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3 D Vision Syndrome: Toronto
1. Disclosure Statement:
Nothing to disclose”
Please silence all mobile devices.
Unauthorized recording of this
session is prohibited.
2.
3.
4.
5. Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
AOA National Spokesperson on 3 D Vision Syndrome
AOA Classroom 3D Project Team Member
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)
dmaino@ico.edu
MainosMemos.blogspot.com
www.ico.edu nw.optometry.net
6. Lecture Rules:
1.) Yes, you may ask questions.
2.) But only if I know the answer!
3.) My answer is always right!
4.) An updated version of this
presentation can be found at
www.slideshare.net/DMAINO/
10. 3 D Tipping Point
A 3D TV Tipping Point?
http://www.cnbc.com/id/41591929/A_3D_TV_Tipping_Point
Stereoscopic 3D Technologies Reach Tipping Point on PC Market – JPR.
http://www.xbitlabs.com/news/video/display/20100526234951_Stereoscopic_3D_Technologies_Rea
ch_Tipping_Point_on_PC_Market_JPR.html
10/114
11. ESPN: 3D Is at the Tipping Point
3D Printing Technology Nearing Tipping Point
Will you one day print yourself a new bowl or even a new house using 3D printing
technology? 3D printers are nearing a tipping point according to one expert cited in a
TechWeb article.
Sharp’s New Cell phone Video May Be a Tipping Point for 3D
http://www.bnet.com/blog/gadget-guy/sharp-8217s-new-cellphone-video-may-be-a-
tipping-point-for-3d/315
3-D reaches a tipping point in Europe
http://www.variety.com/article/VR1118004886
Dr. Karl Kapp: "the tipping point for 3D will be in the healthcare industry“
3D Medical Education
http://medical-animation-studio.com/
13. Many activities including: http://www.youtube.com/watch?v=9U4
AoDWPEQ0
Symposia, 3D Users Experience Tech Summit, The 3Ds of
3D Viewing, AOA YouTube Videos
3D in the Classroom: See Well, Learn Well
14. The Public Health Implications of
Virtual 3D
Michael Duenas, OD
The Visual System and Virtual 3D
Jim Sheedy, O.D., Ph.D.
3D: The User Experience Story
Philip J. Corriveau
15. Exploring a New Dimension
Chris Haws
Do You Know if the Kids are OK?
Maureen Powers, PhD
Improving Binocular Vision-
Creating a Better 3D Audience
3D Vision Syndrome
Dominick M. Maino, OD, MEd, FAAO,
FCOVD-A
16. The Public Health Implications of
Virtual 3D - Michael Duenas
(http://www.youtube.com/watch?feature=player_embedded&v=howdZm-d7Z0)
17. Public Health Model
3D Movies Have a New Dimension: Protecting Eye Health
1850 Snellen Eye Chart
Snellen eye chart has a 27% sensitivity (OMG!!)
High rate of FALSE Negatives.
Children that are referred because they fail the eye chart ….
Have a distance VA problem
Pediatrician screening? School nurse screening?
Only 3 states have mandatory vision screening.
Only a small percentage of children ever get the care they need
25% of school children have one or more vision problems
Undiagnosed untreated vision disorders are very prevalent
Cost of untreated vision problems staggering
All BV are treatable and preventable:
Great Public Health Model
18.
19. The Visual System and Virtual 3D - Jim Sheedy, O.D., Ph.D.
(http://www.youtube.com/watch?v=ZLpwCC5yxlo&feature=related)
20. 3D: The User Experience Story - Philip J. Corriveau
(http://www.youtube.com/watch?v=1IiHNit3RPM&feature=related)
21. Exploring a New Dimension- Chris Haws
(http://www.youtube.com/watch?v=4qZw98mkIhI&feature=related )
22. Brock String Debuts at the Consumer Electronics Show
Kids@Play Summit at CES 2011
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
(http://mainosmemos.blogspot.com/2011/04/dr-dominick-maino-at-consumer.html)
20/114
25. Improving Binocular Vision - Creating a Better Audience
Maybe Mike, from "Monsters, Inc.,"
looks so sad because he realizes
3-D doesn't do you any good if you
don't have binocular vision.)....
