Ординатура / Офтальмология / Английские материалы / Relearning To See_Quackenbush_2000

As in Part A, the purpose of this activity is to activate and relax (not work) the eye that is under more strain. Effort should never be applied to the visual system.

Important: If the student feels discomfort or gets tired, he should stop and rest. Palming is one of the best ways to rest the eyes after using the patch.

Some children who have amblyopia are given a patch to wear for long periods of time, even all day long. This can create more stress than the stress producing the amblyopia. Oftentimes, the child refuses to wear the patch.

If a patch is used, the approach should be one of teaching the amblyopic eye to relax. Therefore, any time a patch is used, games and activities that are enjoyable to the child should be employed. Implementing the principles and habits of natural vision are important when using a patch.

F U S I O N 2 : T H E B E A D G A M E

T H E B E A D G A M E : CONVERGENCE

The Bead Game is one way of determining how well the eyes are converging and fusing.

In order to experience the Bead Game, two strings need to be seen, which means both eyes need to be switched on. Though a person with amblyopia may not experience two near fingers, two far fingers, or two Dixie Men in the Fusion i activities above, she may experience two strings in the Bead Game.

As Bates pointed out, a person may have proper convergence, yet still have amblyopia. In this case only one string would be seen. This, however, is not very common. Most students who have normal convergence have proper fusion.

A student will recognize the Bead Game

as being an "infinite" fingers activity. If you were able to hold up many fingers out in front of you in a row, you would have a continuous "string" of fingers. The Fusion l activities with the near finger, far finger, and Dixie Man are a prelude to the Bead Game.

The Bead Game should never be approached as a near-to-far exercise or drill, as presented in several books, tapes, and "kits" on eyesight. The Bead Game is only used to observe convergence, or lack of convergence, of the two eyes.

ALIGNING THE STRING FOR THE BEAD GAME

Refer to Plate 55: Fusion 2—The Bead Game.

As with the finger alignments in Fusion 1, the alignment of the string is very important. You may want to have a second person do the Bead Game with you, holding the other end of the string. In this way you can check each other's aUgnment.

Obtain a string about three feet long. Place three different colored beads, or buttons, %-Vi inch in diameter, along the string. In the following examples, red, green, and blue beads are used. The red bead is the close bead, green is the middle bead, and blue is the far bead. If another person is not holding the other end of the string, you can tie it to a doorknob or other steady fixture.

While sitting in a chair, rest your elbows comfortably on a cushion or table. Hold one end of the string between the thumb and forefinger of one hand, such that the string goes over the forefinger out into the distance. The forefinger and string should be held one inch from, and at the same height as, the nose. The string held in your hand must be positioned exactly in front of the nose, and the head must be exactly straight. The correct alignment is

shown in Plate 55: Normal Convergence— Middle Green Bead, a-i. To help align the string, touch your nose with the thumb holding the string, and then move the thumb and string straight out one inch. Have someone check your alignment if needed.

Do not turn your head to the left or right. Do not align the string with one eye. Students, especially those with strabismus and amblyopia, often align the head and/or string incorrectly. If this is done, it will be difficult or even impossible to experience the Bead Game correctly. The aUgnment of the head and string is very important.

The red bead should be positioned about six inches out from the forefinger holding the string. The green bead should be positioned about ten inches beyond the red bead. The blue bead should be about ten inches beyond the green bead.

If a second person is holding the other end of the string, the blue bead should be about six inches from her nose.

Be sure there is adequate hghting, and that the lighting is fairly equal on both sides of the string.

NORMAL CONVERGENCE

WITH THE B E A D G A M E

Refer to Plate 55. Fusion 2—The Bead Game,

Normal Convergence—Middle Green Bead, a-i,a-2, andfl-3.

Sketch the middle green bead. Remember to breathe abdominally and blink frequently during the Bead Game.

How many strings are there?

If there is only one string, study a-i, a-2, and a-3.

Fusion 1, Far Finger, a-i and a-2.

Remember to take a break and rest if you become tired doing this Bead Game.

TOM'S PERSONAL LOG: In the beginning, I could only do the Bead Game for a very short time. I found it very uncomfortable and annoying. Two strings flashed off and on alternately. I had very high tension in my visual system. Now it is easy to do.

If you see two strings, but they do not cross through the middle green bead, note where the strings cross. They may cross in front of or in back of the green bead.

