A wedding without double vision

This weekend I attended a friend's wedding. I enjoyed it immensely. It was a reminder of the fact that not everything in life has to be a struggle. Not everything needs to be difficult. It's nice to see so many happy faces celebrating a joyous occasion.

During the last three years I have gone out of social circulation a bit. This is because I was suffering from all the symptoms you might associate with a severe concussion due to chronically untreated and mistreated strabismus. Social circumstances don't always bend to health and resting needs. It's weird to suddenly need to close your eyes to rest them or have to lie down so I prefer to avoid such situations. It has been hard enough to manage and explain my condition to my in house family. It has often proven challenging not to lose my nerve and get angry at their incomprehension of what is obvious, at least, to me. Certainly when thinking they could have avoided the whole thing by using their own brains. Sometimes Sartre is right. L'enfer, c'est les autres.

I also didn't socialize too often because it doesn't change anything about my peculiar problem, drains my energy and adds to the frustration. I simply have to 'do the time' while not bashing into the walls too much. I have been fairly successful at doing my recovery time without repaying, often unintentional, hurt with hurt. That's the best and most sensible way of doing it. I'm good at restraining myself from doing stupid things.

Still, life goes on.  Everyone else goes on to live their life and you have to start from scratch. While they get to have opportunities, jobs, weddings and babies, I have to teach myself how to read. The wedge has always been there, and I have done a remarkable job of covering it up, but in the end the truth remains. I don't possess the visual motor skills to do even basic reading. High intelligence and impeccable work ethic will only get you so far without those.

Meritocracy is dead. I felt as if whatever I do makes no difference and gets me nowhere in life. No wonder I didn't feel like socializing. I mostly felt furious and alienated. This is why, despite being a sociable person and having lovely friends, I was not always capable of being good company. The last thing I wanted to do is lash out at them for something that isn't their fault. They can't help the fact that they have what I want without even giving it a second thought. They can't help a whole series of ignorant, negligent and blameful people made me squander my youth and are still making me pay for their mistakes. However, irritation is natural when being locked in in your own body. Usually thinking about all this lost time and effort makes me want to throw up. Fortunately I have a good understanding of the situation now and know the only solution for me is to take my losses and build a better visual system.

This weekend I felt differently. It might be because I was able to get through the entire day without running into double vision or insurmountable exhaustion. This made me enjoy the day, the lovely people and the beautiful party. However, I think there's more to it. Even though I'm not exactly aiming for a 'normal' life, it must be nice to be able to function normally. In other words, take your life into your own hands. I think I can eventually attain that freedom. I'll have to work with the delayed time frame but I feel as if there's still hope for me after all. In a recent e-mail conversation with Sue Barry, she told me: "It's amazing how much we were missing visually, but this also gives us the opportunity to keep improving. Although my biggest visual changes occurred when I was in formal therapy in 2002 and 2003, I still strategize with my optometrist a few times a year about new exercises I can practice at home, and my vision continues to improve. I'm 60 years old, and while all my friends are complaining about how they are aging, I'm seeing better. So, there are compensations and -you're right - the best is yet to come."

Being there I could just savor the moment without feeling betrayed by anyone having had 'an easier time' than me. I could be happy for them without thinking about our contrasting lives. I won't have to be a dysfunctional illiterate person without opportunities forever. I too will be okay one day and get out of this mess. Among all those happy people I thought about how far I have already come in recovering the unrecoverable, enjoyed my single vision and smiled. Indeed, the best is yet to come.

Session 76: Bring in the periphery

Skills acquired so far
- Smooth eye movements, improved vergence amplitudes and eye alignment
- Improved accommodation amplitudes and continuing improvement with flippers
- Stabilizing Vestibulo-Ocular Reflex
- Being able to judge depth using physiological diplopia and reference cue

Left to do:
- Automation and stamina
- Integration, integration, integration.
- My VT seems to be expecting I'll see some float in the Vectograms rather soon. To accomplish this I have to widen the span of my visual field.  That's hard for me. Most of my life I've been busy suppressing my peripheral vision as an adaptation to strabismus. When I try to include more objects into my field of attention my gaze tends to get unsteady. This happens because my limited attention resource partly shifts from eye alignment to the widening of visual intake. That will be the next hurdle to take. "Bring in the periphery!" as my Italian friend Llaria likes to say.

