by Leo Anghart
There are two parts to the strabismus training:
• The first objective is to correct the divergence between the two eyes by encouraging flexibility in the eye muscles. We want to encourage the strabismic eye to co-ordinate with the other eye. This is done by using a piece of string as the reference point. The aim is to see the phantom cross that is present when the eyes are co-ordinated and converge on the object of interest.
• Secondly, we need to train the divergent eye, since it is usually more myopic than the dominant eye. In children this may be of lesser consequence, since the difference may be within the accommodative powers of the eye.
For the major part of strabismus training, we use a piece of string as a feedback device. In Vision Training it is important to always involve the brain to provide a clear response. The string provides both a measure of progress as well as clear feedback as to when you have succeeded.
The butterfly exercise
To attain the first objective of correcting the divergence between the two eyes, follow these steps. You will need somebody to assist with this exercise.
1. Hold the string to the tip of your nose in such a way that you have a straight line. Ask your assistant to hold the other end of the string.
2. Cover the good eye by placing a hand over it to block out all vision. This will force the brain to engage the divergent eye. Usually the eye is perfectly capable of moving and focusing on the object of interest.
3. Use a colorful object such as a marker pen and move the pen in the plane where the eye is diverging. For example, if the eyes are moving inward (esotropia) then move the pen back and forth so the brain moves the eye muscles that need to be adjusted. Move the pen back and forth (in the plane where the eye diverges) using larger and larger movements so that you become aware that your eyes can indeed track an object. Then make the movements smaller and smaller as you settle on the string, like a butterfly fluttering about before finally settling on a flower. The gradually smaller movements help train the divergent eye.
4. Now very slowly open the good eye. At one point you will have a brief glimpse of the phantom cross that occurs when both eyes converge. Initially this may be just a brief moment. Eventually it will be longer and longer until the eyes begin to track together.
5. When the eyes begin to track together, you follow the marker pen with both eyes, training them to move in unison. This movement initially takes place in the same plane. When the eyes are comfortable tracking in one plane, begin to move the marker in and out so the eyes need to converge at different planes in order to follow it. You are then practicing the second objective of getting both eyes to co-ordinate in a natural way.
Do this exercise for just a few minutes at a time but frequently during the day, as is convenient. It is better to do the exercise ten times a day for 1 minute than to do 30 minutes of the exercise once. The objective is to train the mind to co-ordinate the eye muscles so both eyes converge on the object of interest.
With children it is best to use different objects in order to catch their attention. It is also very important to make the exercise a game and not insist upon doing it because it has to be done. Remember, the child’s mind must be involved and this is best presented as entertainment. Perhaps you could give a little reward when certain milestones are achieved. This usually helps to keep the interest level high.
The long body swing exercise
This exercise has been used by vision trainers since the turn of the century and has been found particularly useful for strabismus. It is sometimes referred to as the elephant swing since the movement resembles the movement an elephant makes when chewing its food.
Swinging slowly from side to side relaxes the eyes and therefore encourages natural eye co-ordination. It works with the mind’s natural tendency to converge on a desired object. As you slowly swing from side to side, the mind will naturally try to converge on the object of interest as you swing by. This exercise is best done with children old enough to understand the instructions.
1. Stand with your feet parallel and sufficiently apart for comfortable balance. Shift your weight from one foot to the other in the easy swaying motion you have seen elephants make in the zoo. As you sway gently from side to side let your head and shoulders turn with your swing. Let the arms and hands hang limply from loose shoulders allowing the momentum to lift and swing them as you turn from side to side. Count aloud rhythmically in tempo with the swing. This is important because when you are counting aloud or singing it is impossible to hold your breath. Deep rhythmic breathing is essential for relaxation and good vision.
2. Be sure that neck, shoulder and chest muscles are loose and relaxed. Swing all of your body to one side, then to the other. As you count from 1 to 60 you develop the relaxation you need. From 60 to 100, you fully release nerves and muscles. Best of all, your eyes begin to shift with their many involuntary vibrations, which brings improved vision. You are not able to sense this but you will know that it is taking place when the entire room starts slipping past you in the opposite direction as if you were traveling in a row of railway cars going back and forth. Perhaps you can find a piece of music that will help you to sway in time.
Do this exercise slowly. The objective is to relax. Should you feel dizzy, you are leaving your eyes behind. Be sure you get the feeling of motion as you swing. When mind and eyes allow the world to pass by without clinging and fixing on passing objects, carsickness, elevator sickness and seasickness will be a thing of the past.
Do this exercise two or three times a day to induce general relaxation and better eye co -ordination.
The mirror swing exercise
This exercise comes from Clara Hackett and is described in her book Relax and See (1955: 181). The purpose is the same as the full body swing – to relax the eyes and encourage them to track together. It is a convenient exercise to do in the morning whilst you are in the bathroom.
