Vision Performance Institute: 3D Vision Syndrome Creating a Better Audience


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Millions of people who view 3D movies, television, use 3D in the classroom and while playing video games suffer from blurred vision, 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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Vision Performance Institute: 3D Vision Syndrome Creating a Better Audience

  1. 1. Dominick M. Maino, OD, MEd, FAAO, FCOVD-A AOA National Spokesperson on 3 D Vision SyndromeAOA Classroom 3D & Technology Project Team Member Professor, Pediatrics/Binocular Vision Service Illinois College of Optometry Illinois Eye Institute Lyons Family Eye Care L
  2. 2. Millions of people who view 3Dmovies, television, use 3D in theclassroom and while playing videogames suffer from blurredvision, headache, diplopia, dizziness,and motion sickness. The properdiagnosis is important, but onlytreatment will allow patients toimprove their quality of life.
  3. 3. House, ODIs Dx Important?
  4. 4. House, ODIs it the only thing of importance?
  5. 5. House, ODWhat else isimportant?
  6. 6. How to Dx an Individual with 3D Vision SyndromeComprehensive Exam Visual EfficiencyStrabismus/Amblyopia Special Testing(Visagraph, TOVA, etc)
  7. 7. How to ClinicallyDx an Individual with 3D Vision Syndrome Case Hx Salient Findings
  8. 8. Visual AcuityRefractive Error Oculomotor Optomotor Heterophoria VergenceAccommodationJump Vergences 1st, 2nd, 3rd Degree Fusion 10/51
  9. 9. Non-strabismic BV disorders Prevalence• Convergence Insufficiency: 1.3% to 37% of the population; most report 3-5%• Convergence Excess: ~6%• Divergence Anomalies up to 4%• Accommodative disorders: 3-5% 15-18 million people
  10. 10. Strabismus & Amblyopia3-5% of the population 9-15 million
  11. 11. Should determine Vision Function &Functional Vision
  12. 12. 3D Vision Syndrome What constitutes a syndrome?A group of symptoms thatcollectively indicate orcharacterize adisease, psychologicaldisorder, or other
  13. 13. So is the 3D Vision Syndrome Really a Syndrome? Yes! Yes.The symptoms and signs consistently include:headaches, nausea, dizziness, a vision inducedsense of motion, diplopia, blurred vision andeyestrain; as well as a disconnect betweenaccommodation and vergence.
  14. 14. So is the 3D Vision Syndrome Really a Syndrome? Yes! Yes.Discussed even less is the psychological and cognitivedisconnect that occurs because of where we knowthe image to be (at the screen) and where weperceive it to be (inches from your face).
  15. 15. How to Tx an Individual with 3D Vision SyndromeWe really don’t know the best methodology/approach.
  16. 16. Use what we do know Rx/Prism OptometricVision Therapy
  17. 17. Use what we do knowGlasses/Prism Clear Retinal Image @ Dist/Near 20/51
  18. 18. Pang Y, Teitelbaum B, Krall J.Factors associatedUse what we do know with base-in prism treatment outcomes for convergence insufficiency in symptomatic Glasses/Prism presbyopes. Clin Exp Optom. 2012 Mar;95(2):192- 7. doi: 10.1111/j.1444-0938.2011.00693.x. Epub 2012 Jan 11 There was no significantSingle Image association between the CISS score with any of the baseline binocular vision measurements before or after prism treatment. …...
  19. 19. Optometric Vision Therapy… is a sequence of therapeutic proceduresprescribed and monitored by the doctor to developefficient visual skills and processing. It is prescribedafter a comprehensive eye examination has beenperformed and has indicated that vision therapy isan appropriate treatment option. The vision therapyprogram is based on the results of standardizedtests, the needs of the patient, and the patientssigns and symptoms. The use oflenses, prisms, filters, occluders, specializedinstruments, and computer programs is an integralpart of vision therapy……
  20. 20. Optometric Vision TherapyCiuffreda K. The scientific basis for and efficacy ofoptometric vision therapy in nonstrabismicaccommodative and vergence disorders.Optometry 2002;73:735-62.The findings clearly support the validity ofoptometric vision therapy.Furthermore, the results are consistentwith the tenets of general motor learning.
  21. 21. Optometric Vision TherapyConvergence Insufficiency TreatmentTrial Study Group. Randomized clinicaltrial of treatments for symptomaticconvergence insufficiency in children.Arch Ophthalmol. 2008 ;126(10):1336-49.….Office-based vergenceaccommodative therapy is aneffective treatment forchildren with symptomaticconvergence insufficiency.
  22. 22. Optometric Vision TherapyConvergence Insufficiency Treatment Trial Study Group.Long-term effectiveness of treatments for symptomaticconvergence insufficiency in children. Optom Vis Sci. 2009Sep;86(9):1096-103.Most children … who were asymptomatic after a 12-week treatment program … for convergenceinsufficiency maintained their improvements insymptoms and signs for at least 1 year afterdiscontinuing treatment….
  23. 23. Optometric Vision TherapyScheiman M, … Convergence Insufficiency Treatment TrialStudy Group. Treatment of accommodative dysfunction inchildren: results from a randomized clinical trial. Optom VisSci. 2011 Nov;88(11):1343-52.Vision therapy/orthoptics is effective inimproving accommodative amplitude andaccommodative facility ….