Nice list of acquired skills though. What a journey it has already been over the last three and a half years... Every summer things look different. I'll keep inching forward and by next summer we'll have some good and honest 'float'. Ha!

Some of my current home based VT activities

Everything we do or don't do has neurological consequences. That's why everything we do or don't do matters.

It's important to note that these activities are not suitable for every VT patient. Nor are they suitable at any stage in the rehabilitation process. They are suitable for me because my ability to control my eyes has reached a level allowing me to handle these activities without imploding, albeit with appropriate rest. Getting to this stage has taken a long time. I've had to do a lot of boring ground work first. Expanding the range of ocular movements, improving saccades, tracking and so on. VT is an active form of patience.

Another important reason of why these activities are appropriate for me as a VT patient is that my central suppression, especially while moving, is very poor. This means there is a very strong incentive for me to use both eyes and align them, rather than trying to suppress one eye. That's a very important point. Taking that into consideration, this means that I'm ALWAYS doing VT. I'm always trying to align my eyes and see binocularly because there's no alternative as there would be in a strabismic with good suppression. That's exhausting, particularly when trying to get out of an initial post-surgery double vision situation. Yet this might have some advantages at a later VT stage.

So what do I do outside the VT office?

1. Bar reading or, when more tired, listening to a text with TextAloud while tracking the words with my eyes. Even without suppression controls, I know when I'm doing it right when the text doesn't go double. The audio support while reading brings some relieve to my vision while still being able to practice saccades and integrate vision, audio and reading comprehension. Over time I feel like the saccades become easier and the audio support is less necessary. I'm gradually inserting prism and spherical flippers into the process to keep it challenging. So far however, (bar) reading hasn't been particularly easy yet.

2. Wearing a translucent filter on my glasses in order to stimulate my left eye and the neurology behind it. I do it in the morning when I'm relatively crisp. Initially doing this was a serious source of energy drainage. The filter in front of the 'good eye' makes the 'lazy' eye work harder in terms of acuity. It also forces me to acquire more dexterity relying on the more impaired eye. Lastly, there's a higher tendency for my eyes to go EXO with the filter requiring more of an alignment effort. To sum up: it works on acuity, eye motility and general integration of the eye into the nervous system.

3. When having to rest, meaning I just want to stare, I sometimes watch some kind of series or movie. When I'm up for it I use the flippers while watching. It's less tiresome than using them while reading because the eyes are more stationary. In fact, the spherical flippers help to relax my eyes when they are all tensed up. It's like stretching soar muscles.
When watching I also like to put a finger (or a remote) in front of my face. If I see two of them I am sure I'm not suppressing part of the view. (physiological diplopia)

4. Head turns. My Vestibulo-Ocular Reflex hasn't been working properly for a long time. This means that when my head moved, my eyes didn't make the appropriate compensatory movements to maintain a stable world view. This year (my 4th VT year) this has finally been leveling out and my eyes do make the appropriate movements for the world to stay fixed and stable. This new and highly anticipated skill isn't entirely reliable as it often gives way when I get tired. That's why I often check up on it and train it for short intervals by making head turns. My VOR needs further refinement, integration and staying power.

5. Anaglyphs: I play with these cards or other anaglyph visuals when I feel like it. Lately it's more fun because I can figure out the DEPTH in them by using my hand and physiological diplopia as a reference. It helps the learning process of corelating eye posture, image disparity and distance. The needed information is being picked up by my brain but I need to further automate these inferences. In the VT office we also use vectograms.

6. Lately I'm playing a lot of football (soccer), sometimes with the translucent filter in front of my left eye. Movement is good. Interaction with the environment is good. Messing around with a football is good visio-motor exercise. When my eyes stop aligning because of fatigue I notice two footballs and know it's time to call it a day.  It's important not only to get both eyes working together but also to integrate them into a moving body. I put special emphasis on using both feet and both sides of my body, mixing it up and trying to stay aware of the entire visual field and physiological diplopia. Football may not be for everyone but I have some very fond memories of playing football as a child so I try to tap into that. Positive emotions and enthusiasm are very important in terms of motivation and creating new pathways in the brain. 

