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3D Vision Syndrome: Solving Patient Problems-Creating a Better 3D Viewing Consumer


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3D Vision Syndrome: Solving Patient Problems-Creating a Better 3D Viewing Consumer

  1. 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 Illinois College of Optometry Illinois Eye Institute Lyons Family Eye Care L LyonsFamilyEyeCare.comMillions of people who view 3Dmovies, television, use 3D in the House, ODclassroom and while playing videogames suffer from blurred vision, Is Dx Important?headache, diplopia, dizziness, andmotion sickness. The proper diagnosisis important, but only treatment willallow patients to improve theirquality of life. 1
  2. 2. 6/7/2012 House, OD House, ODIs 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 2
  3. 3. 6/7/2012 Visual AcuityRefractive 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 inducedcollectively indicate or sense of motion, diplopia, blurred vision andcharacterize a disease, eyestrain; as well as a disconnect between accommodation and vergence. Regarding 3Dpsychological disorder, or glasses: No one complains about the red mark onother abnormal condition their nose from the 3D glasses. 3
  4. 4. 6/7/2012 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). 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 4
  5. 5. 6/7/2012 Optometric Vision Therapy Optometric Vision Therapy… is a sequence of neurosensory and neuromusculartherapy procedures prescribed by the doctor to Ciuffreda K. The scientific basis for and efficacy ofdevelop, rehabilitate and enhance visual skills and optometric vision therapy in nonstrabismicprocessing. 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 theresults of standardized tests, the needs of the The findings clearly support the validity ofpatient, and the patient’s signs and symptoms. Theuse of lenses, prisms, filters, occluders, specialized optometric vision therapy. Furthermore,instruments, and computer programs is an integral the results are consistent with the tenetspart 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 TherapyScheiman M, … Convergence Insufficiency Treatment Trial Scheiman M, et al. Non-surgical interventions forStudy Group. Treatment of accommodative dysfunction in convergence insufficiency. Cochrane Database ofchildren: 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 moreVision therapy/orthoptics is effective in effective than placebo reading glasses in improvingimproving accommodative amplitude and clinical signs or symptoms in children; 2. In-office vision therapy/orthoptics is moreaccommodative facility …. effective than home-based convergence exercises or home-based computer vision therapy/orthoptics in improving clinical signs and symptoms in children… 5
  6. 6. 6/7/2012 3D Vision Syndrome 3D Vision Syndrome Patient #1 Patient #1 27 y/o white femaleSingle Subject Design Research College educated Study Athletic trainerSymptoms: Hx of reading problemsblurred vision, since 5th grade Remedial reading classdouble vision, in collegenausea, headache, Seasonal allergiesdizziness 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 6
  7. 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 TherapyPhase 1 Phase 2 Phase 3 Phase 4 OVT #1Mono Biocular Binocular Integration HC SaccadesOculo- add anti- add Stabilization HC RockMotor, 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 BuildingFranzblau Red Rock (binoc reading) Brockstring Quoits 7
  8. 8. 6/7/2012 3D Vision Syndrome 3D Vision Syndrome Patient #1Patient #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 TherapyPatient #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 eyeVectogram Jump Random dot 20 ‘ Vergence During evaluation no diplopia, pain, suppression, stable findings Lifesaver Cards Symptoms improving, not resolved3D 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 scheduleChicago Skyline Saw 3D movie…no (jump) problems! 45/51 8
  9. 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 TNMajority 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 Therapydysfunctions, Headache, Diplopia, Blurred vision, Double vision, Nausea, DizzinessAll 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 3D Eye COVD Vision Performance Institute OEPF No matter your age, if you have 3D Vision Syndrome Optometrists Network it is treatable. 9
  10. 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) 10