Leaders in Eye Health have a Common Vision

By Briar Sexton


The Insight Leaders Council of British Columbia held its inaugural event on July 12. Remarkably, it was the first time that the opticians, optometrists and ophthalmologists of B.C. jointly organized and attended an event designed to facilitate inter-professional relationships and to promote excellence in eye care.

In the words of event coordinator Sheila Bissonnette, managing director of Summit Hill Strategies in Vancouver: “Why not Canada and why not B.C.? Why can’t we create a model of eye care that is recognized globally for its achievements?”

In addition to local eyecare professionals, the event attracted industry leaders from Alcon, Essilor and Vertical Bridge Corporate Consulting.

Held at the Vancouver Club, the evening featured a cocktail reception and two guest speakers. The first was Donovan Tildesley, three-time Paralympic medalist in swimming and the Canadian Paralympic flag bearer at the Beijing Paralympics. Blind since birth with Leber’s Congenital Amaurosis, Donovan delivered a strong message that you can achieve what you believe. He also provided a sobering reminder that even for a Paralympian who skis Black Diamond runs, one of his biggest achievements is full-time employment. Less than one-third of blind Canadians have adequate employment.

Melanie Ross, executive director of the British Columbia Society of Eye Physicians and Surgeons, said, “A glimpse at Donovan’s life is such a reminder that my eyesight is a wonderful gift. It is humbling that someone who is particularly accomplished should consider full-time employment such a great achievement. To a person who has overcome more barriers than most of us can imagine, we put up a yet greater barrier because of our inability to believe in them as a whole person with skills and the ability to do the job.”

The second speaker was Dr. Kevin Gregory-Evans, a UBC professor and the Julia Levy B.C. Leadership Chair in Macular Research. He informed the crowd of some of the cutting-edge work being done in B.C. and expressed great confidence that vision scientists will eventually cure blindness.

By the end of the evening some participants were asking when the next event would be held. Kim McEachern, program director for the Opticians Association of Canada, said, “It was an inspiring evening with so many eye health professionals coming together to get acquainted. I hope to see more opportunities moving forward.”

Sheila Bissonnette hopes that the next event reaches an even larger audience. “Our committee feels we made a great start,” she said. “There is clearly an appetite for professional collaboration amongst all disciplines of eye health and we welcome all stakeholders who want to make their voices heard.”

The success of the inaugural Insight Leaders Council event and the passion for eye care among its participants demonstrates that British Columbia is taking steps toward becoming a forward-thinking leader in eye care. Why not B.C., indeed.

Of Mice and Men: New Research Breakthrough in Aniridia

By Briar Sexton, MD

Dr. Cheryl Gregory-EvansUniversity of British Columbia researcher Dr. Cheryl Gregory-Evans and her scientific team have made a landmark breakthrough in the treatment of aniridia.

Aniridia is a genetic eye disease that is present at birth. It is a panocular condition causing lack of or poor development of the cornea, fovea, iris and optic nerve. It also causes glaucoma, nystagmus, dry eye and cataracts. Individuals born with aniridia generally have vision between 20/80 and 20/200.

The genetic fault in aniridia is a nonsense mutation: effectively there is a stop sign or “stop codon” where there should be a green light. The result is a shortened protein that doesn’t function properly and leads to abnormal development of the eye in utero.

Ataluren is a commercially available drug that identifies the false stop sign and enables manufacture of the complete protein. It is already being used for diseases like muscular dystrophy and cystic fibrosis. Dr. Gregory-Evans posited that if Ataluren could be delivered to the eye it might help the eyes of newborn mice to develop more normally.

Her lab’s initial attempts were unsuccessful. The Ataluren drops did not dissolve and reach the back of the eye and they irritated the eyes of the mice. Her lab then pioneered a special formulation of Ataluren that dissolved and did not irritate. Mice that were born with abnormally developed eyes experienced a reversal of the damage with Ataluren treatment.