7. Recently I had ten days of access to a trampoline. You'd think it doesn't really make that much of a difference but it does. When getting off the trampoline the world feels like it's moving beneath your feet. It's similar to disembarking a boat. Trampolines are great to further load and consolidate visio-motor and vestibulo-ocular skills. If that gets easy, you can further load the exercise with cognitive processing. Have a look at this cool exercise: http://www.oepf.org/sites/default/files/journals/jbo-volume-21-issue-3/21-3%20Slotnick.pdf 

8. Yoked prisms. These powerful prisms, used with bases to one side, shift your entire visual field to the direction of your choice. The lenses are adjustable. I use them bases up, down, left and right. By doing so I train internal adjustment to new visual circumstances. More specifically they stress test the brain's ability to ajust its egocentric localization, eye and body posture as well as sense of balance and spatial vision.  I have found them very useful in terms of aligning my subjectively perceived and objective midline which is often an issue in strabismus patients. Be careful with these toys though. Don't use them for more than 10 minutes at a time or you might suddenly get licked. They are effective but exhausting. I don't use them every day either. That said, I've had my most 'unusual' visual experiences after using yoked prisms.

9. Deck of cards exercise. It's similar to the 'classic' accommodative rock exercise. Get yourself two decks of cards. Tape one on the window, hold one in your hand and start scanning the window looking for corresponding cards. Emphasize accuracy, binocularity and physiological diplopia. Do it well rather than fast.

10. Taking walks. As for integration of the eyes into the body walking is perfect. Fast is easy, slow is hard. Running is not bad either but you might be paying less attention to the visuals and wasting a lot of energy that could be used for visual consolidation. Vision first, running later. That's how I see it. While walking, take care of your visual experience: eye alignment, physiological diplopia and just being aware of your body and the view. Don't just go walking around dull-minded with ear-buds. 

11. Being aware of my left side and using my left hand sometimes. As my left eye is my amblyopic eye, my right brain hemisphere needs fitness. This is almost surely a gross oversimplification but nonetheless trying to become more bilateral is part of becoming more binocular. Eg. if there's no time pressure I try to use my left hand. My mother told me that before I developed strabismus and amblyopia due to undetected farsightedness at age three, it was very hard for my kindergarden teachers or herself to tell whether I was left or right handed. I was just using either one. Then when I became strabismic the right side heavily dominated things visually and motorically. The chauvinist left hemisphere started hindering the development of my right hemisphere, visually and otherwise. Apparently, as I'm recovering, this is somewhat being reversed. Sometimes when I'm bored I doodle. Yesterday I was doodling with my left hand and noticed I could draw reasonably well with my left hand too. This is new!

Left hand drawing

12. Thump-Pinky Vergence Rock. An exercise similar to the Brock String. The best thing about this exercise is that it works on the integration of visual and proprioceptive input. This is often a decisive factor in getting ahead.  

 

13. Doing somersaults with my eyes open until I get dizzy. Usually three. That's another Vestibulo-Ocular Reflex integration exercise.

Obviously these activities are not exhaustive. There are many ways to combine and load activities according to your current level. I also don't do all of them every day. Rather, I try to make whatever I'm doing into a visual exercise. If you have some idea how a healthy visual system is supposed to work, you can aspire to that goal.  Just as important as what you do, is how you do it. In the end, life is just one big visual exercise!

Aside from exercising, I'm also eating a lot. It appears that I have already reached one of the goals I set for next year. In two to three months I've gained 6 kilograms bringing me up to 75kgs. This takes my BMI (height=1,85m) from 19.9 to 21.9.  I'd been trying to gain weight for a long time but I guess I'm finally calm enough for it to stick.
I'm mentally preparing myself for the fact that eliminating the residual Convergence Insufficiency and other visual instabilities up to a workable level will likely take another year to year and a half. With some luck and steady work I'll be an 80kg binocular machine by next year. That reminds me... I need to go eat something!

Strabismus, visual field loss and visual-spatial neglect

"Right after I lost vision in my eye, I was so bad at walking that I ran into a girl eating ice cream, and knocked her cone out of her hand. She screamed: ‘Are you blind!?!?’ I turned to her and said: ‘I am blind actually, I’m so sorry, I’ll buy you a new cone.’ And she said: ‘Oh my God! I’m so sorry! Don’t worry! It’s no problem at all! I’ll buy another one.’ So we walked into the ice cream store together, and the clerk said: ‘I heard the whole thing. Ice cream is free.’"

