1. 6/7/2012
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
AOA National Spokesperson on 3 D Vision Syndrome
AOA Classroom 3D & Technology Project Team Member
Professor, This lecture available at
Pediatrics/Binocular Vision Service
http://www.slideshare.net/DMAINO/maino-vpi-treatment
Illinois College of Optometry
Illinois Eye Institute
Lyons Family Eye Care
L
dmaino@ico.edu MainosMemos.com
www.ico.edu LyonsFamilyEyeCare.com
Millions of people who view 3D
movies, television, use 3D in the House, OD
classroom and while playing video
games suffer from blurred vision, Is Dx Important?
headache, diplopia, dizziness, and
motion sickness. The proper diagnosis
is important, but only treatment will
allow patients to improve their
quality of life.
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2. 6/7/2012
House, OD House, OD
Is it the only thing of What else is
importance? important?
How to Dx an How to Clinically
Individual with Dx an Individual
3D Vision with
Syndrome 3D Vision
Syndrome
Comprehensive Exam
Visual Efficiency
Strabismus/Amblyopia
Case Hx
Special Testing
(Visagraph, TOVA, etc) Salient
Findings
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3. 6/7/2012
Visual Acuity
Refractive Error Non-strabismic BV disorders
Oculomotor Prevalence
Optomotor • Convergence Insufficiency: 1.3% to 37% of the
population; most report 3-5%
Heterophoria
• Convergence Excess: ~6%
Vergence • Divergence Anomalies up to 4%
Accommodation • Accommodative disorders: 3-5%
Jump Vergences
1st, 2nd, 3rd 15-18 million people
Degree Fusion 10/51
Strabismus & Amblyopia
Should
determine
3-5% of the population
Vision Function
&
9-15 million Functional Vision
3D Vision Syndrome So is the 3D Vision Syndrome Really a Syndrome?
Yes!
What constitutes a
syndrome?
Yes.
The symptoms and signs consistently include:
A group of symptoms that headaches, nausea, dizziness, a vision induced
collectively indicate or sense of motion, diplopia, blurred vision and
characterize a disease, eyestrain; as well as a disconnect between
accommodation and vergence. Regarding 3D
psychological disorder, or glasses: No one complains about the red mark on
other abnormal condition their nose from the 3D glasses.
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4. 6/7/2012
So is the 3D Vision Syndrome Really a Syndrome?
Yes!
Yes.
Discussed even less is the psychological and cognitive
disconnect that occurs because of where we know
the image to be (at the screen) and where we
perceive it to be (inches from your face).
How to Tx an Individual with
Use what we do
3D Vision Syndrome
know
We really don’t know the best Rx/Prism
methodology/approach.
Optometric
Vision Therapy
Pang Y, Teitelbaum B, Krall J.Factors associated
Use what we do know with base-in prism treatment outcomes for
Use what we do Glasses/Prism
convergence insufficiency in symptomatic
presbyopes. Clin Exp Optom. 2012 Mar;95(2):192-
7. doi: 10.1111/j.1444-0938.2011.00693.x. Epub
know 2012 Jan 11
There was no significant
Glasses/Prism Single Image association between the
CISS score with any of
Clear Retinal the baseline binocular
Image @ vision measurements
Dist/Near before or after prism
treatment. …...
20/51
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5. 6/7/2012
Optometric Vision Therapy
Optometric Vision Therapy
… is a sequence of neurosensory and neuromuscular
therapy procedures prescribed by the doctor to Ciuffreda K. The scientific basis for and efficacy of
develop, rehabilitate and enhance visual skills and optometric vision therapy in nonstrabismic
processing. The vision therapy program is based on accommodative and vergence disorders.
the results of a comprehensive eye examination or Optometry 2002;73:735-62.
consultation, and takes into consideration the
results of standardized tests, the needs of the The findings clearly support the validity of
patient, and the patient’s signs and symptoms. The
use of lenses, prisms, filters, occluders, specialized
optometric vision therapy. Furthermore,
instruments, and computer programs is an integral the results are consistent with the tenets
part of vision therapy…….. of general motor learning.
