Free anti-suppression Tetris

A while back I discovered an inspired programmer and blogger had tried to build an anti-suppression Vision Therapy tetris game. Upon finding it I was very excited and set out to try it with my red green anaglyph glasses. The game itself is a normal tetris game and I suppose the coloring had already been changed but it still wasn't suited for anti-suppression play because I could 'cheat' my way through the game using only one eye.

Before I'd also tried squinty Josh's anti-suppression solitair game. He applied the right colors in order to make his solitair game 'uncheatable', meaning that you are forced to use both eyes. So similarly I made the Tetris blocks look red and blue and made sure the background was black so you can't even cheat using the edges of the blocks. Of course, red green anaglyph glasses are required.

You can download the anti-suppression Tetris game with a plain black background here.

For some people the black background has proven to be stressful to start out with. Because of this a more tech-savvy VT friend  of mine named Aaron added a couple of sliders at the top enabling you to adjust the background color to alleviate frustrations a little and ease into the game.

You can download the anti-suppression Tetris game with adjustable background here.

It's definitely good anti-suppression practice. I'm still very insecure about positioning my blocks!

To keep things interesting and visually more challenging you might want to turn around your glasses every so often (or interchange the colors in the html file). That way the eyes switch color and the amblyopic eye takes on different roles within the game.

Demo video

PS: If you have enjoyed or benefited from this and other blog entries, consider supporting my work of proliferating Vision Therapy as a vital treatment option for amblyopia and strabismus by donating an amount as small as 5$. There's no better feeling in the world than knowing that your hard work is being appreciated. In addition, I can use some encouragement and financial support to do an even better job and get through my own visual rehabilitation.

Last but not least, share this article on your favorite social network and give it a +1 on Google if you think other parents and patients should be have access to this low cost vision therapy exercise.

Good luck in solving binocular vision problems!

Other articles you might like:
- Free anti-suppression Solitaire

- How to use 3D gaming in Vision Therapy

- FAQ: "I have a cross-eyed infant/child so what the hell am I supposed to do?!" - A guide based upon what I would have wanted my parents to know twenty years ago

Time to reset

By the end of the month I will have reached a total of a thousand days (2 years and eight months) of visual training and counting. I admit some days I am really getting anxious and impatient about wanting to see even the slightest bit of stereo. On the other hand I have to remind myself, aside from being twenty years behind on schedule, I'm pretty much on schedule given the circumstances under which I started out on this mission. Thinking back about how after the surgeries the angle of my visual axes uncontrollably varied while trying to track an object, about how I couldn't even hold a stable gaze so let alone align my eyes, about how I had double vision 24/7 and about how utterly hopeless the situation seemed my current state is already light years removed from that. More than one mountain has been moved to get to this point. According to my optometrist I have already exceeded his expectations various times but if you ask me this ain't over until it's over. Unless I've experienced some stereo vision, I haven't changed anything structurally.

Having read various case studies or success stories of people with similar histories it seems to me that 3 years is the period of time often quoted to overcome their affliction. Having come this far already this is actually good news. I'm going to try forget the fact that I've been doing this for a 1000 days now and take on the last stretch with the same boundless motivation I set out with. A lot of things have changed and happened during that time but it doesn't matter. As long as I can get the this thing done nothing is lost. After all, it must be right around the corner about now. No time to start diminishing efforts. Once more I'll be and remain Mr Pragmatism.

So I started rethinking my current visual situation. What remaining barriers are holding me back from acquiring stereo vision?
- My left, traditionally amblyopic, eye is still lacking a bit of speed in its movements to really be a swift part of the binocular team. Mind you, compared to my starting point a thousand days ago it's already quite supersonic but it's not sufficient yet. (Motor fusion)
- I am aware of both input streams coming from each individual eye but I don't feel they are reaching the same space in my head and add up. Subjectively I feel like the two input streams aren't merging yet although I can superimpose them by aligning my eyes. It's like trying to mix two distinctly coloured fluids but instead of getting a true mix of both colours (a new third colour), I just get an unstable ensemble of the two initial colours in one flask. Even though the input from my left eye is never completely absent, the overall impression while using red green anaglyph glasses is that the right eye is still quite dominant. (Binocular rivalry, no luster fusion, partial suppression, limited sensory fusion)

Notwithstanding the fact that I am to some extent binocular, there is still a power struggle going on between both eyes or more correctly stated the neurological setting behind them. I'd say my left eye counts for 30% of vision while the right eye takes on the other 70%. But what's worse, the left side of things (but the right hemisphere of the brain) isn't involved enough to have proper binocular summation. That's the core problem even after all this time. So I'm going to shake things up.

