Vision Therapy Works

Vision therapy works!  because when you don’t do it, it stops working…sort of….

My strabby self enjoyed a little bit of a “summer vacation” for the past several months.  I had reached a plateau in my vision therapy success, and I must admit this caused me to feel discouraged, because when I would do my vision therapy homework nothing amazing would happen.

That lack of excitement and reward disappointed me…and like any good little lab rat, the lack of reward made me stop doing the behavior to try to earn the reward.  At the start of summer when I stopped doing any VT homework at all, and I will admit that I enjoyed not doing it!  Because VT homework can be boring.  And it takes time.

As a result of not doing any daily VT homework, some of my vision-related skills have deteriorated, such as:

• ability to see at near
• binocularity
• double vision double vision
• my retained Moro reflex that I had integrated started creeping back
• and I started feeling like a one-eyed cyclops

yet some of my hard-earned eyeball skills have stuck around, like my eyes appearing straight aka cosmesis, and most importantly, my budding 3D vision ability.

Soooooo……..after summer vacation, I had to be responsible and realistic, and realize that I was having real strabby symptoms and that I need to continue pursuing vision therapy.  Because vision therapy works.  During my plateau I was maintaining, I was having good results and my eyes felt great, even though I wasn’t experiencing life-altering results (like seeing 3D or fixing my left eye) and I was bored.

To fix my problems, I decided to do two things: to order my own copy of Dr. Len Press’ Applied Concepts in Vision Therapy book (which I had seen sitting Jeri’s desk) and to call Jeri, my vision therapist, and schedule an appointment.

It turns out Dr. Press’ book is a bit tricky to buy on the Internet.  At Bernell, it’s impossible to add his book to your online shopping cart.  Too bad a software bug has prevented me from being your customer, Bernell.  At Amazon, you can’t buy the new version, and the cheapest used copy is available for $99–which is $4 more than new!  There are also three used copies selling for about $169. My favorite used versions are the $697.06 priced one, the $999.00 “like new” one, and the most astounding:  $1,858.52 for “very good” condition.

Luckily I had been on the COVD’s page and saw that it’s for sale there.  I called the number and spoke to a pleasant gal in California and my own new copy is on its way…and I paid less than a thousand dollars!

The day after I ordered my book, I got a phone call from Jeri.  How fortuitous!  I’m still waiting for my book, but I have already had a vision therapy appointment with Jeri.  There was no scolding, and no reason to be ashamed at having ‘falling off the VT wagon’ or whatever I think I might have done.

Instead, I’ve decided that all this is simply what my vision therapy journey has included.  An intense period of success and change, and then the plateau, and then taking a break–doing no VT homework for a while–and now.  Vision therapy is not a one-year project for Strabby; this is more of a lifestyle, at least for the foreseeable (hahaha) future.  As annoying and boring at VT homework can be for me, I am more annoyed at having strabby symptoms.  I could give up, and be done.  Or I can keep going.

once an amblyope, always an amblyope

My left eye is amblyopic.  I wish I could say it used to be amblyopic, because now it can see, but it cannot see as well as my right eye, even though both of my eyes see 20/20.  Isn’t that weird?

Amblyopia occurs when the nerve pathway from one eye to the brain does not develop during childhood…Strabismus is the most common cause of amblyopia.

As a result of vision therapy, my left eye stopped being a non-seeing amblyopic eye, but it is still amblyopic…how can that be, and what am I experiencing?

When I am looking at something detailed with just my left eye, I can see it, but it’s difficult to perceive.  It is not blurry, but it is tricky.  My brain is working hard just to see it, maybe the way the brain works hard to listen to a faint noise.

The Hart chart pictured here is where I really notice the amblyopic quality of my left eye.  It is easier for me to read the letters on the edges of the chart, but the letters in the middle of the chart are very difficult to track.  I loose my place.