26. For the 3D Movie, Television, Video-
gaming and 3D in the Classroom
Techno-Industrial Complex….not having
binocular vision is the 800lbs Cyclops in
the room!
27. Improving 3D Television Technology
but Not Creating
a Better 3D Viewing Audience
1920‟s Image Credit : Baird Television Today
28. Improving 3D Movie
Technology but
Not Creating a Better 3D
Viewing Audience
1953 Image Credit: Mystic Cinema Today Image Credit: Joystiq
29. Improving 3D Gaming
Technology but
Not Creating a Better
Gamer
Image Credit: Daily Motion 3D Image Credit: Nintendo
30. Improving Classroom Technology but
Have Not Created
a Better 3D Viewing Student
30/128
Image Credit: American Optometric Association
Image Credit: mkrstovic.edublogs.org
31. History of 3D
3D in the Classroom: See Well, Learn Well
3D Timeline
32. 3 D Stereo Scopes
1844
Scottish inventor
and writer David
Brewster
introduced the
Stereoscope
1862
USA jurist, author,
inventor Oliver
Wendell Holmes
makes it possible
for all to enjoy 3D!
30/114
33.
34. Some of the first 3D Movies included:
Bwana Devil (1952 ) starring Robert Stack
http://www.youtube.com/watch?v
=4oGl_KqTw-M&NR=1
44. 3D Tech - NASA Uses Video Games for
Visualization & Engineering
http://www.youtube.com/watch?v=v-mFx6blZK8
NASA Video Game Brain Training for ADHD
http://www.youtube.com/watch?v=S26Kk-
ueWjQ&feature=related
Mario Brothers
3D
http://www.youtube.com/wat
ch?v=0U0ZDjnQiXQ
47. Passive
3D glasses technology
Linearly polarized glasses
Two images are projected superimposed onto the same
Use a silver screen so that polarization is preserved.
Can‟t tilt head
48. Passive
3D glasses technology
Circularly polarized glasses
Light that is left-circularly polarized
is extinguished by the right-handed
analyzer, while right-circularly
polarized light is extinguished by
the left-handed analyzer.
The viewer can tilt their head and
still maintain left/right separation.
50. RealD Cinema system uses an
electronically driven circular polarizer
Infitec glasses
Infitec (interference filter technology.)
Filters divide the visible color
spectrum into six narrow bands
"super-anaglyph”
52. 3D glasses technology
Active
Active
LCD shutter glasses
A liquid crystal glasses stop
or allow light in thru
synchronization with the
images seen on the screen
Red eye shutterglasses
The Red Eye Method
reduces the ghosting
50/114
53. Active 3D Glasses
small LCD screens
when voltage applied lens goes dark
synced with screen showing 3D
content then alternates image viewed
each eye different angle of view
creates 3D effect
54. Active 3D Glasses
this method of 3D cuts refresh rate in half
Known to cause headaches
http://www.3d-tvbuyingguide.com/3dtv/3d-glasses.html
55. Active 3D Glasses
3D Personal Display Spectacles
two small screens in the glasses
display separate images to each eye.
Does not require a television
http://www.trendhunter.com/trends/head-mounter-3d
57. Lenticular printing
used to produce
images with an
illusion of depth, or
the ability to
change or move
as the image is
viewed from
different angles
59. Autostereoscopic displays Auto 3D
Nintendo 3DS
Nintendo 3DS is hazardous to the
eyes of children (Nope!)
http://www.digitaltrends.com/gaming/nintendo-3ds-is-hazardous-to-kids-eyes/
60. Remember we want 6 y/olds
using Nintendo 3DS!
3D Vision as
Public Health Model
60/128
61. How Does
Nintendo
3DS Work?
two separate
outputs at slightly
different angles
one for your left
eye and the other
for your right
http://kombo.com/f
eatures/How_the_
3DS_Works/
62. 3D Vision Syndrome
What constitutes a syndrome?
