Pursuing a higher degree of visual freedom

In my last blog entry I talked about 'visual reserves' and how important this concept is for long term comfort and for VT to be successful. The improvement of eye lens focusing and eye movement amplitudes individually is not enough for it to stick. You need to be able to execute those visual skills simultaneously, effortlessly and automatically.

Another great illustration of this processes by Dr Maino is shown below. Mastering those skills paves the way for further consolidation and visual/sensory development of the brain.

Check out the entire slide show for more informative illustrations like these:http://www.slideshare.net/DMAINO/what-is-lazy-eye.

At this point in time, I feel like I'm oscillating between the orange binocular box and the integration stabilization box. However it's not that clear cut. As you do a lot of integration, stabilization and loading, those skills also keep getting better individually while improved timing and daily application make for even more added value.

When it comes to eye lens focusing (accommodation) and eye movement (vergence), I have clear single vision under relaxed, undemanding circumstances. But that's not enough to live a proper life, so you want to go beyond that. To accomplish that you need to artificially separate the accommodation and vergence distance. 

Nice examples of these are cross-eyed 3D photos and parallel viewing stereograms. In case of cross eyed 3D photos, the vergence distance (the intersection of the visual axes) falls in front of your computer screen whereas the accommodation distance is the actual distance of where your screen sits on the desk. You have artificially dissociated both processes.

On the other hand, in case of parallel viewing stereograms the vergence distance is way farther than the accommodation distance. You have to be able to do some serious visual flexing to accomplish both these artificial situations. This kind of visual gymnastics will grant you some nice 'visual reserves' over time.

A classic VT exercise based on the same principle is the aperture rule. Even though you can in principle do the same thing with a computer screen, I very much like the simplicity of this gadget. It's easy to use and makes you jump through the right hoops in order to achieve the same goal. By adjusting the aperture slide you gradually adjust difficulty and have a frame of reference to keep track of your improvements.

In VT the expression 'degrees of freedom' is used in describing the process of building a stronger and more flexible visual system. I very much like that expression. It's accurate in describing the process and correctly implies that visually impaired people are less free in acting, interacting and participating. It also infers that there are degrees in the way that strabismics are affected and no two strabismics are the same.

Susan Barry once said 'You can control your vision and you are learning how to take control'. It's true but it still sucked at the time. After all this time I've already gone from a situation of constant involuntary double vision to one where I can cause myself to have single or double vision at will. I'm well on my way of eliminating my eye muscle palsy. As I gain more control over my vision, I gain more control over my life. I gain more degrees of freedom.

Improvement of accommodation and vergence amplitudes is not enough

I was going through my things and found a piece of information I vividly remember reading and highlighting two years ago. I was very excited to see something I already intuitively grasped written in the 'Optometric Clinical Practice Guidelines ' for dealing with 'Accommodation and Vergence dysfunction'. What an emotional moment it was. I was excited and somehow releaved... I was not going completely insane. At the same time I felt cheated by every doctor I had ever seen and a lot of work was left to be done under difficult circumstances. But at least someone in the world knew what they were talking about and that's something. It's amazing... All this information is freely available online and no one seems to care about it!

Two years later I'm still excited about this paragraph. Maybe even more so because that ultimate 'goal of vision therapy' as it is described has come a hell of a lot closer. To simplify, by vergence is meant the ability to move your eyes towards and maintain appropriate posture and by accommodation is meant the ability to manipulate the shape of your eye lens with the help of tiny little muscles in your eye. It's all managed by the brain and these visual abilities have to be performed at the same time at a level adequate for comfortable vision. It all has to happen in one synchronized motion or things get messy. Back then things were very messy. Vergence was all messed up by strabismic brain development and surgical intervention. Accommodation was all cramped up too. Constant double vision, poor and inconsistent performance of the visual system and wasting massive amounts of energy. This is one of those things that if you try harder, it will get worse. Once you stop trying so hard and relax, things will start to fall into place. These visual problems are not rocket science... You just have to detect them, explain them to the patient/parent and make sure no one gets in the way of recovery. In the search for solutions the right kind of motivation is important. You have to really care. You have to handle the problem as if it is YOUR problem. Clearly that kind of motivation is often lacking these days...