This little charming story by 'Humans of New York' reminded me of the many times I have bumped into people and objects on my left side. For instance, as a kid I was frequently punished for accidently breaking things or 'not behaving'. As a teenager I remember one incident that occurred while I was trying to navigate a busy street. By mistake I bumped into a young woman with my shoulder without bad intentions, immediately apologizing. I quickly left the scene before her Alfa-male boyfriend was ready to punch me. Ha!

On another occasion I quite simply hit the metal detector at the airport with my left side while trying to walk through it. Apparently regulations state that anyone walking onto the detector has to be frisked in any case. Another pleasant left side neglect experience!

Even now, having much less suppression of my left eye, having a wider visual field and being relatively more binocular and bilateral, I frequently bump into objects on my left side. Just yesterday I hit a door post with my shoulder while running into a room. Ouchie.

Fortunately, as it happens, I just read the 'Evaluation and Treatment of Visual Field Loss and Visual-Spatial Neglect' chapter of the book 'Vision Rehabilitation'! Just when I thought I had read all about my life in the Spatial Vision (!) chapter, or at least about what has been missing from it, those vision nerd authors pulled me back in! -------- (Expect a book review, people. Expect it!)

Visual field loss

The most known causes for visual field loss are eye disease (see picture) or damage of some sort to one or both of the eyes. This is the case for the gentleman featured above.

 Often, however, visual field loss can present more subtly on a cortical level. Cortical vision loss can occur developmentally or due to various kinds of brain injury. Whatever the cause of the visual field loss, the symptoms and the suffering associated are similar. Because of the complexity of the brain, cortical vision loss is very personal and presents itself differently in each patient.

This image gives you an idea of how various cortical disturbances can lead to
different types of visual field loss 

Measurements of visual field loss are performed following the quadrant schematic. I’m not going to get into all the possible types of vision loss but it is important to know that various types of visual training, sometimes including the use of prisms, are available to improve visual brain function. Even when it is impossible to recover vision in a certain field, training can systematically improve adaptation by optimizing residual abilities. Relearned environment scanning can avoid future accidents, elevate quality of life and increase independence.

One very interesting aspect about visual field loss is that some patients lose conscious awareness of what is seen in a field due to damage to the primary visual pathway or the visual cortex but can still intercept valuable visual information through unconscious visual processing. This is called blindsight. In case of blind sight a partially blind patient might be able to perform saccading or pointing to an object in the blind field, be able to use information from the blind field to better execute perceptual tasks in the intact field or even be able to ‘guess’ features of an object in the blind field at much higher rates than chance. There is indeed a neurological basis for these peculiar skills. Even more interesting for the cause of vision rehabilitation is that these latent abilities can be trained to eg. improve maneuvering. --- Also check out this video on blindsight

Visual-spatial neglect

Many patients with visual field loss are aware of the fact that they have lost vision in a certain field yet some aren’t. That’s where things get even more tricky. Some patients with visual-spatial neglect are in some sort of ‘denial’ about their missing visual field. It simply doesn’t exist in their mind. People with visual-spatial neglect think they have an accurate representation of their environment and don’t really feel the need to compensate for their visual deficit. This too can present in a number of degrees. There’s personal, peripersonal or extrapersonal neglect. People with personal neglect do not only ignore half of their visual space but also ignore half of their own body image to a greater or lesser extent. Peripersonal neglect indicates the neglect of space within arm’s reach and extrapersonal neglect adds the neglect of space beyond arm’s reach.

The presence of moderate to severe visual-spatial neglect can disrupt a variety of daily activities such as dressing, eating, reading, writing, walking, returning to work, and driving. Patients with left visual-spatial neglect will typically veer to the left when walking or bump their left shoulder on the doorframe. (BINGO) -- Vision Rehabilitation

Since most eye doctors aren’t even capable of detecting or treating any brain based vision dysfunctions which are often literally staring them in the face, it is no surprise visual-spatial neglect often goes undetected. In my case bumping my shoulder and what seem minor mishaps were less worrisome to me than, say, double vision. Nonetheless, many with more severe visual-spatial neglect, but without associated motor deficits, go undiagnosed and untreated following stroke or TBI.

