8 Comments

suppression

If you cover your left eye with your hand and look around, that is how I have been seeing the world. Except that I don’t have to use my hand; my brain has been doing this for me.  The term in the strabismus biz is “suppression”, and here’s a definition from strabismus.org:

…The most common causes of amblyopia are constant strabismus… If one eye sees clearly and the other sees a blur, the good eye and brain will inhibit (block, suppress, ignore) the eye with the blur. Thus, amblyopia is a neurologically active process. The inhibition process (suppression) can result in a permanent decrease in the vision in that eye that can not be corrected with glasses, lenses, or lasik surgery.

I spent my childhood patching my “good eye” (to avoid suppression) and wearing dorky thick glasses with an executive bifocal (we presumed this would help cure the strabismus.)  Imagine my surprise when I heard my doctor talk about me + suppression about two months ago, at a typically agonizing eye appointment at the U of MN. (And there was even more surprise when I noticed on my medical records: L eye AMBLYOPIA.  I had no idea.)

I was compelled to make an appointment and see those yahoos because the double vision I was experiencing daily was starting to drive me crazy.  From what I remember as s a child, I would have double vision only when my glasses were off.  You can imagine, then, as an adult (& two childhood surgeries later), I would be quite alarmed when this double vision was happening with my glasses.  Sometimes at night, watching TV, it was so annoying I’d have to close my left eye.

At this appointment, my doctor said something like, “well, when you’re suppressing, then you don’t have that bothersome double vision, so if you can do that, you won’t have that neurological piece bothering you.”

“That neurological piece”…when I heard my doctor say this last November, I thought this was an amazing concept–first of all, I never knew my brain had been “suppressing” my left eye’s images this whole time, and that the suppression was keeping me happy by preventing double vision.

I thought:

  • I had strabismus, and if my glasses were the correct prescription, they would keep my left eye from being wonky
  • this would then prevent double vision
  • “everything was cool” because of my surgeries
  • wearing glasses resulted in the straight eyes I saw the mirror

And here’s my doctor, suggesting that I’m not using both eyes–just one–unless I am seeing double.  Wow!  What a giant surprise.  I walked out of that appointment pleased with my new U of MN eye doctor (I’ve had two different MDs since Dr. Letson retired.)  I even got a new prescription for some more prism for my next pair of glasses.  Suppression! the apparent key to my visual happiness, according to Doc Bothun.  I decided to accept this information and overall I felt good about my appointment.

He must’ve read John A. Pratt-Johnson & Geraldine Tillson’s advice on page 253 of their textbook Management of Strabsmus and Amblyopia: A Practical Guide:

An adult patient should be told about suppression and that ignoring the image from the deviating eye will not cause amblyopia as it would do in childhood.  The patient should be encouraged to concentrate on using the dominant eye and to ignore the second image to encourage the normal process of suppression.

About a week after my appointment, I read Sue Barry’s book Fixing My Gaze, and I decided that suppression is actually not a cool thing, despite my MD’s nonchalance.  I started to like my new eye doctor a little bit less, and I started to become quite disappointed in pediatric strabismic opthalmology as an entire discipline, the more I read Sue’s book…meanwhile my enthusiasm for and understanding of developmental optometry increased.

And I began to actually learn about my eyes’ capabilities and about strabismus, and this made me wonder if perhaps my double vision was actually a good thing.  A symptom of a “lazy” left eye that still wanted to see, after all these years, after all that muscle-cutting surgery to yank it into place.  When I see two images, that means my left eye is not suppressed.  It means my eye is aimed in the wrong direction.

It’s my way or the high way. At this point I have learned a bit about suppression and also its “opposite” conditions: double vision or fusion.  For normal people who see in 3D, their eyes are seeing two slightly different images coming into the brain, these two images are fused into one, and that normal person sees one image in regular-style 3D; they do not have double vision.  But for me, when I see one image, I might be suppressing.  My brain does not blend images well, because my eyes aren’t aiming well.  My brain does not want two images of the fire hydrant, so it says, one will do…and left eye, if you are screwing around and providing a double image of the hydrant, you are banished! My way or the highway…shut out.  Shut off.  Done.

