Understanding Binocular Vision Dysfunction (BVD)

TRANSCRIPT

0:00

What are the core parts of an eye exam?

2 seconds

You've got checking your sight, checking what your prescription is in order to maintain good sight, their distance to test.

0:09

9 seconds

We're looking at eye health in a variety of ways. In the front of eye health, back of eye health, measuring pressure.

0:16

16 seconds

You can do some rudimentary tests on where do your eyes rest in their

0:22

22 seconds

position, but that really doesn't really tell you about how flexible your eyes are, how well they're working under, endurance and changing situations.

0:31

31 seconds

Those type of tests are extensions. You have to go looking for those tests.

0:41

41 seconds

If you've ever found yourself rubbing your eyes after a long day at the computer or wondering why reading feels harder than it should, it may not just be tiredness.

0:53

53 seconds

It could be binocular vision dysfunction, where your eyes aren't focusing and teaming the way they should.

0:59

59 seconds

Once again, I'm joined by Harmony Vision Care on the Gold Coast.

1:04

1 minute, 4 seconds

In Paul's clinic, he often sees both adults and children with these problems, known as accommodation convergence

1:11

1 minute, 11 seconds

disorders, which can cause eye strain, blur, and difficulty concentrating on near tasks.

1:17

1 minute, 17 seconds

Today, we'll unpack what that means, why it matters, and what you can do about it.

1:22

1 minute, 22 seconds

If you or your child often experience eye fatigue, headaches, or trouble keeping focus up close, then keep watching because this conversation could make a real difference.

1:32

1 minute, 32 seconds

But first, who am I? I'm the owner of Optics Digital Marketing.

1:36

1 minute, 36 seconds

We're an agency that helps independent eye care professionals to grow their clinics. Hi, Paul. Good to see you again. My name is Paul.

1:45

1 minute, 45 seconds

So to begin with, before we get into the details, how common are focusing and teaming problems in your clinic?

1:54

1 minute, 54 seconds

And do you find that most people don't realize that they even have one?

1:59

1 minute, 59 seconds

It's a bit common part of our practice, we get a lot of referrals in from patients referring other patients in because they notice similarities between what they've had.

2:09

2 minutes, 9 seconds

We get referrals in from other optometrists when they find and discover accommodation conversions problems. And So they refer those to us to treat them.

2:17

2 minutes, 17 seconds

So it's become one of the strong pillars in our practice is to be working with those conditions day in, day out.

2:24

2 minutes, 24 seconds

And look, they're relatively common, and it depends on how you measure it.

2:28

2 minutes, 28 seconds

And I often say that when we're measuring someone, we never measure a perfect visual system.

2:35

2 minutes, 35 seconds

So you can often find little chinks in the arm or in how well you focus and use your two eyes together.

2:41

2 minutes, 41 seconds

It's just a matter of whether those chinks are bad enough to actually start interfering with how well you do your work or your study or even for some people,

2:49

2 minutes, 49 seconds

it can impact on how well they navigate the world in terms of depth of judgment, driving a car, parking a car, that thing.

2:57

2 minutes, 57 seconds

Well, I've heard the term accommodation

3:03

3 minutes, 3 seconds

convergence before, but I personally, I find that I struggle with a little bit because those terms don't seem actually descriptive of the condition.

3:12

3 minutes, 12 seconds

I know that That vision is a complex system, and there are a lot of different elements to it.

3:21

3 minutes, 21 seconds

Can you break down for us what is accommodation convergence?

3:25

3 minutes, 25 seconds

What actually is it and what's going on with our eyes that's impacting Yeah, well, so we've got two eyes, but we see one world.

3:34

3 minutes, 34 seconds

And so part of the mechanism of seeing one world is making sure that both eyes are pointed to the same place in space.

3:44

3 minutes, 44 seconds

So if we move our eyes from distance to near, we have to move the eyes. We also have to adjust our focusing.

3:51

3 minutes, 51 seconds

So convergence is the act of moving your eyes inward. Divergence is the act of moving your eyes outward.

3:56

3 minutes, 56 seconds

And so convergence gets a lot of attention as one of those functions because we do a lot of converging with near work and those sorts of things.