Recruitment for the first clinical trial in humans is currently underway. If successful, this treatment may help with other retinal diseases including Retinitis Pigmentosa and even some types of macular degeneration. The global scientific community is watching with keen interest to see the results of the Canadian trial and Canada’s philanthropic community is interested as well. Both CNIB and the Foundation Fighting Blindness fund Dr. Gregory-Evans’ laboratory.

Comic Vision: How One Mom Put the “Fun” Back Into Fundraiser

By Briar Sexton, MD

DiscoveringAnn Morrison was in no mood to laugh when she received the news that her young son Gavin had Retinitis Pigmentosa (RP) in 1998. RP is an incurable genetic disease that causes the affected person’s vision to narrow to a very small window – and even that window can become blurry. It also severely affects night vision.

But Ann isn’t the sort of person who retreats from a challenge and her reaction was to learn everything she could about the disease.

She attended Vision Quest, a Foundation Fighting Blindness (FFB) annual event that educates patients and families living with eye disease and enables them to connect with one another. In addition to learning about RP, she learned about the FFB.

The organization, which is the largest private supporter of Canadian vision research, donates millions of dollars annually to Canadian researchers working on treatments and cures for genetic eye diseases, including RP and macular degeneration. What Ann learned about the Foundation convinced her the group was worth supporting.

What came next was an idea from her friend, Meg Soper, a nurse and successful stand-up comic, who suggested they get their friends and families together to raise money for the FFB. Their first event in 1999 at The Laugh Resort in Toronto raised $7,800. Buoyed by their success the pair set their sights higher; in 2002 they worked on a second event, this time with a volunteer committee, which led to increased ticket sales and revenue.

In 2003, the Foundation welcomed Ann to their staff and Comic Vision became an official FFB fundraiser. A year later it expanded to Oakville, then London, Vancouver and Calgary; in 2010, Comic Vision was held at Toronto’s “Last Call”, a smaller venue that evokes the event’s roots. In each city Comic Vision received strong support from community volunteers and debuted to crowds of over 300. The momentum continues to grow, and this year, with the event debuting in Halifax, Comic Vision will officially go coast to coast.

The funds raised keep increasing too. Since 1999, Comic Vision has raised over $5 million for the Foundation Fighting Blindness. In 2013 alone, more than 2,500 Canadians attended the various Comic Vision shows, raising $930,000 for vision-saving research by Canadian scientists.

Ann is now the FFB’s Director of Philanthropy. Asked how she remains so dedicated to the organization more than a decade after first getting involved, she says, “The Foundation is not just about restoring sight, it also restores people’s hope. The progress made in the last 10 years is so encouraging, I am confident there will be treatments in the next decade for some forms of retinal disease”.

Anyone attending Comic Vision for the first time will be pleasantly surprised by the event’s atmosphere. The crowd is more “smart casual” than “black tie.” Waitresses circulate with finger foods and tables are adorned with Kernels popcorn, Twizzlers and other treats. The audience munches away while enjoying high-calibre stand-up comedy. It’s the kind of evening people would enjoy even if it wasn’t for a good cause.

Shelagh Anson, the mother of two young children with RP, was apprehensive about attending her first Comic Vision event in Vancouver in 2012. Beforehand, she was on the brink of tears at the mere mention of her kids’ diagnosis. Shelagh did cry that evening, but they were tears of laughter at the comedians’ routines. She and her family actively volunteer with and donate to the FFB and her experience epitomizes Comic Vision’s slogan: “Share the Laughter, See the Hope.”

Comic Vision is the ultimate win-win, a fun evening people will enjoy even if they aren’t affected by vision issues. It’s also a cause anyone can gladly get behind, knowing they’re supporting Canada’s best vision scientists in their truly groundbreaking work.

Incredible New Hope for the Amblyopic Brain

By Paddy Kamen

Photo credits: Pierre Dubois, McGill University Health Centre

Science has once again leapt from a mindset of stagnation to a world of discovery, and a Canadian vision scientist has led the way. In an exciting development, Dr. Robert Hess and his team of international collaborators demonstrated that both eyes can learn to work together for improved vision when one of them is amblyopic. “This was previously thought impossible,” comments Hess, director of the Research Department of Ophthalmology at the Research Institute of the McGill University Health Centre (RI-MUHC).