I will admit this idea is a depressing one for me, because obviously I need to have data coming in from both eyes for success with my vision therapy.  But I am not hopeless about it–I just am fretting about it.

I think about that excerpt from the strabismus textbook, and I have to ask, is suppressing an entire eye “normal”?  Perhaps the authors are confusing the term “commonly found within this population” with the idea of normal.  At my high school, it was very common for students to eat lunch out of the vending machines…but does that make it normal?  I hear someone’s mother, “if everyone jumped off a bridge, would you do it too?!”  So, “deviant eye”, it’s time for my brain to quit suppressing you, and learn to control your wonky roundness.  No matter what the experts writing the textbooks say.

8 comments on “suppression

  1. Strabby … oh, my … I feel like I’ve found a long-lost sister in strabismus!

    I don’t even know where to start … so, I’ll start with THANK YOU! I’ve recently embarked on the journey to “Fix My Gaze” (courtesy of Sue Barry’s beautiful book), and through my research, I’ve met wonderful and inspiring people, yet none whose story mirrors mine so closely as yours! And, none who experience double vision like I do! Much like you, I’ve had surgery, patched my “good eye” (my left), worn the bifocal (and trifocal!) glasses and contacts, and I’ve lived with double vision as long as I can remember (which means for the past 30 years … yes, I’m 30 years old). I’ve gotten the run-around from all types of eye doctors … my “favorite” (cough, cough) was the recommendation to blur out one contact to help make my suppression (and double vision) easier to live with. At the time, it seemed like a sensible option, but I’m so glad I kept faith in the chance that, someday, science could help explain and “cure” strabismus … thank you, Sue Barry!
    Just last week, I had a consultation with an FCOVD-certified vision therapist … she’s familiar with Sue Barry’s work, and she’s passionate about binocular vision and strabismus. After several tests, my Dr. shook her head and said, “You’re going to be a challenging patient … we’ve got a lot of work to do!” I’m motivated and 100% dedicated to pursing vision therapy, with the goal of getting my two eyes to work together (farewell to the double vision!), but I’m nervous about making the financial commitment to something with no guarantee that it will help! Does your insurance cover any of your vision therapy? How often do you go? Does your Dr. think that he/she can get your eyes to align correctly?
    I have so many questions, and I could talk / type forever! Just know that I love your blog and you’ve really inspired me to pursue this journey. It’s also nice to know that I’m not alone … I’m not the only one who struggles with night driving and seeing 2 TV screens! Thank you for sharing your story … I hope we can continue “chatting” and encouraging each other along the journey to “Fix our Gaze!”
    A fellow Strabby Sister …

    • hi Traci! so nice to see you here!

      I am glad you had a meeting w/ an optometrist…that is an important first step. I think if Sue Barry could get her eyes to align and work together, it has to be possible for people like us.

      What other types of patients does your optometrist see? if she has a lot of pediatrics or learning issues patients, of course, people like you and me are going to be “a lot more work” than that. That doesn’t mean un-possible.

      I completely understand your hesitation because of the financial piece. Long story short, I have chosen homebirth for two of my three births, so for me that out-of-network non-insured experience helped me take this plunge with less hesitation (insurance covers a MD-attended hospital birth, but for my low-risk pregnancies, a homebirth was a safer, less interventive, and more appropriate choice…but it was also a choice I had to pay for out-of-pocket.)

      I haven’t gotten into the nitty-gritty with my insurer yet, but vision therapy is an IRS-health care deductible expense. I go once a week, and it’s supposed to take about 9 months for me to be ‘cured.’

      Vision therapy for less than a year…and I’ve been using my eyes incorrectly for 34 years–that time commitment is a blink in comparison.

