Cheiroscope: video, drawing samples and implications

After a nice theoretical post, let's get down to the nitty gritty. How can we get a tangible look into how someone perceives his personal space? How can we determine inconsistent perception of space interfering with the construction of solid brain maps?

As vision writes spatial equations for the muscles to solve, cheiroscopic drawing is an interesting way to gauge the state of ocular motor ability and spatial vision. During cheiroscopic drawing, one's visual system is completely stripped of contextual aids. Broader context often helps strabismics to get around and complete certain tasks by circumventing proper ocular motor movement or spatial vision and by relying on sub-optimal, monocular vision adaptations and other senses. When using a cheiroscope none of that is possible. Your drawing hand and fingers HAS to take its cues from the eyes. The movements of the hand are based on the movements of the eye. If the eyes are positioned well, move together in a smooth and harmonious manner and can maintain a steady posture, you will succeed. If not, you will come up with an inconsistent and skewed drawing. It's that simple. A direct connection. No more adaptations, no more tricks, nowhere to hide from your visual shortcomings. It's a head-on confrontation with your visual limitations but also an opportunity to improve and to chart and compare that improvement over time.

I made a little, informative video about a cheiroscope that can be used at home. I apologize in advance for the constant movement of the camera. My video recording skills also need more work!

Here are some more of my practice run results produced by using that device (March, 2015). They are each of them unique and contain small mistakes. The variations in the drawings are variations in my vision and ocular stability. My vision is still volatile and unstable. Yet, it's a far cry from where I've come from years ago. This maze is very detailed and requires a fairly sophisticated level of ocular control on which to base your solution. Merely being able to try this exercise is already a triumph for me.

Let me show you where I've come from, going all the way back to February, 2011. For that purpose, I will be showing drawings made by me with another type of cheiroscope. This is a standup variation of the cheiroscope. It is called the Wolff cheiroscope named after Bruce Wolff, OD, who designed it.

Recently, at the VT office, we were comparing some cheiroscopic drawings I had made over the years. These pictures compare the results of the same cheiroscopic drawing exercise. The upper drawing was done on October 16th, 2012. The lower drawing was done on March 16th, 2015.

The relative position of the drawings is different because of different eye positioning. Also the quality of the drawing itself is markedly different because of improved ocular stability. In 2012 the left hand drawing was so inconsistent that the sun wasn't even staying her box. Hell, there was not even a clear box! And, as someone acutely pointed out, now the suns do have a smiley face!

What's even more startling is the fact that, on October 16th, 2012, I had already been in Vision Therapy for one year and eight months! Here are two cheiroscopic "Van Orden Star" drawings comparing February, 2011 to October 16th, 2012. The drawn lines should converge onto the highlighted fold. In the first drawing, in 2011, this certainly wasn't the case. I had a considerable vertical misalignment too.

Van Orden Star

Notice that, in the picture with the sun drawings, the upper drawing was drawn on the same day as the lower Van Orden Star drawing. This nicely demonstrates that improvement is relative. On October 16th, 2012, I was delighted about my improvements regarding the "Van Orden Star" drawing. However, the more visually demanding and detailed sun drawing exercise left much to desire. Now, another two years later, the sun drawing too have improved significantly and I will continue to go down this road of more ocular stamina and accuracy. The only thing one can do is to consider his current vision status and keep on stacking incremental improvements to eventually get to a better place in the future.

My primary vision therapy goal is not stereo vision. Stereo vision seems to be a combination of various basic vision skills. Overcoming the crippling legacy of strabismus surgery, which has thoroughly destroyed already ailing basic vision skills, is my primary vision therapy goal. To be specific, I need smooth tracking, reliable saccades and a stable vestibulo-ocular reflex. When I accomplish that, I'm golden. From what I hear, stereo vision will be a nice bonus on top of having these basic visual skills. These basic visual skills by themselves are pretty awesome too though! Without eye muscle surgery, I would already be seeing in stereo! However, as the cards have been dealt this way, these extra hurdles have to be taken. There is no other way.