1. In a previous blog entry I once mentioned that I applied RYSER filters on my glasses to blur out vision coming from my right eye in order to put my amblyopic left eye in the drivers seat. That entry was a year ago. Back then, I couldn't sustain this kind of situation very long for several reasons. Long story short, I experienced it as too exhausting and hence destructive overall. Now however I think it might be the ideal tool to push me over the edge.

It's still pretty tiring but now I feel like it is, instead of destructive, very effective. It really forces my visual system to adapt and makes both eyes change roles. Important to note is that I do not occlude my right eye completely which would take away all binocular stimulation. This way of partial occlusion puts my normally dominant eye in a disadvantage making the left eye take the lead for a change while light is still entering both eyes.

It's important to note that they are not stickers. You can reuse them endlessly.

They stick to the glass just by wetting them and stay there.

2. I'm going to do another four weeks of intensive 30 to 40 minutes of syntonics a day. I've been doing it before and it accelerated my ocular movements among other things. I stopped doing it for a while because of diminishing effects and circumstances but I'm going to do a second round.

Along with my 'usual' VT routines this is going to be my renewed offensive the upcoming month. It's a little more 'aggressive' but I think it might pay off at this point in time.

Visual Impediments to Learning: What's it going to be? Your health or your education?

Somehow I have always felt discriminated. I could never really put my finger on it but it seemed like the normal rules didn't apply to me. Things always were a little bit harder on me. Now it's totally obvious this was because of a motor and sensory brain issue. Of course, kids don't think about their brains. What is striking though is that over the years people have been jumping through all kinds of hoops to make things even harder on me. Parents, educational and medical system alike. Now, I have been fairly fortunate still. However hard it got, however frustrating, however cruel, I always clung to trying to learn and master new skills, even after the debilitating surgeries. This has saved me in the end but has come at a high price in terms of health. I graduated with a masters degree in Economics at the age of 21 and speak four languages but by the time I obtained enough English language skills to find out about Vision Therapy I was already well on my way to disability. At uni it's still fairly easy to hide the fact it is getting increasingly hard to function because of an eroding nervous system. I didn't hide it, but I didn't make a big thing out of it either. No wonder nobody understood the problem when my visual system had collapsed under the increasing study loads and consistent medical sabotage. Double vision? Visual learning disability? What?

The main problem with binocular vision problems and strabismus is that it forces you to make a choice between health and education. I'm pretty masochist so I chose for (some kind of) education at whatever cost. Basically, the current eye care system demands one to suffer through education with poor visual skills, requiring tremendous amounts of energy and stamina, and on the side out-study ophthalmologists after you discovered they haven't told you the whole truth by saying surgery is the only option.

Another nasty thing to consider is that poor vision screening methods used by most mainstream ophthalmologists CREATE the binocular issues in the first place. Hyperopia or farsightedness will not be detected using a Snellen eye chart at a distance of 10 meters. Because, guess what, farsighted people have no problem checking things out at long distance. The problem occurs at close distances where most learning and work happens in modern society. Not detecting and consequently not prescribing glasses for hyperopia puts binocular stress on the visual system often causing accommodative strabismus or it's less visible form called convergence insufficiency.

Click to enlarge infographic

This is a HUGE issue. This deprives a person of normal visual brain development and opportunities later in life. I have lived through this and I had theorized that this must be having great consequences for tons of people. So when I read Dr. Boulet's paper on 'Visual Impediments to Learning' and the immense impact poor detection of hyperopia has in terms of lowered socio economic success and heightened criminality and mental illness among those people, it was a very emotional experience. On the Vision Help blog Dr. Boulet formulated an equally poignant comment:

This (the proper detection and treatment of binocular vision issues) is not simply a matter of best practice, but is truly the balance between social equality and the maintenance of suppression of people and populations. The lack of initiative in this area is nothing less than another implicit form of Jim Crow. Disallowing children to participate fully in democracy by the vehicle of education is an unconscionable abuse of basic human rights and fully incompatible with fiscal conservatism (timely treatment would make for lowered tutoring costs, lowered health care costs, lowered social security costs and most importantly lowered opportunity costs for the person losing the chance to be included and contribute to society).

I hope you will read this 'must read' paper which only counts nine pages. If considered by policy makers, doctors and educators proper detection and treatment of hyperopia and binocular vision issues can make a tremendous difference in peoples lives. A link to a pdf version of the paper can be found here.

Another great study by Patrick Quaid showing the high corelation between uncorrected hyperopia and binocular vision issues and how these affect acadmic performance is this one. "Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls"

Related articles on this blog:
- Book Review: Suddenly Successful: How Behavioral Optometry Helps You Overcome Learning, Health and Behavioral Problems

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.