      Both my eye doctor and my vision therapist (the person who actually does the therapy with me each week) think I will be ‘cured’. At this point, I am taking this with quite a bit of faith–at the same time, it’s happening all around us: people with poor binocular vision work at it with therapy, and then they see. Dr. Press has been passionate about this for over 30 years (check out his visionhelp.wordpress.com blog.)

  2. [...] Optometry and a handful of patients beating the drum with this message.  It is a groundswell of public opinion that includes OTs, PTs, SLPs and Educators who hear the facts from the source rather than being [...]

  3. Bravo, Strabby. You’ve given new meaning to suppression: the suppression of a patient’s concern about their binocular vision. In that sense ophthalmologists who patronize patients about vision therapy suppress better than a well-adapted strabismic.

    Your observations are prescient about suppression not being “normal” are prescient. A more suitable use of the term suppression is a normal adaptation to strabismus. I would suggest there are sources other than Pratt-Johnson and Tillson that you would find more in line with optometric vision therapy approaches to strabismus and undoing or lessening suppression. And I suspect with these experts, you would agree. My complements again on your insights.

    • Dr. Press, well said:

      “You’ve given new meaning to suppression: the suppression of a patient’s concern about their binocular vision.”

      Reading your words helps me better articulate some of my frustrations with my legacy of ophthalmologist appointments–I try to tell them what is wrong, but my words don’t seem to impact the appointment’s protocol in the slightest.

      What a contrast with my first meetings with my vision therapist, who *listened* to me. It is so refreshing, helpful, and liberating to be in an “eye appointment” with someone who actually hears me when I say, “I’m seeing double now, things are blurry, now it’s better.” That’s all I seem to mutter as an eye patient, but my words are heard so differently, depending on my care provider.

      Indeed…Pratt-Johnson and Tillson is not a “good” book for me, in that it speaks of strabismus & amblyopia in a one-dimensional (ha ha) opthalmologic tone. It is tricky for me to source the books I want to read–even with inter-library loan, I am limited to things the University of Minnesota’s bio-med library has on their shelves, or things that occupational therapists at other Minnesota colleges might read. All the “good stuff” is probably on shelves at school libraries that teach developmental optometry.

      Thank you again for your encouragement and positive feedback. It is always exciting when you comment (and my optometrist and vision therapist treat me like I’ve met a rock star, when I tell them “Dr. Press commented on my blog” (: )

  4. Thank you Strabby for a really interesting post. My counsin has suffered all her life with her eye health Even after some vision therapy to cure her mild supression she has still having problems.

  5. Ditto as PP mentioned, this is all so familiar to me, and I’ve only started “focusing” (pun intended) on potential for vision therapy and my suppression recently as a result of finding out my infant son also has an eye turn.

    I don’t know all of my proper diagnoses by name, but I had eye muscle surgery in my left eye and patching at 6 months of age for strabismus related turning noticed very early. I’m also farsighted (+10) and have relatively strong astigmatism (so much so that hard contacts don’t work for me because they spin on their own due to the weight). I went through most of my childhood and adult life knowing that I had “bad eyes” but I did well in sports, drive, ski, read, etc. What I didn’t realize until my son was that I actually don’t see 3D. I knew I couldn’t see 3D movies or those dot 3D pictures but to realize I didn’t see the actual world the same as everyone else was really surprising. How did I manage to do as well as I have with sports, etc.?

    We’re watching my son closely and he passed the “stereo fly” test at 9 months, so there’s hope for him I think.

    I just tried the brock string at my desk and only see one string, either with my left or with my right. So I clearly suppress, but have decent vision (with corrective lenses) in both eyes. Am hoping this means that vision therapy will help but I do not see double, so perhaps they will never work together.

  6. Amy, it’s such an individual thing that you’ll only know if you work at it. I have fusion about 12 inches out from my face (and see double the rest of the way out on the brock string) and I am still working toward stereovision. My amblyopic friend on the other hand, had to wake up her lazy eye and then was able to achieve stereovision in fairly short order. Your suppression may be easier to overcome than you think. Best wishes to you and your son! (My story is at http://www.healingmysight.com).

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