4:05

4 minutes, 5 seconds

And accommodation is that adjustment in the focusing.

4:08

4 minutes, 8 seconds

And the reason that the two names go together is that they're a part of the one process of being able to keep the world single and clear.

4:17

4 minutes, 17 seconds

And in modern life, that's particularly important for keeping the world single and clear when we're doing near work. So when you must say accommodation and focus, are you talking about the...

4:26

4 minutes, 26 seconds

Is it the crystalline lens? Yeah, I've got my model here. So I have a model.

4:33

4 minutes, 33 seconds

So we got a lens that is flexible called the crystalline Lens.

4:37

4 minutes, 37 seconds

So it's basically an elastic bag full of cells, and we have the ciliary muscle around it.

4:42

4 minutes, 42 seconds

And so we change, we activate ciliary muscle, which allows the crystalline Lens to change shape.

4:50

4 minutes, 50 seconds

And so when we move our focus from distance in here, it's the lens that's actually changing in the eye. So it's a way of adjusting the focus.

4:56

4 minutes, 56 seconds

And so that's where the more scientific or medical term of accommodation comes from.

5:03

5 minutes, 3 seconds

So I guess in my own mind, I'm thinking that if you think of the eyes as like two different cameras, and

5:12

5 minutes, 12 seconds

so they've got to be pointed in the right direction, but also the lenses themselves have to be focused properly. Exactly.

5:18

5 minutes, 18 seconds

And if you use the camera example, I'm going to be careful around camera examples.

5:22

5 minutes, 22 seconds

It's fairly static, but that's probably an optometric problem rather than a problem for other But if we think of how a lens and a camera

5:32

5 minutes, 32 seconds

works, the old school ones where you adjusted the focus and the lens moved in and out, where you've got lenses inside that don't change shape.

5:41

5 minutes, 41 seconds

So you change the distance between the lenses in order to change the focus as you move closer and further from what are you trying to take a picture of.

5:51

5 minutes, 51 seconds

So what we have instead is a lens that changes its own power, its own curvature inside the eye to do that adjustment.

5:57

5 minutes, 57 seconds

And it's all about if we have a look at the the retina being effectively the film that you're trying to put the focus the image on,

6:05

6 minutes, 5 seconds

then it's all about as you move your attention to different distances, then we need to readjust how that image lands on the back of the eye.

6:13

6 minutes, 13 seconds

And that's what that lens is all about. Right. Okay. So there's at least two different systems here involved in getting good vision.

6:23

6 minutes, 23 seconds

So why do these systems then sometimes fall out of balance?

6:28

6 minutes, 28 seconds

Well, we're basically designed to be moving around in a three-dimensional world, and instead, we sit still looking at two-dimensional things like you and I are doing right now.

6:39

6 minutes, 39 seconds

And so you've got this motor system that's designed where the eyes are constantly moving.

6:46

6 minutes, 46 seconds

The focusing system is constantly adjusting to keep the world single and clear as we move and look at different distances.

6:52

6 minutes, 52 seconds

And then once you make the focusing system have to sit still at a certain distance, it's going to fatigue.

7:00

7 minutes

And it's really just not designed to hold posture. And it's much like any part of the rest of your body. If you're holding posture for too long, you're naturally going to get fatigue.

7:09

7 minutes, 9 seconds

And so what we see as a fallout is the direct effects of that fatigue creating symptoms.

7:15

7 minutes, 15 seconds

But also you've got this flexibility between your focusing and your convergence system to try and keep everything in balance.

7:23

7 minutes, 23 seconds

And so there's a little bit of degrees of freedom where you can adjust one to keep the other working and vice versa, but that has limits.

7:31

7 minutes, 31 seconds

And when you hit the limits of those adjustments, that's when you start to get symptoms of some sort. Okay.

7:38

7 minutes, 38 seconds

And is this something that would show up in a regular eye test? Like your typical annual check with the optometrist?

7:48

7 minutes, 48 seconds

Well, it depends what's tested. So it is the thing that you do need to go looking for.