Me and my Vision Trainer summarized the current situation as follows. "No one would have thought you would have come this far when you walked through the door, more than four years ago, but now you possess the basic visual skills. You can see through both eyes, you start having fairly good eye motility, you have some fusion in polarized targets and you can even figure out depth in tranaglyphs with a reference object like your finger or a stick! You have all the ingredients and now have to go a little furter and combine them into a good menu." 

The only missing ingredient is more time and work. I can do that. The cloak of subdued dysfunction is slowly lifting itself. I have mentally prepared myself it might take until January 2017 for me to reach workable levels of vision. After six years, I think, this Vision Therapy thing will start to lose some of its charm. Hahaha. Cheers, everyone!

The visual system's important role in figuring out where you are

Developmental strabismics often learn how to suppress sight coming through one eye. Many times they even learn how to alternate between both eyes. This is a useful short term neural adaptation but has many disadvantages in the long haul if not corrected. Having been, and to some extent still being, an alternator, I know how it works in practice and how it feels. If feels like you can shift between two ways of seeing. You are not only switching between your physical eyes but also between two viewing positions in your mind. You litterally have two "mind's eyes". When paying attention to this weird ability and supposing your head/body is a vehicle you are maneuvering, it feels like you can change the driver's seat's position. One moment you are in a normal car. The next moment you are in a Brittish car. You can shift what is called your visual midline (visual midline shift). When I was younger even colors used to look slightly different depending on which eye I was using! I remember when I was fourteen asking my mom: "When I switch from one eye to the other I sometimes get color changes. Do you also get that?". Reasonably enough she didn't really understand what I was talking about and had a disturbed look on her face!

In developmental strabismics the act of alternation is often a subconscious one. Because we developed this way we can usually apply it to our benefit as much as possible. It's not optimal but if you master and control it, it can be manageable. For me problems started occurring when, firstly, this learned visual neuro-adaptation started to unravel by itself due to external pressures (because it is not an optimal nor stable neural equilibrium).  Secondly, these problems were aggravated when the correspondence between how my eyes moved physically and how my neurology worked was radically disrupted through eye muscle surgery. That is why the first couple of days after surgery I even had to relearn seemingly simple acts such as keeping balance and walking. On the surface I learned quickly but a lot of extra unnecessary baggage had been added to tasks of daily living. I did my best to pick up the pieces and held my own for a couple of years but ultimately it was not possible to just forget about the problem and live a normal life. Untangling this neural and physical dissonance is a work in progress.

...

That is why following passages taken from the book Vision Rehabilitation strongly resonated with me. These can be found in Chapter 4 on Spatial Vision, written by Robert Sanet and Leonard Press.

"While walking, patients with ABI may demonstrate a shift in visual midline and altered gravitational sense termed visual midline shift syndrome (VMSS). These patients demonstrate balance impairment and associated motor dysfunction, including leaning, falling, or veering to one side during mobility. VMSS can have an immediate and dramatic effect on the motor dysfunction. 

The sense of awareness of one’s position in space is predicated on what has been referred to as “the invariant.” Without having a stable frame of reference of self, it is impossible to organize space efficiently and accurately. As an example, consider what it would be like to find the location of a specific place on a map using only the coordinates “two miles west and one mile to the north.” One cannot derive the answer without knowing the initial piece of information: “From where?”

 The invariant provides a stable frame of reference upon which we build spatial constructs. The mental representation of space, and perception of straight-ahead body orientation, are related to a number of internal reference frames, including visual, vestibular, proprioceptive, and tactile information that allow us to build accurate spatial maps. That is to say, the brain orchestrates movement using a series of internal models, maps, or schemes of external reality. Even before initiating the movement, the brain has already taken the visual information, anticipated the consequences of the movement, and formulated a series of motor actions to accomplish the goal. The antigravity system, therefore, relies on the integration of many neurological processes, principally as follows: 

- Visual system input that aids in the determination of vertical and horizontal frames of reference, and the perception of self-motion that comes from optic flow patterns across the retina. 

