children's vision and learning conference:3d vision syndrome: research, education and in your...

11/1/2013

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3D Vision Syndrome: Research, Education and In Your Office

Dominick M. Maino, OD, MEd, FAAO, FCOVD‐A

Presenter Disclosures

Consultant/

Speakers bureaus

Expert Witness/Legal Consultant-Gilbert & Tobin, Sydney, AustraliaAmerican Optometric Association Spokes Person, LecturerCollege of Optometrists in Vision Development, LecturerPacific University College of Optometry, Lecturer

Research funding “No Disclosures.”

Stock ownership/Corporate boards-employment

“No Disclosures.”

Off-label uses

Editor/Author

“No Disclosures.”

Visual Diagnosis and Care of the Patient with Special Needs, Lippincott, 2012; American Optometric Association News

This lecture is available from:

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Professor of Pediatrics/Binocular VisionIllinois Eye Institute/Illinois College of Optometry

Lyons Family Eye Care Chicago, Il

[email protected]

LyonsFamilyEyeCare.comMainosMemos.com

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Leonard J. Press, O.D., FCOVD, FAAOPressVision, Fair Lawn, NJ

Len ScroganDigital Learning Architect, Asst. Professor University of Colorado‐Denver; AsstDirector of Instructional Technology, Boulder Valley School District Boulder,

Colorado

Shun‐nan Yang, PhDVision Performance Institute, Pacific University College of Optometry

Acknowledgements:

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Hurry! Hurry! Hurry!

Step this way to see the incredibleSimulated 3D!

Going down the simulated 3D Rabbit Hole.

Hype?Fact?

Passing Fad?Here to stay?

How you respond may significantly affect your practice and your quality of life !

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Simulated 3D: Getting the word out!

http://www.youtube.com/watch?v=GzTMvyqAar0

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3D in the News ABC Chicago

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BV Dx& Tx in the News!!

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The Early Years

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13 Ghosts (1960)

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House of Wax (1953) starring Vincent Price

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3D Television

Stereoscopic television was first demonstrated by John Logie Baird in 1928

Stereo TV

Stereo Receiver

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3D Vision SyndromeA Technologically Driven

Visual Impairment

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.

3D Vision & Eye Health.orgThe 3Ds of Stereoscopic 3D ViewingAOA YouTube Videos

The Public Health Implications of Virtual 3D ‐Michael DuenasThe Visual System and Virtual 3D ‐ Jim Sheedy, O.D., Ph.D.

3D: The User Experience Story ‐ Philip J. CorriveauExploring a New Dimension ‐ Chris Haws

Improving Binocular Vision‐Creating a Better 3D Audience – Dominick M. Maino, OD, MEd

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http://www.3deyehealth.org/

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The Public Health Implications of Virtual 3D – Dr. Michael Duenas)

(http://www.youtube.com/watch?feature=player_embedded&v=howdZm‐d7Z0

In 2009 the ETC @ USC 3D visual think tank: Martin S. Banks, O.D., Ph.D. Christopher Tyler, Ph.D.Maureen Powers, Ph.D. Dominick Maino, M.Ed., O.D. Susan R. Barry, Ph.D. Leonard J. Press, O.D.

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Maino D. The binocular vision dysfunction pandemic. Optom Vis Dev2010;41(1):6‐13.

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10% of movie goers and 20% of home viewers report increased viewing symptoms during and after viewing(Cooper et al., 2011; Yang et al., 2012).Young viewers and those with prior binocular difficulties (nearer NPC and exophoria) are more likely to have heightened symptoms. (Yang et al., 2011; Yang et al., 2012).Eye (visual/ocular) symptoms are weaker and limited; motion sickness symptoms are significant and linger. (Yang et al., 2012).Image disparity equal to or greater than 3% of screen width (~ 1.8° @ 2m viewing distance) induces greatest symptoms and reduce immersion (Yang et al., 2011).

Research

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Ranked 3D Viewing SymptomsSeverity

(high to low)Movie viewing (Yang et al., 2012)

Gaming (Yang et al., 2011)

Animated images (Yang et al., 2010)

1 Double Vision Nausea Disorientation

2 Nausea Dizziness Difficulty concentrating

3 Dizziness Headache Dizziness

4 Blurred Vision Difficulty thinking Difficulty thinking

5 Pain inside eyes Double vision Headache

6 Pulled eyes Neckache Neckache

7 Eye sore Blurred vision Difficulty visually focusing

8 Neckache Pain inside eyes Pulled eyes

Category: Motion sickness / Visual / Ocular / Physical / Cognitive

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Case Study: S3D Gaming

3D racing game (wipeout 3D) 45 subjects (23 females, 15 for each age group: 13‐18, 18‐30, 30+)

Samsung 55” LED 3DTV, active shutter glasses; binocular eye tracking.