7:54

7 minutes, 54 seconds

So if we have a look at what are the core parts So for an eye exam, you've got checking your site, checking what your prescription is in order to maintain good site, their distance to test.

8:08

8 minutes, 8 seconds

We're looking at eye health in a variety of ways. In the front of eye health, back of eye health, measuring pressure.

8:15

8 minutes, 15 seconds

You can do some rudimentary tests on where do your eyes rest in their position, but that really doesn't really tell you about how flexible your eyes are, how well they're working under, the endurance and changing situations.

8:30

8 minutes, 30 seconds

Those tests are extensions. You have to go looking for those tests. Okay.

8:37

8 minutes, 37 seconds

So let's say I might be able to still see clearly, but I might have a binocular vision dysfunction happening in the background.

8:48

8 minutes, 48 seconds

Is that right? And why would that matter? Yeah.

8:52

8 minutes, 52 seconds

And that probably adds on to what we're saying in terms of having to go look for the problems.

8:55

8 minutes, 55 seconds

And so you have to be asking the right questions as a clinician as well, because The symptoms that have, for one of them, they've been a bit doctified.

9:07

9 minutes, 7 seconds

So when you look at a list of symptoms for accommodation, if there's an averse problems, they talk about double vision because we have two eyes. If two eyes aren't working together well, therefore we must get double vision.

9:15

9 minutes, 15 seconds

Honestly, double vision occurs, but it's not that frequent compared to all the other symptoms.

9:22

9 minutes, 22 seconds

And so I talk to patients about, you basically have two groups of symptoms. You've got what we call eye-related symptoms.

9:28

9 minutes, 28 seconds

And that's where myself as an optometrist and someone who's not an optometrist can discuss the symptoms, and we both might conclude that sounds like an eye problem.

9:36

9 minutes, 36 seconds

So we've got blurriness, double vision, sore eyes, tired eyes, and possibly some people might equate some headaches with that.

9:47

9 minutes, 47 seconds

And so you can go, okay, they're the eye related symptoms.

9:51

9 minutes, 51 seconds

But you've got the other ones that people may not immediately put down to it being a vision problem. And I tend to call them performance problem.

10:00

10 minutes

So I'm not concentrating well, losing attention, losing my place on the page, getting bored while I'm doing the clear

10:07

10 minutes, 7 seconds

work, general concentration issues, maybe some depth judgment issues.

10:14

10 minutes, 14 seconds

And so those are the things that people may not realize that they've been avoiding certain tasks because there's an underlying vision problem that doesn't allow them to do it well.

10:23

10 minutes, 23 seconds

And they naturally just drift away from doing it.

10:27

10 minutes, 27 seconds

So is this a condition that mostly affects people who are doing near work, like students, office workers, that type of role?

10:36

10 minutes, 36 seconds

That's when it's going to pop up, most obviously.

10:39

10 minutes, 39 seconds

So as I said, as I've been saying, you can have some depth judgment issues if you've got a particular type of accommodation convergence problem,

10:49

10 minutes, 49 seconds

but more commonly, you're going to get into, they talk about something like digital eye strain. So it's just eye strain.

10:56

10 minutes, 56 seconds

We call it digital now because most people on digital devices.

10:59

10 minutes, 59 seconds

And I will often joke that when I was at school, it was, if you weren't academic, you were outside.

11:06

11 minutes, 6 seconds

So you weren't really, there weren't that many people getting getting eye strain.

11:10

11 minutes, 10 seconds

Whereas now it doesn't matter what your level of engagement, involvement in school.

11:14

11 minutes, 14 seconds

If you use a device for enough, you're at risk of developing some eye strain symptom.

11:22

11 minutes, 22 seconds

Okay, well, let's talk a little bit more about eye teaming or focusing.

11:28

11 minutes, 28 seconds

So there I guess there are different ways that this problem can manifest itself.

11:36

11 minutes, 36 seconds

You've talked about convergence in sufficiency. Can it also be a problem the other way where the eyes turn too much?

11:48

11 minutes, 48 seconds

Yeah. And depending on how you measure it, people might have a little bit of both.

11:55

11 minutes, 55 seconds

When they're doing things at one moment, they're turning their eyes too much.