A group of symptoms that collectively
indicate or characterize a disease,
psychological disorder, or other
abnormal condition
63. So is the 3D Vision Syndrome
Really a Syndrome?
Yes.
The symptoms and signs consistently
include: headaches, nausea, dizziness, a
vision induced sense of motion, diplopia,
blurred vision and eyestrain; as well as a
disconnect between accommodation and
vergence.
64. The 3D’s of 3D Viewing:
Discomfort, Dizziness and Lack of Depth
Discomfort:
Since 3D viewing is based on
the eyes converging in front
of or beyond the screen,
viewing 3D images can
potentially create eyestrain
and headaches
65. The 3D’s of 3D Viewing:
Discomfort, Dizziness and Lack of Depth
Dizziness:
3D technology can
exaggerate visually induced
motion sickness …causing
consumers to feel dizzy or
nauseous during or after
viewing 3D content.
66. The 3D’s of 3D Viewing:
Discomfort, Dizziness and Lack of Depth
Lack of Depth:
A viewer lacking binocular
vision, simply won‟t see 3D.
While this doesn‟t pose any
problem viewing the screen, it
serves as a “vision screening”
that something is abnormal
with the viewer‟s binocular
vision. Photo credit: Photobucket
67. Symptoms of 3D Vision
Syndrome
asthenopia, headaches, blurred vision,
eyestrain, diplopia, dizziness/nausea and
vision induced motion sickness …..or ….
Image credit: squidoo.com/3d-
Image Credit: American Optometric Association animated-gif
68. Symptoms of 3D Vision
Syndrome
…a happy, actively engaged users of 3D
content?
Image Credit: American Optometric Association
69. 3D Vision Syndrome …
… is comprised of a group of symptoms and
physical signs that collectively indicate or
characterize a functional vision and/or eye
health disorder that manifests when viewing
simulated 3D technology. These signs and
symptoms include but are not limited to
headaches, blurred vision, eyestrain, double
vision, dizziness/nausea, decreased depth
perception and vision induced motion sickness.
71. Scope of The Problem
Amblyopia 2% (6,239,043 US)
Strabismus 2-5% (15,597,609 US
Accommodation 2.5-9.2% (28,699,600 US)
Eye Coordination (CI 7%)
Up to 25% (77,988,195 US)
Vertical Misalignment 7-52%
(162,215,135 US)
US Census Bureau: U.S. 311,952,183
World 6,954,459,463
AOA Clinical Guidelines: http://www.aoa.org/x4813.xml US Census:
http://www.census.gov/main/www/popclock.html
72. According to Statistics Canada, the
population of Canada, as of January 1,
2011, is estimated to be 34,278,400.
Amblyopia 2% (686,568)
Strabismus 2-5% (1,713,920)
Accommodation 2.5-9.2% (3,085,056)
Eye Coordination (CI 7%)
Up to 25% (8,569,600)
Vertical Misalignment 7-52%
(17,842,768)
74. Chicago is only a bit
more than an hour
plane ride from
Toronto…so if you don‟t
want to care for these
folks….
75. How to Dx an Individual with
3D Vision Syndrome
Examination Sequence
Comprehensive
Visual Efficiency/Strabismus/Amblyopia
Special Testing (Visagraph, TOVA, etc)
76. How to Dx an Individual with
3D Vision Syndrome
Case Hx
Salient Findings
77. How to Tx an Individual with
3D Vision Syndrome
We really don‟t
know the best
methodology/approach.
78. How to Tx an Individual with
3D Vision Syndrome
Use what we do know
Rx/Prism
Optometric Vision Therapy
79. These are your patient‟s eyes….
These are
your patient‟s
eyes
On 3D!
80. 3D Vision Syndrome
Single Subject Design
Research Study
Patient #1
Symptoms:
blurred vision, double
vision, nausea,
headache, dizziness
while watching 3D
movie 80/128
81. 3D Vision Syndrome
Patient #1
27 y/o white female
College educated
Athletic trainer
Hx of reading problems since 5th grade
Remedial reading class in college
Seasonal allergies
Nephrectomy
82. 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 Variable
83. 3D Vision Syndrome
Patient #1
Initial Findings
Random Dot 100” (?)
