Vision Stress Testing: 5K Run

April 14th, 2015

After being out for a couple of years and focusing my energy on my vision, I decided to slowly give running another try. Running is not my main focus but I try to use it as complementary training to my vision rehab. That is, when I feel I can handle it and won't go in overload.

It's unfortunate that these mistreated vision problems have dragged my physical and neurological condition down to such an extent because I used to be a natural at running. My performance should be peaking rather than dipping right now. I've never done many races in my life but so far I have done 5K, 10miles (16K) and a half marathon (21K). I decided to do another 5K race in 12 days. I'm looking forward to it but I'm keeping expectations low. I think I can do 23 minutes but we'll just see what happens. If I clock at 25 minutes, that will be alright too!

Here are some of my previous running results. If I can have the same outcome as in 2012, it is a de facto improvement because my vision (ocular motor control) is much better now than it was back then.

April 28th, 2015

I immediately added the results of this year to the image. The race went pretty okay. I started out easy and then, after the 3KM point, deployed whatever energy I could muster. During the last kilometer my vision was getting very shaky. So much so that I barely recognized my awesome friends who were cheering by the side of the road. Fortunately you don't need that much vision to run your longs out. When I arrived I was very dizzy but I fairly quickly recovered my normal (current) level of ocular control. I did not revert to double vision. Running the 5K wasn't the actual challenge. The challenge was to see what would happen afterwards. Would I be able to function normally and get home or not? To my delight I did alright. My nervous system and ocular motor control recovered enough not to be a zombie for the rest of the day. We went to grab some food and we had a nice day without me crashing.

Nonetheless, it remains interesting to see these time differences. I attribute it to the following cause (but I could be wrong). When I was younger, I would have a very low resting heart rate. When checking my heart rate, doctors would always ask me, 'Do you do any extreme sports?' or 'Are you doing sports on a professional level?'. I didn't. I didn't even run that often. Just when I felt like it, which was usually on Sunday. I was simply physically strong from having to endure academics with limited visual skills. To me, reading is much harder and physically taxing than running.

Sadly, these days my resting heart rate is not that slow anymore. I have the occasional panic attack and have to endure the stresses of an unrecognized handicap without income replacement or compensation for medical malpractice. The only thing I can do is wait and do my vision rehab which has been a very long and arduous process without breaks. Fortunately, relatively speaking, I can now see light at the end of the tunnel. I was lucky to find enough support and have played my cards flawlessly to get to this point. Now over the next year or so I have to finish it. I think that only after having acquired the security of reliable vision and body performance and hopefully, God forbid, a steady income stream, I will get some peace and might be granted a more slowed heart rate once again. Being more relaxed from time to time helps your body recover and allows you to build reserves. In that case of a slow heart rate, you can elevate that heart rate to a much greater extent when it is actually needed for physical performance. This instead of heart throbbing from being cornered and betrayed or the occasional, and ultimately useless, panic attack when dealing with a visually (and otherwise) unstable world.

Nothing is more crucial to the survival and independence of organisms—be they elephants or protozoa—than the maintenance of a constant internal environment. Claude Bernard, the great French physiologist, said everything on this matter when, in the 1850s, he wrote, “La fixité du milieu intérieur est la condition de la vie libre.” ,- Oliver Sacks

Jaw clenching, Vision Therapy and earthquake resistant structures

Personally I learn a lot from reading/listening up on vision rehab and anatomy but I learn just as much from having conversations with other strabismics. I think it's a practice that could be useful to anyone with any problem. Don't compare yourself to people with a very differing, in this case neurological, background. Learn from people who are similar to you and dealing with similar day-to-day problems. What follows is a blog post constructed on this type of conversation.

PASQUALE: Hi Michael, in many blog entries you mention jaw clenching. I too have said that I engage numerous facial muscles while I try converging and diverging at different targets.  It feels like the brain is recruiting other muscles because it still hasn't figured out how to properly use the eye's extra-ocular muscles.

MICHAEL: I always think of it like learning how to do something with your left arm (unless you are left-handed). First you use your entire arm, often in a contorted way. Then you move on to more specialized movements of the joints and ultimately you can do things smoothly having very fine control over your arm, hand and fingers. Theoretically the potential for improvement is limitless.

Let's transpose this to the visual realm. At first, when trying to accomplish a visual task, you are doing it very clumsily and inefficiently. Your brain is trying to accomplish a task which requires fine ocular motor skill but it's not succeeding because of a lack of (lasting) control. Because many of us are hardheaded we redouble our effort and adjacent regions and resources like facial muscles are drawn into the process to little or no avail. Not good. Instead of redoubling our effort employing a very limited set of visual skills we should go back to the drawing board and improve and multiply our skills. Technique is more important than 'brute' force.

The visual system involves six of the the twelve cranial nerves. That's a lot of guns to fire and potentially misfire. When I experience jaw clenching after too much reading or just a visually or otherwise stressful situation, that implies I've gone beyond my current visual skill level and I need to back down.