1. With feet slightly apart stand with your back to the mirror. If your left eye turns in, then cover your right eye with one hand and look straight ahead with your left eye.
2. Slowly turn the upper part of your body left until you see your left eye in the mirror. Slowly return to the start position. Do this four to six times.
3. Next cover your left eye and turn right to see the right eye in the mirror. Do this two or three times.
The principle behind this exercise is to always encourage the diverging eye to straighten out. So start the turn in the direction in which you want the eye to turn. If the eye turns too much to the right, then you should turn towards the left.
The balance swing exercise
This is another of Clara Hackett’s exercises for strabismus. The purpose here, once again, is to encourage the eyes to track. It is always good to have a variety of exercises to play with.
1. Stand with your feet slightly apart and with both arms stretched out at shoulder level. Always turn to the opposite side from where the eye diverges. So if your left eye turns in, or your right eye turns out, you turn your head to the left.
2. Bend the upper part of your body to the right, raising your left arm to the ceiling and at the same time lowering the right arm to the floor.
3. Straighten, and then bend to the left, lowering the left arm and raising the right arm. Keep watching the left hand as your head and body move. Do this six to eight times. Then turn and do the same thing while watching the right hand.
If your right eye turns in, or your left eye turns out, complete as above but start by turning your head towards your right hand.
Tromboning exercise
This exercise was originally suggested by Janet Goodrich in her excellent book Natural Vision Improvement (1986: 129). As the name suggests, you move an object back and forth just as a trombone player moves the slide on his instrument.
First you need to create your trombone. Make a paddle similar to a table tennis paddle from some colorful cardboard. Put some attention-grabbing stickers on the cardboard so that there are l
ots of interesting things to look at.
• If the right eye diverges out, then move the paddle across your body’s midline and outwards to the left. Cover the left eye as you slowly move the paddle back and forth while looking at some of the details in the stickers and trying to keep them in focus for as long as possible.
If the eye turns in then move the cardboard from the nose and out.
• If the left eye diverges out, then move the paddle across your body’s midline and outwards to the right. Cover the right eye as you slowly move the paddle back and forth while looking at some of the details in the stickers and trying to keep them in focus for as long as possible.
• If the left eye goes in, then move the paddle away from your body’s midline to the left. Cover the right eye as you move the paddle from the center and out, while looking at the stickers and trying to keep them in focus for as long as possible.
If the eye turns then move the cardboard from outside towards the nose.
• If the right eye goes in, then move the paddle away from your body’s midline to the right. Cover the left eye as you move the paddle from the center and out, while looking at the stickers and trying to keep them in focus for as long as possible.
This exercise can be done with almost any prop – whenever is convenient. The movement encourages the mind to adjust the co-ordination of the eye muscles. Repeat this exercise for short periods of time, but do it frequently.
21. Amblyopia
Amblyopia is defined as defective visual acuity which persists after correction of the refraction error and removal of any pathological obstacle to vision. This is a condition of unknown origin where vision in one eye is switched off by the brain. Recently amblyopia has been thought of as a sensory adaptation to strabismus, a condition where one eye looks out in the wrong direction.
Some clinicians believe that there is a sensitive period of development for various visual functions. Experiments made with monkeys suggest that early visual deprivation (age 3 to 6 months) abolishes pattern and binocular vision. A later onset of visual deprivation (up to 25 months) results in reduced contrast sensitivity. Vaegan and Taylor (1980) note that visual deprivation in the first three years of life left only rudimentary vision. Patients with a later onset of vision deprivation suffered less visual loss, and patients deprived after ten years of age suffered no loss. Incidentally, many of the patients in the study showed substantial improvements in vision after optical correction and Vision Training (orthoptic treatment).
Amblyopia may develop due to a number of reasons such as:
• Deviating eye – Amblyopia is likely to develop in children under the age of 3 if one eye is deviating (turning in or out) as in strabismus. In untreated conditions a marked decrease in visual acuity may develop within just a few weeks.
• Defocused eye – When one eye is severely near-sighted and the images appear blurred at all distances (more than 4 diopters), amblyopia is likely to develop. Adults with one eye that is severely myopic may develop amblyopia if Vision Training is not undertaken, even if they wear corrective lenses.
• Deprived eye – Amblyopia can develop as a result of covering one eye for a whole day, for as little as a week, during the early stages of an infant’s visual development.
The medical treatment of choice is patching the good eye, which over the years has been supplemented with active stimulation of the eye using electrical and chemical stimulants. Strategies used include total occlusion, excluding all light and form, such as using adhesive occludes worn on the skin. Opaque black contact lenses, frosted glass and other filters are also used to this end.