Refer to Plate 55: Normal Convergence— Near Red Bead, b-i, b-2, and b-3.

Sketch the near red bead.

The two strings should now cross through a single red bead. There should now be two middle green beads and two far blue beads. This experience is equivalent to Fusion 1,

Near Finger, b-i and b-2.

Refer to Plate 55: Normal Convergence— Far Blue Bead, c-i, c-2, and c-3.

Sketch the far blue bead.

The two strings should now cross through a single far blue bead. There should be two near red beads, and two middle green beads. This experience is equivalent to Fusion 1,

Dixie Man, c-i and c-2.

When sketching the far blue bead, the strings may look more like an inverted "V" than an "X."The two strings seem to join at the far blue bead.

If the X crosses through each bead, you do not need to do any more activities in this chapter.

If the X does not cross on one or more beads, continue with the next section.

STRABISMUS

Strabismus is the condition in which the eyes are not aligned to see the same point simultaneously. For example, the right eye correctly

sees a book across the room, but the left eye turns out to the side, seeing a door on the left side of the room.

In cases of strabismus, the initial tendency is to experience double vision. The visual system wants to maintain binocular vision, but because prolonged double vision is very stressful, the brain usually turns off one of the pictures, creating amblyopia. This is why most people who have strabismus become amblyopic.

STRABISMUS AND THE BEAD GAME

If one or both eyes are not converging correctly on a bead in the Bead Game above, a student will not experience the X crossing at a bead being sketched.

There are many non-convergence experiences possible during the Bead Game.The more common types are discussed below.

Conventionally, the strabismic eye has been called the "deviating" eye, and the normal eye the "fixating" eye. Since the words used in vision training can affect the student's sight, it is better to refer to the strabismic eye as simply the "strabismic" eye, or the "turning'' eye. The "fixating" eye is better called the "centralizing" eye for reasons discussed in Chapter 9, "The First Principle—-Movement"

In esophoria the X crosses in front of the bead of interest. In exophoria, the X crosses in back of the bead of interest. Fusion occurs where the X crosses. But, since at least one eye is not converging properly to the bead of interest, fusion is not occurring at the conect location. The mind's interest is on a bead, but only one eye is seeing the bead with correct convergence and centralizing. A student is usually aware if he has strabismus.

COMMON T YPES OF S T R A B I S M U S

The four most common types of strabismus are esophoria, exophoria, hyperphoria, and hypophoria.

ESOPHORIA

Esophoria (from the Greek eso, meaning "inward," and phoria, meaning "direction") is also called crossed eye, esotropia, and convergent. (The term convergent here means the eye is turning inward abnormally; it does not mean the eye has normal "convergence.") Typically, one eye turns inward, and the other eye is straight. If one or both eyes turn inward toward the nose, the X will cross in front of the bead you are sketching.

Compare Plate 56: Esophoria—The Bead Game, Esophoria—Both Eyes, with Plate 55: Fusion 2, Normal Convergence—Middle

Green Bead

In Esophoria—Both Eyes, both eyes turn inward too far. The right eye turns too far to the left, and the left eye turns too far to the right. As a result, the two strings appear to cross in front of two green beads.

In Esophoria—Right Eye, the right eye turns toward, too far to the left. The left eye converges and centralizes normally on the middle green bead. (In these diagrams, the right eye is slightly more esophoric than in

inward too far to the left. As a consequence, the string seen by the right eye, REso, appears to angle loo far to the right compared to the string seen by the right eye in Normal Con- vergence—Middle Green Bead, RNor. The string seen by the normal left eye, LNor, is the same in Esophoria—Right Eye and Normal Convergence—Middle Green Bead.

In Esophoria—Left Eye, the left eye turns inward, too far to the right The right eye converges and centralizes normally on the middle green bead. (In these diagrams, the left eye is shghtly more esophoric than in Esopho- ria—Both Eyes.)

Compare the positions of the strings in

Esophoria—Left Eye, c-2 and c-3, with the strings in Esophoria—Both Eyes, a-2 and a-3, and in Normal Convergence—Middle Green Bead, a-2 and a-3.

In Esophoria—Left Eye, the left eye turns inward too far to the right. As a consequence, the string seen by the left eye, LEso, appears to angle too far to the left compared to the string seen by the left eye in Normal Con- vergence—Middle Green Bead, LNor. The string seen by the normal right eye, RNor, is the same in both Esophoria—Left Eye and

Normal Convergence—Middle Green Bead.

