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Dominick M. Maino, OD, MEd, FAAO, FCOVD-A AOA National Spokesperson on 3 D Vision Syndrome AOA Classroom 3D Project Team Member Professor, Pediatrics/Binocular Vision Service Illinois College of Optometry Illinois Eye Institute 3241 S. Michigan Ave. Chicago, Il. 60616 312-949-7280 (Voice) 312-949-7358 (fax) firstname.lastname@example.org MainosMemos.blogspot.com www.ico.edu nw.optometry.net
Lecture Rules:1.) Yes, you may ask questions.2.) But only if I know the answer!3.) My answer is always right!4.) An updated version of thispresentation can be found atwww.slideshare.net/DMAINO/
3 D Tipping Point A 3D TV Tipping Point? http://www.cnbc.com/id/41591929/A_3D_TV_Tipping_Point Stereoscopic 3D Technologies Reach Tipping Point on PC Market – JPR.http://www.xbitlabs.com/news/video/display/20100526234951_Stereoscopic_3D_Technologies_Rea ch_Tipping_Point_on_PC_Market_JPR.html 10/114
ESPN: 3D Is at the Tipping Point3D Printing Technology Nearing Tipping PointWill you one day print yourself a new bowl or even a new house using 3D printingtechnology? 3D printers are nearing a tipping point according to one expert cited in aTechWeb article.Sharp’s New Cell phone Video May Be a Tipping Point for 3Dhttp://www.bnet.com/blog/gadget-guy/sharp-8217s-new-cellphone-video-may-be-a-tipping-point-for-3d/3153-D reaches a tipping point in Europehttp://www.variety.com/article/VR1118004886Dr. Karl Kapp: "the tipping point for 3D will be in the healthcare industry“3D Medical Educationhttp://medical-animation-studio.com/
Many activities including: http://www.youtube.com/watch?v=9U4 AoDWPEQ0Symposia, 3D Users Experience Tech Summit, The 3Ds of3D Viewing, AOA YouTube Videos3D in the Classroom: See Well, Learn Well
The Public Health Implications of Virtual 3D Michael Duenas, ODThe Visual System and Virtual 3D Jim Sheedy, O.D., Ph.D. 3D: The User Experience Story Philip J. Corriveau
Exploring a New Dimension Chris Haws Do You Know if the Kids are OK? Maureen Powers, PhD Improving Binocular Vision- Creating a Better 3D Audience 3D Vision SyndromeDominick M. Maino, OD, MEd, FAAO, FCOVD-A
The Public Health Implications ofVirtual 3D - Michael Duenas(http://www.youtube.com/watch?feature=player_embedded&v=howdZm-d7Z0)
Public Health Model3D Movies Have a New Dimension: Protecting Eye Health 1850 Snellen Eye Chart Snellen eye chart has a 27% sensitivity (OMG!!) High rate of FALSE Negatives. Children that are referred because they fail the eye chart …. Have a distance VA problem Pediatrician screening? School nurse screening? Only 3 states have mandatory vision screening. Only a small percentage of children ever get the care they need 25% of school children have one or more vision problems Undiagnosed untreated vision disorders are very prevalent Cost of untreated vision problems staggering All BV are treatable and preventable: Great Public Health Model
The Visual System and Virtual 3D - Jim Sheedy, O.D., Ph.D. (http://www.youtube.com/watch?v=ZLpwCC5yxlo&feature=related)
3D: The User Experience Story - Philip J. Corriveau (http://www.youtube.com/watch?v=1IiHNit3RPM&feature=related)
Exploring a New Dimension- Chris Haws(http://www.youtube.com/watch?v=4qZw98mkIhI&feature=related )
Brock String Debuts at the Consumer Electronics Show Kids@Play Summit at CES 2011 Dominick M. Maino, OD, MEd, FAAO, FCOVD-A(http://mainosmemos.blogspot.com/2011/04/dr-dominick-maino-at-consumer.html) 20/114
Available from: AOA 3D@Home 3deyehealth.org MainosMemos
Binocular Vision Dysfunction as a Medical &Public Health Issue
Improving Binocular Vision - Creating a Better AudienceMaybe Mike, from "Monsters, Inc.,"looks so sad because he realizes3-D doesnt do you any good if youdont have binocular vision.)....
For the 3D Movie, Television, Video-gaming and 3D in the ClassroomTechno-Industrial Complex….not havingbinocular vision is the 800lbs Cyclops inthe room!