Four levels of scene depth (1%, 2%, 3%, 4% of screen width or .6 to 2.4° added convergence angle @ 2m).

Surveyed for symptom before and during viewing; immersion during gaming.

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Case Study: S3D‐based Vision Testing

Objectives:

To test effect of binocular ability on S3D experience/discomfort To identify source of viewing discomfort To evaluate broader use in general examination of binocular vision ability.

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Mismatch between

accommodation & vergence signals

Conflicting sensory inputs on motion and vection

Symptomatic S3D viewer

(sig. discomfort while playing S3D games)

Traditional clinical exams

VPI vision programs

?

Possible causes Test predictability

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Stereoacuity

Stimulus: image of 4 circles within a diamond frame, one with convergent disparity (target disparity)

Locations of the 4 circles varied in each trial to remove symmetry clues

Result: the smallest disparity passed

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S3D floating text

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S3D motion sickness

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Testing Setup

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Summary on Discomfort & Immersion

Discomfort and immersion both increase with added disparity up to a threshold.

Above‐threshold discomfort resulted in reduced discomfort.

Younger viewers and those with eye misalignment (tendency to turn outward) report greater symptoms.

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Post‐S3D Gaming Discomfort Survey

Difference between groups (Symptomatic ‐ Control)

• Subjects reported mild ~ moderate levels (25~75/100) of discomfort (figure not shown)

• Symptomatic subjects experiences more severe discomfort in Accommodative‐Vergence related questions and VIMS‐related discomfort.

‐50 0 50

Q1 general physical discomfort

Q2 headache

Q3 difficlty concentrate

Q4 difficlty thinking

Q5 tired eye

Q6 eye strained

Q7 watery_dry eye

Q8 eye pulling

Q9 irriteted eye

Q10 buring eye

Q11 eye ache

Q12 blurry vision

Q13 double image

Q14 image jumping

Q15 trouble focusing

Q16 trouble switching focus

Q17 dizzy nausea

Q18 vertigo spinning

Q19 unsteady floating

Q20 confusion disorientation

Difference of rating between groups

(Sym

ptomatic ‐Control)

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Post‐S3D Reading Discomfort Survey



• Symptomatic subjects experiences more severe discomfort in Accommodative‐Vergence related questions discomfort.

‐20 0 20 40 60

Q1 general physical…

Q2 headache



Q5 tired eye

Q6 eye strained

Q7 watery_dry eye

Q8 eye pulling

Q9 irriteted eye

Q10 buring eye

Q11 eye ache

Q12 blurry vision

Q13 double image

Q14 image jumping



Q17 dizzy nausea



Q20 confusion…


(Sym


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Post‐2D Motion SicknessDiscomfort Survey



• Symptomatic subjects experiences more severe discomfort in VIMS‐relateddiscomfort.

‐20 ‐10 0 10 20 30 40

Q1 general physical…

Q2 headache



Q5 tired eye

Q6 eye strained

Q7 watery_dry eye

Q8 eye pulling

Q9 irriteted eye

Q10 buring eye

Q11 eye ache

Q12 blurry vision

Q13 double image

Q14 image jumping



Q17 dizzy nausea



Q20 confusion…


(Sym


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Results

15 subjects were confirmed as symptomatic subjects based on detailed history survey, most subjects are also companied with slightly higher rate of vergence misalignment

Discomfort intensity differ by symptomatic at Accommodative‐Vergence and VIMS‐related symptoms, depending on the task. S3D reading: more severe for Accommodative‐Vergence related

symptoms

VIMS stimuli: more severe for VIMS‐related symptoms

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S3D Benefits and Advantages: What Is Known?

S3D viewing provides added productivity (Badani et al., 2005; Blavier et al., 2006).

Learning of mathematical knowledge and scientific concepts can be facilitated by S3D viewing (DeLuca et al., 2009; Livingstone et al., 2008).

S3D improves performance and immersion in 3D gaming (Yang et al., 2012).

S3D Enhances viewer’s motivation and engagement in distance communication (Yang et al., 2013).

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Case Study: S3D presentation and Opinion Persuasion

90 adults (age 18 to 40 years) with good near and far binocular acuity (20/12 to 20/25).

Viewed 6 videos of 3‐ to 4‐minute length (3d vs. 2d, mono vs. stereo, for vs. against).

Assessing viewer’s related opinion before and after viewing.

Recalling detailed visual/orated contents.

