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3 D Vision Syndrome: Toronto


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This lecture was given in Toronto, CA 11-5-11 during the

This lecture was given in Toronto, CA 11-5-11 during the

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  • 1. Disclosure Statement: Nothing to disclose” Please silence all mobile devices. Unauthorized recording of this session is prohibited.
  • 2. 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)
  • 3. 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
  • 4. Photo credit:
  • 5. Virtual 3 D: Why Now?
  • 6. 3 D Tipping Point A 3D TV Tipping Point? Stereoscopic 3D Technologies Reach Tipping Point on PC Market – JPR. ch_Tipping_Point_on_PC_Market_JPR.html 10/114
  • 7. 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 3D reaches a tipping point in Europe Karl Kapp: "the tipping point for 3D will be in the healthcare industry“3D Medical Education
  • 8. +
  • 9. Many activities including: AoDWPEQ0Symposia, 3D Users Experience Tech Summit, The 3Ds of3D Viewing, AOA YouTube Videos3D in the Classroom: See Well, Learn Well
  • 10. 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
  • 11. 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
  • 12. The Public Health Implications ofVirtual 3D - Michael Duenas(
  • 13. 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
  • 14. The Visual System and Virtual 3D - Jim Sheedy, O.D., Ph.D. (
  • 15. 3D: The User Experience Story - Philip J. Corriveau (
  • 16. Exploring a New Dimension- Chris Haws( )
  • 17. Brock String Debuts at the Consumer Electronics Show Kids@Play Summit at CES 2011 Dominick M. Maino, OD, MEd, FAAO, FCOVD-A( 20/114
  • 18. Available from: AOA 3D@Home MainosMemos
  • 19. Binocular Vision Dysfunction as a Medical &Public Health Issue
  • 20. 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.)....
  • 21. For the 3D Movie, Television, Video-gaming and 3D in the ClassroomTechno-Industrial Complex….not havingbinocular vision is the 800lbs Cyclops inthe room!
  • 22. Improving 3D Television Technology but Not Creating a Better 3D Viewing Audience1920‟s Image Credit : Baird Television Today
  • 23. Improving 3D Movie Technology but Not Creating a Better 3D Viewing Audience1953 Image Credit: Mystic Cinema Today Image Credit: Joystiq
  • 24. Improving 3D Gaming Technology but Not Creating a Better GamerImage Credit: Daily Motion 3D Image Credit: Nintendo
  • 25. Improving Classroom Technology but Have Not Created a Better 3D Viewing Student 30/128 Image Credit: American Optometric AssociationImage Credit:
  • 26. History of 3D 3D in the Classroom: See Well, Learn Well 3D Timeline
  • 27. 3 D Stereo Scopes1844Scottish inventorand writer DavidBrewster introduced theStereoscope1862USA jurist, author,inventor OliverWendell Holmesmakes it possiblefor all to enjoy 3D! 30/114
  • 28. Some of the first 3D Movies included:Bwana Devil (1952 ) starring Robert Stack =4oGl_KqTw-M&NR=1
  • 29. House of Wax (1953) starring Vincent Price
  • 30. 13 Ghosts (1960) I
  • 31. The Mask (1961)
  • 32. 3D Television Stereoscopic television was first demonstrated by John Logie Baird in 1928 Stereo TV Stereo Receiver
  • 33. 3D TelevisionStereoscopic television was first demonstrated by JohnLogie Baird in 1928
  • 34. 3D EducationVRMagic Digital BIO 40/128
  • 35. 3D EducationVRMagic Digital BIO
  • 36. 3D Education 40/114
  • 37. 3D Video-games
  • 38. 3D Tech - NASA Uses Video Games for Visualization & Engineering NASA Video Game Brain Training for ADHD ueWjQ&feature=relatedMario Brothers 3D ch?v=0U0ZDjnQiXQ
  • 39. 3D in the Classroom: See Well, Learn Well
  • 40. 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
  • 41. 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.
  • 42. Circularly polarized glasses
  • 43. RealD Cinema system uses anelectronically driven circular polarizerInfitec glassesInfitec (interference filter technology.)Filters divide the visible colorspectrum into six narrow bands"super-anaglyph”
  • 44. Dolby 3D theatresComplementary coloranaglyphs (use red and cyan)
  • 45. 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
  • 46. 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
  • 47. Active 3D Glassesthis method of 3D cuts refresh rate in halfKnown to cause headaches
  • 48. Active 3D Glasses 3D Personal Display Spectacles two small screens in the glassesdisplay separate images to each eye. Does not require a television
  • 49. Autostereoscopic displays Auto 3D Almont Green 3D Photography (
  • 50. Lenticular printingused to produceimages with anillusion of depth, orthe ability tochange or moveas the image isviewed fromdifferent angles
  • 51. 3D Printing
  • 52. Autostereoscopic displays Auto 3D Nintendo 3DS Nintendo 3DS is hazardous to the eyes of children (Nope!)
  • 53. Remember we want 6 y/olds using Nintendo 3DS! 3D Vision as Public Health Model 60/128
  • 54. How Does Nintendo3DS Work? two separateoutputs at slightly different angles one for your lefteye and the other for your right 3DS_Works/
  • 55. 3D Vision Syndrome What constitutes a syndrome?A group of symptoms that collectivelyindicate or characterize a disease,psychological disorder, or otherabnormal condition
  • 56. 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.
  • 57. 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