It’s like trying to count two dozen ducks floating on a pond as they move with the waves and one of them flaps its wings and another bobs its head under the water…you just want them all to freeze motion for just a second so you can track them.  It is hard for me to track and hold on to those wily letters in the middle of the Hart chart.

bars around the H

Everyone in the strabismus biz knows about this phenomenon.  It’s called crowding and Dr. Len Press has a nice discussion of it on his blog.

When my eye doc examined my vision the other day, I looked at the line of letters across the room and recited them; everyone knows that routine.  With my right eye, she projected regular letters.  But for my amblyopic eye, she used letters like the one pictured here…the contour bars around that H are magical.  With those bars, I can see the H.  Without them, it’s harder to keep my eye on it…like those diving ducks.

 

My eye doctor explained my amblyopic eye this way, the signal coming from my left eye to my brain is not as strong as the signal from my right eye.  This concept makes me think of how we are right-handed or left-handed…all of that writing we do with the right hand, day after day, makes the right hand strong and capable.

 I read slowly with my amblyopic eye, compared with my right.  Reading is effortless with my right eye, but I am concentrating like kid who has just learned to read when I use my left.  And again, I’ll just remind my readers that both my eyes are 20/20 with contacts…there is so much more to good vision than a good score on the vision chart at the eye clinic.

it’s like a growing garden

Last week I had another vision therapy appointment, and I realized something profound: I have been thinking about my vision therapy achievements all wrong.  I have thought about my successes (and “failures”) in a linear way.

For example, with red/green bar reading.  The way that is supposed to go is like this:

• read large text with red/green bars over the text while wearing red/green glasses
• read regular-sized text
• read while using a low-power flipper
• read while using a higher-powered flipper
• be a VT winner

However, I have had sporadic success, if success is measured by getting to “read while using a higher-powered flipper.”  I read with a flipper when I wore bifocals, now with my nonbifocal contact lenses I can’t use a flipper, even though I’ve been trying for months.

Meanwhile……as I have fretted that I can’t nail the red/green reading, something else wonderful has been happening….

…my sense of depth in space and 3D vision is beginning to blossom!  It is like Sue Barry’s experience with the faucets projecting out at her, but for me, it’s the handles on spoons and spatulas that stick out at me.

hey, dude, look up and around

So I decided to think of my vision in a new way; it is like a growing garden.  I have planted my seeds and I am trying to coax them all to flourish, but while I was preoccupied with the red/green reading skill, I didn’t really notice my wonderful  growing 3D skills.

I realized that VT success is not always: do A then get result B.  Maybe for improving my blind, amblyopic left eye, patching did clearly lead to that eye improving it’s vision to 20/20.

But everything is all mixed up, because eyes and brains are complicated.  Every VT activity I do does have a specific goal, but they all work together in my brain to improve all the facets of my strabby vision.

I look up at that photo and think about how that fellow is focused intently on his little rows growing in his raised garden bed, yet there is so much wonderfulness growing all around him.

still here, still strabby

In addition to being a member of the strabby club, I’m a member of the started-a-blog-and-then-neglected-it club.

My last published blog post in November 2011 described my frustration with coasting along a vision therapy plateau…now I can share my frustration with falling off the vision therapy homework wagon, and what happened to me when I did.

Thanksgiving 2011 and the entire busy month of December allowed me to justify letting my vision therapy homework practices slide, and with that slide I lost some of the gains I had maintained on my plateau.

In January 2012, I felt my eyes working together less well.  I noticed more double-vision.  I noticed that I couldn’t see as far down the Brock string as well as I could in the summer.  It was once again very hard to read MFBF.  This was depressing to me, but it was also very instructive:

• vision therapy works
• homework is required
• some gains can be lost
• some gains have been integrated so well they are still here

So in January when I met with Jeri, we talked about this, and I was assigned some homework activities I hadn’t done in a long while, including a few patched activities and ball-smacking.  I quickly made some progress but I am still not back to the peak performance I had in fall 2011.