- Vestibular system input through the otolith and semicircular canal systems of the inner ear give information about head position relative to gravity, and changes in acceleration and deceleration. 

- Proprioception system input from the stretch receptors in the muscles that give information on body position.

Visual input to the vestibular and proprioceptive systems that direct movement, such as when adjusting balance or moving the body and hand to grasp an object or to catch a ball, is due in large part to subcortical “unconscious” visual pathways. The automatic, unconscious visual prediction and computation that supports motor planning and execution of accurate motor movement is often disrupted when patients experience ABI. This results in visual-spatial confusion and inaccurate visual guidance of motor movement."

This short clip by the BBC nicely demonstrates how disrupting changes to visual input can be for balance and motor ability.

I particularly like the concept of having a stable frame of reference of self in relation to the environment constructed upon various sensory streams of information referred to above as "THE INVARIANT." Vision plays a crucial role. Simply put, the visual system has four essential questions to answer:
1. Where am I?
2. Where is it? (an object or objects of interest)
3. What is it?
4. What do I need to do or say about it?

If that primary sense of awareness of where one is in space (the invariant) has become variable because of conflicting visual information due to for instance eye teaming difficulties, the answer to the first question has been compromised. If the invariable becomes variable, spatial uncertainty is compounded. This will have far-reaching effects on the visual system's ability to answer question 2 to 4. This interference and uncertainty will negatively impact the ability to oversee situations, interact with objects or find relevant information. Secondly, it will also compromise movements, memory, verbal ability and might cause serious fatigue and mental confusion. In short, without controlled and stable visual input to the brain, the ability to interact and build proper spatial brain maps suffers greatly.

...

To get back to my own story... Nowadays my, what is supposed to be, invariant is all too often variable and this has a profound effect on my ability to function. I am physically strong but this leak in the system can throw me off balance and drain my energy without mercy. I like to move but I do it in settings where I can easily retreat when needed. Over time my variable invariant is getting more fixed and coherent. When I have good moments and have relatively high amounts of ocular control, I can see abilities and talents I knew I have had all along flaring up. If I can get my invariable to be invariable more often and hopefully indefinitely, the sky is the limit.

One example of this is a basketball video I recorded a few weeks ago on "a good eye day".

This is pretty good for having no stereovision.  However, I cannot play like this consistently. Same goes for reading performance or any other kind of performance. It depends on whether I have good or bad ocular control that day or that moment. As optometrist Myron Weinstein once said: "Vision writes spatial equations for muscles to solve." Can my brain rely on the visual and proprioceptive input provided by my eyes?  Isn't it too exhausting to get my eyes in line? Those factors will determine how variable my "invariable" is at that moment and how well I will perform.

"We are never tired as long as we can see far enough"  ,- Emerson

Fortunately I know I can improve indefinitely, even with damaged eye muscles, and I will. As there is no other option but to do this rehabilitation thoroughly, I should not settle for damage control but I should try to unify these two alternating monocular ways of seeing into one coherent binocular system. This in turn will contribute to my body's sense of position, motor abilities and my ability to construct brain maps of any kind.

If you are interested in learning even more about strabismus, suppression and brain maps, I had a first attempt at making a watchable video tutorial about this topic. Enjoy!

When you hit a wall and can't push through it, erode it

When you hit a wall and can't push through it, erode it.

"It's always impossible until it becomes inevitable." - Jeffrey Sachs 


So far I've already reached some major visual goals I set out to achieve. Good! I know more or less how this process works and how real unexpected change can and does happen over time. Good! The downside is that the time table always turns out to be much longer than I'd hoped for. Nevertheless, results do materialize. I watched some of my previous eye videos, some of which were more than two years apart, and re-examined the progress made. It dawned on me that, for my vision to be completely automated, I'd might need another some such amount of progress as was achieved in between those two videos.