When talking about 'vergence and accommodation dysfunction', it's important to note that we haven't even scratched the surface of what happens when your brain develops amblyopia. We're just talking 'simple mechanics' for the moment. (If amblyopia were to occur or has occured because of lack of prevention or binocular treatment a lot can still be done and the American Optometric Association guidelines for Amblyopia are pretty neat too.)

To get back to my excitement... Lately I often use the phrase 'my vision is leveling out'. By this I simply mean that I possess the reflexes to maintain eye alignment and a clear image the overwhelming majority of the time. Also while doing funky head turns, running, playing basketball, ... The whole caboodle. Until I get really, really tired or tense. Let's say that if vergence scored 20/100 on a random, relative scale two years ago, it now scores 100/100 in comparison. I just about get by for simple, daily living. I have more control over accommodation too which is great for the syncing up process, although my prescription has not radically changed.

Alright, so from the inside of my head the visual dysfuction is less blatant than it was two years ago. Mostly undoubled vision unless you put me in a stressful situation (like reading more than 20 minutes haha). BUT as the paragraph states 'Improvement of amplitudes is not sufficient'. 'The goal of vision therapy is to establish automated, effortless accommodative and vergence responses under any stimulus condition.' 100/100 is not enough. To be comfortable you need 'visual reserves'. You need more than just getting by. You need 200/100. You need to be able to maintain visual performance when things get tough. Not only that, you need it so you can actually focus on seeing rather than trying to see. As my VT friend Matan told me earlier, the most profound changes don't result from improved eye movements. The most changes happen when you can execute those flawlessly and effortlessly. Then the perceptual and cognitive gates really start to open up. Based on the rather radical changes that have already been achieved over the last 3 years, I don't see why that final goal would be out of reach. Ahhh man, this stuff is so exciting and it's basically just a matter of time at this point!

In a following post I'll try to explain how the aperture rule or its computerized equivalents of cross eyed 3D pictures and parallel viewing stereograms are useful in cultivating 'visual reserves'.

Session 42: Accommodation versus Vergence?

The visual system, as far as your actual eyes are concerned, consists of two systems which have to be in tune with each other. On the one hand there is the accommodation system which makes sure the image you see is clear and sharp. On the other hand there is the vergence system that makes sure your eyes are both aiming at your target. For most people a well functioning vergence system, meaning aligned eyes, is one of the first things they learn in life and is at the core of their habit formation. This is something that cannot be fixed by simply putting on a pair of glasses. It requires a learning process to anchor this reflex into the brain so it will never be lost. However the accommodative system can be corrected for by glasses so the image you see is clear. Having to wear glasses for simple accommodation, as is the case for many people, isn't a big deal. In young children eye coordination (vergence) isn't really established yet and too much pressure on the accommodative system can unsettle healthy eye movement, leading down a dark path. This can happen with farsighted children who have to put in too much of an effort to accommodate in order to see things close up and as a result eye coordination breaks. This is what happened to me and my eyes and brain have been malfunctioning ever since. It shouldn't have been a big problem if they had given me glasses earlier. Or started me on Vision Therapy as a kid or even as a teenager. Or...

That brings me to today’s session. Currently those two systems aren't working in sync very well, they are working based on tradeoffs. If I blur out my vision and accept an unclear image, my eyes can take on certain positions. If I decide I want to see clearly to read something for instance, eye coordination gives up. It's pretty interesting if I tell it like that, but also pretty annoying to live with. The good news is that the sum of both systems is starting to yield better results (synergies, business school pays off after all!). Eye coordination is starting to hold up WHILE seeing a clear image. Be that as it may, we are still talking about baby steps... The only way to achieve these better results is to lay low. The only way to fix this problem is to lower the load, rest and slowly work on it before putting it back in rotation. As in any discipline overtraining is the worst you can do because at the end of the day you are weaker. Crawling out 40 marathons over 4 years with a broken leg without proper medical treatment doesn't make you stronger, it kills you. That's what university was to me. Boy, this is starting to sound like a depressing message but actually it's not. :D As the body and brain are pretty amazing we are rebuilding what has never been little by little and are reconciling both systems, and it’s working. Celebrate every small improvement.