Friday, October 21, 2016

What is the purpose of prisms in vision therapy?

It's been a week since I'd started using a seven diopter prism, base-in, with the fixation cards exercise, and I've been noticing quite a difference.  In just a week, I'd made quite a lot of progress toward fusion.  Still not yet there, but getting closer and closer.

I am now able to sort of fix with both eyes simultaneously while doing the fixation cards exercise.  It's a little weird because I don't yet have full simultaneous control of both eyes, so there is this sort of confusing feeling of my head existing in two separate realities.  Like my head is in two different rooms, and one of the rooms is drifting around a bit.  But overall it's a nice sensation, because it feels like I am doing the right thing, and this is where I need to be going.  So I'm now fixing, but not quite yet fusing.

So what is the purpose of prisms in vision therapy?  I think a not bad explanation is that they are like a stepping stool.  They make it easier to achieve fusion in the first place, by accommodating for whatever eye turn you may have.  In my own experience, I think an even better explanation for what prisms are in vision therapy is that they are like sticky hands.

Imagine that you are in a big, empty white room.  Except that in the middle of it there is a big white cube, and for some inexplicable reason you feel an incredible desire to get on top of it.  The problem is that the cube is as high as you are.  You cannot see the top face of the cube unless you jump.  In order to get on top of the cube, you're going to have to run toward the cube as fast as possible, jump up as high as possible while slamming your body into the side of the cube, and try to get your hands on top of the cube.  Then you will need to try and grip the top face of the cube with your hands and swing your lower body up to the top of the cube until you can get one leg on top, and then sort of roll the rest of the body over.  Damn.  I'm sweating just thinking about it.

Now imagine that the top of the cube is slippery, and you have no ability to grip the top of the cube.  You can run and jump and slam your body into the cube as much as you want.  Once you get your hands on top of the cube, they're going to slip right off.  If your hands slip off the top of the cube, then nothing else matters.  No amount of planned technique for how you're going to swing your body or what you're going to do with your legs will matter.

In my experience, what prisms have allowed me to do with vision therapy is get a grip.  Prisms have allowed me to grab and hold onto the top of the cube.  And now I can begin to think about what I am going to do next.  The stepping stool analogy isn't bad, but this analogy, although more verbose, is more accurate and precise.

I can speculate why using the prisms work in this way, but I don't frankly know.  I've used them in this way in the past and not with the same results.  But now, for whatever reason, prisms are working for me, and very importantly they make sense to me.  For the longest time, I always had this expectation that stereopsis was suddenly going to pop in for me as Sue describes her steering wheel suddenly popping out at her.  What does that mean?  Does that mean the eyes suddenly go from strabismic to straight?  Part of me, and I'm embarrassed to say it, thought that that's how it worked.  Not really, but kind of.

The prisms seem to free up energy to enable you to build on other skills like fusion and motor ability.  Without the prisms, it's just so much work to get superimposition, nevermind fusion, and the effort takes so much energy, nothing is left for building these important skills.  By freeing up energy, you're enabled to get a grip and build the important skills, and then ramp up a smooth gradient of progress.

Thursday, October 13, 2016

Getting closer to fusion with the help of a seven diopter prism

I'm getting quite a bit closer to fusion with the help of my seven diopter prism.

I started using it out of frustration, because I'd been doing the same regimen for about two months, and it seemed like I would be able to, in time, get accommodation synchronized across the eyes with the fixation card exercise.  But I stopped making progress.  Since accommodation and eye angle are linked, I figured I might be able to coax equal eye accommodation via a prism. So that's what I did.  I started using a seven diopter prism base in.  This enabled me to get both double images very close to being in sync--both in terms of fusion and accommodation.

It seemed to free up some energy, and while I don't yet have fusion, it has brought me very close to fusion.  The targets are almost a single fused target at times.  The prism has brought fusion into much closer and more realizable reach.  There are times where I was sure that I had fusion, briefly.

Interestingly, it hasn't hurt my ability to diverge my eyes.  I would have thought it might because my using the prism I'm sort of conceding to my eye's esotropic tendencies, and rendering it even lazier in terms of divergence.  But that doesn't appear to be a problem.  In fact, the Brock String exercise has improved quite a bit since I incorporated the prism in the fixation card exercise.

The rationale is to really practice fusion and teach my brain that this is what it wants.  And then to reduce the prism.  But somehow I doubt that that will be the big part.  I think the big part will be achieving fusion.  In all my years I never had it.  I think my eye's laziness was such an ingrained habit that in all of my years of vision therapy no amount of coaxing would enable me to truly get both eyes working together.  I'd used prisms before.  But now they seem to be working.  Or I had finally started making sense of what I'm doing with prisms.