The research was recently published in the prestigious journal Current Biology, with Hess as the senior author. The key scientific principle that underlies the research is the notion of brain plasticity: the idea that the brain can change at any age in response to experience. And so, Hess uses the language ‘the amblyopic brain’ as opposed to ‘the amblyopic eye’.

“We have known for some time that the amblyopic eye is quite normal and the problem is in the visual processing regions of the brain. But the old way of thinking was that the amblyopic eye learns ‘bad habits’ early in the child’s development and that these habits are only amenable to change through patching the good eye. Thus, the so-called ‘lazy eye’ has been forced to work harder or better for hundreds of years. This has been the main ‘treatment’ for amblyopia and it has serious limitations.”

Patching helps less than half the time, says Hess. “When it does work, it can improve vision quite a bit, and even get the vision to almost normal. But patching doesn’t usually get the two eyes working together. Restricting children to operating in a low vision world can be dangerous to their safety and it causes stress. It also stresses the parents as they try to keep the kid wearing the patch.”

Hess knows from personal experience how stressful patching an eye can be. As part of an experiment he patched one of his eyes for four days. “It had a devastating effect on me,” he explains. “While it disrupts your 3D vision, reduces the visual field and makes one clumsy, the main problem was that I became depressed and the world looked dull and boring. After four days, my family was begging me to take off the patch. I certainly wouldn’t have predicted such a dramatic effect.”

Vision scientists have long assumed that binocular vision or stereopsis is not terribly important, asserts Hess. Now he knows that it is, in fact, essential to a sense of well-being. “One can get good at compensating, but it takes more trial and error to learn simple tasks and this can affect self-esteem in children. There is more research coming out on hand-eye coordination and the importance of stereopsis. Three-dimensional vision gives life a richness that we take for granted.”

Hess’ team began thinking about amblyopia in a different way, hypothesizing that the amblyopic eye is not passive by nature but is instead actively suppressed by the stronger eye. “In the visual areas of the brain, signals from the good eye turn off signals from the other eye, in order to avoid confusion. We think this happens in infancy or early childhood as a reaction to an eye that is not straight or in which the vision is poor. The two eyes should be working together but instead one eye dominates, turning off the brain connection in the other eye and leading to a loss of function. So we thought, why not try to get the eyes working together?”

Hess learned that visual contrast is the determining factor in the ability of the strong eye to dominate. He explains: “We arranged viewing conditions that reduced contrast to the stronger eye. Using the popular video game Tetris, we placed head-mounted goggles on the subjects that presented aspects of the game dichoptically, where the weaker eye saw the geometric shapes falling and the stronger eye saw only the ground-plane objects. The information was thus distributed between the two eyes in a complementary manner. We lowered the contrast in the stronger eye, until we found a level at which it didn’t suppress the amblyopic eye. Over time we increased the contrast to the stronger eye until it approached normal vision, while at the same time not suppressing the amblyopic eye.”

This was a controlled, crossover study in which one group of subjects played the game monocularly with the weaker eye (having the stronger eye patched), and the other group played the game dichoptically. After two weeks, the dichoptic group showed a dramatic improvement in the vision of the weaker eye (three lines on the letter chart), and over half of the subjects regained 3-D depth perception by a factor of 3 in a Randot test. When the monocular patching group, which had showed only a moderate improvement, was switched to the new dichoptic training, their vision also improved dramatically.

A large clinical trial with children, comparing this technique to patching is in the planning stages.

“We already know that it works with the younger population but a formal controlled study is essential to prove efficacy,” says Hess. “If our method comes out on top, it can take the place of patching, giving an improved quality of vision to millions of children, and helping them to enjoy the richness of life and to learn more easily.”

Study Identifies Cause of Blindness

By JoAnne Sommers

DiscoveringAn exciting gene discovery by a McGill University-led team of international scientists could soon pave the way for treatment of Leber congenital amaurosis (LCA), a devastating genetic form of blindness that appears at birth or within the first few months of life. LCA affects about one in 80,000 newborns.