Optometric Vision Therapy
Convergence Insufficiency Treatment Optometric Vision Therapy
Trial Study Group. Randomized clinical Convergence Insufficiency Treatment Trial Study Group.
trial of treatments for symptomatic Long-term effectiveness of treatments for symptomatic
convergence insufficiency in children. convergence insufficiency in children. Optom Vis Sci. 2009
Arch Ophthalmol. 2008 ;126(10):1336- Sep;86(9):1096-103.
49.
Most children … who were asymptomatic after a 12-
….Office-based vergence week treatment program … for convergence
accommodative therapy is an insufficiency maintained their improvements in
effective treatment for symptoms and signs for at least 1 year after
children with symptomatic discontinuing treatment….
convergence insufficiency.
.
Optometric Vision Therapy Optometric Vision Therapy
Scheiman M, … Convergence Insufficiency Treatment Trial Scheiman M, et al. Non-surgical interventions for
Study Group. Treatment of accommodative dysfunction in convergence insufficiency. Cochrane Database of
children: results from a randomized clinical trial. Optom Vis Systematic Reviews. 2011;(3)CD006768.
Sci. 2011 Nov;88(11):1343-52.
1. Base-in prism reading glasses were no more
Vision therapy/orthoptics is effective in effective than placebo reading glasses in improving
improving accommodative amplitude and clinical signs or symptoms in children;
2. In-office vision therapy/orthoptics is more
accommodative facility …. effective than home-based convergence exercises or
home-based computer vision therapy/orthoptics in
improving clinical signs and symptoms in children…
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6. 6/7/2012
3D Vision Syndrome 3D Vision Syndrome Patient #1
Patient #1 27 y/o white female
Single Subject Design Research College educated
Study
Athletic trainer
Symptoms:
Hx of reading problems
blurred vision, since 5th grade
Remedial reading class
double vision, in college
nausea, headache, Seasonal allergies
dizziness Nephrectomy
3D Vision Syndrome Patient #1 3D Vision Syndrome Patient #1
Initial Findings Initial Findings
VA’s CLS RE/LE 20/20 Random Dot 100” (?)
OR RE -.25, LE PL Acceptable Fit NPC 2/6/4”
MR RE -4.25-50X175 20/15, After 5 attempts pain noted
LE -4.00-.50X175 20/15 PFV/NFV @ near could not do/diplopia
Pursuits/Saccades +4 Accommodative amplitudes (lens)
CT 18 XOP @ near -could not do
2nd Degree Fusion Variable NRA +2.00 diplopia
30/51
PRA -1.00
3D Vision Syndrome
Patient #1 3D Vision Syndrome Patient #1
Initial Findings Diagnosis
Diplopia, Convergence insufficiency
Accommodative Accommodative
Facility, dysfunctions
MEM variable Headache
Ocular health mild Diplopia
allergic conjunctivitis Allergic conjunctivitis
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7. 6/7/2012
3D Vision Syndrome Patient #1
3D Vision Syndrome Patient #1
Previous Eye Examination (10/09)
Plan
“No Binocular Testing Done!”
Obtain past records
Hx “General Exam”, health “good”, Aided VAs 20/20
Start RE/LE, SLE unremarkable, Non-dilated fundus evaluation
unremarkable, Ret -4.00 Sph RE/LE, MR -4.00-50X175 RE,
Optometric Vision -4.00-.50X180 LE, CT 2XO dist/Ortho near, BI 20/8, BO
24/12 near
Therapy Dx Myopia, Astigmatism
3D Vision Syndrome 3D Vision Syndrome
Patient #1 Patient #1 Optometric
Vision Therapy
Optometric Vision Therapy
Phase 1 Phase 2 Phase 3 Phase 4 OVT #1
Mono Biocular Binocular Integration HC Saccades
Oculo- add anti- add Stabilization HC Rock
Motor, suppression vergence HTS (saccades, pursuits,
HE, Acc accommodation)
Brockstring
3 month post OVT maintenance Tx and
final progress evaluation HVT
Sent Home all of the above
3D Vision Syndrome 3D Vision Syndrome