Trigeminal nerve - 5th cranial nerve

PASQUALE: Have you figured out exercises that eliminate engaging other muscles except for those needed to coordinate the various components of the eyes.

MICHAEL: Well, any activity that encourages 'the eyes', meaning the appropriate muscles and neural processes associated, to do the work without recruiting other muscles. That implies not going too far beyond your current skill level and paying a lot of attention without getting frustrated. For me it means slowing down and lowering expectations while gathering finer motor control. As long as my jaw doesn't clench, I'm in the safe zone. Once I start hurting, I'm overdoing it. It's not always easy to be patient and sometimes there are just visually stressful tasks I have to deal with. Then I'm tired, dizzy and in pain.


When thinking about this problem I'm reminded of something I learned about earthquake resistent structures. There's no such thing as a completely earthquake resistent building but you can improve a buildings capacity to withstand external shifts to a large extent. There are various approaches you can adhere to when going about the seismic retrofitting of a structure.
- You can increase the global capacity of a structure. (strengthening)
- You can isolate the foundation so the structure can shake on it. (partial flexibility)
- You can impose intelligent structural changes. Structural vibration control technologies minimize forces and deformations. (flexibility)
The last option implies that various individual parts of the building can move or flex allowing for shock absorption.

Vision Therapy is akin to a seismic retrofit for the visual system. You make structural changes in how it works and learn how to control and flex individual parts. You learn to lean into a quake rather than stiffening up.  That way you can withstand more external demands, with reduced energy drainage and avoid collapse of the structure/system.


For me, eye teaming remains a big challenge but I'm getting there. A related challenge is to gain more independent control over vergence and accommodation, i.e. taking on any binocular stance while manipulating my eye lens as I please. Either component should have limited effects on the other one's performance and there should be a certain ease in doing this. Just like using indivudual fingers while playing the piano.  An increased 'isolation' of these visual components gives more freedom of movement. To continue the piano anology, you'll be able to play 'visual Mozart' instead of just hitting the keys indiscriminately with all fingers at once.

As far as particular exercises are concerned, there are plenty of options to choose from if you understand the underlying principle. Magic eye stereograms, prism/spherical flippers, Eccentric Circles, Aperture rule, even just playing freely with your vision, ... Many VT practices are grafted on this idea one way or another. They are looking to improve smooth eye teaming, lens focusing and then increasing skill level by adding more activities (balance, body coordination, cognitive skill, ...).

In that respect, I particularly liked a quote from the interview I did with Mark last month. It illustrates this point very nicely.

MARK: I still have strabismus but I have a greater degree of control. The reduced suppression helps. I can line everything up that I need for stereopsis (fixation on an object, in focus, no suppression, awareness of peripheral vision etc.). It can be an enormous effort but it's like any other form of learning. Repetition is the key and progress, however slow, will be made!

The only catch 22 when talking about all this 'control' is that you won't necessarily attain it by going about this like a control freak. Be relaxed, patient but determined.

One month later... 

PASQUALE: It has taken me over eight months to finally feel that my brain can move my eyes with better coordination without trying to recruit a battery of other facial, non ocular muscles. I have gone through an entire slew of other muscles including those around the temple region, jaw, even moving my ears. The worse was when I actually felt my upper jaw putting tremendous stress on my entire skull as if trying to separate one from the other. I have to say that I see more positive progress now that my brain isn't trying to move my eyes through the recruitment of all those other muscles.

Session 80: Large rope circles projected on the wall

After almost four years of me doing Vision Therapy, our VT office finally got around to repairing an old projector they had in storage. It's pretty cool. Now we can finally do polarized quoits vectograms on a bigger scale by projecting them on some kind of grey screen on the wall. My Vision Therapist named Sofie was doing the exercise simultaneously with me. Funnily enough her ocular movement ranges at that distance (2 to 3 meters) were similar to mine. Keeping my circles singled out is going pretty well then but I didn't see any depth or changes in circle size (SILO - Small In Large Out). Damn it!

This brings me back to the goals I stated in July 2014. Easy convergence, more agile accommodation, sensory fusion and possibly stereo vision. That's what I hope to achieve by July 2015. That's all still on the table. Let time to its job. On a positive note, I have already reached the 75 kilograms weight target. One goal down, four to go.

I'm also working on procuring Rapid Alternating Occlusion Goggles which are supposed to help with decreasing remaining fields of suppression and stimulate sensory fusion. Movement seems to be the key to 'blowing open' the magnocellular pathways, even when that movement is so rapid one does not consciously perceive it anymore. Read some papers about it, talked to the optometrist who invented it, ... I am very excited about the research papers but I'd like to SEE it for myself. More about this later!

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

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

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

Bill Johnston."

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

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

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

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

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

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

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

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

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What about strabismus and anxiety?

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

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

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

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

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

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

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

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

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

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

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