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.

Head rotations, bar reading and bring on the prism flippers

Head rotations
Last week, for the first time, I had a completely stable percept while doing my head turns. I couldn't believe it!  I thought I was suppressing or something but I wasn't. Both eyes were just heedlessly adjusting to the head movements without error. It must be great to be able to take these reflexes for granted! I had predicted this milestone for the end of April et voila. Another hurdle taken. The reflexes are not equally reliable every day but that, again, is a matter of time.

Speaking of head turns... I'm reading this awesome book called 'Vision Rehabilitation: Multidisciplinary care of the patient following brain injury' which I will review properly later on. It had some interesting things to say about the anatomy of vision and head rotations.

The cortical or supranuclear influence on gaze is carried out by six distinct neural networks: (1) the saccadic eye system directs the fovea from one object to another object of interest; (2) smooth pursuits hold the image of a moving target on the fovea; (3) the vergence system acts to move the eyes in opposite directions (i.e., convergent and divergent) so that the image of a single object in space can be placed simultaneously on the fovea; (4) vestibulo-ocular holds images still on the retina during brief head movements driven by signals of the vestibular system; (5) optokinetic system holds the image still insofar as possible during sustained head rotation or watching a sustained stimulus going by, such as a train; and finally (6) the fixation system holds the fovea in place on a stationary target. These complex supranuclear networks result in eye movements coordinating whole muscle groups. With the exception of the vergence system, supranuclear eye networks mediate conjugate eye movements. Thus, other than vergence system disorders, supranuclear damage does not lead to diplopia, but to restrictions of conjugate gaze, as in loss of upgaze or downgaze.

Misalignment of the two visual axes with complaints of diplopia frequently results with lesions involving the infranuclear portion of the gaze system, including Cranial Nerve III, IV, or VI or the myoneural junction or extraocular muscles they innervate. Intranuclear lesions also result in diplopia. Innervation of extraocular muscles is ipsilateral to the CN nucleus for CN III and VI, and contralateral for CN IV. The infranuclear ocular motor system is a complex motor system requiring the coordination of twelve muscles to move the eyes.

So there you have it then... I've got problems with the supranuclear, ifranuclear and intranclear portions of the gaze system but the head rotations are on their way! :D In my case it was not a traumatic head injury but a combination of uncorrected developmental weakness and bad surgical intervention. The result for the visual system however is the same. I remember a number of ophthalmologists/strabologists giving me some spiel about third cranial nerve palsy 'with unknown cause'. Yeah, sure mate... Unknown cause. After the surgery there was not only horizontal misalignment but also vertical misalignment meaning the stress on that nerve had increased because the muscles had become so much harder to operate. Vertical alignment also meant that now CN IV had become affected. Overall visual stress on the visual system had become too much to bare as some parts of the system had been ignored and neglected whereas other parts had been damaged in surgery.

Bar reading
I'm a bit repetitive in my mentioning bar reading. I just love this exercise. Nowadays I just wake up, eat something and spend an hour or so bar reading until I get tired. Not completely exhausted though. Up until the point that I still got some juice left but it's time to go for some less visually stressful activities as the day progresses. The hardest part about bar reading is to stop and wait until the next day so I can do it all over again. That's just because I love reading too. I've gone from zero pages at the beginning of this year to 14 to 15 pages a day by the end of April. Hopefully things keep progressing at this pace. It's much more fun to read properly and binocularly than to read in a half assed way. The bars keep you tied up in a 'binocular straight jacket' preventing you from falling back to double vision and visual confusion. Reading while experiencing double vision and visual confusion feels like you are hurting yourself and giving yourself a headache on purpose. I've done this many times to study the things I needed to know to survive but it's not the way to live your life in the long haul. When my bar reading juice is up for the day, I resort to text to speech software, audiobooks or other normal day activities which can include less cognitively taxing forms of visual exercise.

Bring on the prism flippers
To enhance the bar reading progress and the elimination of my remaining convergence insufficiency I'm going to start using prism flippers by the end of May. Making it a little harder yet again. Going to the next level. The new normal.