I decided to draw a graph of my vision therapy progress…I drew three lines to represent the different ways I am thinking about it.  The most meaningful part of this graph, to me, is that I had tremendous gains with vision therapy at first: my left eye stopped being amblyopic, both eyes started working together, and the 3D vision ability began…and then the slower, deliberate process of expanding my 3D abilities.

“You’re a post-op strab times two,” says Jeri.  And I understand that’s why it will take a long time, and I understand that every day I don’t do my homework, I’m one day farther away from my goals.

world’s largest plateau

I “graduated” from weekly vision therapy visits in early October.  I had completed 35 weeks of vision therapy, which is what my optometrist Dr. Jill scheduled me for in January 2011.  It felt odd to graduate because I do not feel done.  My eyes have not yet achieved the lofty goals I have: depth perception and 3D vision…even though I have achieved so much already.

My 3D vision is still just developing, and it is developing s-l-o-w-l-y.  Week after week Jeri assigns me the same things:

• eccentric circles
• red/green reading
• Brock string
• overlapping pictures

And every week I see her, the improvements are nonexistant or very slight.  It takes a long time, for me, because I’m an old lady and a post-op strab times two.  It is emotionally challenging, to stay positive while on top of this longterm plateau.

Jeri decided to assign me a set of homework to work on for a month or so, and then I would see her again.  Instead of weekly appointments, we would have twice-a-month or monthly appointments.  She said I’m so good at doing my homework.  She was looking forward to the COVD 2011 41st Annual Meeting at the Tropicana in Las Vegas and would tell me about any new insights she learned about my course of therapy the next time we met.

She said she couldn’t wait to introduce herself to Dr. Len Press (who, at the meeting, received the 2011 G.N. Getman Award in recognition of his clinical expertise in developmental optometry and his dedication to patient care) as the vision therapist to the blogging Strabby.

I’m trying to see if my own Jeri is bustin’ a move:

I’m looking forward to meeting with Jeri again, to hear about her trip to Vegas, to hear about meeting Dr. Press, and to see what she thinks are the next steps for me with my vision therapy.

I’m not looking forward to admitting to her that I’m not the vision therapy homework rockstar I seemed to be.

I try to do my homework every day, but it seems to turn into every other day…and the more I slip, the worse I feel about slipping, and now I’m worried that my plateau is turning into a backslide.

When vision therapy is once a week, doing homework every day is critical.  But when my next vision therapy appointment is weeks away, “missing one day can’t hurt” is a perilous attitude to have.

I think another reason I’ve been slipping on my homework is the lack of reward: throughout most of this vision therapy process, I would be assigned homework, and by the end of the week, I would have mastered several new skills.  Maybe they were teensy improvements, but there was a mental reward for doing the homework.

Sue Barry talks about this in a blog post:

Novel and rewarding experiences not only encourage people to work harder at their therapy but also have direct effects on brain wiring. When a person experiences something new and gratifying, neurons in the brainstem and basal forebrain are activated and liberate powerful neuromodulators onto circuits in the cerebral cortex.

On the plateau, I do the work, day after day, and it seems like nothing changes.  Where’s my basal forebrain activation?!

I’d better go see Jeri soon.  Then she can help me discover how to liberate some neuromodulators onto my cerebral cortex’s circuits…that’s the only way I’m going to get moving along off this plateau to develop more 3D vision.

my first 3D peeks

September 2011 was a magical month for me, because it is when I first began to see 3D.  One day I was painting (painting my chickens’ hen house) and as I looked up and the handle of this painting tool was right in my 3D ‘sweet spot’, where both of my eyes work together, binocularly.

I was astounded.  Seeing this handle in 3D was unlike any other 3D experience I have had at the vision therapy office or at home doing homework.  All of those 3D experiences are more like 2D flat images popping out at me.

Seeing this handle floating in front of my face was indescribable, yet I will attempt to describe it.

It was like I was seeing the handle from two different angles at the same time:

 

it made me think of this quote from Dr. Len Press’s VisionHelp blog:

As the French phenomenologist Maurice Merleau-Ponty famously said, vision is the brain’s way of touching.