They may be misdiagnosed as having dementia, as family and caretakers are unable to understand why a person might end up with their pants on backward (when they put them on, they only acknowledged one leg, so there was no frontward or backward choice), or why they forget to finish a task or put away tools. It is not always as easy as noticing that they do not finish food on one side of their plate. Patients with visual-spatial neglect are frequently misdiagnosed as having visual field deficits by vision care practitioners who are unaware of the possible diagnosis or visual-spatial neglect. -- Vision Rehabilitation

Indeed, it is not always easy to determine whether a patient has visual field loss, visual-spatial neglect or both! That’s why appropriate testing has to be done in order to get answers to those questions and get appropriate treatment.

Visual field loss and visual-spatial neglect in strabismic and amblyopic patients


As for the connection between strabismus, visual field loss and visual-spatial neglect, it is clear there must be a considerable incidence of neglect among strabismics. Suppression of part of the visual field to deal with misaligned eyes can be seen as self-induced visual field loss. This suppression of one of the eyes, be it permanently or alternately, leads to a reduced field of vision. In my case it is no surprise I bump into doors with my left shoulder as my left eye was traditionally the ‘lazy’ one. Even now with a field of vision that is as binocular as ever, I still tend to suppress peripheral vision coming from my left eye in more stressful situations requiring focus. Clearly this also affects my body image as I seem to be less likely to take into account the existence of my left side while moving.

The most common location for the lesion causing left spatial inattention is thought to be the right parietal lobe. In most patients, corresponding lesion to the left parietal lobe causes mild or transient visual-spatial neglect of the right space. It has been hypothesized that the right hemisphere modulates attention to both hemi-fields, where the left hemisphere modulates attention mainly to the right hemi-field only. Thus, damage to the left parietal lobe may cause an imbalance in allocation of attention from the pre-injury state, but damage to the right parietal lobe, common in middle cerebral artery infarct or aneurysm, causes marked visual-spatial neglect, as this is the major cortical substrate for orienting and allocating selective attention to the left hemifield. (!) In very young children, this hemispheric dominance for spatial attention is not yet fully developed (!) as evidenced by line-bisection tasks at age 4-5 years (!). Children show adult-like bisection with a slight leftward bias in bisection by 7-8 years of age. -- Vision Rehabilitation

That solves the mystery then. At the age of three my bispherical development went array and I developed amblyopia, strabismus and visual-spatial neglect. In addition to the distorted body map and frequently missing visual fields, unreliable alignment of the visual axes produces conflicting input to answer the basic ‘where am I?’ and ‘where is it?’ questions. Answering those two questions are the two primary objectives of the visual system preceding the ‘What is it?’ and the ‘What to do about it?’ questions. In developmental strabismus, neglect might in fact be a way of dealing with these conflicting inputs. To resolve the conflict one side has to foot the bill. That’s why, at this point in my rehabilitation, I am putting a lot of emphasis on not only aligning the eyes but also paying attention to my entire visual field and doing activities that promote bilateralism. Again it seems to come down to the magic three: the integration of visual input, vestibular input (balance) and proprioceptive input (self awareness and body image).

I'll try to be more practical about what I actually DO to integrate those types of sensory input next time. :)

Session 75: Trusting yourself

I had another training session on Tuesday. I did more 'feeling depth' in anaglyph pictures by reaching out for them with my fingers. It's very exciting how that keeps working. This practice also enhances physiological diplopia. That makes sense given that this ability is based on positioning your eyes correctly, seeing the object of interest single and everything after it double. When my hand is singled out and the object of interest is singled out, that's where it should theoretically be in space. It isn't really, because it's just an anaglyph stereogram of course. That sounds pretty obvious but it wasn't when I first started doing this exercise. It takes accuracy.

I'm so astonished by the fact that this is starting to work out for me. My training optometrist/vision therapist Sofie (as opposed to the supervising optometrist who does the check-ups) said: "Yeah, just trust yourself. That's how it should be." After all these years of double vision, it's hard to trust my vision. The illusion of seeing is believing is gone. It feels like it was all just one crazy conspiracy designed to screw with me. So I guess trusting myself would be a good start. In this spirit, my brain is finally starting to interpret the normal alignment of the visual axes. Sweet.

Of the supervising optometrist I already knew from the very first meeting he thought my case was hopeless and I should not even start training, but Sofie had never said this with so many words.  She'd always been patient. For the first time she now admitted: "I never thought you would ever get to this stage of correctly interpreting stereograms by reaching out for them." There's always been progress but this new feat is very outspoken. It's added functionality and that is what we have been laying the groundwork for all along. I like it. It's like the first time you used WiFi. It's awesome and incredible, yet it's 'normal'.