11:59

11 minutes, 59 seconds

At other times,the brain is going, I've had enough, and that lets go of convergence. So it's really about that imbalance between focusing and it teaming.

12:06

12 minutes, 6 seconds

So between the accommodation conversion system are out of balance. And what you're seeing is the person trying to cope.

12:13

12 minutes, 13 seconds

So if I push harder, I might turn the eyes in a bit more. It becomes a convergence excess. If my eyes are giving up and letting go, it might look more like an insufficiency.

12:23

12 minutes, 23 seconds

The critical part is you've got symptoms and things are out of balance, and that's what we need to deal with.

12:29

12 minutes, 29 seconds

So And how about the other aspect, the focusing?

12:34

12 minutes, 34 seconds

So is it like, are there some situations where people's focusing system might be too weak or too slow to react, or perhaps even just gives up?

12:47

12 minutes, 47 seconds

I think there's lots of different labels and names out there.

12:52

12 minutes, 52 seconds

I think there's possibly two categories where you have and they're relative,

13:00

13 minutes

but you have a convergence insufficiency often goes hand in hand with an accommodation excess.

13:05

13 minutes, 5 seconds

So what that means is I'm focusing too much compared to how much I'm converging. So convergence is insufficient compared to accommodation.

13:14

13 minutes, 14 seconds

So I'm focusing here, but I'm converging out there.

13:18

13 minutes, 18 seconds

And then the other one is convergence excess and accommodation insufficiency, where I'm tending to converge too close, but focussing is not keeping up.

13:27

13 minutes, 27 seconds

And so it's that stepping back and saying that these things often are paired problems rather than occurring in isolation.

13:35

13 minutes, 35 seconds

And if someone's got a very fatigued system, sometimes it can look like both because both systems have just fatigued and let go.

13:42

13 minutes, 42 seconds

And so that's part of our job to sift our way through and work out what's been happening there.

13:49

13 minutes, 49 seconds

And what environmental factors can aggravate this condition?

13:58

13 minutes, 58 seconds

I'll be talking about things like lighting, just stress in general, what other factors could aggravate things?

14:06

14 minutes, 6 seconds

If we take a leap from ergonomics in general.

14:10

14 minutes, 10 seconds

So if you're in good health, good nutrition, working under good lighting, that all helps because our visual system, we obviously need light.

14:21

14 minutes, 21 seconds

The better the quality of the light, the better the contrast, the less the brain has to work to figure out what it's looking at.

14:27

14 minutes, 27 seconds

So that is a level of fatigue and attention in the background because vision and attention are so tied together that anything that takes up your attention is potentially going to impact on how will you use your vision and vice versa.

14:40

14 minutes, 40 seconds

And if we talk about general stress feeding into all these little stressful things, I've got deadlines, I'm tired, my eyes aren't working well, and they're all chewing up concentration.

14:50

14 minutes, 50 seconds

So you've got all of those sorts of things.

14:52

14 minutes, 52 seconds

And there's an interesting thing to look at where you go, okay, well, the kids plan on the iPad for four hours straight and not bothered by but can't read for 15 minutes without being tired.

15:02

15 minutes, 2 seconds

Well, okay, they're both near tasks, and it's very easy to say, oh, well, they're just the same thing. They're not.

15:09

15 minutes, 9 seconds

They're a different level of engagement as a start. There are different activity, iPads and computers tend to be a bit more passive. You are self-directed.

15:18

15 minutes, 18 seconds

You're doing your own thing on it.

15:21

15 minutes, 21 seconds

But if you have to do required reading for studying, that's a much bigger cognitive load.

15:26

15 minutes, 26 seconds

And if you're still learning how to decode and decipher for what these squiddles on the page mean, that's an entirely different task to looking at a cartoon or a picture or playing a game on an iPad.

15:36

15 minutes, 36 seconds

And so the type of task that you're doing can make an impact.

15:40

15 minutes, 40 seconds

And I like to use the analogy that if you've got a certain level of energy available, And you go out to dinner with your best mates. You don't realize how late it gets sometimes.

15:49

15 minutes, 49 seconds

Yet you go to another function that's not your cup of tea and you're yarning and bored many hours before that, yet you walked in with the same level of energy.