Amblyopia is treated in childhood and rarely starts after the age of 8. If strabismus is involved, surgical replacement of the eye muscles is often performed in an attempt to straighten the eye so that both eyes track together. This results in a more pleasing appearance.
The success rate with patches is not especially high. A study, conducted by Watson et al. (1985) compared the effects of full-time and part-time occlusion. It was found that 23 percent of the patients studied showed no improvement despite adequate and vigorous treatment. The argument that is often proffered to explain the failure of the method is that the patient is not following the instructions. However, this study was done in a hospital setting so there was no possibility of patients not following the regime.
People who have gone though this treatment in childhood will often tell you that they hated wearing the patch and that it didn’t make much difference anyway.
If you are a parent you will know that it is virtually impossible to get a patch to stay on a child. Because of this, in some cases the children’s elbows were actually put into splints to prevent them from ripping the patch off. I believe that today many people would consider this to be child abuse.
Recently I worked with a 7-year-old called Shara in Mexico. She’d had the lens removed from her left eye. The operation was successful but she had developed severe amblyopia in the eye. The eye looked lifeless and was beginning to divert slightly. Shara had not responded to any medical treatments. In essence, she had given up hope of ever regaining sight in her left eye.
Initially Shara did not respond to any of the exercises. She had perfect 20/20 vision in the right eye and was consequently using that eye all the time. The other children in the workshop were doing an exercise using eye-charts. In a moment of inspiration, I took down one of the charts and asked her to look at the large “E” about 20 cm from her left eye. She could recognize the “E.” I asked her to relax her eyes by palming. Soon she was able to see the 20/200 and even the 20/160 line from 20 cm. This was a tremendous experience for both her and her mother because it now became apparent that her eye could respond to Vision Training.
The next day, after many short exercises, Shara was able to see even smaller letters with her left eye. Most important, however, was the changing appearance of her eye.
It had more life and was beginning to track together with the dominant right eye. Shara, with the help of her mother, needs to do exercises for a long time – perhaps years. The good news is that Shara now believes it is possible for her to get her vision back. After all, cataract removal does not affect the part of the eye that actually sees (i.e., the retina).
The problem with the traditional approach is that it is passive and does not involve the mind. You are, in essence, trying to use force to get the eyes to function normally.
Vision Training principles for amblyopia
• First establish the extent of vision in the amblyopic eye. This is done using a string and markers (see page 124).
• Train the amblyopic eye to see clearly inch by inch gradually extending the visual acuity.
The first milestone will be when you have reached the same near point for both eyes. The next milestone will be when you can manage to read using both eyes.
Include strabismus training, if necessary, to get both eyes to track together.
The Vision Training approach involves including the mind in the training. We assume that the eye has the capacity to see naturally, so it is just a matter of doing the right exercises with it. In many cases, involvement of cross-lateral movements, such as Brain Gym® exercises, are of great help in activating the various brain functions involved in well co-ordinated behaviour. Kids love to move around so Brain Gym exercises serve a useful function in making the session enjoyable and fun. It may take a long time and the exercises have to be done many times every day. However, there is a worthwhile reward – clarity of vision.
22. Color Perception
The Vision Training approach to color perception deficiency in the common red–green spectrum is to encourage finer differentiation of the problem colors. The instruction consists of exercises using colors, thus gaining a deeper understanding of how color works. Our ability to perceive colors is one of the things that makes the world beautiful. Colors are not only beautiful, they are also exceptionally useful. The color of an apple lets you know whether or not it is
ripe. Colourful displays, book and magazine covers attract our attention. Colors are also essential to fashion. Each season has a new set of colors.
Color perception deficiency affects almost 8 percent of the male population. It is believed to be inherited, usually from the maternal grandfather. The typical red–green color perception deficiency can be greatly improved by Vision Training.
The scientific study of color starts with Iasaac Newton’s great work, Opticks (1704). This is an extraordinary work detailing Newton’s experiments in Trinity College, Cambridge. In Opticks. Newton showed that white light is made up of all the spectral colors. The later wave theory of light made it clear that each color corresponds to a specific frequency.
In the nineteenth century Thomas Young proposed the trichromatic color theory which suggests that there are three primary colors. German scientist Hermann von Helmholtz developed Young’s ideas further and it became the Young–Helmholtz theory. There are three color sensitive receptors (cone cells) which respectively respond to red, green and blue. All colors are seen by a mixture of signals from the three color receptors. Incidentally, this is the same principle behind your computer screen. In computer parlance it is known as the RBG color system.
Opponent color theory
German physiologist Ewald Hering noted that red and green are never seen simultaneously and the color red/green is never used. Colors are either red or green, but not both. The same is true for blue and yellow. This observation led Hering to propose the opponent color vision theory (1964).