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

Can standing on your head result in better vision? Please read before you go around breaking your neck.

"My lazy eye turned on on New Years Day, I don't have amblyopia anymore and I do have depth perception for the first time in my life. The whole world is more beautiful than I ever could have imagined. I will be 70 years old in the fall. 

Last June I started standing on my head every morning as a fitness exercise. It wakes up and tones the muscles all up and down my body, why not my eye muscles, too? I can't say for sure that's what turned the eye on, but try it. Even if it doesn't fix your eyes it will still be good for your body.

Bill Johnston."

LOVED this story! A seventy year old man standing on his head and boldly going where he'd never gone before. Hell yes. I'm not implying we should all go standing on our heads to recover our vision, much less do I want to be held responsible for any aneurysms resulting from it. I did want to explain why this, however strange it might sound, is a totally reasonable quote from a neurological standpoint. I'm sure most doctors will already be getting in line to say there is no scientific basis for any of this but that's just because they are not interested in looking for one. In the early days neurologists went around calling synesthetes crazy, whereas we know now there are very valid neurological explanations for eg. seeing sounds and hearing colors!

So why might standing on his head have contributed to BJ's visual recovery? Because it works on the integration of (what I randomly call) the holy trinity of Vision Therapy: (eye) muscle tone, visual input and balance.

1. (Eye) muscle tone - Proprioception
Standing on your head radically changes the demands for muscle tone and no muscle in the body is exempt from this. Everything has to be re-calibrated which might induce lasting changes and more flexibility in the  contraction of muscles. Your eyes don't move in isolation and shouldn't have individual agendas. Ideally they move seamlessly and harmoniously in accord with the rest of your body. This daily re-calibration might contribute to this overall effect.

2. Visual input
Standing on your head puts your worldview upside down. That reminds me of a study I read about earlier.

"Incredible plasticity in the adult visual system has been demonstrated in psychology experiments by application of inverting prism in normal adults. Initially when wearing these prisms, the world appears upside down and backward. However, after wearing the prisms for several days, the world returns to its normal appearance, demonstrating the amazing plasticity of the visual-perceptual apparatus, as well as the vestibular-ocular reflex, which must also invert. Upon removing the prisms, the world is again, upside down and backward until the visual and vestibular systems reorient." - Vision Rehabilitation

Thus standing on your head taps into the same measure of adaptation and will enhance visual plasticity. This change, this call upon action due to frequent (daily) new environmental demands, might have reinforced the connection between the visual system and vestibular system (sense of balance). This might have created the need for his vision to become more binocular and in turn activate the 'lazy' or amblyopic eye. Contrary to popular believe amblyopia is not so much about the reduced acuity in the 'lazy' eye as it is about reduced overall SPATIAL vision. Amblyopia is a disorder of spatial vision first and a visual acuity disorder second. Integrate the amblyopic eye into the binocular team using the 'vestibular back door' and the acuity will catch up as a consequence as happened in Mr. BJ's case. Nothing we do in life goes without neurological consequences.

3. Balance - Vestibular System
Sense of balance can be the 'secret' VT weapon spurring on our binocular vision to get better in order to successfully cope with a balancing assignment. Standing on your head clearly puts your vestibular system to the test and is similar to the use of yoked prisms in VT. Yoked prisms also work on the three factors mentioned here. They shift the perceived image in a certain direction changing visual and muscle tone feedback. This makes it considerably harder to move through space and maintain balance. Coordination of movements and sense of balance are highly dependent on steady visual input so messing with that input will result in a challenge. I'd say standing on your head can compete with yoked prism training. Likely, it's even harder! Go seventy year old Mr BJ!

In short, standing on your head is a great way to integrate these three essential elements needed for good vision. I would say however it is something for the later stages of therapy, if at all. Standing on your head is not for everyone but  there are definitely compelling reasons to believe this kind of gymnastics contributed to BJ's visual rehab. In this case, the underlying neurological and environmental conditions were such that standing on his head  further integrated motor and visual skills and took Mr BJ from monocular vision to stereo vision. Brave new world!

Want more of this? Support the blog by donating!

Session 72: In pursuit of more speed, accuracy and consistency

The foundation has been put in place. Finishing it up by perfecting the collaboration between vergence (eye movements) and accommodation (manipulation of the eye lens by your tiny muscles in the eye) and increasing capacity will be the closing deal. Major physical restrictions have been largely eliminated. More speed, more accuracy and more endurance. These will be the stakes as I move towards normal functionality. The time that I could not even participate in certain training activities has passed. Finally most activities are accessible and progress will, rather than being merely damage control and laying foundations, start to improve daily function and influence the way I can interact with my environment. Things are about to get extroverted instead of introverted.