Assessing attention with binocular eye tracking.

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Summary of S3D Benefits

Direct attention to the visually informative part of video.

Cognitively more persuasive.

Enhance content recall.

Promote group consensus.

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How is 3D used in Education?

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Types of 3D Content

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What strategies are teachers using with 3D? 46

3D Document Cameras

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3D PowerPoint and Game Design Software

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What’s Different about edS3D?49

…Slower

…More negative parallax

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…Shorter sustained viewing

…More immersive ‘gulping’

51 Why Schools use 3D… 52

You are there

It’s like they are there!53

It is here!

It’s like it is here!54

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Visualization Matters Visualization

Matters

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Students using 3D: were better able to put molecules in

relationship to one another demonstrated a higher level of

understanding of the processes. included more details performed better on their essays evidenced less misconceptions

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$45,000

$15,000

$8,800.00

$6,700.00 $5,700.00

$2,800.00 $0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000

y2004 y2007 y2009 y2010 y2011 y2013+

3D in Education Cost Trajectory

Cost Per Classroom

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3D in Your Office

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Discomfort, Dizziness, or Lack of Depth

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Clinical Aspects of S3D: The 3Ds of S3D Viewing

Discomfort

Asthenopia Accommodative‐vergence adjustments/instability

Stereoscopic delay/processing speed

Dizziness

Visual motion hypersensitivity/visual‐vestibular dysfunction

Mismatched “what” and “where” systems

Lack of Depth

Strabismus

Stereoblindness

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Clinical Aspects of S3D: The 3Ds of S3D Viewing

The 4th D:

Call your Doctor of Optometry!

(Where’s Dominick?)

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3D Vision Syndrome

What constitutes a syndrome?

A group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition

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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. There is also a cognitive/psychological disconnect as well (We know the image is at the screen but perceive it either closer or further away from us).

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How to Dx an Individual with3D Vision Syndrome

Examination Sequence

ComprehensiveVisual Efficiency/Strabismus/AmblyopiaSpecial Testing (Visagraph, TOVA, etc)

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How to Dx an Individual with3D Vision Syndrome

Case Hx

Salient Findings

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How to Tx an Individual with3D Vision Syndrome

We really don’t know the best methodology/approach.

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How to Tx an Individual with3D Vision Syndrome

Use what we do know

Rx/PrismOptometric Vision Therapy

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MainosMinions!

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Combination of Monocular & Binocular Cues

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Cues to 3D

Ocular or physiological

accommodation

convergence

Kinetic

motion parallax

optic flow

kinetic depth effect

interocular velocity difference

Pictorial

perspective

size

texture gradients

aerial perspective

superposition

Stereopsis

disparity

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Vision Induced Motion Sickness (See Sickness)

Induces dizziness when viewing moving targets such as movies or TV

Associated with binocular instabilities

Compounds sensory conflict

Winkler & Ciuffreda – Optometry 2009

See Sick Syndrome: Its Diagnosis and Treatment with Simple Home or Office Vision Therapy: Roderic Gillilan, OD, Nora M. Y. Chan, BS, and Hong T. Nguyen, BS gotohttp://www.pacificu.edu/optometry/ce/documents/SeeSickSyndromeManual.pdf

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The Examination

Use standard examination techniques in primary care and visual efficiency examinations ……and…..consider….

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S3D Symptom Survey

Do you experience eyestrain or headaches during or after viewing 3D?

Do you feel nauseous or dizzy during or after viewing 3D?

Is it difficult for your eyes to adjust back to normal after watching 3D? (“visual hangover”)

Are you more comfortable viewing 2D than 3D?

Is the 3D viewing experience not as vivid as it is for others watching the same picture?

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S3D Clinical Principles

Most S3D displays are dynamic

Clinical assessment and therapy should include dynamic stimuli

Assess processing speed and stamina

‐ Educational environment may differ from entertainment

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Accommodative Stability

Open View Autorefractor or Retinoscopy

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VergenceStamina

Vergence facility

12^ BO/3^BI

Gulden Ophthalmics Bernell

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Accommodative‐Vergence Conflicts(Hoffman, Girshick, Akelely& Banks, J of Vision 2008)

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Speed of Stereoscopic Response

Selwyn Super

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Distance Stereo Testing

Innova Systems

M&S Technologies

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Marco Distance Stereo: Relative Depth

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Simulated Distance Projection

Correct Eye Scope

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Stereo Optics of View Master

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Red Maddox Rod to Note Cyclo‐vergence

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Cyclo‐vergence ‐Adaptive Head Tilt to Sustain Binocular Viewing

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Sustained Viewing of S3D

Ergonomics

S3D media is a socially compulsive, physiologically challenging, sustained binocular task

adapted from Harmon/Skeffington

Optics

Effects of binocular imbalance in Rx will be magnified over time

Consider vectographic refraction

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3D Vision Syndrome Single Subject Design Research Study

Patient #1

Symptoms:

blurred vision, double vision, nausea, headache, dizziness

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Do you experience eyestrain or headaches during or after viewing 3D?