NPC 2/6/4”
After 5 attempts pain noted
PFV/NFV @ near could not do/diplopia
- Lens amplitudes could not do
NRA +2.00 diplopia
PRA -1.00
84. 3D Vision Syndrome
Patient #1
Initial Findings
Accommodative Facility diplopia
MEM variable
Ocular health mild allergic conjunctivitis
89. Randomized clinical trial of treatments for symptomatic convergence
insufficiency in children. Arch Ophthalmol. 2008 Oct;126(10):1336-49.
Convergence Insufficiency Treatment Trial Study Group.
CONCLUSIONS:
Twelve weeks of OBVAT results in a significantly
greater improvement in symptoms and clinical
measures of near point of convergence and
positive fusional vergence and a greater
percentage of patients reaching the predetermined
criteria of success compared with HBPP,
HBCVAT+, and OBPT. Application to Clinical
Practice Office-based vergence accommodative
therapy is an effective treatment for children with
symptomatic convergence insufficiency.
90. Scheiman M, Cotter S, Kulp MT, Mitchell GL, Cooper J, Gallaway M, Hopkins
KB, Bartuccio M, Chung I; the Convergence Insufficiency Treatment Trial Study
Group. Treatment of Accommodative Dysfunction in Children: Results
from a Randomized Clinical Trial. Optom Vis Sci. 2011 Nov;88(11):1343-
1352.
CONCLUSIONS: Vision
therapy/orthoptics is effective in
improving accommodative
amplitude and accommodative
facility in school-aged children with
symptomatic CI and
accommodative dysfunction.
90/128
91. Long-term effectiveness of treatments for symptomatic convergence
insufficiency in children. Optom Vis Sci. 2009 Sep;86(9):1096-103.
Convergence Insufficiency Treatment Trial Study Group.
CONCLUSIONS: Most children aged 9 to
17 years who were asymptomatic after
a 12-week treatment program of
OBVAT for convergence insufficiency
maintained their improvements in
symptoms and signs for at least 1 year
after discontinuing treatment. ….
92. Scheiman M, Mitchell GL, Cotter S, Kulp MT, Cooper J, Rouse M, Borsting E,
London R, Wensveen J. A randomized clinical trial of vision
therapy/orthoptics versus pencil pushups for the treatment of
convergence insufficiency in young adults. Optom Vis Sci. 2005
Jul;82(7):583-95.
DISCUSSION:
In this study, vision therapy/orthoptics was the only
treatment that produced clinically significant
improvements in the near point of convergence and
positive fusional vergence. ……
Pencil Push ups do not work very well!
93. Ciuffreda KJ. The scientific basis for and efficacy of optometric vision
therapy in nonstrabismic accommodative and vergence disorders.
Optometry. 2002 Dec;73(12):735-62.
BACKGROUND:
For nearly 75 years, optometric vision therapy has been an important mode of
therapy for both children and adults who manifested a range of nonstrabismic
accommodative and vergence disorders.
METHODS:
In this article, the scientific basis for, and efficacy of, optometric vision therapy
in such patients will be discussed. Using bio-engineering models of the
oculomotor system as the conceptual framework, emphasis will be focused on
studies that used objective recording techniques to directly assess
therapeutically related changes in oculomotor responsivity.
RESULTS AND CONCLUSIONS:
The findings clearly support the validity of
optometric vision therapy. Furthermore, the
results are consistent with the tenets of general
motor learning.