The team, led by Dr. Robert Koenekoop, director of the McGill Ocular Genetics Laboratory and chief of Pediatric Ophthalmology at the Montreal Children’s Hospital, identified the gene, which is called NMNAT1. One of 18 genes which are responsible for LCA, NMNAT1 is crucial for the survival of neurons. It has never before been associated with any human disease.

“This is probably one of the most important discoveries in neuroscience and blindness in the past 15 years,” said Dr. Koenekoop. “Researchers have been looking for the link between NMNAT1 mutations and human disease in the brain or body for many years.”

The gene NMNAT1 is found in every cell in the human body. It produces a vital coenzyme called NAD, which is involved in hundreds of reactions in the cell. Interestingly, NMNAT1 is also part of a rescue mechanism that slows degeneration of neurons and thus helps to prevent the onset of many diseases, including Alzheimer’s and Parkinson’s.

To Dr. Koenekoop NMNAT1 is one of the most exciting of the genes known to cause LCA because it opens up a whole new pathway of disease. “We can now identify the gene responsible for LCA in 75 per cent of children,” he said. “We are getting closer to being able to identify all the genes for this form of child blindness and develop effective treatments.”

Because higher levels of NAD have been shown to significantly delay degeneration of neurons, the team’s work raises the possibility that giving NAD as a drug in young LCA patients with NMNAT1 mutations may be a potential therapeutic option to cure blindness in the near future, he added.

The team has already developed a one-hour genetic test that can determine whether a newborn with LCA has the NMNAT1 mutation and costs only $1 to administer. The ability to determine the existence of the mutation at such an early age is very important because LCA is a progressive disease; there is significant atrophy of the retina by age 10 so early treatment would be very beneficial.

“If you think a baby has LCA (it usually becomes evident at six weeks when the infant stops looking at the parents) a blood test will determine conclusively whether the condition is present,” said Dr. Koenekoop.

The project was funded in part by the Government of Canada through GenomeCanada, the Canadian Institutes of Health Research and the Ontario Genomics Institute. Additional funding was provided by Génome Québec and Genome BritishColumbia. It was also funded in part by the Foundation Fighting Blindness (FFB), a national private charity that funds vision research to find the causes, treatments and cures for inherited, degenerative forms of blindness.

“Dr. Koenekoop and his colleagues have had tremendous success in uncovering and understanding the genetics of LCA,” said Sharon Colle, the Foundation’s CEO and President. “Identifying the mutations that cause LCA helps families struggling with this rare disease get a firm diagnosis, which is the first step towards potential treatments.”

In addition to Dr. Koenekoop’s group, the study involved the laboratory of Dr. Rui Chen, Texas Children’s Hospital, Baylor College of Medicine,Houston; the laboratory of Dr. Jacek Majewski at the McGill University and Génome Québec Innovation Centre; The University of Leeds, UK team and FORGE Canada Consortium.

The study results were published in the journal Nature Genetics.

Stem Cells Harvested from the Retina

By Paddy Kamen

DiscoveringIt sounds spooky to be sure, but fresh donor cadavers have been used to harvest stem cells from the fluid that surrounds the retina at the back of the eye. This spooky science may hold hope for the millions of people with age-related macular degeneration (AMD), the leading cause of blindness in those over the age of 60.

Stem cells, known as retinal pigment epithelium stem cells (RPESC), are part of a single layer of cells known as the retinal pigment epithelium (RPE), which lies at the back of the retina. The RPESCs seem to lie dormant inside the normal adult eye but once extracted they activate and behave as stem cells, and recent research has found them capable of making stable, healthy RPE cells, in addition to cells with the features of neurons, bone cartilage, fat and muscle cells. Researchers found that about 10 percent of cells from the RPE divided prolifically and produced many new cells and shared markers of stem cells.

The link to AMD is this: it is known that macular degeneration causes RPE cells to die. The hypothesis is that RPESCs could regenerate a pure population of RPE in a culture, which could be used for transplantation to help repair the diseased RPF.