  • 58. 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.
  • 59. 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
  • 60. Symptoms of 3D Vision Syndromeasthenopia, headaches, blurred vision,eyestrain, diplopia, dizziness/nausea andvision induced motion sickness …..or …. Image credit: Credit: American Optometric Association animated-gif
  • 61. Symptoms of 3D Vision Syndrome …a happy, actively engaged users of 3D content?Image Credit: American Optometric Association
  • 62. 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.
  • 63. So….is thisreally a publichealth issue? 70/128
  • 64. 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: US Census:
  • 65. 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)
  • 66. Toronto, has apopulation of 2.48 millionpeople (5.5 million in theGTA - Greater TorontoArea)
  • 67. Chicago is only a bitmore than an hourplane ride fromToronto…so if you don‟twant to care for thesefolks….
  • 68. How to Dx an Individual with 3D Vision Syndrome Examination SequenceComprehensiveVisual Efficiency/Strabismus/AmblyopiaSpecial Testing (Visagraph, TOVA, etc)
  • 69. How to Dx an Individual with 3D Vision Syndrome Case Hx Salient Findings
  • 70. How to Tx an Individual with 3D Vision SyndromeWe really don‟tknow the bestmethodology/approach.
  • 71. How to Tx an Individual with 3D Vision Syndrome Use what we do know Rx/PrismOptometric Vision Therapy
  • 72. These are your patient‟s eyes….These areyour patient‟seyesOn 3D!
  • 73. 3D Vision Syndrome Single Subject Design Research Study Patient #1Symptoms:blurred vision, doublevision, nausea,headache, dizzinesswhile watching 3Dmovie 80/128
  • 74. 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
  • 75. 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
  • 76. 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
  • 77. 3D Vision Syndrome Patient #1Initial Findings Accommodative Facility diplopia MEM variable Ocular health mild allergic conjunctivitis
  • 78. 3D Vision Syndrome Patient #1Diagnosis Convergence insufficiency Accommodative dysfunctions Headache Diplopia Allergic conjunctivitis
  • 79. 3D Vision Syndrome Patient #1Plan Obtain past records Start Optometric Vision Therapy
  • 80. 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
  • 81. Optometric Vision TherapyEvidence Based Medicine
  • 82. 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.
  • 83. 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
  • 84. 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. ….
  • 85. 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!
  • 86. 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.
  • 87. 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.
  • 88. 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
  • 89. Use principles of neuro-plasticity therapy:Maino D. Neuroplasticity: Teaching an OldBrain New Tricks. Rev Optom 2009. 46(1):62-64,66-70
  • 90. 3D Vision Syndrome Patient #1 Optometric Vision TherapyOVT #1HC SaccadesHC RockHTS (saccades, pursuits,accommodationBrockstringHVTSent Home all of the above
  • 91. 3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #2 Reviewed HVT Vision Builder (saccadesFranzblau Red Rock Brockstring
  • 92. 3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #3 Reviewed HVT Minus lens dips HC accom rock Vision Builder (binoc reading) Quoits
  • 93. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #4 Reviewed HVT Vision BuilderRandot vergenceEccentric Circles Quoits 100/128 Photo credit VisionHelpBlog
  • 94. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #5 Reviewed HVT +/- Flippers (mono) Eccentric Circles HTS autoslide vergence Jump vergences (vectos) Brockstring (bug on a string) HVTECC BO/Brockstring, HTS jump vergences
  • 95. 3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #6 Review HVT ECC Vectogram Jump Vergence Lifesaver Cards
  • 96. 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
  • 97. 3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #7 Clown vectograms (push BI) Chicago Skyline (jump)
  • 98. 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!
  • 99. 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
  • 100. 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
  • 101. 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!”
  • 102. Computer Programs Used in Optometric Vision Therapy Computer AidedHome Therapy Solutions Vision Therapy
  • 103. 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
  • 104. 3D in the News ABC Chicago y?section=news/health&id=72 98893
  • 105. NBC News Broadcast
  • 106. AOA TV
  • 107. DiagnosisMaino D. Brock String Debuts at 2011Consumer Electronics Show. Optom Vis Dev2011;42(1):6-9.
  • 108. Print /Digital Media
  • 109. Blogs
  • 110.
  • 111. Radio
  • 112.
  • 113. 120/128
  • 114. Pacific Eye Clinic Beaverton Opens 3D Performance Eye Clinic
  • 115. The 3D’s of 3D Viewing:Discomfort, Dizziness and Lack of Depth Discomfort Dizziness Lack of Depth
  • 116. The 4th D of 3D ViewingThe fourth “D” of 3D Viewing should be tocall your….Doctor of Optometry
  • 117. 3D in the Classroom:See Well, Learn Well
  • 118. 3D Resources AOA American Academy of Optometry 3D Eye COVD OEPF Optometrists Network Stereo Photography Products
  • 119. Chris Haws 3D@Home
  • 120. 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)