Graduated from Vision Therapy

I wanted to record here that I have finished vision therapy.

A few years ago, an optometrist observed that my left eye had a problem: it turned off. He was flipping the lenses and asking “better or worse?” and each time I said there was no change. My left eye wasn’t transmitting anything to my brain. Or rather, my brain had turned my left eye off.

He said it was because my old prescription was way off for my left eye, and that once we fixed the prescription, it should work itself out and be fine.

2-3 years later, it wasn’t fine. It was getting a bit worse. So I asked my optometrist what could be done and he recommended that I talk with a vision therapist. I gave them a call in the spring of 2018 and chatted over the phone enough to learn that:

  1. Going in for an assessment would cost me a couple hundred bucks.
  2. Once the assessment was done, I’d immediately need to start therapy, otherwise they’d just have to do a new assessment later.
  3. Therapy was expensive and I could expect it to cost $3-6000 depending on how long I had to go.

I couldn’t swing that in 2018, so I started saving, and then setup an FSA at work, and went in for an assessment in the spring of 2020.

My left eye was diagnosed with intermittent exotropia, which means it drifted to the left, but only sometimes. And that drift was happening because my brain was turning it off. I began doing therapy at the optometrist for an hour a week, and I was supposed to do it at home 3-4 times a week. I did alright at the beginning, but quickly my home therapy dwindled until I was doing almost nothing for the last few months. I would blame it on the new baby, except I wasn’t doing much home therapy before Isaac came along.

Despite my lack of work at home, my vision continued to improve. I had exercises and tests and did all kinds of things to improve my muscle control of my eyes, my focusing system, and my ability to process input from both eyes at the same time. That last was surprisingly difficult and exhausting at first.

Each set of therapy sessions was 12 weeks long followed by an assessment, and yesterday I had my third assessment (if you include that first one). After 27 weeks total, I graduated from vision therapy with a clean bill of health. I exceeded all of the tests they had, went as far as their machines can assess, and am doing great!

My left eye will still drift on occasion, but it never turns off, and I can both tell when it’s drifting and I can move it back into alignment. I can consciously keep it solid and forward 100% of the time now.

They recommended I still do one of my therapy exercises 1-2 times a week to maintain my processing, and I have appointments in 1, 3, and 6 months to check in and make sure there is no regression. But I doubt there will be given the huge improvements I have experienced in the last few months despite little at-home effort. So much of the therapy was learning the feel of my eye muscles and how to control them, and now that I have that, I don’t think I’ll lose it. The doctor echoed that and said that the vast majority of people never need to return for more therapy.

So I’m excited to be better, but I’m also a little sad. I started vision therapy after the pandemic got bad, and meeting with the three women at Vision Clinic who conducted my therapy every week has been one of my only social outings and connections. I spent over half of 2020 seeing them every week, and now it’s over except for the follow-up check-ins.

Focus and visualization

I learned something interesting about myself in vision therapy this week.

I haven’t written about vision therapy here, so for those of you who don’t know, my left eye is intermittent exotropic. That means that sometimes, but not all the time, it drifts to the outside. And when this happens, my left eye turns off–I don’t see anything from it. This isn’t a problem with my eye, but with my brain. My brain is stopping using my eye, so it turns off and drifts, and this impacts my binocular vision, often without me realizing it. I don’t know that it’s turned off and I’m just seeing from my right eye. When my left eye is partially working, I have double vision.

I have been in therapy for it now for around 14 weeks, with another 20 weeks or so to go hopefully. One thing I learned a couple of months ago is that I don’t trust my vision as much as my other senses. Because I have had this problem since I was a kid, I have learned to compensate for it. Hearing and touch are my two primary means of compensating, and that’s evident in a few different ways. For example, I learned to play violin more by listening than by reading music, and I learned to touch-type rather than ever looking at the keyboard.

But this week taught me something new. We did an exercise where there were two pieces of paper, one on the wall and a smaller duplicate in my hands. The paper had coordinates around the edge using letters and numbers like the game Battleship. The therapist would call out a coordinate and I had to find the letter and say it. She’d call out a second coordinate and I had to look to the other piece of paper (wall or hand) and say it. I then had to remember all these letters as she went, and at the end say the word that was spelled.

There are a few different things addressed with this exercise. It’s making me focus near and far, back and forth. It’s requiring me to first find coordinates then to trace a line (horizontally and vertically) to find the letter. And it’s requiring me to put the word together. She encouraged me to visualize the letters and then visualize what they were spelling.