15:58

15 minutes, 58 seconds

Well, your appraisal and whether you enjoy the task and whether you're getting something out of it makes a difference, which is where some kids might read

16:07

16 minutes, 7 seconds

for hours and put up a sore eyes or not even get sore eyes, and others might get sore eyes straight away because they just get a different...

16:17

16 minutes, 17 seconds

They get a different thing out of that process. Yeah. I think we forget sometimes that we're not born to read. It's not something that you...

16:25

16 minutes, 25 seconds

The skill that you have from the moment that you come into the world, it's something It's an unnatural behavior in a way that we've learned to get information by looking at squiggles on a page.

16:39

16 minutes, 39 seconds

So that is something that requires an additional load of concentration on the human brain. Yeah. And it's a pretty recent thing in human history overall.

16:49

16 minutes, 49 seconds

So it's only really in terms of mainstream in the last couple of hundred years, and probably even less when we think about it.

16:57

16 minutes, 57 seconds

Yeah, that's right. Because education It wasn't that widespread beforehand.

17:02

17 minutes, 2 seconds

Well, if you're watching this so far and you're getting value from this discussion, so please do us a big favor and hit the like button.

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17 minutes, 11 seconds

It only takes a second and it really gives us help with the YouTube algorithm and increases the chance that someone else might benefit from this video as well.

17:21

17 minutes, 21 seconds

All right, Paul.

17:22

17 minutes, 22 seconds

Well, so how can somebody tell if they have binocular vision dysfunction and not just ordinary ordinary eye fatigue, say from a long day at the office or a long day at school?

17:34

17 minutes, 34 seconds

Well, I mean, sometimes they can be part of the same story, really. We do sometimes call it the hidden vision problem. So some of the kids we might see, they're just not working up to...

17:44

17 minutes, 44 seconds

They're a bright child, but they're just not working up to expectations. And they're trying to work out what's going on.

17:51

17 minutes, 51 seconds

And like we've been saying, you might have a perfect sight for seeing the screen or the board or birds in a tree, but that doesn't actually

17:59

17 minutes, 59 seconds

predict how well are you going to maintain your place and maintain focus and convergence when you're doing something a bit more cognitive in the classroom.

18:06

18 minutes, 6 seconds

And the modern classrooms are highly visually demanding.

18:11

18 minutes, 11 seconds

But sometimes it can be We have to ask the question, eye fatigue, just normal, and therefore we don't need to put up with it.

18:22

18 minutes, 22 seconds

There's lots you can do to try and help people not get the eye fatigue so that they're doing their work in a better way.

18:29

18 minutes, 29 seconds

So a lot of the symptoms are eye fatigue are the very same symptoms they're looking for in accommodations and conversions problem.

18:37

18 minutes, 37 seconds

So if you're getting a reasonable level of fatigue from your computer work and your desk work, then You really probably should be getting your eyes checked to see if it's something we can be done about it.

18:49

18 minutes, 49 seconds

And certainly, if we're talking, you get it after 15 minutes, half an hour, well, you're definitely in the zone.

18:54

18 minutes, 54 seconds

If you've got a problem, if it's after three or four hours, then okay, well, maybe we can get into. That's just a lot of time on the computer.

19:02

19 minutes, 2 seconds

And the first thing to do is start taking some breaks.

19:05

19 minutes, 5 seconds

Every 60 minutes, take a 10 minute break, get up, walk around, don't look at the device. You can get outside, great. And that all.

19:13

19 minutes, 13 seconds

But if the problem persists as soon as you get back into doing work after that 10 minute break, then maybe you've got a problem. Okay.

19:22

19 minutes, 22 seconds

Well, I'll ask this question very carefully. So there's been a lot of attention in the media recently about ADHD and dyslexia.

19:31

19 minutes, 31 seconds

My understanding is that accommodation and convergence issues often have a lot of ADHD-like symptoms.

19:41

19 minutes, 41 seconds

So what's the research on that?

19:46

19 minutes, 46 seconds

Yeah, look, there was a body of research done around convergence insufficiency, and they did look at ADHD-like symptoms.