Thursday, September 22, 2016

Learned something new. Got over another hurdle.

Two weeks ago I added another exercise into the mix.  It's this guy which I hold here.


As you can see, it is an acrylic sheet with a Sharpied-in cross hair with concentric circles.  It's an exercise that Tuan prescribed to me.  

What I do is put it really close to my eyes to the point at which I can barely get it to come in clearly (about three to four inches).  Then I close one eye and look at the target with the open eye and focus on getting it clear.  Then I relax and look through the sheet and into the distance.  Then I focus and get the target clear again.  Then I relax and look through again.  Back and forth.  Again and again.  Then I close that eye and open the other eye, and I alternate this exercise between the eyes.  

It's an accommodation exercise (obviously), which focuses on building accommodation strength on each eye independently.  

I start with this exercise for four minutes, and then continue with the fixation cards described in the previous entry for twelve minutes (I started with ten minutes, but then later intuited that another two minutes would be beneficial), then do eight minutes of Brock String.  Then I do some VR games for around 20 minutes.  VT takes about 30 minutes per day.  

Anyway, this addition has been pretty beneficial.  It seems I had plateaued and this exercise let me get over it.  I was skeptical about it, because one of the things that I've always noticed is that each of my eyes works perfectly fine on its own.  Accommodation, motor ability, tracking, etc.  It's only when it's time to work both of them to work together that things go awry.  But since I'd included this exercise I'd noticed quite a lot of improvement in all areas.  

The first thing I noticed was how it had improved the fixation card exercise.  It is much easier to keep the double images on top of one another as I pull the card closer and farther away.  And to begin with it's easier to get the double images to (not yet quite) fuse.  As I pull the card closer and farther away the double images stay together much better than ever.  So that's awesome.  

Also the Brock String has improved markedly.  The double images of the beads are getting closer and closer together from all angles as I move the string around in a circle.  I also am getting better depth with the Brock String.  

As they say, you notice improvement in depth with close-up objects.  This is true in my experience.  I was playing Raw Data a few hours ago with the Vive and I noticed quite a lot more vividness and depth particularly when looking at my guns.  Raw Data is one of the most high-quality VR games out there right now.  When you look at your cyborg hands, you can very slightly squeeze the Vive's motion controllers, and you see your hands slightly move.  Give it more, and you see more.  Pull the trigger on the controller slightly, and the trigger on the gun pulls slowly.  Move the controller around and look at it from different angles, and you can see the gun from different angles.  And the gun is sort of skeletal so you can see the mechanics.  It is incredibly slick, and has this tight feedback loop.  It is very satisfying just to look at your guns up close, look at them from different angles, see how the light reflects off it, squeeze the trigger.  And also because it's close, the effect of stereopsis is at its maximum.  There is like this weird sweet spot of stimulation that Survios just nailed.  Feedback, stereopsis, build-quality, light physics, etc.  It's pretty incredible.  Nailed it. 

But yeah, enough about Raw Data.  I was sort of surprised at how the addition of that exercise improved everything else.  It didn't occur to me to exercise each eye independently because I was under the illusion that each eye worked fine.  Because after all, I can close either eye and see everything fine.  Accommodate, track, etc.  What I needed was team training.  But that reasoning doesn't take into account the fact that for the most part, all day, I'm using one eye.  So yes, I can accommodate with each eye just fine.   But maybe fine isn't good enough.  That's the only explanation I can think of.  It must be the case that accommodation on my left eye wasn't good enough because when I began doing this, I saw massive improvement in all areas

It's sort of humbling.  The more I learn, the more I realize I barely have a clue what the fuck I'm doing.  The things I thought I knew aren't true.  The more I think about this stuff, the more I realize how important good vision therapists are.  How necessary and integral they are.  And the less I think that doing vision therapy solo is the answer.  Each time I talk to Tuan, he gives me advice and prescriptions that I find out later were exactly what I needed.  And I'm wondering to myself 'How did he know that?'.  The answer is probably that he's well trained and educated, worked and works his ass off, and is extremely intelligent.  

Vision therapy is probably too complicated for an amateur to do it alone is where I'm starting to move.  There's too much to know.  And some vision therapists have just the right knowledge.  They have the ability to know where you are and what is needed at that moment.  And for you, that knowledge is invaluable.  You haven't had hundreds of patients, and had the iterative knowledge of 'this worked for him in this situation' and 'my experience says now is the time for this'.  They have the formal education of the eye and potentially a huge amount of experience in knowing how people respond to different exercises.  