Patient #1 Optometric Patient #1 Optometric
Vision Therapy Vision Therapy
OVT #3
OVT #2
Reviewed HVT
Reviewed HVT Minus lens dips
Vision Builder HC accom rock
(saccades) Vision Building
Franzblau Red Rock (binoc reading)
Brockstring Quoits
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8. 6/7/2012
3D Vision Syndrome
3D Vision Syndrome Patient #1
Patient #1 Optometric
Vision Therapy OVT #5
Reviewed HVT
OVT #4 +/- Flippers (mono)
Eccentric Circles
Reviewed HVT HTS autoslide vergence
Jump vergences
Vision Builder (vectos)
Randot Vergence Brockstring (bug on a
string) HVT
Eccentric Circles ECC BO/Brockstring,
40/51 Quoits HTS jump vergences
3D Vision Syndrome
3D Vision Syndrome Patient #1 Optometric Vision Therapy
Patient #1 Optometric
Vision Therapy Progress evaluation #1
OVT #6 20/15 BVA, RE/LE NPC TN no pain
CL OR RE +1.00-.50X180 20/20 BI 12/9 near
LE +1.25 20/20 BO > 45
MR RE -3.25-.25X175 20/20 Amps 7 D RE/LE
Review HVT LE -3.250.75X005 20/20
Pursuits +4 Saccades +3
Facility 8 CPM RE, 11 CPM LE, 10
CPM OU
ECC CT 2EP (near)
W4D 4 at all distances MEM +.75 each eye
Vectogram Jump Random dot 20 ‘
Vergence During evaluation no diplopia, pain, suppression,
stable findings
Lifesaver Cards Symptoms improving, not resolved
3D Vision Syndrome 3D Vision Syndrome
Patient #1 Patient #1 Optometric
Optometric Vision OVT #8
Therapy Clown vectograms (push BI)
OVT #7 with +/-1.00
Tranaglyph BC 601
Brockstring
Clown Aperture Rule
vectograms
Switch to HVT only due to
(push BI) change in work schedule
Chicago Skyline Saw 3D movie…no
(jump) problems! 45/51
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9. 6/7/2012
3D Vision Syndrome Started Here: Ended Here:
Patient #1 Optometric Vision Therapy VA’s CLS RE/LE 20/20 Majority of symptoms resolved
OR RE -.25, LE PL Acceptable BVA 20/20 RE, LE
Progress Evaluation #2 1 month later Fit Slight + CL OR
MR RE -4.25-50X175 20/15, CT ortho/2 EXO, NPC TN
Majority of symptoms resolved LE -4.00-.50X175 20/15 After 5 trials TN
BVA 20/20 RE, LE Amps 8.33 RE/LE
Pursuits/Saccades +4 NPC with RL 7/10 cm
Slight + CL OR NRA +2.50
CT 18 XOP @ near Vergence dist BI x/14/10 BO X/30/25
CT ortho/2 EXO PRA -2.25
2nd Degree Fusion Variable Near BI 16/12 BO 35/25
NPC TN Facility 6 RE, 7LE, 8 OU CPM no W4D 4 all distances,
Random Dot 100” (?)
After 5 trials TN suppression Random Dot 25’
NPC 2/6/4”
NPC with RL 7/10 cm MEM +.50 RE, LE Pur/Sac +4
After 5 attempts pain noted
Vergence dist BI x/14/10 BO RTO 6 mos CEE, intermittently do PFV/NFV @ near could not Amps 8.33 RE/LE
X/30/25 HVT NRA +2.50, PRA -2.25
do/diplopia
Near BI 16/12 BO 35/25 - Lens amplitudes could not do Facility 6 RE, 7LE, 8 OU CPM
W4D 4 all distances Facility/NRA +2.00 diplopia no suppression
Random Dot 25’ PRA -1.00 MEM +.50 RE, LE
Pur/Sac +4
Convergence insufficiency, Accommodative Computer Programs Used in Optometric Vision Therapy
dysfunctions, Headache, Diplopia, Blurred vision, Double
vision, Nausea, Dizziness
All resolved in 8 OVT visits and HVT Personal Trainer
for Vision Computer Aided
Home Therapy Solutions Training! Vision Therapy
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!”
3D Resources
AOA
http://www.aoa.org
3D Eye Health.org
http://www.3deyehealth.org/
COVD
http://www.covd.org
Vision Performance Institute
http://www.pacificu.edu/vpi/
OEPF
No matter your age, if you have
http://www.oepf.org 3D Vision Syndrome
Optometrists Network
it is treatable.
http://www.vision3d.com/
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10. 6/7/2012
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)
dmaino@ico.edu MainosMemos.com
www.ico.edu LyonsFamilyEyeCare.com
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