Yes

Do you feel nauseous or dizzy during or after viewing 3D?

Yes Is it difficult for your eyes to adjust back to normal after watching 3D? (“visual

hangover”)

?

Are you more comfortable viewing 2D than 3D?

Yes

Is the 3D viewing experience not as vivid as it is for others watching the same picture?

?

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3D Vision Syndrome Patient #1

27 y/o white female College educatedAthletic trainer

Hx of reading problems since 5th gradeRemedial reading class in college

Seasonal allergiesNephrectomy

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Initial FindingsVA’s CLS RE/LE 20/20

OR RE ‐.25, LE PL Acceptable FitMR RE ‐4.25‐50X175 20/15,

LE ‐4.00‐.50X175 20/15Pursuits/Saccades +4CT 18 XOP @ near

2nd Degree Fusion Variable

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Initial FindingsRandom Dot 100” (?)NPC 2/6/4”After 5 attempts pain notedPFV/NFV @ near could not do/diplopia‐ Lens amplitudes could not doNRA +2.00 diplopiaPRA ‐1.00

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3D Vision Syndrome

Initial Findings

Accommodative Facility diplopiaMEM variableOcular health mild allergic conjunctivitis

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3D Vision Syndrome

Diagnosis

Convergence insufficiencyAccommodative dysfunctionsHeadache, DiplopiaAllergic conjunctivitis

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Plan

Obtain past recordsStart Optometric Vision Therapy

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Previous Eye Examination (10/09)

“No Binocular Testing Done!”Hx “General Exam”, health “good”, Aided VAs 20/20 RE/LE, SLE unremarkable, Non‐dilated fundus evaluation unremarkable, Ret ‐4.00 Sph RE/LE, MR ‐4.00‐50X175 RE, ‐4.00‐.50X180 LE, CT 2XO dist/Ortho near, BI 20/8, BO 24/12 near

Dx Myopia, Astigmatism

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Optometric Vision TherapyPhase 1 Phase 2 Phase 3 Phase 4Mono Biocular Binocular IntegrationOculo‐ add anti‐ add StabilizationMotor, suppression vergenceHE, Acc

3 month post OVT maintenance Tx and final progress evaluation

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3D Vision Syndrome Patient #1 Optometric Vision Therapy

OVT #1HC SaccadesHC RockHTS (saccades, pursuits, accommodationBrockstring

HVTSent Home all of the above

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OVT #2

Reviewed HVTVision Builder (saccades)Franzblau Red RockBrockstring

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OVT #3

Reviewed HVTMinus lens dipsHC accom rockVision Building (binoc reading)Quoits

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OVT #4

Reviewed HVTVision Builder Randot vergence

Eccentric CirclesQuoits

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OVT #5

Reviewed HVT+/‐ Flippers (mono)Eccentric CirclesHTS autoslide vergenceJump vergences (vectos)Brockstring (bug on a string)HVTECC BO/Brockstring, HTS jump vergences

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OVT #6

Review HVTECCVectogram Jump VergenceLifesaver Cards

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Progress evaluation #1

20/15 BVA, RE/LECL OR RE +1.00‐.50X180 20/20

LE +1.25 20/20MR RE ‐3.25‐.25X175 20/20LE ‐3.250.75X005 20/20Pursuits +4 Saccades +3

CT 2EP (near)W4D 4 at all distances

Random dot 20 ‘

NPC TN no painBI 12/9 nearBO > 45

Amps 7 D RE/LEFacility 8 CPM RE, 11 CPM LE, 10

CPM OU

MEM +.75 each eye

During evaluation no diplopia, pain, suppressionstable findings

Symptoms improving, not resolved

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OVT #7

Clown vectograms (push BI)Chicago Skyline (jump)

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OVT #8

Clown vectograms (push BI) with +/‐1.00Tranaglyph BC 601BrockstringAperture Rule

Switch to HVT only due to change in work

schedule Saw 3D movie…no problems!