The research team was lead by Dr. Sally Temple, co-founder and scientific director of the Neural Stem Cell Institute (NSCI), based in Rensselaer, NY. Dr. Temple is the recipient of many prestigious awards, including the Jacob Javits Merit award from the Bethesda, MD-based National Institutes of Health (NIH) (2003), as well as a MacArthur fellowship award (2008) in recognition of her contributions to neural stem cell developmental biology.

The NSCI, which aims to harness stem cell technology to relieve suffering caused by injury and diseases of the brain, spinal cord and retina, is the only independent, non-profit stem cell research institute in the U.S.

It turns out that RPE cells can be extracted from live donors as well as from cadavers, and in this study, RPESCs were isolated from donors ranging in age from 22 to 99.

It was the fact that the RPE layer is generated very early in embryonic development that led Dr. Temple and her colleagues to test whether these cells, so essential for proper vision, possessed stem cell-like characteristics.

The NSCI is planning to study AMD and RPESCs on animal models. The scientists are also investigating which other types of nervous system cells can be produced by RPESCs, which may lead to future treatments for other nervous system diseases such as Alzheimer’s and Parkinson’s.

“The hope,” said Dr. Temple, “is that these cells can be harvested from a patient, then re-injected to help repair nervous system damage, without the need for immune-suppressive therapies.”

RPESCs are also being used as a substrate in the culture dish to screen for drugs that may prove effective for AMD.

Research findings were published in the journal of the International Society of Stem Cell Research, Cell Stem Cell, in January 2012[i].


Photoreceptor Transplants in Mice Prove Successful

Three (or more) blind mice are now able to see, at least enough to find their way through a dimly lit maze, thanks to research by the University College London’s (UCL) Institute of Ophthalmology, published in the journal Nature.[ii]

Researchers transplanted immature rod-photoreceptor cells (one of two types of photoreceptor cells in the eye – the other is cones) from healthy young mice into the retinas of adult mice that were blind due to non-functioning rod-photoreceptors. Rod cells are extremely light sensitive, enabling mice (and people) to see in low-light conditions.

The transplanted cells appeared to function almost as well as normal rod-photoreceptor cells and were transmitting visual information to the brain after only four to six weeks, thus verifying earlier research by the same team that showed this to be a possibility.

Running the maze in low-light conditions would be the litmus test of visual acuity in the transplanted mice. They performed far better than untreated mice, finding a visual cue to a hidden platform and getting there quickly, whereas the untreated mice had to find the platform by trial and error.

“We’ve shown for the first time that transplanted photoreceptor cells can integrate successfully with the existing retinal circuitry and truly improve vision,” said UCL Professor Robin Ali, who led the research. “We’re hopeful that we will soon be able to replicate this success with photoreceptors derived from embryonic stem cells and eventually develop human trials.

“Although there are many more steps before this approach will be available to patients, it could lead to treatments for thousands of people who have lost their sight through degenerative eye disorders. The findings also pave the way for techniques to repair the central nervous system as they demonstrate the brain’s amazing ability to connect with newly transplanted neurons.”

Eye diseases that could benefit from photoreceptor transplantation include AMD, retinitis pigmentosa and diabetes-related blindness.

1 SALERO et al. “Adult Human RPE Can Be Activated into a Multipotent Stem Cell that Produces Mesenchymal Derivatives”, Cell Stem Cell, vol. 10, Issue 1, p. 88 – 95, January 2012  http://www.cell.com/cell-stem-cell/abstract/S1934-5909(11)00579-0

[ii] PEARSON et al. “Restoration of vision following transplantation of photoreceptors”, Nature, April 2012, http://dx.doi.org/ 10.1038/nature10997.

Controversial Contributions to Vision Science

By Paddy Kamen

discoveringIn the Jan/Feb 2012 issue of Envision: seeing beyond, we touched on the controversial Bates Method of Vision Improvement. You may recall that vision scientist, Laura Sewall, Ph.D., author of Sight and Sensibility: The Ecopsychology of Perception, used a variation of the Bates Method to profound effect. The article, Vision and the Possible Humanwhile not idealizing Bates, does celebrate his scientific curiosity.

