Tuesday, April 28, 2015

Vision Stress Testing: 5K Run

April 14th, 2015

After being out for a couple of years and focusing my energy on my vision, I decided to slowly give running another try. Running is not my main focus but I try to use it as complementary training to my vision rehab. That is, when I feel I can handle it and won't go in overload.

It's unfortunate that these mistreated vision problems have dragged my physical and neurological condition down to such an extent because I used to be a natural at running. My performance should be peaking rather than dipping right now. I've never done many races in my life but so far I have done 5K, 10miles (16K) and a half marathon (21K). I decided to do another 5K race in 12 days. I'm looking forward to it but I'm keeping expectations low. I think I can do 23 minutes but we'll just see what happens. If I clock at 25 minutes, that will be alright too!

Here are some of my previous running results. If I can have the same outcome as in 2012, it is a de facto improvement because my vision (ocular motor control) is much better now than it was back then.

April 28th, 2015

I immediately added the results of this year to the image. The race went pretty okay. I started out easy and then, after the 3KM point, deployed whatever energy I could muster. During the last kilometer my vision was getting very shaky. So much so that I barely recognized my awesome friends who were cheering by the side of the road. Fortunately you don't need that much vision to run your longs out. When I arrived I was very dizzy but I fairly quickly recovered my normal (current) level of ocular control. I did not revert to double vision. Running the 5K wasn't the actual challenge. The challenge was to see what would happen afterwards. Would I be able to function normally and get home or not? To my delight I did alright. My nervous system and ocular motor control recovered enough not to be a zombie for the rest of the day. We went to grab some food and we had a nice day without me crashing.

Nonetheless, it remains interesting to see these time differences. I attribute it to the following cause (but I could be wrong). When I was younger, I would have a very low resting heart rate. When checking my heart rate, doctors would always ask me, 'Do you do any extreme sports?' or 'Are you doing sports on a professional level?'. I didn't. I didn't even run that often. Just when I felt like it, which was usually on Sunday. I was simply physically strong from having to endure academics with limited visual skills. To me, reading is much harder and physically taxing than running.

Sadly, these days my resting heart rate is not that slow anymore. I have the occasional panic attack and have to endure the stresses of an unrecognized handicap without income replacement or compensation for medical malpractice. The only thing I can do is wait and do my vision rehab which has been a very long and arduous process without breaks. Fortunately, relatively speaking, I can now see light at the end of the tunnel. I was lucky to find enough support and have played my cards flawlessly to get to this point. Now over the next year or so I have to finish it. I think that only after having acquired the security of reliable vision and body performance and hopefully, God forbid, a steady income stream, I will get some peace and might be granted a more slowed heart rate once again. Being more relaxed from time to time helps your body recover and allows you to build reserves. In that case of a slow heart rate, you can elevate that heart rate to a much greater extent when it is actually needed for physical performance. This instead of heart throbbing from being cornered and betrayed or the occasional, and ultimately useless, panic attack when dealing with a visually (and otherwise) unstable world.

Nothing is more crucial to the survival and independence of organisms—be they elephants or protozoa—than the maintenance of a constant internal environment. Claude Bernard, the great French physiologist, said everything on this matter when, in the 1850s, he wrote, “La fixité du milieu intérieur est la condition de la vie libre.” ,- Oliver Sacks

Sunday, April 12, 2015

Aperture Rule: A Vision Therapy empathy top tip

As you might know, at this point my eyes are looking pretty much normal most of the time but the inability to converge consistently remains crippling. It drains and strains a lot. It's like a massive extra backpack I'm wearing, or an invisible barrier between me and the world, preventing me from getting things done more easily.

Currently, much of the time, I'm living with a male cousin named Thierry (22) and female cousin named Cynthia (26). They are very nice about my peculiar situation and try to understand. I, in turn, am very patient in trying to explain my neurological vision problem even though, after all this time, I'm often fed up trying. By now, however, I am getting quite proficient at linking theory and experience into a coherent narrative. More importantly, they are really interested and concerned on a personal level so it's worth the effort to make them understand more fully. I'm really lucky in this respect because that quality is not something that can be taken for granted. They even defend me and try to re-explain the issue when other people ask them, "What is your cousin doing with his time all day?". They try to grasp and explain the reason why I am seemingly unproductive. Because of the nature of this problem, I know it's nearly impossible for them to understand completely but they are very considerate and do their best. That's a prerequisite for true communication.

To my delight, Thierry, who is also an engineering student, got so interested that he wanted to perform some of my exercises himself. Earlier we did some trial runs on the Cheiroscope and he was very good at it. His drawings were very stable and deliberate and his corners nice and sharp. That was to be expected. The fact that my drawings aren't stable and deliberate is basically the only reason I didn't end up to be an engineer in the first place.

 Now, what was even more interesting is our experience with the aperture rule. The aperture rule artificially dissociates accommodation and vergence. In other words, it makes it harder to use both of these basic visual functions appropriately to see a single AND clear image. The goal of this exercise is to further automate and incorporate these skills and enable the patient to use them without effort. This is an often re-occuring theme in Vision Therapy. The Rule has 12 levels for convergence and 12 levels for convergence depending on which Aperture plate you use. I, myself, am not super-solid on any level but my best performance, including head turns while viewing, is at level 4 using the double aperture (divergence setting). Generally I am more at ease with the divergence setting but I can only go up until level 6 before the target picture doubles up.

In the convergence setting (single aperture), I have often trouble keeping a clear and single image regardless of the level. Much depends on my fatigue level but generally there is improvement. When well rested, I can go up to level 6 or 7 when keeping my head still and focusing intensely. With head movements things tend to jump around. After all, this exercise is particularly hard because of the artificial dissociation of accommodation and vergence. It is my dream to be able to do the aperture rule fluently and without too much effort up to level 8 or 9. Well, the higher the better but let's start with that. Good stuff ahead! Can't wait!

Let's get to my point. I had both Thierry and Cynthia do the Aperture Rule. I got them to do convergence which they could do well, as I expected. They could go all the way up to level 12, albeit with some effort. At the higher levels they started to need some time to fine tune their vision to adjust to the heavy load of seeing both singly and clearly. They started to have the experience of having to work for your vision! They uttered things such as, "I can see it but I can't see it well", or "It takes a lot of effort!". Thierry even said, "You've explained your vision issues so many times but this is the first time I REALLY understand what you were talking about. It must be so exhausting having to work for your vision in this manner ALL the time!" Afterwards he said he was very tired.

For my part, I told them they were fortunate because in modern life convergence is most important when it comes to completing daily living tasks successfully. My inability to converge is the main reason why I'm out of service. Then I had them try divergence. They were completely floored. They even had trouble figuring out how to see level 1 correctly. Maybe it was not an inability to diverge but rather an inability to grasp what was expected of them. It's not always easy to figure out the Aperture Rule the first time you encounter it. Nonetheless, Thierry was intrigued. He remarked, "Apparently I have a visual limitation. I don't like it. I want to improve, especially as I want to try and become a pilot later on." 

There you have it, people. A Vision Therapy empathy top tip: the Aperture Rule. If you can't shake your vision problem easily or quickly, make 'em join you!