Improving 3D Television Technology but Not Creating a Better 3D Viewing Audience1920‟s Image Credit : Baird Television Today
Improving 3D Movie Technology but Not Creating a Better 3D Viewing Audience1953 Image Credit: Mystic Cinema Today Image Credit: Joystiq
Improving 3D Gaming Technology but Not Creating a Better GamerImage Credit: Daily Motion 3D Image Credit: Nintendo
Improving Classroom Technology but Have Not Created a Better 3D Viewing Student 30/128 Image Credit: American Optometric AssociationImage Credit: mkrstovic.edublogs.org
History of 3D 3D in the Classroom: See Well, Learn Well 3D Timeline
3 D Stereo Scopes1844Scottish inventorand writer DavidBrewster introduced theStereoscope1862USA jurist, author,inventor OliverWendell Holmesmakes it possiblefor all to enjoy 3D! 30/114
Some of the first 3D Movies included:Bwana Devil (1952 ) starring Robert Stack http://www.youtube.com/watch?v =4oGl_KqTw-M&NR=1
3D Tech - NASA Uses Video Games for Visualization & Engineering http://www.youtube.com/watch?v=v-mFx6blZK8 NASA Video Game Brain Training for ADHD http://www.youtube.com/watch?v=S26Kk- ueWjQ&feature=relatedMario Brothers 3Dhttp://www.youtube.com/wat ch?v=0U0ZDjnQiXQ
Passive 3D glasses technology Linearly polarized glassesTwo images are projected superimposed onto the same Use a silver screen so that polarization is preserved. Can‟t tilt head
Passive 3D glasses technologyCircularly polarized glassesLight that is left-circularly polarizedis extinguished by the right-handedanalyzer, while right-circularlypolarized light is extinguished bythe left-handed analyzer.The viewer can tilt their head andstill maintain left/right separation.
RealD Cinema system uses anelectronically driven circular polarizerInfitec glassesInfitec (interference filter technology.)Filters divide the visible colorspectrum into six narrow bands"super-anaglyph”
Dolby 3D theatresComplementary coloranaglyphs (use red and cyan)
3D glasses technology ActiveActiveLCD shutter glassesA liquid crystal glasses stopor allow light in thrusynchronization with theimages seen on the screenRed eye shutterglassesThe Red Eye Methodreduces the ghosting 50/114
Active 3D Glasses small LCD screenswhen voltage applied lens goes dark synced with screen showing 3Dcontent then alternates image viewed each eye different angle of view creates 3D effect
Active 3D Glassesthis method of 3D cuts refresh rate in halfKnown to cause headaches http://www.3d-tvbuyingguide.com/3dtv/3d-glasses.html
Active 3D Glasses 3D Personal Display Spectacles two small screens in the glassesdisplay separate images to each eye. Does not require a television http://www.trendhunter.com/trends/head-mounter-3d
Autostereoscopic displays Auto 3D Almont Green 3D Photography (http://almontgreen.wordpress.com/)
Lenticular printingused to produceimages with anillusion of depth, orthe ability tochange or moveas the image isviewed fromdifferent angles
Autostereoscopic displays Auto 3D Nintendo 3DS Nintendo 3DS is hazardous to the eyes of children (Nope!)http://www.digitaltrends.com/gaming/nintendo-3ds-is-hazardous-to-kids-eyes/
Remember we want 6 y/olds using Nintendo 3DS! 3D Vision as Public Health Model 60/128
How Does Nintendo3DS Work? two separateoutputs at slightly different angles one for your lefteye and the other for your righthttp://kombo.com/features/How_the_ 3DS_Works/
3D Vision Syndrome What constitutes a syndrome?A group of symptoms that collectivelyindicate or characterize a disease,psychological disorder, or otherabnormal condition
So is the 3D Vision Syndrome Really a Syndrome? Yes.The symptoms and signs consistentlyinclude: headaches, nausea, dizziness, avision induced sense of motion, diplopia,blurred vision and eyestrain; as well as adisconnect between accommodation andvergence.
The 3D’s of 3D Viewing:Discomfort, Dizziness and Lack of Depth Discomfort: Since 3D viewing is based on the eyes converging in front of or beyond the screen, viewing 3D images can potentially create eyestrain and headaches
The 3D’s of 3D Viewing:Discomfort, Dizziness and Lack of DepthDizziness:3D technology canexaggerate visually inducedmotion sickness …causingconsumers to feel dizzy ornauseous during or afterviewing 3D content.