“When vision is working well, it guides and leads; when it is not, it interferes.” - John Streff

The coming year we will go over that speed bump and make my vision guide and lead rather than interfere with my behavior. Right now my vision deficits still monopolize my life but I can feel and imagine how it will be as I gradually break through that 'visual firewall'.

Not only are all exercises accessible now but I'm making tangible, numerical progress at them and we can compare it to 'the standard values'. Before I also made numerical and tangible progress but it was still so subpar it sometimes seemed a Pyrrhic victory. At this time, I have entered the charts approaching normal function. This is totally new and makes it more fun. It's a game, not a tragedy. Three years and five months into the game I feel as optimistic as ever. Everything indicates a successful outcome and things keep moving into the right direction. When (eye) muscle tone, visual input and sense of balance will be synced up, I'm in for a major brain fart.

When testing my abilities on the biopter, both divergence and convergence, I could successfully execute up to slide 5 (out of 8), whereas last year I'd be stuck at slide 3. Well, pre-VT I'd be stuck at slide zero. :D

When playing with the vectograms today, which are supposed to bring out stereopsis if you already possess that skill, I was asked to 'grasp' the portrayed characters. If percieved correctly with the polarized glasses they would be floating midair. I don't see them floating at differing distances but when grasping for them my arm movement apparently more or less reflected the appropriate distance, or at least the right hierarchy.

*Spoiler alert* The king was closest, the monopoly guy furthest and the girl in between in terms of 3D distance, if I'm not mistaken. So there's that intuitive feeling telling me something based on my vergence movements I suspect. They are still too sloppy to be good, but we'll deal with that over the next year. Can't wait to put the cherry on that visual cake. I've been told Americans put cherries on everything. On top, on cakes, on your lips, in the fridge... Wherever you put it, I'll put it there.

Next time: "Standing on your head, yoked prisms and prism flippers".

Things that make you wonder...

This morning I went for an eye-hand basketball training session at the local public basketball court. Near point fixation for better reading skills is my priority but you can't focus on that all day because then it gets counter productive. On the court next to the one I was occupying there was a tall, black kid also throwing some baskets etc. We just did our thing, observing each other.  I'm pretty good at throwing baskets and dribbling, even if I say so myself. I don't look at the ball when I'm dribbling because I can just do it based on the sound, I think. That's nice. After a while he asked me whether I wanted to play a one-on-one match as our levels seemed compatible.

I explained to him that I was recovering from a brain injury and I just throw baskets as a way of 'entraînement visio-manuel'. My vision is not fast or consistent enough to react to too many unexpected changes so I have to play calmly. Sometimes my vision still goes double and I tire easily when losing control.

That's the big difference between him and me. Even without stereo vision I look as descent a player as him but my visual skills are not subconscious and automatic enough to deal with fast paced situations.

As a kid I've always been above average when it comes to football (soccer) and basketball. I was a natural at running and could easily do 5 km in under 20 minutes. Of course running is the only sport which doesn't require much spatial vision so that's why I was good at it.

Because that guy seemed to be taking his training regimen seriously I figured he played professionally. He did. He played in the junior team (younger than 21) of one of the major Belgian clubs. He asked me whether I played for a team, which I don't and never have. He just answered 'Really?'.

That stuff really makes one wonder... Take the strabismus out of the kid and he just might be a professional athlete in whatever discipline. But I'm not deterred. I'll just eliminate the strabismus, go back to being 18 and do this thing! :D Get those visual skills in order and you can do just about anything.

What many people don't realize is that vision is not only about eye sight, but just as much about action, integration, perception, reaction, ... A continuous and crucial loop of information.

"The visual system is a covert system, where the process and outcome are evidenced not as “visual”, but as motor or verbal outputs."

You need good visual input for good motor output, but you need good (ocular) motor abilities for proper visual input. If something goes wrong in that loop the whole system is sub-optimal and can even destroy itself trying to compensate for a weak link in the chain leading up to a burn-out. True story!

I wonder what stereo vision would do to my game. Probably I'd have to get used to it first but would then result in major improvements. We shall see.

What about strabismus and anxiety?

A few months ago I started working on a blog entry called 'Vision and the limbic system'. I was going to blast you guys away with brain regions, circuits and neurotransmitters so we'd all go tell our friends how cool this is and how  it explains everything in the known universe. So that entry was just sitting there in the draft section waiting for its Nobel Prize when our strabismic buddy Connor (21) popped this simple question:

Question! Do any members of the group with strabismus experience anxiety? Do you think the anxiety is a symptom of the strabismus?

Upon this question I decided to keep it real and say something meaningful about this subject instead of dissecting it like a dead frog.

To formulate an answer I will be drawing on my own experience, neuroscience/neurology courses I've taken and visual rehab books I've read/listened to.