19:54

19 minutes, 54 seconds

And if you look at a symptom checklist for convergence insufficiency and some of the previous symptoms checklist for ADHD, there were a lot

20:02

20 minutes, 2 seconds

of commonalities, because if we talk about those performance symptoms, avoiding close work, not being able to concentrate, and not being able to tend well, those sorts of things,

20:12

20 minutes, 12 seconds

you need to rule out a vision problem as part of the diagnosis for ADHD.

20:19

20 minutes, 19 seconds

So part of the work up is which part of those symptoms might be a vision problem and which part of those symptoms might be more related to the actual condition itself.

20:30

20 minutes, 30 seconds

On top of that, there is some evidence that if you take a group of kids who have been diagnosed with ADHD, there's a higher prevalence of things like convergence insufficiency in that population.

20:39

20 minutes, 39 seconds

So yet another reason to help these kids, so they're not dealing with two problems because we can treat convergence insufficiency.

20:46

20 minutes, 46 seconds

So if we can treat that, that's one less problem that they need to deal with.

20:50

20 minutes, 50 seconds

And if you treat a child and their ADHD-like symptoms disappear, well, you know it was an ADHD to begin with.

20:55

20 minutes, 55 seconds

Now, I'm not getting into suggesting that a lot of kids have been misdiagnosed or I've heard people say that, and I don't think that's fair.

21:03

21 minutes, 3 seconds

But we do have a responsibility to make sure that the kids are dealing with two problems at the same time.

21:08

21 minutes, 8 seconds

And the same thing when we talk about dyslexia, the whole debate around vision versus other things as a cause of dyslexia.

21:16

21 minutes, 16 seconds

We're not getting into that.

21:18

21 minutes, 18 seconds

It's around if I have a human being who's not performing well at school and I discover a vision problem, it shouldn't matter whether they have dyslexia or whether they're a normal reader.

21:28

21 minutes, 28 seconds

That vision problem may well in the way of their best performance, whatever that may be, and they deserve the right to have that vision problem managed.

21:35

21 minutes, 35 seconds

Because if we look at dyslexia, it's often considered to be a lifelong problem. The vision problem doesn't need to be a lifelong problem.

21:43

21 minutes, 43 seconds

And There's been dribs and drabs of statistics that indicate that kids who have reading problems and kids

21:53

21 minutes, 53 seconds

who have dyslexia have a high proportion of these accommodation and convergence problems. Now, that's not getting into any suggestion that one causes the other.

22:01

22 minutes, 1 second

And we can speculate on why that might happen.

22:04

22 minutes, 4 seconds

But part of the thing I look at is that, well, if you're a struggling reader, you're doing more work to get on top of reading to catch up,

22:12

22 minutes, 12 seconds

all of those things compared to the child where reading comes a bit more naturally and easily to you.

22:18

22 minutes, 18 seconds

Again, that's more opportunity for an undiagnosed or hidden vision problem to impact on you even further. So let's deal with the vision problem because that's not lifelong.

22:26

22 minutes, 26 seconds

We can get rid of that and we can manage that. And that way you can concentrate your efforts on your reading.

22:33

22 minutes, 33 seconds

Well, you mentioned treatment, and that's a really good segue in my last question here, which is, so can the eyes be retrained to work properly?

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22 minutes, 44 seconds

So can you talk about some of the vision therapy that can be done? Yeah.

22:52

22 minutes, 52 seconds

And look, there are things like we call them eye exercises, but we're not exercising the eyes.

22:57

22 minutes, 57 seconds

I mean, the eye muscles are sophisticated and they're much stronger than they need to be for the weight of the eyeball or the weight of the lens that they're trying to shift.

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23 minutes, 7 seconds

And it's all about it being a fine motor control.

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23 minutes, 10 seconds

When we talk about fine motor control, it's teaching this to control these things, much like doing fine motor control to learn something new.

23:20

23 minutes, 20 seconds

You're not necessarily building stronger finger muscles. You're learning to send the right signals to them.