Thus when being completely honest with myself I realize that it might take another two years. I'm hoping one year but I should mentally prepare for the worst. It's clearly possible to streamline my visual system and remove the remaining blockages providing me with a proper functional level but it will take some more time and concentrated effort. Not to get lost or discouraged I work in blocks of six months. When looking at it this way there are only four of those blocks left! That doesn't sound too bad!

I'm already much less in a warlike state of mind than four  years ago. It's interesting how my temper has cooled as my vision has further improved. However, there is still a vital need for improvement. Drawing on the last twenty years of experience I learned that you can't just go running around like some idiot hoping things will resolve themselves. Therefore I organised myself and got the political support I need to pursue my goal. No man can do it alone. Certainly not if there is no official support system whatsoever (clueless ophthalmologists/strabologists screwing over their patients, no social security when binocular vision problems impair productivity, you name it, ...). The current main stream treatment of strabismus by the medical establishment, only offering surgery, is nothing less than continued and organised character assassination of people with binocular vision problems. To survive this you need to approach Vision Rehab as a regular enterprise: deal with the disability and damage inflicted by surgery, find funding and support for your recovery, do the research and ultimately do the work in order to get to the end of the tunnel they have carved out for you. No potential has ever been harnessed without some type of investment. Reliable and workable vision and basic reading ability is one of the fundamental elements of independent life and therefore a must. I'm not planning on depending on others forever. I rather die. It's that simple.

I should never forget to be pragmatic though. In that respect, I'm unrolling some new projects this year. First of which were the Rapid Alternation Goggles as mentioned in my last blog entry. It's going to be a good year! :)

Check-up 9: Our four year anniversary

On December first I had my half yearly optometric evaluation. Sight in both eyes is good but the axis of astigmatism in my left eye has shifted marginally.

This is my current Rx.
OD: +2.50
OS: +2.50 cyl -1.0 axis 35°

When testing my binocular vision my ocular motor abilities are approximating what it should be. When testing sensory fusion things are less clear. Looking through an haploscope using some basic targets I do perceive the suppression controls and have what looks like a consistent and fused image. Based on this my optometrist tells me I have 'central and peripheral fusion'. I'm not so sure though. Using anaglyph (stereo)targets I do not perceive 'luster' fusion, rather I perceive constant switching between red and green. It seems hard to agree on a definition of fusion. But it is true that even though I might still have some form of intermittent and partial suppression at times, it is very easy to consciously break that suppression. Nonetheless it might still be too conscious a decision, especially while in motion. (More about the issue of unconscious intermittent and partial suppression and a potential solution in later blog posts).

In stereo targets, as seen through the haploscope, I can discern the correct relative distance between various elements of the picture by the way my eyes converge or diverge while viewing each of them in turn. When using polarized stereomaterials I do not directly perceive any 3D. To sum up, during none of the tests did I perceive any salient 3D but there are promising signs. "Certainly no bad news today.", the optometrist said.

Revised 'timeline' - Last surgery was in August 2009

The challenge as a chronically untreated young adult with strabismus would have been to overcome the neurological atrophy and the decay of my vision, both motorically as perceptually, as it unfolded ever since my visual development went array. Compared to the current undertaking, that would have been relatively easy. Not easy, but relatively easy. However, I (and my optometrist with me) would say that eighty percent of my recovery is about overcoming the abysmal results of the surgeries I have undergone as a young adult (ages 16, 18, 19) completely obliterating my academic and professional prospects. That is why I am about to enter my fifth year of Vision Therapy.

In order to add more perspective, I'd like to translate and paraphrase some of the conversation I had with him in Dutch.

MICHAEL:  "Let's forget I've been doing this for four years and I were to walk into your office for the very first time in my current condition. What would you tell me?"