This article will look at the actual variation of the Bates method that Sewell practiced. We will also examine how the profession of developmental optometry views the contributions of W.H. Bates.

The woman who taught Laura Sewell to dramatically improve her vision was the late Janet Goodrich, Ph.D. Her daughter, Carina Goodrich, is herself a vision educator and has taken over her mother’s business, which is based in Queensland, Australia (www.janetgoodrichmethod.com). Carina Goodrich is also an author, having published The Practical Guide to Natural Vision Improvement[i], in 2010.

Carina says Janet wore glasses from age seven to 25, at which point she began to study the Bates Method along with the work of Margaret Corbett (a teacher of the Bates Method who also expanded on the work), in addition to Reichian therapy (emotional/psychological healing based on the work of Wilhelm Reich). At age 27, Janet had the vision-related restriction removed from her driver’s license and never wore glasses again.

Janet Goodrich consolidated the work of Bates, Corbett and Reich into her own method, which emphasized activities designed to decrease stress and increase relaxation in the visual system. She examined stress in the human body and its impact on eyesight. Goodrich trained instructors in her method and authored two books: Natural Vision Improvement[ii] and ‘How to Improve Your Child’s Eyesight Naturally[iii].

Carina Goodrich notes that in Bates’ era (1860–1931) the prevailing medical model was of the body as a kind of machine, with parts and systems generally considered as separate structures. At that time, the eye was thought to work like a camera. “Bates, an ophthalmologist himself, headed in another direction and dared to suggest that the eyes are nothing like machines and that their ability to capture light and process it into clear images in the brain was dependent on much more than just the physical structure of the eyes. As our knowledge of the human brain, and the effects of stress on every area of our health and wellbeing improves, Bates’ theories about eyesight only increase in their sensibility.”

Bates’ work has been refined a great deal over the past nearly 100 years, according to Carina Goodrich. “Yes he was wrong about some things. Nowadays we certainly wouldn’t suggest Sunning with the eyes open[iv]. It is, however the subsequent use and refinement of his work that helps to sort the wheat from the chaff. While his work still forms the basis of many things vision improvement therapists do today, they are usually quite different from what he originally proposed.”

Bates’ contribution to vision science has also been carefully considered by developmental optometrist, Dr. Leonard J. Press, the American Optometric Association’s vision and learning specialist, and optometric director of The Vision and Learning Center in Fair Lawn, New Jersey (www.pressvision.com).

“Bates definitely made a contribution, primarily in his concept of learning to relax focus,” says Press. “People who do sustained close work definitely have a shift of their resting focus inward. The brain adapts to the fact you are doing extended close work and doesn’t believe that when focus out that you will stay there. So it holds on to extra tonus for near vision, believing you will come back to it. Bates understood that by consciously putting yourself in a position of relaxation or distance focus, however you do it, you are going to limit the progression of nearsightedness. And vision science has proved him correct on this.”

Many of Bates’ original training techniques are crude compared to what is done by developmental optometrists today, notes Press. “That’s where technology comes into play. There are many ways to reset focus to distance. For example, we can do this with accommodative rock lenses where one side stimulates focus and the other relaxes it.”

Press finds that Bates’ work has been elaborated into an holistic approach that is sometimes misleading. “I feel some of it is over extrapolated,” he says. As one example, he points to Dr. Jacob Lieberman’s EyePort system. “We have one here in the office and use it from time to time. While there is some good independent research that backs up its usefulness, it’s not a magic stand-alone tool quite in the way it is presented.”

Press is also eager to point out that vision therapy exercises, such as those that work on near and far accommodation, are only a small part of the work done by developmental optometrists. “Developmental optometry is the umbrella term for the field. And vision therapy is one of the applications within developmental optometry.”

The next article in this series will cover the kinds of vision problems addressed by developmental optometry in more detail.