94. Maino D. The number of placebo controlled,
double blind, prospective, and randomized
strabismus surgery outcome clinical trials:
None! Optom Vis Dev 2011;42(3):134-136.
http://www.covd.org/Portals/0/OVD/42-3/Editorials/OVD%2042-
3%20Journal_Editorial_Maino_web.pdf
96. Use principles of neuro-plasticity therapy:
Maino D. Neuroplasticity: Teaching an Old
Brain New Tricks. Rev Optom 2009. 46(1):62-
64,66-70
97. 3D Vision Syndrome
Patient #1 Optometric Vision Therapy
OVT #1
HC Saccades
HC Rock
HTS (saccades, pursuits,
accommodation
Brockstring
HVT
Sent Home all of the above
98. 3D Vision Syndrome
Patient #1 Optometric
Vision Therapy
OVT #2
Reviewed HVT
Vision Builder
(saccades
Franzblau Red Rock
Brockstring
99. 3D Vision Syndrome
Patient #1 Optometric
Vision Therapy
OVT #3
Reviewed HVT
Minus lens dips
HC accom rock
Vision Builder
(binoc reading)
Quoits
103. 3D Vision Syndrome
Patient #1 Optometric Vision Therapy
Progress evaluation #1
20/15 BVA, RE/LE NPC TN no pain
CL OR RE +1.00-.50X180 BI 12/9 near
20/20 BO > 45
LE +1.25 20/20 Amps 7 D RE/LE
MR RE -3.25-.25X175 20/20 Facility 8 CPM RE, 11 CPM LE,
LE -3.250.75X005 20/20 10 CPM OU
Pursuits +4 Saccades +3
CT 2EP (near) MEM +.75 each eye
W4D 4 at all distances
Random dot 20 „
During evaluation no diplopia, pain, suppression
stable findings
Symptoms improving, not all resolved
104. 3D Vision Syndrome
Patient #1 Optometric Vision Therapy
OVT #7
Clown vectograms (push BI)
Chicago Skyline (jump)
105. 3D Vision Syndrome
Patient #1 Optometric Vision Therapy
OVT #8
Clown vectograms (push
BI) with +/-1.00
Tranaglyph BC 601
Brockstring
Aperture Rule
Switch to HVT only due to
change in work schedule
Saw 3D movie…no problems!
106. 3D Vision Syndrome
Patient #1 Optometric Vision Therapy
Progress Evaluation #2
1 month later
Majority 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
X/30/25 RTO 6 mos CEE, intermittently do
Near BI 16/12 BO 35/25 HVT
W4D 4 all distances
Random Dot 25‟
Pur/Sac +4
107. Started Here: Ended Here:
VA‟s CLS RE/LE 20/20 Majority of symptoms resolved
OR RE -.25, LE PL Acceptable Fit BVA 20/20 RE, LE
MR RE -4.25-50X175 20/15, Slight + CL OR
LE -4.00-.50X175 20/15 Pur/Sac +4
Pursuits/Saccades +4 CT ortho/2 EXO, NPC TN
CT 18 XOP @ near After 5 trials TN
NPC 2/6/4” NPC with RL 7/10 cm
After 5 attempts pain noted Vergence dist BI x/14/10
PFV/NFV @ near could not BO X/30/25
do/diplopia Near BI 16/12 BO 35/25
W4D Fusion Variable W4D 4 all distances, Random
Random Dot 100” (?) Random Dot 25‟
- Lens amplitudes could not Amps 8.33 RE/LE
do NRA +2.50, PRA -2.25
NRA +2.00 diplopia Facility 6 RE, 7LE, 8 OU CPM
PRA -1.00 no suppression
MEM +.50 RE, LE
108. Convergence insufficiency, Accommodative dysfunctions, Headache, Diplopia,
Blurred vision, Double vision, Nausea, Dizziness
All resolved in 8 OVT visits and HVT
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!”
109. Computer Programs Used in Optometric Vision Therapy
Computer Aided
Home Therapy Solutions Vision Therapy
110. 3D as a Public Information
and Marketing Tool
3D in the News-Print Media-Internet
In Your Office-3D Pictures-Newsletters
Website/Blog/Facebook/SOVOTO/LinkedIn
Media Awareness!
110/128
111. 3D in the News ABC Chicago
http://abclocal.go.com/wls/stor
y?section=news/health&id=72
98893
128. 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)
dmaino@ico.edu MainosMemos.blogspot.com
www.ico.edu nw.optometry.net