G. NAEGELS: "I would tell you you have a slight exophoria and all physiological preconditions for stereopsis recovery are present. In view of the fact that you only developed strabismus at the age of three (accommodative strabismus) your recovery prospects back then would have been excellent. At that age it is very likely you have already SEEN in stereo up until the binocular disruption. I'd recommend for you to try and re-acquire stereo vision because it will greatly improve the quality and stability of your vision and life in general. I think it's within reach now. But it has to happen of course."

MICHAEL: "I'll have to make it happen then."

G. NAEGELS: "That being said, I still think that deontologically speaking I made the right call four years ago by telling you there was not much hope for recovery. Not every patient is as motivated and persistent as you are. I could not have foreseen that and I would not want to arouse expectations that can not be met by the optometrist alone. I've never seen someone so engaged in his recovery. I'm very happy to may have witnessed this in person. It's a pleasant surprise for me and it reaffirms what we are doing here."

MICHAEL: "Thanks. I have no other option so I act pragmatically. It's swim or drown. It's that simple. This HAS to work out."

'The ticking time bomb that split my world in two'

About a week ago me and a man named Ryan Brooks had a thought-provoking conversation on my Facebook wall.  I had just shared my latest blog entry 'The margin of error'. He commented "I always find your posts extremely interesting. I had a bleed in the brain stem which has left me with double vision. This is how I see now."

That is not your every day Facebook comment but I knew the visual phenomenon he was talking about of course. As I'm always open to learning about how other people deal with visual brain problems, I asked him whether he wanted to share more about what happened to him. He was prepared to do so and I am happy for it. Even though our histories are different (developmental vs cerebral incident), we are talking about closely related visual issues and symptoms. Thank you for sharing your incredible story, Ryan!

I present to you, Mr. Ryan Brooks.

Part 1
RYAN: "I am 40 years old. I live in Newcastle NSW, Australia. I was an occupational health and safety manager in the mining industry and traveled the world to places like New Caledonia and New Guinea to name a few. I had only been home for eight weeks when the incident happened. Over a period of three months prior to the bleed I had experienced three separate dizzy spells and racing heart episodes but only lasted for about ten minutes. I attributed it to maybe anxiety due to my stressful job.

The brain bleed happened on the 25th of June, 2012 at 11.15AM, I woke up feeling great and drove down to a cafe on the beach for a coffee. As I walked down the beach to the cafe my vision started to blur and I felt a strange buzzing feeling at the back of my head near the base of the skull. I put it down to still being half asleep. I ordered a coffee and sat at a table outside watching the surf. The buzzing started to get worse. I started to feel like I had butterflies in my stomach and felt increasingly faint. I got up to go to the bathroom to wash my face. As I got to the door... Boom. Suddenly I felt as if pins and needles were penetrating my face. Down my left arm and leg I felt numbness as well as pins and needles. All this combined with a feeling of complete disorientation. I managed to stumble back to the front counter and said "Call an ambulance, I'm having a stroke." Then I passed out over a table. A short while after, I came back to and noticed no one was helping me. I was in a bad way. I remembered there was no phone signal inside so I got on my hands and knees and crawled out the front door. I laid on the path, rang my sister and told her what had happened and for her to call an ambulance. The people at the bar told my sister that they thought I was a drug addict having an overdose. My sister went absolutely ballistic. The ambulance arrived 20 minutes later and off to hospital we went. After some brain scans the doctors realized that I had a bleed in the upper mid brain, which is part of the brain stem. More conspicuously, by merely looking at me, they could see my left eye was turned in so hard towards my nose you could barely see it. "

Ryan and his daughter

 Part 2
"The official diagnosis was a cavernous malformation. In plain English this means that a blood vessel wasn't formed properly at birth and it took 38 years to wear out and rupture. In other words, a ticking time bomb."

MICHAEL: After the incident and the diagnosis, did they do something about that blood vessel?