It must be said, the visual system and limbic system: big marriage, grand ceremony, long-lasting relationship, potential for beautiful off spring and all that kind of stuff. It's the holiest of unions. Hallelujah! But how exactly do our feelings and vision relate?

Some people think of strabismus as a cosmetic problem which does cause its share of social anxiety. It's annoying and awkward sometimes. Certainly. Although the problem goes much deeper than that. I do feel anxious sometimes but I don't look very strabismic anymore. The anxiety comes from being acutely aware of the fact that I do not yet possess the visual skills to handle many situations effectively. This simply creates anxiety. That generated a follow up:

I've just noticed that sometimes I feel anxious for no reason, and when this happens my strabismus is worse. So I was wondering. Is the anxiety a symptom of strabismus, or is my strabismus a symptom of anxiety?

Since strabismus or vision disorders are head-to-toe problems, I'd say these are communicating sources. When one feels threatened or anxious, your brain makes short cuts and ponders less on the visual input it is receiving to make a potential reaction more timely. Your autonomic nervous system goes into sympathetic mode (fight or flight) and a whole bunch of attention resources are being relocated for other purposes than enjoying the view. On the other hand, when you are calm and are enjoying a parasympathetic state (rest and digest), you are getting more nutrients out of your food and the energy is distributed in such a manner visual input is processed more elaborately. In other words, your brain and body can invest in the future and build new capabilities rather than just having to survive.

Here's the catch 22. A defective visual system and impaired reading skills are a source of stress by itself. You are going to have to work harder to get things done. You are being excluded from many opportunities. Energy-wise you are not getting much bang out of your nutrient buck and so this vicious cycle grabs hold. With a vision dysfunction you can work yourself to death and still get nowhere even though you have above average intelligence (whatever that means). You try, you succeed, you try, you succeed, you try, you sacrifice everything, you succeed barely, the effort is increasingly disproportionate to the result, you keep working, surgery gone bad, keep working, another surgery to make up for the other one, you burn out, you partly recover, you keep working, you burn out again, there's no help to be found, you end up in prison or an insane asylum and lose everything. The end. Anxious yet? Treat the vision dysfunction appropriately when it presents itself and you can avoid this whole mess. Prevention, prevention, prevention.

One of the big challenges for me is to stay calm in a de facto underdog position but I'm getting it down. :) Contain the environment and get your juice back. Being anxious is a big waste of energy and slows down vision rehab, nevertheless it has to run its course and potential threats have to be handled with your primary goal in mind. Once you've depressed to a low key mood and are still not in prison, things do get better. Peace of mind is a great asset as the limbic system is the gate keeper of brain power but it's hard to acquire!

Want more of this? Support the blog by donating!

How to make your own bar reader sheet

By Mike Robinson

Self-made bar reader sheets

"These are my homemade red/blue reading bars for getting both eyes working together. Wear red/blue glasses and hold it over your book or tablet. I got the clip on red/blue glasses and assortment of colored acetate sheets on Amazon. I cut the sheets into strips and, for the smaller one, I glued them onto a clear cd case cover, just using glue at the top and bottom. For the larger one I cut a hole in the middle of a file folder, put glue all over the inside of the folder, placed the strips so they're glued top and bottom and then closed the folder to stick it all together and make it more rigid."

Illustration of the principle that underlies
the practice of bar reading. One is forced to use
both eyes while reading otherwise
parts of the text are invisible.

You want more evidence? I'll give you some evidence right here.

“Every man can, if he so desires, become the sculp­tor of his own brain” - Santiago Ramon y Cajal (1852–1934)

Ever since I was four years old I've been cross-eyed (accommodative esotropia). My brain learned to suppress the image of one eye by turning the eye inwards. Over the years my visual situation changed and expensive mistakes were made. If you want to read the entire story click here. After the last surgery I had very little control over my eyes and they tended towards exotropia although that highly depended on the viewing direction. Bottom line: constant double vision, restrictions in gaze and considerable convergence insufficiency. An esotropic brain in an exotropic-ish body isn't easy. Not workable, not livable, not good, ...

Here's a video I made on December 5th, 2011 showing how hard it was to converge my eyes. Not being able to merely converge while putting your full attention to the task is clearly going to ruin your every day vision, reading ability, energy levels and performance. How the hell did I graduate like this? At this point I was already in VT for a year and had already somewhat improved compared to my initial post-surgical starting position.

The second video was recorded on the 3rd of May, 2014. It's still pretty hard to converge but there has been huge improvement as you can see. In another year'll converge like it's nothing. The year after that even better!

This is three years and four months into VT. It is still all hands on deck to finish the job but progress is obvious. My brain is changing and my eye muscles are recovering and stretching. The better I see, the safer I feel. The safer I feel, the better I see.

Want more of this? Support my rehabilitation and the blog by donating!