So that's where I'm starting to lean.  And it's problematic for reasons I've talked about in other entries.  How do you know who is going to be helpful?  And how do you afford help from these professionals if you don't have a lot of money?  Well, for the previous one you have to get their credentials.  The more people they've helped achieve their goals the better.  Get records of whom they've helped.  Do not get a cheap but inexperienced vision therapist.  Experience matters.  A vision therapist is not a vision therapist is not a vision therapist.  

And for the second question that's more tricky.  How one affords vision therapy.  Sometimes insurances covers it, sometimes not.  What Tuan and I did worked very well.  I got an evaluation done from a local vision therapist to get various metrics of the status of my eyes, and then he would listen to me and give me advice over Skype.  Because it's remote, there's no need for an office, which saves money for him, and the talks are usually around 20 minutes.  And the information got is incredibly useful.  My impression is that technology is probably the answer to the problem of the cost of vision therapy, and making the knowledge and expertise of high quality vision therapists accessible.  

But anyway, that was a long-ish entry, but it was something that I'd been thinking about.  I don't know of anyone who's recovered stereoscopic vision via vision therapy who didn't have help, with the exception of Frederick Brock and James Blaha.  I guess it has become increasingly apparent to me that I would probably be going in circles if it wasn't for an experienced and high quality vision therapist like Tuan.  Thank you, Tuan. 

Thursday, July 14, 2016

Accommodation and eyeball motor control

If there's anything that's been on my mind lately about vision therapy and my experience of what vision therapy has been, it's the link between accommodation and ability to accurately direct the eyeballs with facility.

It's been on my mind that as my ability to synchronize accommodation across both eyes has improved, actually controlling the direction of the lazy eye has become a viable option.  It's like... when the eyes aren't synced together, the eye that's out of focus might as well not even be a part of your anatomy.  You don't really have any kind of control of that eye.  Or at least that's been my experience.

So it's sort of funny to me when vision therapists say stuff like 'try to use both eyes at the same time with everyday activity'.  Well, when my lazy eye wasn't a part of my body that didn't even make sense.  Did not compute.  It's sort of like a miracle worker saying to someone who had his limb amputated 'Just have another arm.'  That doesn't even make sense.

I know they mean well and are trying to do their best.  And while they're educated in the eye and binocular vision, they do not know everything.  There's probably quite a bit about visual system mechanics that most vision therapists don't know.  And then on top of that, they're trying to understand what's going on with your visual system based on their measurements and based on what you're reporting to them about your visual system.  They have to do their best with incomplete and sometimes shoddy information.  I recognize that their job is hard, and that the field of vision therapy therapy is itself often seen through skeptical and or disdainful eyes.  I completely understand and do not begrudge.  I am incredibly thankful to their existence, especially to qualified vision therapists.

Ironically something happened when Tuan got me training on synchronizing my accommodation by essentially saying 'just do it'.  Wiggle your big toe.  And that got me on the path to fixing my accommodation issues.  And only in the past couple of days has 'control your lazy eye with everyday activity' begun to make any kind of sense.  When doing the Brock String, or sometimes when my attention shifts from my current task to what is around me, I notice that I'm seeing through both eyes.  It's particularly noticeable when doing the Brock String.  And I notice that my control is much finer, and controlling it as a new thing, a new part of my life that is there, is starting to make intuitive sense.  It's bizarre, miraculous, and very exciting.  And this new skill seems to directly coincide with my ability to get both circles sharp as I move the fixation card closer and farther away.

I've talked about it before... I've said stuff about the link between attention and accommodation and motor control, and not being able to pay attention through an unaccommodated eye.  Not sure whether it's true for anyone else, but it definitely is true in my case.  It makes sense, and my success with synchronizing accommodation (not done yet!) appears to be a vindication of this line of reasoning.

Tuesday, July 12, 2016

More progress

I knew it was a long time since my last update, but I'm surprised by how long it's been.  About a month and a half.  Things have been crazy busy.

I haven't changed my regimen for sometime now.  But really it's only been since March, or about four months that I'd been doing it, and during those months I'd seen massive progress.  I'm 100% sure that what I'm doing with the fixation cards is fixing my vision.  Or at least it's taking care of a major aspect of my vision training.

It's the accommodation mismatch.  It's getting so much better, and the control is so much better.  And today it occurred to me that the last week has been significantly better than ever before.  The accommodation across the eyes are almost completely in sync with one another up to the most closest.  My eyes are much straighter.  I recently visited my family in NH, and my mom said that my eyes are straighter and bigger.  So it's not just the imagination.