RYAN: "They did an angiogram and injected ink into my brain which basically gave them a map of all the blood vessels in my brain and of the problematic area of vessels in particular. They didn't do anything because the brain area where it happened is very complex. The vessels in that area of the brain stem are the size of a strand of hair. Fortunately they were not arteries. Doing something to 'fix' it would entail too much risk. An intervention might kill me or give me a major stroke. Instead we opted for yearly brain scans. There's no guarantee it won't happen again."

MICHAEL: How did things proceed from there on out?

RYAN: "After four initial weeks of rehab for partial paralysis down my left side everything started to get back to normal. Sort of... Concerns regarding double vision as a result of the bleed and nerve damage remained.

MICHAEL: Can you describe your current visual situation?

RYAN: "The official definition of the visual dysfunctions caused by the brain bleed goes as follows. Bilateral asymmetrical superior oblique paresis, cranial nerve paresis with convergence retraction nystagmus and some myopia in the left eye. But I would like to try and explain what that really means from my point of view.

From the outside my eye alignment looks normal other than a slight turn of the left eye.  Yet from the inside that's a different story. When I look straight ahead the image of my right eye looks pretty level but the image of my left eye is on a 45 degree vertical angle.The left eye also has very bad torsion.

When I tilt my head up and down the torsion becomes worse.  I have vertical up gaze palsy and so when I try to look up my eyes wiggle. Notwithstanding, when I tilt my head slightly to the right it pulls the torsion nearly square. In that moment my brain relaxes because it almost feels like I have normal and steady binocular vision again. Sadly I can't sustain the binocular posture. It's like a stare and after five seconds my left eye starts to drift.

When I turn my head left and right the images split up and down so I have to patch my left eye. It is very hard after 40 years of normal sight to now have two separate images that 'do what they do'.

When I walk without the left eye covered, the image coming from that eye bounces. So when using my right eye, with my left bad eye covered, the eye's movement compensates for any head movement. The image stays stable and straight (proper Vestibulo-Ocular Reflex). On the other hand, when I close my good right eye and only have to draw on my left eye, the image inadvertently moves up and down following head movement (compromised Vestibulo-Ocular Reflex). Not only does the image move up and down, but it also tilts because of the torsion. It's quite nauseating and throws my balance out. If I walk with only my bad left eye open,  it feels like I'm walking across a very steep hill. The image just bounces around inconsistently.

I have also noticed that the color isn't as good in my good right eye. At night my right good eye doesn't see as well as my left bad eye. Everything is a sort of tinted darker when looking through my right eye.

When I close one eye, my vision feels quite normal. although I had to get used to the difference in depth perception. At night, when there is little light, it feels like my vision is back to normal which stops the headaches. That's the only time my brain isn't fighting to get properly aligned binocular input. Then I can relax.

Considering all the above, using my vision is a very fine balancing act."

MICHAEL: How do you make these example images? Do you use an app?

RYAN: "You are actually the one who inspired me to investigate the internet and thus coming across the apps to help explain what I see to other people. These are the two apps. My Doctor was very impressed with the idea of taking photos of what I see and simulate what I see as I move my head into different directions. The images shift when doing so. This way he can see exactly what I see."

MICHAEL: What kind of treatment have you been getting or participating in?

RYAN: "I have been seeing a strabismus specialist in Melbourne at the Private Eye Clinic by the name of Dr Lional Kowal. I had VT for 12 months. While doing VT I was also going to Melbourne every three months for examinations. The VT pulled my eye nearly back to its normal position but the double vision remained.

After that initial year of VT, I have had five correctional surgeries but none have been successful due to damage to the 3rd, 4th, 6th, 9th and 10th cranial nerve. Every time a surgery was done it had a negative effect on either the vertical or horizontal relative positioning of the images. Unfortunately after five surgeries, two of which were to undo previously performed surgeries which had made my double vision worse, I am back to square one."

MICHAEL: I'm just thinking out loud... You had the incident in June 2012. Then you had one year of Vision Therapy aka Visual Neurorehabilitation. That brings us up to August 2013. So you must have had five surgeries in one year? How did that go? You seemed to be making VT progress, albeit slow. Who proposed the surgery? What did the Doctor tell you about its effectiveness, risks and possible outcomes?