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Progress Evaluation #21 month later

Majority of symptoms resolvedBVA 20/20 RE, LESlight + CL ORCT ortho/2 EXO

NPC TNAfter 5 trials TN

NPC with RL 7/10 cmVergence dist BI x/14/10 BO X/30/25

Near BI 16/12 BO 35/25W4D 4 all distancesRandom Dot 25’

Pur/Sac +4

Amps 8.33 RE/LENRA +2.50PRA ‐2.25

Facility 6 RE, 7LE, 8 OU CPM no suppression

MEM +.50 RE, LERTO 6 mos CEE, intermittently do HVT

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Ended Here:

Majority of symptoms resolvedBVA 20/20 RE, LESlight + CL OR

CT ortho/2 EXO, NPC TNAfter 5 trials TN

NPC with RL 7/10 cmVergence dist BI x/14/10; BO X/30/25

Near BI 16/12; BO 35/25W4D 4 all distances, Random Dot 25’

Pur/Sac +4Amps 8.33 RE/LE

NRA +2.50, PRA ‐2.25Facility 6 RE, 7LE, 8 OU CPM

no suppressionMEM +.50 RE, LE

Started Here:

VA’s CLS RE/LE 20/20OR RE ‐.25, LE PL Acceptable

FitMR RE ‐4.25‐50X175 20/15,

LE ‐4.00‐.50X175 20/15Pursuits/Saccades +4CT 18 XOP @ near

2nd Degree Fusion VariableRandom Dot 100” (?)

NPC 2/6/4”After 5 attempts pain notedPFV/NFV @ near could not

do/diplopia‐ Lens amplitudes could not do

NRA +2.00 diplopiaPRA ‐1.00

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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!”

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Take homes: Tell Patients to sit in the “Sweet Spot”

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Take homes:

Ask the right questionsDo the right evaluationDetermine the right DxDetermine the right TxRefer out if necessaryDo not ignore

http://www.COVD.org

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Make your own 3D

http://www.image3d.com

Bibliography Badani, Ketan K., et al. "Comparison of two‐dimensional and three‐dimensional suturing: is there a

difference in a robotic surgery setting?." Journal of endourology 19.10 (2005): 1212‐1215.

Blavier, Adélaïde, et al. "Impact of 2D and 3D vision on performance of novice subjects using da Vinci robotic system." Acta Chirurgica Belgica 106.6 (2006).

De Lucia, Andrea, et al. "Development and evaluation of a virtual campus on Second Life: The case of SecondDMI." Computers & Education 52.1 (2009): 220‐233.

Livingstone, Daniel, Jeremy Kemp, and Edmund Edgar. "From multi‐user virtual environment to 3D virtual learning environment." Research in Learning Technology 16.3 (2008).

Yang, S.‐N., and Sheedy, J. E. (2011). Effects of vergence and accommodative responses on the comfort of viewing stereoscopic 3D stimuli. SPIE proceeding: Steroscopic Display and Applications, 7863, 78630Q. doi:10.1117/12/872546.

Yang, S.‐N., Schlieski, T., Selmins, B., Cooper, S., Doherty, R. A., Corriveau, P. J., Sheedy, J. E. (2012). Effects of stereoscopic 3D viewing on perceived immersion and viewing symptoms. Optometry and Vision Science, 89(7), 1068‐1080.

Tai, Y.‐C., Gowrisankaran, S., Yang, S.‐N., Sheedy, J.E., Corriveau, P.J., Younkin, A. Hayes, J.R. (2013). Depth perception from stationary and moving stereoscopic three‐dimensional images. SPIE proceeding: Stereoscopic Display and Applications, 8648‐26.

Yang, S.‐N., Gowrisankaran, S., Sheedy, J.E., Corriveau, P.J., Younkin, A. Hayes, J.R. (2013). Discernible difference and change in object depth afforded by stereoscopic three‐dimensional content. SPIE proceeding: Stereoscopic Display and Applications, 8648‐48.

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Leonard J. Press, O.D., FCOVD, FAAOPressVision, Fair Lawn, NJ

Len ScroganDigital Learning Architect, Asst. Professor University of Colorado‐Denver; AsstDirector of Instructional Technology, Boulder Valley School District Boulder,

Colorado

Shun‐nan Yang, PhDVision Performance Institute, Pacific University College of Optometry

Thanks again to:

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Professor of Pediatrics/Binocular VisionIllinois Eye Institute/Illinois College of Optometry

Lyons Family Eye Care Chicago, Il

312‐949‐[email protected]

ICO.eduLyonsFamilyEyeCare.com

MainosMemos.com

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The Public Health Implications of Virtual 3D – Dr. Michael Duenas)

(http://www.youtube.com/watch?feature=player_embedded&v=howdZm‐d7Z0

children's vision and learning conference:3d vision syndrome: research, education and in your...

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