One thing that's very significant is my modified Brock String exercise.  I think I'm on the verge of officially getting depth with the Brock String.  I just need to create a new one.  My clear acrylic ring contraption has been beat to shit.  When I move it around in all of the extremes both of the eyes are almost completely on it.  It feels like I could be a few months away from achieving my goals.


Tuesday, May 24, 2016

Vision therapy and the ketogenic diet

What is a ketogenic diet?

A ketogenic diet is a diet that puts the body into a state of sustained ketosis: that is when the body uses fat for fuel instead of carbohydrate.  Ketogenic diets are, therefore, very high in fat and very low in carbohydrate.

What does it have to do with vision therapy?  I don't know that it has anything to do with vision therapy, but I suspect that at least in my case it might.

People use ketogenic diets for many reasons.  Most probably use ketogenic diets for weight loss.  Many people who have difficulty losing weight are able to lose weight using a ketogenic diet.  Often they'll lose tons of weight and then get close to their goal and then stop losing.  Then they'll cut out the remaining carbs so that they're close to zero carbohydrate, and then they're able to lose the rest.

Another reason people use ketogenic diets is because it allows them to avoid the glucose/insulin dynamic, particularly people with type 1 diabetes.  For instance they don't produce insulin, so ketogenic diets work out very well for type 1 diabetics.

Another reason people use the ketogenic diet is that it's supposedly really helpful for assuaging the symptoms of epilepsy.

I don't know why I tried it initially -- I think it's because I'm a believer in experimenting on the self.  You never know what can be your baseline experience of reality unless you change up the inputs in a systematic way.  A small and simple change can have a radical impact on the quality of your life.  For me, the ketogenic diet is an example of this.

For me, the ketogenic diet doesn't make me particularly lean.  I stay at about the same BMI, but I eat quite a lot.  Probably around 2,000-2,500 Calories, and maybe about 50 Calories worth of carbohydrate since it's difficult to completely eliminate those.  But very highly ketogenic, very high fat, and I try not to get too high on protein.

The main benefit I get from the ketogenic diet is cognitive.  I remember the fourth day of doing the ketogenic diet I remember coming back from the gym and a few hours later I suddenly felt a very unusual cool calmness wash over me.  I was sitting at my desk doing work and I suddenly noticed that I was in sync with myself.  I wasn't making any typing errors.  I stopped having to use the backspace button.  I wasn't rushing ahead of myself, and I could focus very easily.  I could watch myself focus and direct myself easily without getting distracted.  It was one of the most unusually pleasant experiences I'd had.  Very similar to being in a meditative state, but it was stronger than any meditative state I'd experienced.

Later that night I was reading a book.  At one point I noticed that I was reading much more quickly than I normally do, and I wasn't going back to re-read things.  I was just continually reading quickly and comprehending everything I was reading perfectly.  It was a very new experience.  Yet another thing I noticed is that I didn't lose energy.  Never had any sagging.  Just always awake, high focus energy throughout the day.  And I didn't seem to need to sleep as much.

I kind of got off the particular way I was doing the ketogenic diet.  I'd experimented with Calorie restriction, and I've also experimented with doing ketosis continually for more than a week.  That was bad.  Doing Caloric restriction on the ketogenic diet just takes away a lot of the huge energetic benefits that a high Calorie ketogenic diet gives me without any change in body composition.  Doing the ketogenic diet for multiple weeks in a row gets me really sick, I've learned.  After one week of high Calorie ketogenic diet with close to zero carbs, I get to about 3.2 m/MOL blood ketone levels.  If I keep at it, the m/MOL levels just keep climbing and by the end of the week it'll be at 6.8 m/MOL, which is very close to ketoacidosis.  Supposedly non-diabetics have buffering mechanisms which prevent ketoacidosis--I probably never did, and some people can stay at these levels indefinitely.  But I've done this a few times, and each time I did it, I felt god awful and got sick.  But taking a day off to load up on carbs fixes this almost immediately.

Thus, I now stick to high Calorie ketogenic diet and I load up on carbs every Saturday.  When I do this, everything works amazingly.

But I finally got back to doing two ketogenic meals per day--one in the morning, one in the evening--and the original experience is back.  I feel freaking fantastic, energy is there, and if I sleep like crap one night, it's no biggie.

I do suspect that it's having a positive effect on my vision therapy.  Like I mentioned--if you're doing high Calorie ketogenic--you get insane focus--or I do.  In particular doing the fixation cards--the accommodation seems to be getting more easily achieved.  I can get closer and closer to the cards without running into the accommodation out of sync issue.  It's still there, but I can get farther than ever before.  More energy, or I've gotten better?  I think probably both, but the energy has helped me get better.  I don't come home from work tired.  I come home from work ready to do stuff.  So the extra energy is definitely helping with vision therapy in my experience.

