutely nothing to change the underlying neurological problem and in unlucky cases inflicts quite a lot of physical trauma. As far as binocular vision is concerned current ophthalmology practices fail completely or partly in the majority of cases but in cases of double vision I would even call them life threatening. However, I am nearing the end of my rehabilitation which has taken many bad turns because the many misconceptions out there about strabismus. This problem has taken decades of my life and honestly I could not do it all over again if it were required.

I am making this point because recently I met Emily. She is a 17 year old Austrian girl who is suffering from constant double vision. Of all strabismics I have spoken to, she is one I relate to most. She has a history of long standing strabismus and ended up with double vision almost entirely due to what I would call medical malpractice. Sadly these practices of jumping to surgery without any attempt to draw on the potential of neuroplasticity through visual training are still routine… What’s more, Emily has childhood medical records stating that she has had stereo vision at one point which she is now lacking! If only there would have been a vision therapist or behavioral optometrist around to make sure things didn’t go array!

Just a month ago she poignantly described her frustrations in dealing with ophthalmologists after a recent surgery.

"Just came back from my eye doctor appointment and don’t quite know how I should be feeling. I mean they were really pleased by the way my eyes looked and all but that doesn’t change anything about the fact that my vision is still messed up. I mean… Yeah, I get that it must be quite hard to understand how I feel because I must admit I’m no good at telling people how much my vision really holds me back from doing the things I’d like to do. But still…they know me and they do know how much I struggle! They just know it when they look at me. And then they still pretend everything is fine and that they are happy that I’m feeling so much better… And I’m thinking like: No, just noooo!!!

 I don’t even know what I expected… Because somehow every time I go see my ophthalmologist I feel that way when I come back home. It’s just strange how I suddenly change the way I “look” at things. If you had asked me yesterday how I feel about my eyes then I’d probably said: Great, every things just fine! Maybe I would have said that double vision gives me trouble but no more than that. 

And then here we are today. Emily all frustrated because she doesn’t know how to cope…OK I got told that I’ll have to live with the fact that I’ll never have “normal” vision. Thanks a lot, that was kinda obvious to me but never mind. So no help what so ever! I’m just really pissed off (sorry for my language) and annoyed because I feel so left alone! They did tell me that I can always ring them if I start having problems… Hey, that means I should be on the phone calling them all the time! Not sure if they particularly want that. So what do I do now!? Carry on just the way I did before. Seems like that’s my plan. 

How strange is it that I’m starting to wonder if surgery was the right decision…Ok I had this stupid Fresnel lens on my glass and it made me look like an idiot BUT I didn’t have constant double vision with my glasses (I’m just ignoring the fact that it’s the best feeling being able to look at people without being ashamed of a turning eye…so don’t take the last couple of lines to serious, I’m just feeling sorry for myself hahaha.) 

Ahhh but isn’t it a good sign that they are just leaving me for 6 moths…letting me going my own way! It is, right? Means that my eyes are not too messed up! Or it could mean they have no idea what they should do with me… Doesn’t really matter anyway because either way I’m in the same position and left with stupid double vision.”

This message hit me hard, even now, because it portrays exactly how I felt a few years back. In particular concerning the hypocrisy of people saying they care but exhibit a very limited attention spam when it comes to figuring out a long term solution and instead just urge you to ‘learn to live with it’. Well, I can’t live with it and I have always stated I can't live like this forever. Fortunately I did find out the truth. I don’t have to live with it and I will fix this even if it kills me. However, knowing the truth and knowing that you are right and they are wrong is a very cheap consolation prize considering the stakes involved...

And as if that message wasn’t familiar enough, she even did me one better.

"You know what really bugs me...is when people come up to me and keep telling me how great and fantastic my eyes don't look and I must be feeling sooooooo much better... I'm thinking 'oh good...so you know what I'm going through! Well then let's swap for 10 minutes... I bet you'd feel like jumping out of the window in just 2 seconds! For god's sake it's not about the turning eye. It's about the double vision.' ”

God, she was saying all the right words! It’s like listening to myself! Or maybe rather my past self… After two and a half years of Vision Therapy my double vision is facing extinction but I can’t wait to wrap this baby up in a few months and top it off with some stereo vision. Yes, it most certainly is possible and I won't be the first nor will I be the last one to do it either.

NSA, if you read this, tell NASA to look into the vestibulo-ocular system

Recently I came across an interview female astronaut Karen Nyberg gave to CNN. I was struck by some remarks concerning long term vision problems astronauts are having.

 KN: This week we've been doing a lot of experiments on our ocular health. We've noticed some problems over the past several years with many of our astronauts. 

They come back to Earth after three to six months in space and have long term vision problems, changes in their vision. We are trying to figure out what exactly is causing that. 