Earlier, when listening to the book 'Phantoms in the Brain', I was struck by an anecdote very similar or related to using fingers to sense depth and develop binocular depth perception.

"... Many stroke patients, like Bill, with dyscalculia also have an associated brain disorder called finger agnosia: They can no longer name which finger the neurologist is pointing to or touching. Is it a complete coincidence that both arithmetic operations and finger naming occupy adjacent brain regions, or does it have something to do with the fact that we all learn to count by using our fingers in early childhood? The observation that in some of these patients one function can be retained (naming fingers ) while the other ( adding and subtracting) is gone doesn't negate the argument that these two might be closely linked and occupy the same anatomical niche in the brain. It's possible , for instance, that the two functions are laid down in close proximity and were dependent on each other during the learning phase, but in the adult each function can survive without the other. In other words, a child may need to wiggle his or her fingers subconsciously while counting, whereas you and I may not need to do so. ..."

V. S. Ramachandran, Sandra Blakeslee - Phantoms in the Brain: Probing the Mysteries of the Human Mind page 19

This excerpt demonstrates the intimate interaction of seemingly unrelated neurological functions during developmental processes. Body image, (ocular) movement, counting, seeing, whatever... They all cross contaminate each other and create synergies. Right now I have to use my fingers to judge depth in a similar fashion as a kid learning how to count with his fingers. As I'll develop further and my vision matures, dependence on finger reference will decline. For now however, it's all still highly connected. That's why it's obvious that if I want to see better, the movement of my eyes and their integration in a moving body will have to be perfected further. Nonetheless, it's not only about getting both eyes to work together. It's about getting the two sides of the body, notably the two brain hemispheres, to work together. That's a tough job and that's why I'm tired a lot of the time. Unlike a normal job, this job goes on every waking hour. Even though it's exhausting, I'm very excited about it. The elimination of Convergence Insufficiency and the integration of balance, proprioception and other senses are now entering a critical phase.

In order to integrate my visual streams, vestibular system and proprioception, I'm trying to move a moderate amount every day. Biking, walking, two-footed football juggling, ... Not brute force movement, but activities that emphasize (eye) movement, balance and taking in the environment. It makes me kind of dull and tired afterwards as my visual accuracy diminishes but it's beneficial in the long haul. That's training. Stress yourself, get a little worse and tired and then get better. In contrast to the twenty years that have come before, this time there is a clear plan and a road to follow. My eyes have never been on the verge of permanently aligning themselves, making it possible to integrate all these factors for the first time since I was three years old. If all these sensory input streams start completing each other instead of competing with each other, I will be set up for life.

More about sensory integration over the next few weeks and months!

Setting goals for July 2015

Much of VT comes down to setting small but attainable goals for yourself and then reaching them. Then doing that again, and again, and again. Three years ago a goal would be 'any reduction of the strabismus angle is a win'. So the first two years I would systematically halve my strabismus angle until I saw my first single image in years. After that I would have to solidify by increasing binocular motility and improving my vestibulo-ocular reflex (VOR) so single vision can be sustained while moving. That's what I've been doing the last year and a half.  Managing the drama, engineering my own brain and putting more wood behind fewer arrows seems to be paying off. So far so good.

Here we are, July 2014. What will be my goals for July 2015?

- Eliminate Convergence Insufficiency and Divergence Insufficiency. My viewing for mid range distances between 2m to 10m is getting more and more comfortable. That's why driving is not thát taxing anymore. I'm not too worried anymore of running out of energy behind the wheel and relapse into double vision. I'm not venturing any road trips yet but at least I can drive somewhere for 30 minutes, enjoy an activity and drive back without going to my limit. Good start.

What remains to be conquered are the very short and, albeit less urgent, long distances. Most of all, I want to get rid of my Convergence Insufficiency by next summer. At this moment reading is still a problem, along with computer work and even using a cell phone.

Two days ago my cell phone died and I had to buy and configure a new one. It's not very complicated but it's just a tough convergence job. That's just one example. Of course not being able to read with ease leaves one stranded on a much broader level. Reading should be a basic skill or you are left to the wolves. Even for someone as well-informed as me it's easy to get worked up and frustrated about this inability to accomplish 'easy' tasks without great physical discomfort. Fortunately, I know exactly what's wrong and I'm very aware of what I have to do to fix it, namely be patient and work on it gradually. Achieving comfortable reading will be a major liberation.