[i] The Janet Goodrich Method, Australia, 2010. Also available as an e-book: www.janetgoodrichmethod.com

[ii] First published inAustralia 1985 by Greenhouse Publications and in 1989 by Penguin Books. Published in theU.S. by Celestial Arts 10 Speed Press. Now out of print.

[iii] First published in Australia 1996 by Sally Milner Publications. Now published in the U.S. by Inner Traditions (under the title How To Improve Your Child’s Eyesight Naturally).

[iv] Bates initially believed that the eye could be trained to look directly at the sun. He later changed his views and Sunning was defined as exposing the closed eyes to sunlight. See: http://en.wikipedia.org/wiki/Bates_method#Sunning.

Vision Science and the Possible Human

By Paddy Kamen

After spending two days at a workshop with Dr. Lester Fehmi learning how to relax and broaden my attentional capacity, I had a startling experience with my eyesight. I was lying in bed in my darkened hotel room listening to tunes on my laptop. It was time to change the selection, so I turned on the light, sat up and looked at the screen without putting on my eyeglasses. The letters were blurry but then they came into focus as if I used a pair of binoculars! This had never happened before.

The following day I mentioned my experience to Fehmi, originator of the Open Focus method of attentional training. While his training system has nothing to do with vision training, per se, he said other system users have also experienced significant vision improvement.

Open Focus trains the brain to broaden awareness or focus by fostering increased alpha wave synchrony across the lobes of the brain. This gives rise to an experience of being relaxed yet alert. This article is not about Open Focus (you can learn more about it at: www.openfocus.com) but about the possibility of improving vision via unconventional means. It was inspired by Sight and Sensibility: The Ecophyschology of Perception by Laura Sewall, Ph.D.

It is a truism that the scientific method is based on observation, experimentation and repeated verification of results. It is also true that scientists are wrong much of the time, that they have persisted in beliefs that belie the facts before them (e.g. the belief that the brain cannot reorganize itself – plasticity – in response to experience), and that they are often not open to exploring the unexplainable, unexpected and unusual. Like people in other walks of life, scientists are sometimes more interested in maintaining the status quo than in discovering the full range of the possible.

Laura Sewall is a vision scientist, who came to the study of vision partly as a result of experiencing a profound vision improvement via an unorthodox method. Having worn glasses for nearsightedness since her late teens, Sewall grew frustrated with the limitations her myopia imposed and began to study the Bates Method of Vision Improvement. She soon noticed occasional but significant improvement in her vision — “I suddenly glimpsed sharp, razor-like edges and neon colours… I could not believe my eyes…soon fabulous shapes and brilliant colours signaled to me, edges were sharp all the time…”

One aspect of the Bates theory is that the eye needs to learn to relax and not pull objects to it, instead focusing both far and near, alternately, by performing specific exercises. Some of Bates’ theories have been disproven, but what if this pioneer was actually on to something?

Later, Sewall traveled to Tanzania to study baboons in their natural habitat. There, she was further awakened to the possibilities inherent in the human visual system. She was amazed that her research partner, a Tanzanian scientist with years of experience on the savanna, could identify individual baboons from amongst three troops of 120, half a mile away.

By the time she got to Brown University’s graduate school, Sewall had stopped doing most of the Bates exercises and gradually lost her superior visual acuity, because of too much computer work and reading. She writes: “Despite the loss of my clear and inspired vision, I continued my research. I read between the lines, asked many questions in carefully controlled labs and pieced together a developing story: the neural structure of the visual system changes when the attentional processes in the brain are activated. It was assumed by researchers that this… occurred only during particular developmental stages in young animals. Among visual scientists, the discussion of such fundamental change in the visual capacity of adult animals was apparently heretical. Questions posed in research seminars about structural changes in the adult visual system — questions that implied visual potential — were met with quick glances around the table and unsatisfying answers.”

Sewall’s search of the scientific literature showed there were unanalyzed and unpublished data on structural changes in the visual cortex of animals that went well beyond the developmental stages. She became suspicious of scientific methods that ignored the outstanding in favour of the norm. “I learned that this kind of oversight is one of the classic limitations of Western scientific methodology. Like lies of omission, science names truth without reminding us that there is more to be revealed… Why, I wondered, did our research tradition focus on norms at the expense of identifying the great potential inherent in having… an exquisitely tuned human body?”