And I think this mental focus that a high Calorie ketogenic diet has given me has been helping a lot with my vision therapy exercises as of late.  Vision therapy is all about focus.  The better you can focus and concentrate on what you're doing the better.  The better your brain works, the more effective vision therapy is going to be.

Everything--all of our salient traits--from a biological standpoint--seem to be touched, influenced, and perhaps shaped, by the fact that we're energetic beings with a finite amount of energy.  Everything is an energy trade-off.  And this is definitely true of the visual system.  One part of your visual system can sap and take aware energy from other aspects of your visual system.  Coordination of your cilliary muscles can take away your ability to coordinate the direction of your eyeballs and vice versa.  Vision therapy can make you physically exhausted.  This might be at least part of the reason why doctors tell their patients to sleep a lot after LASIK surgery.

But if you have a huge amount of energy available always, it seems like there may be fewer required biological compromises to make.  And I don't know why this wouldn't be true of the visual system since it is part of our biology.  That's at least what my experience with the ketogenic diet has been.  It definitely feels like I need to make fewer compromises.  I can take it for granted that the energy is going to be there if I eat the fat.  I almost feel guilty because it makes me so much more effective at everything.  Almost.

Saturday, May 14, 2016

Brock string and fixation cards are still effective

There's still quite a bit of work that needs to be done.  But the good thing about the way I'm using the fixation cards is that it tells me what needs doing and how far I have to go.

The closer I am able to get to the card while having good accommodation for both eyes while fixing each eye on its respective target, the closer I am to achieving my goal of stereopsis.  My eyes have to be accommodated and focused on their targets clearly in order for stereopsis to happen.  That might not be the only thing that's needed; there may be other things as well, but I am focusing on this for now, and doing this is proving beneficial.

In the past few weeks I've noticed quite a bit of progress, especially earlier this morning.  I was able to get pretty close.  Then I close one of my eyes and then bring the paper within a few inches of my eyes until I reach the limit of accommodation.  I realize that I don't have that much further to go.

These changes to my vision seem to be translated into other areas.  I've noticed this while looking at my eyes in the mirror.  Double images of myself when I look at myself in the mirror are particularly uneven.  One set of images is significantly off.  But that seems to have improved quite a lot.  Brock string has improved a lot.  One of my weaknesses has always been getting superimpositioning the beads on top of one another when I'm looking at them obliquely, particularly if they're at the top right of my visual field.  Well, this is still an issue, but the distance of how far away the double images are has significantly gone down.

So I'm still chugging away, doing eight minutes fixation cards, eight minutes of Brock string, and then messing around with my HTC Vive.

Oh yeah, I haven't mentioned my HTC Vive.  I got it a few weeks ago.  It is goddamned incredible. The motion controls, the walking around in VR.  There is a pretty cool zombie shooter that I've been playing called Hordzes.  Because I do not yet have stereopsis, VR is not as engaging or stimulating as it is for people with stereopsis--not by a long shot.  I think the level of stimulation that some people are able to achieve with VR opens the possibility of people getting PTSD from experiences in VR.  VR is a powerful medium that has the ability to give people experiences that they remember.  It sears memories into their brains, the stuff is so powerful.  To give you an idea of what I mean:

https://www.youtube.com/watch?v=6urJejluX44

But the past few times I've been playing Hordze, I've been noticing that I'm finding it harder and trickier to not shit myself at times.  I can feel the 'oh shit' come and the electricity jumping through my arms and feel sudden clamminess on my arms and hands.  A real visceral response.  Not sure if that's just a testament to the immersion that the Vive is able to give to people with stereoblindness, or if it means that my vision is really improving and that I'm on the way to no longer being stereoblind.  I suspect the answer is that it's both.

The motion controls really are amazing, as they change from game to game.  There is an element of cheesiness because the motion controller I'm holding is light, but in the game I see this giant assault rifle that I can turn around and look at from all angles.  As they say, stereopsis really applies only to fairly close objects.  You don't really benefit from stereopsis when you're looking at mountains (although I'm sure there are still other advantages to looking at mountains with two eyes).  The stereopsis sweet spot is really up close, and I notice it particularly when I'm looking at my motion contollers in VR.  It's not true stereopsis, but it is definite a form of stereopsis that I'm experiencing.  I do get the impression that practicing this stereopsis experience, even in if it is at a low level, is helping me achieve my goal of stereopsis along with the other exercises I'm doing.  I feel like what I'm doing is working, and that feels good.