  24. 24. Optometric Vision TherapyScheiman M, et al. Non-surgical interventions forconvergence insufficiency. Cochrane Database ofSystematic Reviews. 2011;(3)CD006768.1. Base-in prism reading glasses were no moreeffective than placebo reading glasses in improvingclinical signs or symptoms in children;2. In-office vision therapy/orthoptics is moreeffective than home-based convergence exercises orhome-based computer vision therapy/orthoptics inimproving clinical signs and symptoms in children…
  25. 25. 3D Vision Syndrome Patient #1 Single Subject Design Research StudySymptoms:blurredvision, doublevision, nausea, headache, dizziness
  26. 26. 3D Vision Syndrome Patient #1 27 y/o white female College educated Athletic trainerHx of reading problems since 5th gradeRemedial reading class in college Seasonal allergies Nephrectomy
  27. 27. 3D Vision Syndrome Patient #1 Initial 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 Variable30/51
  28. 28. 3D Vision Syndrome Patient #1Initial Findings Random Dot 100” (?) NPC 2/6/4” After 5 attempts pain notedPFV/NFV @ near could not do/diplopia Accommodative amplitudes (lens) -could not do NRA +2.00 diplopia PRA -1.00
  29. 29. 3D Vision Syndrome Patient #1Initial FindingsDiplopia, Accommod ative Facility, MEM variable Ocular health mildallergic conjunctivitis
  30. 30. 3D Vision Syndrome Patient #1DiagnosisConvergence insufficiency Accommodative dysfunctions Headache Diplopia Allergic conjunctivitis
  31. 31. 3D Vision Syndrome Patient #1Plan Obtain past records Start Optometric Vision Therapy
  32. 32. 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 fundus evaluationunremarkable, Ret -4.00 Sph RE/LE, MR -4.00-50X175RE, -4.00-.50X180 LE, CT 2XO dist/Ortho near, BI20/8, BO 24/12 near Dx Myopia, Astigmatism
  33. 33. 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
  34. 34. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #1 HC Saccades HC Rock HTS (saccades, pursuits, accommodation) Brockstring HVTSent Home all of the above
  35. 35. 3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #2 Reviewed HVT Vision Builder (saccades)Franzblau Red Rock Brockstring
  36. 36. 3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #3 Reviewed HVT Minus lens dips HC accom rock Vision Building (binoc reading) Quoits
  37. 37. 3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #4 Reviewed HVT Vision Builder Randot Vergence Eccentric Circles40/51 Quoits
  38. 38. 3D Vision Syndrome Patient #1 OVT #5 Reviewed HVT +/- Flippers (mono) Eccentric CirclesHTS autoslide vergence Jump vergences (vectos) Brockstring (bug on a string) HVT ECC BO/Brockstring, HTS
  39. 39. 3D Vision SyndromePatient #1 Optometric Vision Therapy OVT #6 Review HVT ECCVectogram Jump Vergence Lifesaver Cards
  40. 40. 3D Vision Syndrome Patient #1 Optometric Vision Therapy Progress evaluation #1 20/15 BVA, RE/LE NPC TN no painCL 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 LE -3.250.75X005 20/20 Facility 8 CPM RE, 11 CPM LE, 10 Pursuits +4 Saccades +3 CPM OU CT 2EP (near) W4D 4 at all distances MEM +.75 each eye Random dot 20 ‘ During evaluation no diplopia, pain, suppression, stable findings Symptoms improving, not resolved
  41. 41. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #7 Clown vectograms (push BI)Chicago Skyline (jump)
  42. 42. 3D Vision Syndrome Patient #1 Optometric OVT #8Clown vectograms (push BI) with +/-1.00 Tranaglyph BC 601 Brockstring Aperture RuleSwitch to HVT only due to change in work scheduleSaw 3D movie…no problems! 45/51
  43. 43. 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 RTO 6 mos CEE, intermittently do X/30/25 HVT Near BI 16/12 BO 35/25 W4D 4 all distances Random Dot 25’ Pur/Sac +4
  44. 44. Started Here: Ended Here: VA’s CLS RE/LE 20/20 Majority of symptoms resolved OR RE -.25, LE PL Acceptable BVA 20/20 RE, LE Fit Slight + CL OR MR RE -4.25-50X175 20/15, CT ortho/2 EXO, NPC TN LE -4.00-.50X175 20/15 After 5 trials TN Pursuits/Saccades +4 NPC with RL 7/10 cm CT 18 XOP @ near Vergence dist BI x/14/10 BO X/30/25 2nd Degree Fusion Variable Near BI 16/12 BO 35/25 Random Dot 100” (?) W4D 4 all distances, NPC 2/6/4” Random Dot 25’ After 5 attempts pain noted Pur/Sac +4 PFV/NFV @ near could not Amps 8.33 RE/LE do/diplopia NRA +2.50, PRA -2.25- Lens amplitudes could not do Facility 6 RE, 7LE, 8 OU CPM Facility/NRA +2.00 diplopia no suppression PRA -1.00 MEM +.50 RE, LE
  45. 45. Convergence insufficiency, Accommodativedysfunctions, 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 andsaid, “Just saw a 3D movie. It didn’t hurt! It was an awesome experience!”
  46. 46. Computer Programs Used in Optometric Vision Therapy Personal Trainer for Vision Computer AidedHome Therapy Solutions Training! Vision Therapy
  47. 47. 3D Resources AOA 3D Eye Health.org COVD http://www.covd.orgVision Performance Institute OEPF Optometrists Network
  48. 48. No matter your age, if you have 3D Vision Syndrome it is treatable.
  49. 49. 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)