- Be able to seamlessly use spherical flippers up to +-2 and prism flippers up to 4 diopters. My ultimate ambition is to be able to do this even while bar reading. Bar reading, c'est mon dada.

These flippers make tasks artificially hard and require great visual flexibility. If you can handle these flippers while doing all kinds of visual tasks your visual system is working quite 'effortlessly'. If I would manage to eliminate the CI and handle these stressors, my afferent visual system will be strong enough to supply the visual cortex with a robust and high quality visual information stream. THAT'S THE DREAM, DUDE! Hahaha. No seriously! Since stereovision is first generated at the level of the visual cortex, it needs to be supplied well. If the afferent pipelines to the visual cortex can be firmly established, the supply of solid visual information will broaden my binocular visual field of focus (as opposed to tunnel vision) and hopefully generate some stereo. Then we can finish and solidify the process by further strengthening the link with the dorsal 'where and how' stream and the ventral 'what' stream. These visual improvements will in turn supply the motor side of things with more accurate information to base (eye) movement upon. Once that happens the downward cycle has been turned into an upward one.

- Stereovision
If I'm lucky achieving the first two goals will lead to this result. The magic might just be around the corner.

- 75kg
I used to weigh 73kg. For the last three years I've been stuck at 68kg after losing a lot of weight due to circumstances. Nowadays I'm entering the seventies again but I need more reserves, especially since 73kg was on the skinny side of the spectrum already considering my height. I'm eating a lot of good food and staying fairly calm so I should just continue to gain weight from now on. I think we've had the worst.

- Running 5K under 20 minutes again
Accomplishing the aforementioned goals will be a tough job. Even if it would be accomplished by December 2015 rather than July 2015, I'd still be happy! On the other hand, if it would go unexpectedly swell and it would work out faster than I'd hoped, I'd like to participate in a 5K run again. A month ago I ran 5K after a long period of inactivity and I did it in 22min50'. My biggest problem while running was vision. Yes, that's right! By the end of my run I was getting motion sick for lack of visual stability. I started closing my eyes during the final patches of my run and that felt much better! When I get carsick in the backseat, I also close my eyes. For the moment, that's the best way to eliminate the incongruity between visual and other sensory input.

"The intrinsic role of vision in counterbalancing gravitational forces and in visually guided movement is reflected in clinical tests of standing and walking balance. Separate scores for times executed with eyes open and eyes closed help differentiate the contributions of visual input from the somatosensory and vestibular input. Under normal circumstances, the ability to offset postural sway is significantly better with eyes open as compared with eyes closed. A patient with ABI who has compromised antigravity processing due to visual imbalance will have little difference in their ability to maintain balance with eyes open versus eyes closed. When vision is interfering with, rahter than supporting balance, the patient may even initially exhibit better balance with eyes closed as compared with eyes open." - Vision Rehabilitation

As a 14 year old kid I'd run 5K in 18min50. If it weren't for all this ophthalmology and surgery nonsense, my performance would be peaking right now. I honestly think that if I can accomplish the above goals, I'll just go back to 'my natural state' and run it in under 20 minutes again.

Many of these goals are actually not separate goals. Many of them would be happy consequences of increased control of my vision. Improved visual enjoyment, reading, productivity, sports performance, ...  Continuing to develop my vision is the lever to make all of this happen.

I still believe these vision problems are just a bump in the road. A bump maintained by people who have a stake in it. Everyone, including my behavioral optometrist, had written me off but nowadays it seems I'm considered a 'feasible case'. We've already done the impossible so I'd like to finish by doing the possible. :)

Football without stereoscopic depth perception (video + optometric analysis)

HISTORY

As a strabismic child that suppressed one eye at the time, I played football (soccer) during every recess period at school. Clearly I had no stereo vision. Nonetheless I was a fairly good player and loved playing. I could be totally absorbed by it. At one point I also tried playing in a club. Because of my vision dysfunction I didn't have the energy to both keep up with my school work and go to the training sessions so I had to quit. Suppressing one eye is a wasteful business. I had good reading comprehension but read very slow and have never been able to fluently read aloud. Just doing my homework was enough of a physical training.