Luca (Parmitano) and I have been involved in numerous tests. We're doing tonometry -- we are looking at the pressure of the eye. We are doing ultrasounds to look at the morphology of the eye, we are doing fundoscopy to take images of the retina, vision tests. 

We are hoping that we can determine exactly what is causing this and hopefully mitigate the problem, especially if we start longer duration missions going to Mars ... we really need to understand this so we don't degrade the vision of every astronaut that is going into space.

I have a theory. After an extended period without gravity the brain adapts to the new situation. So when coming back to earth the vestibular system, which is intricately linked to the visual system, isn't used to gravity anymore. Vision doesn't happen in the eyes, it happens in the brain. The long term vision problems experienced after their prolonged stay in space can be resolved by aiding the brain to readjust to gravity through Vision Therapy.

As a matter of fact, some vision therapy procedures exploit the relationship between balance and vision. Every one of my sessions includes walking over a beam using, each in turn, 4 different kind of prism glasses. This creates a totally new situation for my vestibulo-ocular system to which I am forced to adjust while balancing. It's a good exercise to create some flexibility in the visual system and readjust it's relationship to the vestibular system.

Other exercises combine visual tasks while jumping on a trampoline or using a bongo board.

Session 56: Bankrupt?

My fine ocular motor skills keep improving making head on anti-suppression exercise the main focus now. No 'luster' yet, but I am not disheartened. It is really unbelievable that after 2,5 years of dedication to my vision read brain, my motor control still keeps getting more refined. It's hard to believe how badly I was doing back then, isn't it? I can't blame people for not understanding me because I almost take every improvement for granted instantly... I would compare it to having accumulated this this huge amount of debt (health wise) starting at the age of three which had seemed impossible to pay back at the age of twenty making every small reimbursement (VT effort) seem insignificant. However, that's just a one sided metaphor falling short of describing this life crushing stuff... So yesterday I said jokingly 'It's starting to look like I'm going to be able make up for 20 years of medical negligence and abuse in more or less three years, so I can't complain.' Eat that VT skeptics. The best is yet to come.

Session 55: A courting exercise

Lately motor fusion is becoming more of a given rather than a struggle. Because of the last two surgeries, almost five years ago, both converging as well as diverging my eyes had become a problem. This made for zero comfort zone. Now after more than two years of conscious effort, with some bumbs along the road, I have recovered some control. Vision therapy, a stoic attitude towards other peoples incomprehension and most recently Syntonics have gotten me this far already.

Even though my involuntary double vision because of lack of ocular control before, I am still to some extent suppressing crucial information needed for solid stereo vision. I certainly do receive information from both eyes but poor visual processing is still very much an issue. Aside from maintaining my level of motor fusion, I am focusing on sensory fusion. Increasing anti-suppression and proper visual processing is the last step towards my goal of fully integrated and efficient stereo vision enabling one to live a better life.

What does that mean in practical terms? Anyone knowing anything about vision therapy is very familiar with the red green anaglyph glasses used for anti suppressant therapy. There are endless ways of using them, even games. They are a simple and low tech tool to stimulate your brain towards better binocular integration.

You can also use them on a computer screen for example

Seen through the red eye filter

Seen through the green eye filter

Bar reader

I used them before in therapy but they were rather frustrating because I could not even point my eyes sufficiently. So back then, even though I could do an extra anti-suppressant effort, this just resulted in a more confusing form of double vision. Now things are different. I can make sure my eyes are both pointing at the point intended and put more emphasis on retrieving the input of both to see a coherent whole.

Regardless of the great strides forward taken on the motor fusion front, I'm still taking baby steps as far as sensory fusion is concerned. If you are doing it right you should, instead of some green and red spaces, even see a mix of both colours named 'luster'. It's supposed to be something like orange or gold. So in short, the next step in the process is my brain manufacturing a 'whole new colour' by correctly blending the inputs from both eyes. That's a pretty mind blowing idea... Then again, one should consider that everything we perceive is just virtual reality manufactured by your brain.

As I'm not one to take half measures anymore I gathered as much advise and information as possible on the subject. Such as there are "It's not necessarily logical, you have to allow yourself to see it" and "At this point you just have to keep stimulating your vision and it will come to you." As vague as that may sound, it makes sense to me from a neuroplastic point of view. It's more a courting exercise than a clear cut race towards an obvious finish line. And if pursuing stereo vision really was a courting exercise, she is definitely the mistress of 'hard to get'. I'll have to keep making sure the circumstances are right and trick my brain into making the right connections, as it was tricked into learning plenty of things. However frustrating obtaining basic abilities at a later age may be, unexpected things have happened before so I will make sure they keep happening.

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.