The 3D’s of 3D Viewing:Discomfort, Dizziness and Lack of DepthLack of Depth:A viewer lacking binocularvision, simply won‟t see 3D.While this doesn‟t pose anyproblem viewing the screen, itserves as a “vision screening”that something is abnormalwith the viewer‟s binocularvision. Photo credit: Photobucket
Symptoms of 3D Vision Syndromeasthenopia, headaches, blurred vision,eyestrain, diplopia, dizziness/nausea andvision induced motion sickness …..or …. Image credit: squidoo.com/3d-Image Credit: American Optometric Association animated-gif
Symptoms of 3D Vision Syndrome …a happy, actively engaged users of 3D content?Image Credit: American Optometric Association
3D Vision Syndrome …… is comprised of a group of symptoms andphysical signs that collectively indicate orcharacterize a functional vision and/or eyehealth disorder that manifests when viewingsimulated 3D technology. These signs andsymptoms include but are not limited toheadaches, blurred vision, eyestrain, doublevision, dizziness/nausea, decreased depthperception and vision induced motion sickness.
So….is thisreally a publichealth issue? 70/128
Scope of The Problem Amblyopia 2% (6,239,043 US) Strabismus 2-5% (15,597,609 USAccommodation 2.5-9.2% (28,699,600 US) Eye Coordination (CI 7%) Up to 25% (77,988,195 US) Vertical Misalignment 7-52% (162,215,135 US) US Census Bureau: U.S. 311,952,183 World 6,954,459,463 AOA Clinical Guidelines: http://www.aoa.org/x4813.xml US Census: http://www.census.gov/main/www/popclock.html
According to Statistics Canada, thepopulation of Canada, as of January 1,2011, is estimated to be 34,278,400. Amblyopia 2% (686,568) Strabismus 2-5% (1,713,920)Accommodation 2.5-9.2% (3,085,056) Eye Coordination (CI 7%) Up to 25% (8,569,600) Vertical Misalignment 7-52% (17,842,768)
Toronto, has apopulation of 2.48 millionpeople (5.5 million in theGTA - Greater TorontoArea)
Chicago is only a bitmore than an hourplane ride fromToronto…so if you don‟twant to care for thesefolks….
How to Dx an Individual with 3D Vision Syndrome Examination SequenceComprehensiveVisual Efficiency/Strabismus/AmblyopiaSpecial Testing (Visagraph, TOVA, etc)
How to Dx an Individual with 3D Vision Syndrome Case Hx Salient Findings
How to Tx an Individual with 3D Vision SyndromeWe really don‟tknow the bestmethodology/approach.
How to Tx an Individual with 3D Vision Syndrome Use what we do know Rx/PrismOptometric Vision Therapy
These are your patient‟s eyes….These areyour patient‟seyesOn 3D!
3D Vision Syndrome Single Subject Design Research Study Patient #1Symptoms:blurred vision, doublevision, nausea,headache, dizzinesswhile watching 3Dmovie 80/128
3D Vision Syndrome Patient #1 27 y/o white female College educated Athletic trainerHx of reading problems since 5th grade Remedial reading class in college Seasonal allergies Nephrectomy
3D Vision Syndrome Patient #1Initial Findings VA‟s CLS RE/LE 20/20 OR RE -.25, LE PL Acceptable Fit MR RE -4.25-50X175 20/15, LE -4.00-.50X175 20/15 Pursuits/Saccades +4 CT 18 XOP @ near 2nd Degree Fusion Variable
3D Vision Syndrome Patient #1Initial Findings Random Dot 100” (?) NPC 2/6/4” After 5 attempts pain noted PFV/NFV @ near could not do/diplopia - Lens amplitudes could not do NRA +2.00 diplopia PRA -1.00
3D Vision Syndrome Patient #1Initial Findings Accommodative Facility diplopia MEM variable Ocular health mild allergic conjunctivitis
3D Vision Syndrome Patient #1Plan Obtain past records Start Optometric Vision Therapy
3D Vision Syndrome Patient #1Previous Eye Examination (10/09) “No Binocular Testing Done!”Hx “General Exam”, health “good”, Aided VAs 20/20RE/LE, SLE unremarkable, Non-dilated fundusevaluation unremarkable, Ret -4.00 Sph RE/LE, MR-4.00-50X175 RE, -4.00-.50X180 LE, CT 2XOdist/Ortho near, BI 20/8, BO 24/12 near Dx Myopia, Astigmatism
Optometric Vision TherapyEvidence Based Medicine
Randomized clinical trial of treatments for symptomatic convergenceinsufficiency in children. Arch Ophthalmol. 2008 Oct;126(10):1336-49.Convergence Insufficiency Treatment Trial Study Group.CONCLUSIONS:Twelve weeks of OBVAT results in a significantlygreater improvement in symptoms and clinicalmeasures of near point of convergence andpositive fusional vergence and a greaterpercentage of patients reaching the predeterminedcriteria of success compared with HBPP,HBCVAT+, and OBPT. Application to ClinicalPractice Office-based vergence accommodativetherapy is an effective treatment for children withsymptomatic convergence insufficiency.