I really struggled with that last goal. Instead, I memorized the letters as I went because that’s how I was taught to spell. I memorized word spelling, and if there was a word I struggled with, I wrote it hundreds of times until I had it down. I am generally good at remembering spelling now for many words.

In this case, it made the exercise much harder because I naturally try to remember the letters and put them together, but I couldn’t differentiate between the letters and the coordinates. I memorized all of them. But because they were mixed together (two coordinates, then letter, then two coordinates, then letter, etc.), it made it more challenging to get the word. And as the words got longer, it became really hard. We stopped at six letters, by which point “flower” became “glewer” because I had substituted some coordinate letters for the word letters.

Visualization was hard in this context. What’s interesting to me about this is that I am able to visualize very well in other contexts. I read a lot, and when I read a good book, I became imaginatively immersed in it. I fully see the setting, the characters, and what’s happening as if I am there or as if I’m watching it on an IMAX screen. Also notable is that I read pretty fast, but without skimming (or skipping): I’m getting the words, but I’m diving into the scene. When I really get into the flow, I’m not even necessarily noting the individual words, but rather the scene that they’re constructing: I’m putting the sentences and paragraphs together.

This dovetails with another exercise I am doing: reading with a red/green bar screen on my Kindle and red/green glasses. I keep the green lens over my left eye, and as a result, the green bars are very hard to see through while the red are mostly transparent. This will help me develop binocular vision where both eyes are active at the same time, and my brain will learn to receive input from both eyes simultaneously and process it.

What ends up happening is that I’m focusing really hard on individual words and reading quite a bit more slowly, and the green bars continue to be pretty dark. It’s almost impossible for me to get into the scene. If I close my right eye, though, the green bars practically disappear, similar to how the red bars are all the time.

I began to wonder this morning if the problem is that I’m naturally too focused on the individual words. That is to say, maybe I’m focusing too much on those individual letters and words instead of widening my focus and seeing the whole page at the same time.

This is another thing I have been learning through vision therapy, and which my last assessment demonstrated I am improving on: widening my perspective. I have learned to compensate for my lazy eye by forcing myself to focus really hard on one point. When that happens, only one of my eyes is typically active, which is not ideal. I need to learn how to use both of my eyes, see both the point in space I’m looking at while also being aware of everything around, ahead of, and behind that point, and see the point clearly. I think this is easy for many people, but it’s quite challenging for me.

There is a psychological aspect to this therapy in addition to the physical. I am having to learn to trust my vision at least as much as I trust my other senses, which is surprisingly hard for me. My vision hasn’t been reliable almost my entire life. It’s like asking me to trust a person who hasn’t been reliable, and that’s hard. And this concept of widening my perspective so I can see the whole instead of a single point also seems to have some psychological aspects to it.

I was working hard this morning with the bar screen to not try and read the words for now, but just to keep both eyes active, keep them looking at the overall screen, and try to get both the red and green bars to be transparent. I didn’t get there, and it kind of made me nauseous. What’s happening is my left eye is turning on and off rapidly, and while I don’t perceive much change in my vision while that happens, it shifts focus and distance perception very slightly and very quickly. Think of it like putting on 3D glasses and having the 3D screen do a strobe effect of turning the 3D effects on and off, but probably a bit less dramatic because my brain is struggling to process it.

Which is really the crux of the matter: my brain is getting overwhelmed with the processing. Like any muscle, I can develop and improve this. It has been done before, and I will do it also. But like most exercise, it is hard and takes time.

I have already showed a lot of improvement. In many areas, I went from outside the desired norms to having normal vision and function, so that’s pretty cool. My drawing is a bit better. I noticed a few weeks ago when we were at a park that I’m better able to watch Simon and also appreciate everything around us–I’m seeing the foreground and background of the point at which I’m looking more than I was before.

But I’m also reflecting on what this says about me as a person beyond what’s going on with my vision. The way I absorb letters to construct words, and the way I put together words into a sentence, and the way I combine words and sentences into meaning… I feel like that hints at something about how I perceive and interact with the world. It likely says something about how I approach my work.

I don’t yet know exactly what it says. This light bulb just started to come on and I wanted to write it down so I could reflect more on it later. But I sense that there’s more to this, and I think understanding it will help me improve both my physical vision and my mental and imaginative vision.