Therefore my football practice stayed confined to school recess and lasted up until the age of 12-13. Past that age football was gradually reduced to the occasional game during mandatory gym classes in school. Still, I LOVED playing that sport. Nothing so exhilarating and relaxing as just going for it during a game of football. 

After the age of 13 school work increasingly started absorbing ridiculous amounts of time. When I developed double vision at the age of 18 and underwent the misplaced surgery, leisure sports went down the drain except for the occasional run. Double vision is not very practical when it comes to ball games, or anything else for that matter.

PRESENT

It's been a little over a year since my diplopia started to subside after 5 years of constant double vision.  However, it's only recently that  the increasingly accurate positioning of my eyes is starting to 'sink in'. A month ago, spurred on by the WC merchandise machine, I bought a cheap football in the supermarket thinking it'd be fun to do some oculo-motor 'cross-training'.

Have a look at what happened after a week or two after messing around daily for an hour or so. The video builds up towards the end and the last thirty seconds are pretty neat even though I say so myself.

Not bad in light of my history of strabismus (surgery) and the fact I don't even have stereo vision yet! Please allow me to explain why this is happening at this point in time.

"It is important to understand the many aspects of vision to be examined, and to gather quality data on each patient, as the visual system is a covert system, where the process and outcome are evidenced not as “visual”, but as motor or verbal outputs." - Vision Rehabilitation

As you might have noticed from previous blog entries, I've been putting a lot of work in refining my eye movements. By this I mean getting them to be more precise and consistent as opposed to spastic and erratic. In my case the first phase of strabismus rehabilitation can be described as overcoming oculo-motor restrictions/palsy. The way our eyes move might just be the most important part of seeing and most people don't even realize it. Depending on the strabismic patient and whether or not he had surgery this will take some time. However long it takes, it has to be done in order to progress to more advanced levels of binocular and visio-motor integration.

 I've NEVER been able to effectively juggle a football before, let alone 33 kicks without it touching the ground. The only reason why I can do this now, after years of not playing, is that I can keep both of my eyes focused on the ball. Even though I don't have full blown stereoscopic depth perception yet, my brain already makes these subtle trigonometry inferences about its position. That never happened before. The first 17 years of my life I was suppressing one eye, then I lived through a couple of years of double vision and now the eye alignment is starting to be incorporated at a cortical level. This is an aspect of binocular vision which is evidenced as motor output as I do not SEE any depth yet. Cool, right?

This was again confirmed in my VT session (#74) today. I had a 90 to 95% success rate deciphering the relative position of objects while viewing tranaglyphs and polarized vectograms by 'grasping them' in midair. It's unbelievable! I was just staring at my hands thinking 'magic hands'. Magic brain rather! This depth perception stuff is creeping up on me silently!

Finally my brain is slowly starting to make subconscious inferences about
depth based on the input and position of both eyes!
If your brain doesn't do that, you'll end up like this physicist.

IMAGE BY BILL AMEND

In light of that, these new found football skills make sense. The target is pretty large and it's a bit further than the distance range used for reading. Thus it requires less accuracy and less converging than reading. A nice stepping stool. This is good news as my optometrist said that this kind of motor feel for depth often precedes the actual seeing of depth.

FUTURE

My Dutch VT friend Yvette used to be horrible at catching things. This, to her own surprise, improved dramatically after working on her binocular vision skills for a year or two. She now says 'I can see the hole in the Frisbee and actually catch it'. When she, unrelated to her DIY VT efforts, enrolled for a course of slack-lining (walking a tightrope), one of the exercises was to catch things while keeping balance. 'Even though I was shaking like hell and did not find a stable balancing position, I was able to catch everything. Now I can also catch with my left hand, even without looking directly at the object.'

This is remarkable for a clumsy strabby who was never able to catch anything before! As she already acquired some stereovision, this is something to look forward to. Nevertheless, the benefits of stereovision are much broader than being able to catch stuff. From what I read, it's a whole different way of life. For now the punch line is that I'm making good progress and the best is yet to come. We ain't seen nothing yet!

Additional reading on vision, the brain and football
- http://www.axonpotential.com/teaching-your-brain-how-to-play-soccer/

If there are any football clubs out there wanting to sponsor my
strab rehab or you just like my blog... ;)