Scheiman M, Cotter S, Kulp MT, Mitchell GL, Cooper J, Gallaway M, HopkinsKB, Bartuccio M, Chung I; the Convergence Insufficiency Treatment Trial StudyGroup. Treatment of Accommodative Dysfunction in Children: Resultsfrom a Randomized Clinical Trial. Optom Vis Sci. 2011 Nov;88(11):1343-1352.CONCLUSIONS: Visiontherapy/orthoptics is effective inimproving accommodativeamplitude and accommodativefacility in school-aged children withsymptomatic CI andaccommodative dysfunction.90/128
Long-term effectiveness of treatments for symptomatic convergenceinsufficiency in children. Optom Vis Sci. 2009 Sep;86(9):1096-103.Convergence Insufficiency Treatment Trial Study Group.CONCLUSIONS: Most children aged 9 to17 years who were asymptomatic aftera 12-week treatment program ofOBVAT for convergence insufficiencymaintained their improvements insymptoms and signs for at least 1 yearafter discontinuing treatment. ….
Scheiman M, Mitchell GL, Cotter S, Kulp MT, Cooper J, Rouse M, Borsting E,London R, Wensveen J. A randomized clinical trial of visiontherapy/orthoptics versus pencil pushups for the treatment ofconvergence insufficiency in young adults. Optom Vis Sci. 2005Jul;82(7):583-95.DISCUSSION: In this study, vision therapy/orthoptics was the onlytreatment that produced clinically significantimprovements in the near point of convergence andpositive fusional vergence. …… Pencil Push ups do not work very well!
Ciuffreda KJ. The scientific basis for and efficacy of optometric visiontherapy in nonstrabismic accommodative and vergence disorders.Optometry. 2002 Dec;73(12):735-62.BACKGROUND:For nearly 75 years, optometric vision therapy has been an important mode oftherapy for both children and adults who manifested a range of nonstrabismicaccommodative and vergence disorders.METHODS:In this article, the scientific basis for, and efficacy of, optometric vision therapyin such patients will be discussed. Using bio-engineering models of theoculomotor system as the conceptual framework, emphasis will be focused onstudies that used objective recording techniques to directly assesstherapeutically related changes in oculomotor responsivity.RESULTS AND CONCLUSIONS:The findings clearly support the validity ofoptometric vision therapy. Furthermore, theresults are consistent with the tenets of generalmotor learning.