23:25

23 minutes, 25 seconds

And so when we're doing vision therapy or eye exercises, we're We're setting up a situation where the person can explore how to use the two

23:34

23 minutes, 34 seconds

eyes together more efficiently so that the brain learns to use these organs and point them in the right direction.

23:39

23 minutes, 39 seconds

I mean, eyes are just bits of brain that we point at things, and we need to learn how to point at them, point give them at things more accurately

23:46

23 minutes, 46 seconds

and more efficiently and more automatically so that we're not burning up cognitive energy in concentration on what should be a basic skill.

23:56

23 minutes, 56 seconds

And so part of the role when we do vision therapy, and this is why we believe clinic-based or office-based

24:06

24 minutes, 6 seconds

therapy is the most effective way of doing it, is that you can set up lots of different ways to manipulate the balance between convergence and focusing so that you get a pretty strong generalized skill.

24:20

24 minutes, 20 seconds

And so we might use things like a lens, and you have to find ways of discovering through practice how to make that lens clearer.

24:29

24 minutes, 29 seconds

You You might move the lens further away and it gets blurry, and you've got to work out how to readjust it. We might even use that lens and say, can you purposely make it go blurry?

24:38

24 minutes, 38 seconds

Okay, so that you're really learning to send the right signal so that you as a person can choose how clear or how blurry that image is.

24:47

24 minutes, 47 seconds

We might use a way of selecting the input from one eye to the other so that we can create this 3D effect.

24:57

24 minutes, 57 seconds

And then we might manipulate where those images sit And you've got to readjust your focusing and teaming to keep that image single and clear.

25:04

25 minutes, 4 seconds

And so we're able to step out into almost like a step into, I should say, into an artificial environment to really stretch the boundaries of that flexibility between the convergent system and the focusing system.

25:18

25 minutes, 18 seconds

And then so we have lots of different tools. A classic one is people are seeing the block string. That is a tool, a tool by itself.

25:24

25 minutes, 24 seconds

I think it has some limitations, but it's certainly something we use as part of just one activity in an overall program to help people discover how to use their focus and their teaming better.

25:36

25 minutes, 36 seconds

Sorry, I'm not familiar with that tool that you just mentioned. Binocular string. So it's a string and we put beads on it and you put it on your nose.

25:46

25 minutes, 46 seconds

And it's a way of judging how accurately your eye is landing.

25:50

25 minutes, 50 seconds

So you look at the beta and then you get feedback on how accurate it is where your eyes are landing. But we can also use it as a feedback slowly You can move your eyes in and out.

26:02

26 minutes, 2 seconds

So a lot of our instruments are about giving you, the patient, the right feedback with having a therapist guide you so that you know when you're doing it right, when you're not doing it right.

26:12

26 minutes, 12 seconds

And that's the critical part of a good therapy program is that feedback. It's a bit like doing personal coaching at the gym.

26:19

26 minutes, 19 seconds

You're going to learn to use the equipment better in the right way and not the wrong way when you've got a personal trainer or a personal coach.

26:27

26 minutes, 27 seconds

And they're also adjusting your program based on the individual goals. And that's what we're doing in the therapy room as well.

26:34

26 minutes, 34 seconds

So you think that office-based therapy is going to be more effective than, let's say, computer-based therapy?

26:44

26 minutes, 44 seconds

Because there are some apps and things I think you can download, aren't there? Yeah, look, there might be one or two conditions.

26:52

26 minutes, 52 seconds

If you're, for example, there's some stuff coming into the amblyopia space where you might be looking at one particular thing that you're trying to to change.

27:00

27 minutes

And so a simple activity to change one thing, maybe that might work. But accommodation and conversions is quite a complex system.

27:08

27 minutes, 8 seconds

Just doing some computerized therapy, the problem with that is that you might get good at the game, and then you can't actually transfer it into real life.

27:17

27 minutes, 17 seconds

That's why we need to use different bits of equipment and create these different environments so that you're able to generalize those skills and take them away so that they're working more automatically.

27:26

27 minutes, 26 seconds

One of the risks we see with computer therapy is that if you're doing it yourself, you might overtrain an aspect. You might find a particular thing.

27:34

27 minutes, 34 seconds

If you are someone who converges too much, you might jump onto a convergence program and go, wow, this is easy.