RYAN: "As the double vision wasn't disappearing mainly due to the torsion aspect of my case, the Doctor or Neuro-Ophthalmologist suggested surgery. They explained the risks. He was confident he could give me an improvement.

The first operation was performed on both eyes and made the double vision worse. Five days later that surgery had to be undone.

Another three months later I had more eye muscle surgery on both eyes while being awake using only the use of anesthetic drops. They placed a black letter T on the ceiling and also on the wall in front of me. He started with the left eye. Cutting and manoeuvring the muscle a millimeter at a time. Then he'd wash out the eye, take the eye clamps out and tell me to look at the T and ask if there was any difference. Then he'd sit me up and tell me to look at the T on the wall in front of me and ask whether there was any difference. My response was 'it has adjusted slightly'. So back down for more adjusting. This process went on thee times until he said he couldn't do any more. He stated that if he overstretched the muscle it was irreversible. Next we repeated the same process for the right eye.

It was an extremely stressful experience. I could hear my heart racing. I was boiling hot due to the lights and surgical blankets. To be honest, after you have had your eye ball cut open, the eye muscles cut  and then flushed out with water, the mix of blood and water makes your vision quite blurry. So any indication of what I was seeing was compromised and not really accurate. My eyes kept drifting as my muscles were cut, my vision was blurred and the environment was extremely stressful.

A week later after letting my eyes recover a bit the double vision was worse. Another week later I went in for surgery again in an attempt to undo things. Under total anesthesia this time.

Four months later, one more surgery was done to do some slight tweaking. I was completely under for this one. Whatever the result was, I was going to have to live with it."

MICHAEL: You said 'I am back to square one'. Do you feel the surgeries were just a useless exercise or would you say it deteriorated the situation? I'm asking out of genuine curiosity, not because I myself had a very bad experience with strabismus surgery.

RYAN: "Now it is more or less back to where it was after the brain bleed, although a little different. Looking back I'm glad we gave it a try because now I know that at least we tried. I put my trust in my Doctor and we came out the other side not having gained but not having lost much either. He was a wonderful Doctor and only charged me for the first surgery. All the other surgeries he put through my medical fund at a significant price reduction. That was an incredibly kind gesture and showed that he was more interested in my case than in my money. On top of that I was extremely fortunate to have wonderful friends and family who organized a charity events such as a dinner party, an auction and a golf day. They ended up raising enough money to cover my surgeries, anesthetist, flights, accommodation, check ups, glasses, lenses, ... That all amounted to 30.000 dollars. If they read this, I want to thank Brett & Gail Purcell, Nathan Palmer, Tim & Macushla Spencer, Chad Edwards, Leeanne & Jeremy Symes and many other friends and family members who were involved. I had been 14 months off work so without this bunch of phenomenal friends my treatment would definitely have been cut short. I'm immensely grateful to them all."


Part 3
"Nowadays I'm using a tailor made contact lens that looks normal but really isn't. The outer edges are clear so you can still see the colour of my eye but the area covering my pupil is completely blacked out. I had to have my pupil measured so it looks cohesive with my other eye. This means that I am basically blind in my left eye when I have the lens in. Well, not completely blind... I still get peripheral vision from my left eye as the dot on the lens is a little smaller than my pupil and pupil size is variable depending on light conditions. Therefore, I still wear my glasses.   When I'm not wearing my glasses, I have learnt to ghost the images of my left eye but after a while this gives me head aches. So back on go the glasses! Looking at me you couldn't tell anything is wrong. However, without my blacked out lens and my glasses the double vision still gives me constant headaches. .

In general, my life has changed considerably following my accident. I no longer work in the mining industry. I now work as a disability case manager and spend much more time at home with my beautiful daughter."

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!

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!

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... ;)

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

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".