Alternation, cyclopean eye and the attentional spotlight

As my eyes are aligned most of the time by now I have no real concept of alternating between both eyes anymore. Despite the mechanical alignment of my eyes, I still do not use them equally. My vision still seems to be rather lateralized to the right. When I intentionally give myself double vision by moving my eyes apart, the image from my right eye is still the 'main image' and the one from the left eye feels secondary. In fact, in double vision mode I can still alternate. I can switch main images and make the one from the right eye 'secondary'. So my subjective viewing perspective is not yet positioned in the middle of my head. My cyclopean eye is not positioned behind my nose. Most of the time I'm seeing the world from the right side of my head (subjectively, because this probably indicates there's a strong lateralization towards the left hemisphere). This means that even though my left eye nicely follows my right eye, it's still not an equal part of the team.

I'm doing a couple of things to actively work on that. As mentioned in previous entries I apply filters or transparent tape on my glasses to blur out vision in my dominant eye putting the left eye in charge. This changes the entire visual situation to the other extreme without entirely discouraging binocular eye teaming. I do this while doing all kinds of activities and it is effective in regaining and integrating the left eye into the visual system. But lately there's more... Aside from actively training, it is equally important in my experience to relax and just play with your perception. Often I lie or sit down and let my eyes wander around having things go double. Rather than constant pathological diplopia or double vision this is controlled physiological diplopia I can instantly resolve at will. So during those playful sessions I give myself double vision (vergence), blur and unblur my vision (accommodation) and more generally flex my visual system without overdoing it. Then I try to focus my attentional spotlight in between  the two images so neither one of them is the main or secondary image. I'm trying to rebalance the equation by relaxing, playing, flexing, dreaming, focusing attention in the middle of the double images. It's pretty cool but the circumstances need to be right. One of the biggest problems facing visually impaired people in recovering is intolerance and lack of understanding. After all, I'm well informed  now and I found a place to rest my head but things have been different...

Another interesting topic I wanted to bring up again is how awesome bar reading is. I think this exercise is so cool because of its simplicity and capacity to combine cognitive integration while doing visual exercise. It also clearly shows that visual problems are a biology problem, not a technology problem. All you need is a piece of plastic, cheap glasses, a book and a peaceful environment. In the past I would clearly express to other people how I had to chose between eye alignment or cognitive activity like reading. Not that they'd understand. :) That situation of course makes it very hard to read if you experience double vision rather than suppression... Now I'm entering a stage where I can more or less do the visual stuff and the cognitive stuff at the same time. The line between the visual brain functions and other cognitive abilities is blurry at best so we might just say overall capacity is improving. Reading comprehension while bar reading isn't very good but I'm trying to go for good visual exercise rather than intellectual distinction for the moment. In adherence to this idea, I'm going to try paint an old chess board in red and green colors. That would be nice visual and cognitive integration too if I can make it to be 'cheat proof'.

This week I finally received all supplies needed to try tDCS and I will do it this weekend. To be continued...

Session 67: Learning how to read

My new year's resolution for 2014 was to do more bar reading because the exercise is finally starting to be within my reach. I started out with two pages a day. The first week I still had to do quite a bit of alternating, but after two weeks I could more or less keep my gaze steady and focus on 'making the bars transparent' without really having to change my eye posture. This was a major morale booster. It also shows that VT progress can be accomplished quite fast. It's not that VT progress has suddenly accelerated, but it's just that the progress before now was damage control. Now things are getting interesting at last. As eye movements keep getting more refined and converging gets easier, more energy and attention can actually be spend at really looking at what I'm seeing. It's exciting! Man, oh man. Life must be quite relaxing if you can do that and read without effort and without having to strain yourself all the time... Today it's the 23th of January and I've done 5 pages of bar reading. I go for a little bit of proper binocular reading rather than large quantities of painful and double vision reading. Quality first, quantity later. Not something they teach you in school apparently. I was telling my grandmother (whom I live with) about how exciting it is to start applying visual skills to real life tasks like reading. She answered grinning 'So you're in first grade again learning how to read, are you?'. As funny as that may sound for someone with a degree, it's true. This time I'm going to learn how to read properly and it's going to be awesome.

Because it is starting to take less effort to converge my eyes, I'm also getting better at fusional targets such as eccentric circles for instance. I feel like they are getting 'less ambivalent' and make 'more sense as a single image' rather than seeing two distinct superimposed images. Things are starting to get interesting. Man, oh man!