For the first time in my life, my mind was seeing 3D in real life, and I could experience the handle, its size and shape, with my mind.

It was like seeing a cup of coffee…and smelling it.

It was like biting and apple…and tasting it.

It was seeing an object in space and understanding where in space it is–not using ‘monocular clues’ like seeing objects overlapping.  I could see depth because I could see 3D because my eyes were working together!

After I told Jeri, my vision therapist, this exciting news, she gave me an unusual homework assignment–go to the theater and watch a 3D movie.  It is easy for her to assign activities to work on 3D vision up close, but it is difficult to work on 3D vision at distance.

I took my two sons and we watched The Lion King, wearing our Real3D polarized glasses.  The 3D previews were incredible, with the Disney castle in the middle of space flying towards the audience and little sparkly stars occupying space behind it, and in front of our faces.  I was so overwhelmed with sensation and 3D appreciation–this new experience wholly enveloping me, I was on the verge of tears.  It was such an all-encompassing, novel, and profoundly real experience that was also unbelievable.

The actual Lion King movie, however, was slightly disappointing in the 3D department for me.  The first 10-15 minutes offered some 3D grass in front of the animals, but I think two things contributed to the blah-ness of the 3D: my eyes are not binocular professionals, and they got tired.  Also, The Lion King was originally a 2D movie, and maybe when the studio transforms a 2D movie into 3D, there isn’t that much 3D-ness to enhance in the first place.

During the middle of the movie, I had to take my son to the bathroom.  When we returned to the theatre, as I was walking down the aisle, the 3D popped on the screen for me again.  It made me think about Jeri who is always saying, ‘movement is good for strabs.’

I really wanted to pace up and down the aisle.  But I restrained myself.

I left that theater waiting for the rest of my life to slowly pop into 3D, just like the painting tool handle.

At home, I was drinking from a glass of water.  I realized: the front of the glass is in 3D, and the back is not.  The contrast between the two perceptions, at the same time as I sip from the glass, is phenomenal.  The back of the glass looks exactly like it does in this picture, but the front part is curved, real, existing, actual, and so different than the other side.

I think the whole glass is not in 3D for me because my 3D abilities are so new and undeveloped.  I have a ‘sweet spot’ where my eyes are looking at the object in a binocular way, and I am not seeing binocularly in front of that point or behind that point.

Another part of my 3D vision: it is blurry.  When I ‘clear’ it, or strain my eyes so that the object is no longer blurry, I feel my left eye zoom towards my nose and the object doubles (double vision.)  The Lion King movie wasn’t blurry, and the painting tool wasn’t blurry, but usually up-close things I can see in 3D are blurry.  Acquiring 3D vision isn’t exactly a completely predictable, incremental process.  It comes in fits and starts.

And you cannot predict what your first 3D experience will be.  I would have never guessed ‘painting tool’.

double vision

Diplopia, or double vision.  I have lived so much of my life with double vision, because of my misaligned eyes.  It is so normal for me to see two of something….and that is so weird!  How can I even drive–how do I know which lane is the ‘real’ lane?  I really don’t know the answer, but maybe it’s because I’m such a highly skilled professional strab.

Double vision is hard for the brain to deal with.  This is why my parents were so concerned when I was a strabby baby, because the eye doctor warned that my crossed eyes meant I was seeing double, and if I’m seeing double, the brain will put an end to that.

My brain began ignoring the doubled data coming from one eye, suppressing the images coming from that eye, and ultimately for me, my left eye became amblyopic (basically blind, and unused by my brain.)

After 12 weeks of vision therapy, my left eye became un-amblyopic.  After more weeks of vision therapy, it now it sees 20/20, but it is still misaligned and crossing inwards…so at distance, I see double vision.

If I’m looking at something father away than arms’ length, it doubles.  The better I get at diverging my eyes, the less double vision I will have at distance.

At this point, I can tolerate the double vision.  It is annoying sometimes, but it is also reassuring: it means both of my eyes are on and seeing.