Maino D. The number of placebo controlled,double blind, prospective, and randomizedstrabismus surgery outcome clinical trials:None! Optom Vis Dev 2011;42(3):134-136.http://www.covd.org/Portals/0/OVD/42-3/Editorials/OVD%2042-3%20Journal_Editorial_Maino_web.pdf
3D Vision Syndrome Patient #1 Optometric Vision TherapyPhase 1 Phase 2 Phase 3 Phase 4Mono Biocular Binocular IntegrationOculo- add anti- add StabilizationMotor, suppression vergenceHE, Acc 3 month post OVT maintenance Tx and final progress evaluation
Use principles of neuro-plasticity therapy:Maino D. Neuroplasticity: Teaching an OldBrain New Tricks. Rev Optom 2009. 46(1):62-64,66-70
3D Vision Syndrome Patient #1 Optometric Vision TherapyOVT #1HC SaccadesHC RockHTS (saccades, pursuits,accommodationBrockstringHVTSent Home all of the above
3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #2 Reviewed HVT Vision Builder (saccadesFranzblau Red Rock Brockstring
3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #3 Reviewed HVT Minus lens dips HC accom rock Vision Builder (binoc reading) Quoits
3D Vision Syndrome Patient #1 Optometric Vision Therapy Progress evaluation #1 20/15 BVA, RE/LE NPC TN no pain CL OR RE +1.00-.50X180 BI 12/9 near 20/20 BO > 45 LE +1.25 20/20 Amps 7 D RE/LEMR RE -3.25-.25X175 20/20 Facility 8 CPM RE, 11 CPM LE, LE -3.250.75X005 20/20 10 CPM OU Pursuits +4 Saccades +3 CT 2EP (near) MEM +.75 each eye W4D 4 at all distances Random dot 20 „ During evaluation no diplopia, pain, suppression stable findings Symptoms improving, not all resolved
3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #7 Clown vectograms (push BI) Chicago Skyline (jump)
3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #8 Clown vectograms (push BI) with +/-1.00 Tranaglyph BC 601 Brockstring Aperture Rule Switch to HVT only due to change in work scheduleSaw 3D movie…no problems!
3D Vision Syndrome Patient #1 Optometric Vision Therapy Progress Evaluation #2 1 month laterMajority of symptoms resolved BVA 20/20 RE, LE Amps 8.33 RE/LE Slight + CL OR NRA +2.50 CT ortho/2 EXO PRA -2.25 NPC TN Facility 6 RE, 7LE, 8 OU CPM no After 5 trials TN suppression NPC with RL 7/10 cm MEM +.50 RE, LE Vergence dist BI x/14/10 BO X/30/25 RTO 6 mos CEE, intermittently do Near BI 16/12 BO 35/25 HVT W4D 4 all distances Random Dot 25‟ Pur/Sac +4
Started Here: Ended Here: VA‟s CLS RE/LE 20/20 Majority of symptoms resolvedOR RE -.25, LE PL Acceptable Fit BVA 20/20 RE, LE MR RE -4.25-50X175 20/15, Slight + CL OR LE -4.00-.50X175 20/15 Pur/Sac +4 Pursuits/Saccades +4 CT ortho/2 EXO, NPC TN CT 18 XOP @ near After 5 trials TN NPC 2/6/4” NPC with RL 7/10 cmAfter 5 attempts pain noted Vergence dist BI x/14/10PFV/NFV @ near could not BO X/30/25 do/diplopia Near BI 16/12 BO 35/25 W4D Fusion Variable W4D 4 all distances, Random Random Dot 100” (?) Random Dot 25‟- Lens amplitudes could not Amps 8.33 RE/LE do NRA +2.50, PRA -2.25 NRA +2.00 diplopia Facility 6 RE, 7LE, 8 OU CPM PRA -1.00 no suppression MEM +.50 RE, LE
Convergence insufficiency, Accommodative dysfunctions, Headache, Diplopia, Blurred vision, Double vision, Nausea, DizzinessAll resolved in 8 OVT visits and HVT Last Progress Evaluation on 7/10 On 8/1/10 the patient texted me and said, “Just saw a 3D movie. It didn‟t hurt! It was an awesome experience!”
Computer Programs Used in Optometric Vision Therapy Computer AidedHome Therapy Solutions Vision Therapy
3D as a Public Information and Marketing Tool 3D in the News-Print Media-InternetIn Your Office-3D Pictures-NewslettersWebsite/Blog/Facebook/SOVOTO/LinkedIn Media Awareness! 110/128
3D in the News ABC Chicago http://abclocal.go.com/wls/stor y?section=news/health&id=72 98893
3D Resources AOA http://www.aoa.org American Academy of Optometry http://www.aaopt.org 3D Eye Health.org http://www.3deyehealth.org/ COVD http://www.covd.org OEPF http://www.oepf.org Optometrists Network http://www.vision3d.com/Berezin Stereo Photography Products http://www.berezin.com/3d/
Questions?Dominick M. Maino, O.D., M.Ed., F.A.A.O., F.C.O.V.D-A. Professor, Pediatrics/Binocular Vision Service Illinois College of Optometry Illinois Eye Institute 3241 S. Michigan Ave. Chicago, Il. 60616 312-949-7280 (Voice) 312-949-7358 (fax) email@example.com MainosMemos.blogspot.com www.ico.edu nw.optometry.net