27:41

27 minutes, 41 seconds

And because it's easy, you keep doing that part and you avoid training the parts that you're not so good at. And so you can actually create some problems by overtraining the wrong thing.

27:52

27 minutes, 52 seconds

All right.

27:52

27 minutes, 52 seconds

Well, and how long would it typically take for someone to see the difference if they were having a series of office therapy sessions with you guys?

28:03

28 minutes, 3 seconds

How long is a piece of string? It really does depend on what condition we're looking at.

28:10

28 minutes, 10 seconds

But if we're looking at a regular accommodation conversion.

28:14

28 minutes, 14 seconds

Sessions problem, then we're looking around that 16, 20 sessions to get you a point where you're automatic, that we don't need to do any more therapy.

28:26

28 minutes, 26 seconds

You're probably seeing improvements anywhere between in a 6-12 week mark, and it's all a bit different depending on how you present it, because there's a little head esteem.

28:35

28 minutes, 35 seconds

You don't know how to do it. We've got to build some capacity in learning how to do it.

28:40

28 minutes, 40 seconds

And what we've learned is that If you stop too soon, you haven't made those new skills, you don't own them. They're not a habit.

28:52

28 minutes, 52 seconds

You've got to turn them into a habit. So it's developing a new visual habit so that you're using your eyes without having to think about it in a much more efficient, better way.

29:02

29 minutes, 2 seconds

So we just need to do it long enough to have that happen. That's part of our review process is, how are you going? Are you getting to expect the progress?

29:11

29 minutes, 11 seconds

And when can we see that you really own those skills? And we can be hands-off and you get on with life.

29:17

29 minutes, 17 seconds

So it's really like training the brain and your eyes to work

29:24

29 minutes, 24 seconds

together and just making that an ingrained habit with the way that you That you operate. Yeah.

29:32

29 minutes, 32 seconds

It's just getting the brain to find the quickest and easiest way to use the eyes without all the extra effort. Yeah.

29:40

29 minutes, 40 seconds

Okay. Well, fantastic insights as always, Paul.

29:44

29 minutes, 44 seconds

And before we wrap up, do you have any final words of advice for people who think they might have this issue?

29:53

29 minutes, 53 seconds

Well, yeah. If you're getting eye strain symptoms, you're getting concentration symptoms.

29:57

29 minutes, 57 seconds

Even if you see well, then getting a thorough checkup that includes a good thorough look at your convergence and binocular system, sorry, convergence and accommodation system is something we would recommend.

30:08

30 minutes, 8 seconds

And while we've talked about vision therapy, there are some simple things we people where it's just the right prescription is all we need to do.

30:16

30 minutes, 16 seconds

So it's not one of these things where you're necessarily going to be having to go down the path of a big program.

30:22

30 minutes, 22 seconds

There are some relatively simple things we can do through prescribing that can help you.

30:26

30 minutes, 26 seconds

You need to at least rule out whether it's just a bit of advice on taking breaks versus, no, you've got a problem that we need to deal with and that we can manage

30:35

30 minutes, 35 seconds

and make your life easier and better so that you're not having to burn up a lot of attention and your energy on something that could be easily managed.

30:44

30 minutes, 44 seconds

Okay.

30:46

30 minutes, 46 seconds

Well, once again, if you found this video helpful, please hit the like button so others can discover it on YouTube.

30:52

30 minutes, 52 seconds

And don't forget to subscribe to the Harmony Vision YouTube channel for more conversations with with Paul about important eye care issues.

31:04

31 minutes, 4 seconds

So Paul, how can people get in touch with you there at Harmony Vision Care?

31:08

31 minutes, 8 seconds

So we've got So we've got the phone number there, which is we've got a wealth of information on that website.

31:19

31 minutes, 19 seconds

You can also book your appointments through a function on the website.

31:27

31 minutes, 27 seconds

We've got Facebook, Instagram as well, where you can find out more and see what we're doing. All right, then.

31:35

31 minutes, 35 seconds

Okay. Well, thanks for watching, everyone. Take care of your eyes. And until next time. Bye for now. Thank you.Sync to video time