Exophoria

Esophoria—Both Eyes.)

Compare the positions of the strings in

Esophoria—Right Eye, b-2 and b-3, with the strings to Esophoria—Both Eyes, a-2 and a-3, and in Normal Convergence—Middle Green Bead, a-2 and a-3.

In Esophoria—Right Eye and Esophoria—

Both Eyes, the esophoric right eye turns

Exophoria (from the Greek exo, meaning "outward") is also called "wall eye," exotropia, or divergent. Typically, one eye turns out too far toward the temple, while the other is straight. If one or both eyes turn outward, the X will cross in back of the bead you are sketching. If one or both eyes turn too far outward, there may be two strings, but they

Hypophoria

Hypophoria (from the Greek hypo, meaning "under" or "down") is also called hypotropia. Like hyperphoria, convergence may not be possible during the Bead Game, as the string seen by the hypophoric eye may appear higher than the string seen by the normal eye.

Refer to Figure 18-5: Head Balancing, b and с Noticing the heights of the two near fingers (or pencils) while sketching the far finger can give some clues as to hypophoria.

If the right eye is hypophoric—without tilt­ ing the head—the near left finger may appear too high. If the left eye is hyperphoric—with­ outtilting the head—the near right finger may appear too high.

Infinite Possibilities

There is an infinite number of possibilities involving strabismus and amblyopia. One eye can be esophoric while the other eye is both exophoric and hyperphoric. And, as pointed out by Bates, the degree and type of strabis­ mus can be a function of time, particularly in relation to stress.

ACTIVITIES F O R S T R A B I S M U S

PHORIA (DIRECTIONAL) SWING S

In strabismus, the muscle(s) is too tight in the direction the eye is turning. The idea behind phoria swings is to teach the strabismic eye to relax by coaxing it to move in the direc­ tion opposite to the direction it is turning.

For esophoria and exophoria, do the Bead Game, described above, to determine where the X is crossing when sketching the near red bead, the middle green bead, and the far blue bead. To review, the X usually crosses:

1.at each bead you are sketching, in which case the student already has the experiences he wants to have and there is no need to continue; or,

2.the X crosses in front of the bead (esophoria); or,

3.the X crosses in back of the bead (exophoria).

For hyperphoria and hypophoria, sketch a distant object while holding a finger or pen­ cil in front of you as described above. Notice whether one finger or pencil is too high or too low.

Phoria Swing for Esophoria

Do the Bead Game. If the X crosses in front of the middle green bead, and if only the left eye is esophoric:

1.Cover or patch the right eye. Then move an object (e.g. your finger, a ball, a small light) in a circular pattern toward the left. The head remains fac­ ing straight ahead, while the left eye follows the moving object. The idea is to coax the left eye outward so that it will converge correctly on the middle green bead. Do this for three minutes.

2.Then cover only the left eye. Sketch objects normally with only the right eye. (If the right eye is also esophoric, keep the head facing straight ahead and move an object in a circular pat­ tern over to the right, following the object's movement with the right eye.) Important: Never activate only one eye; both eyes must be activated, even if one eye has normal convergence. Do this for one minute. (Do this for three minutes if both eyes are esophoric.)

3.Remove the patch and sketch objects normally, using both eyes, for three minutes.

(If only the right eye is esophoric, simply reverse the above directions.)

4. Return to the Bead Game to see if the X is crossing closer, or even on, the middle green bead. When first doing the phoria swing, the X may appear either closer to, or exactly on, the middle green bead for a moment or two. Then the X may move back to the position it was in before doing the phoria swing. In time, the X can move closer to and on the middle green bead for longer periods of time.

Phoria Swing for Exophoria

Do the Bead Game. If the X crosses in back of the middle green bead, and if only the left eye is exophoric:

1.Cover or patch the right eye. Then move an object (e.g. your finger, a ball, a small light) in a circular pattern over toward the right. The head remains facing straight ahead, while the left eye follows the moving object. The idea is to coax the left eye inward so that it will converge correctly on the middle green bead. Do this for three minutes.

2.Then cover only the left eye. Sketch objects normally with only the right eye. (If the right eye is also exophoric, keep the head facing straight ahead and move an object in a circular pattern over to the left, following the object's movement with the right eye.) Important: Never activate only one eye;

both eyes must be activated, even if one eye has normal convergence. Do this for one minute. (Do this for three minutes if both eyes are exophoric.)

3.Remove the patch and sketch objects normally, using both eyes, for three minutes.

(If only the right eye is exophoric, simply reverse the above directions.)

4.Return to the Bead Game to see if the X is crossing closer, or even on, the middle green bead. When first doing the phoria swing, the X may appear either closer to or exactly on the middle green bead for a moment or two. Then the X may move back to the position it was in before doing the phoria swing. In time, the X can move closer to and on the middle green bead for longer periods of time.

Phoria Swing for Hyperphoria

If the right finger (or pencil) is too low and the left eye is hyperphoric:

Follow the same directions as for the other phoria swings above, except in Step 1, move the object downward a few inches and follow it with the hyperphoric eye. Remember to keep the head facing forward. The idea here is to coax the eye downward, so that it is horizontal and level with the right eye. When it is horizontal, the two fingers will be at the same height.

If the left finger is too low, and the right eye is hyperphoric, coax the right eye downward, and continue with the same themes described above.

If the right finger (or pencil) is too high and the left eye is hypophoric:

Follow the same directions as for the other phoria swings above, except in Step 1, move an object upward a few inches and follow it with the hypophoric eye. Remember to keep the head facing forward. The idea here is to coax the eye upward, so that it is horizontal and level with the right eye. When it is horizontal, the two fingers will be at the same height.

If the left finger is too high, and the right eye is hypophoric, coax the right eye upward, and continue with the same themes described above.

Phoria Swings for Other Types

ofStrabismus

If an eye is turning at any angle, cover the eye that does not have strabismus, and move an object opposite to the direction the strabismic eye is turning. Follow the same themes described above. The idea is to relax the eye back to the straight, normal position.

STRAINING IS N O T TH E SOLUTIO N

Students with strabismus can be (and some have been) taught to "straighten" their eyes with a conscious effort. With this approach, the student then has a double strain—the initial tight muscle which pulled the eye out of alignment, and another tight muscle on the other side of the eye pulling the eye straight.

There was a girl who had strabismus (crossed eye) who was very proud of the "progress" she had made with her straining approach she was taught. While sitting in a chair, she gripped the side of the chair, and with the greatest of effort and straining, she

forced her crossed eye to align straight with the other eye for a few seconds. When she ceased straining, her eye crossed again.

This is not the answer to strabismus.

I M P R O V E M E N T S W I T H S T R A B I S M U S

The Better Eyesight magazine for November 1920 is dedicated to the topic of strabismus. Several case histories of improvements are described.

Clara Hackett, in her book Relax and See, writes of her strabismus students:

There were 179 crossed eye students. Sev- enty-one have achieved straight eyes and also have good fusion; 96 have straight eyes and good fusion except that there is a slight deviation from the norm when they are ill, emotionally upset or fatigued. Twelve had no enduring improvement.8

F I N A L C H A P T E R N O T E S

One of my students said she had "Stressbismus."

Strabismus can be created by an unconscious strain—especially by staring. An indication that relaxation is the solution to strabismus problems is that many children are able to "cross" their eyes at will by straining hard enough. As soon as they stop straining, the eyes return to normal.

This chapter introduced some of the issues involved with binocular vision, stereopsis, and fusion. Only some of the causes of and solutions to strabismus and amblyopia have been presented here.

The activities presented in this chapter are a support for these specific vision problems. The relearning of correct vision principles and habits is the key to removing the under-, lying strain causing nearsightedness, farsightedness, astigmatism, and strabismus.

Those who have strabismus and/or amblyopia need to do these specific activities along with practicing correct vision habits better each day. The Long (Elephant) Swing is especially beneficial in strabismus cases. The oppositional movement releases tension from the visual system.

If you need help in understanding or doing the activities presented in this chapter, consult with a Natural Vision teacher. A student should consult with an eye doctor for any serious vision problems.

N O T E S

1Lael Wertenbaker and the Editors of US. News Books, The Eye: Window to the World (Wash-

ington, D.C.: U.S. News Books, 1981), pp. 73-74.

2Dr. Agarwal was an enthusiastic teacher of the Bates method in India. The title of his book,

Mind and Vision, is the title of Chapter XXIX

India: Sri Aurobindo Ashram Press, 1983), p. 146.

4Ibid., p. 208.

5These graphics, caption, and text are from Per-

8Clara A. Hackett and Lawrence Galton, Relax a n d S e e (London: Faber and Faber, Limited, 1957), P-25.