By participating as a subject in vision experiments on the absolute threshold (measurements of the capacities of the visual system), Sewall noted that she would dimly see lights that would be categorized by the researchers as ‘not seen’, and that she would produce different results, indicating different levels of visual sensitivity depending on, “whether I’d had a cup of coffee before the experiment or too little sleep the night before. I also knew… that my overall visual sensitivity was noticeably greater after meditating… I began to realize that the absolute threshold for perception is relative.” She also learned that the definition of ‘normal’ or 20/20 vision defined by the Snellen eye chart was hardly a scientific measure. “I knew Snellen’s story: he had established the standard for acuity by calling his assistant, who apparently had good vision, to the chart one day to measure what he could see from 20 feet away. And so it was that normal became normal.”

Sewall’s perception of the difference in her visual acuity after meditation practice makes for a fascinating footnote in her book. “Theoretically, when the ‘noise’ – or spontaneous firings in the visual system – is temporarily quieted by meditating, the signal is rendered relatively more salient and is therefore more easily seen. This interpretation of the visual effects of meditation is derived from signal detection theory.”

The above theory and Sewall’s personal experience fit well with both Bates’ concept of the need for the eye to relax and stop reaching for objects, and Fehmi’s theories about why Open Focus (which is actually a type of meditation practice) might have been so effective in at least temporarily improving my eyesight on that one occasion. Could it be that when we let go, broaden our focus and let the mind quiet, the brain can do the job of helping our eyes see more easily? Is it possible that with training, we can become better at this and experience revived and enhanced sensory experience on many levels, not just vision?

We know that Bates was not right about everything (a future article will explain his contributions to science and his errors). But isn’t it wonderful that he dared to pay attention to the actual experience of his patients and to try new methods to help them see better? Isn’t it marvelous thatLaura Sewall has the personal confidence and intellect to pay attention to her own experience, honour it and let others know more about what our potential might be? Our world is improved by those who challenge the status quo by paying attention to the world around them, as it is, unencumbered by the visual and metaphorical cloud of received wisdom.

Laura Sewall’s book opens (and this article ends) with a quote from Søren Kierkegaard:

“If I were to wish for anything, I should not wish for wealth and power, but for the passionate sense of the potential, for the eye which, ever young and ardent, sees the possible.”

Is That All There is? Developmental Optometry Opens the World for Nine-Year-Old Girl

By Paddy Kamen

Jillian Benoit is now a sparkling, confident girl with big dreams. But it wasn’t always so.

It wasn’t until Jillian Benoit was five years old that her mother Robin realized that her youngest daughter was legally blind in her right eye. “Her preschool teacher had put a patch on Jillian’s eye because they were playing pirates,” recounts Benoit. “Jillian threw her hands out in front of her as if trying to reach for something and then fell to the floor screaming and pleading for help.”

The Jacksonville, Florida mother immediately made an appointment with her pediatrician, who referred them to an ophthalmologist. The ophthalmologist supplied a name for Jillian’s condition: amblyopia, which meant she had reasonably good vision in one eye (20/30) and extremely weak vision in the other. In Jillian’s weak eye, her acuity was only six inches.

Benoit subsequently remembered things about her daughter that, in hindsight, were attributable to her vision problem, but which Benoit had assumed were simply developmental delays. These included an inability to reproduce geometric shapes with any accuracy. “She would come home with shapes she had drawn that bore very little resemblance to the triangle, square, or circle they were supposed to represent,” she notes.

In Robin Benoit’s book on the subject of her daughter’s diagnosis and treatment, Jillian’s Story: How Vision Therapy Changed My Daughter’s Life, The P3 Press, she says, “The doctor explained that there is no surgery to correct amblyopia. He said we would start her out with glasses and he would see us in six weeks. At that time, we might have to begin ‘patching’ if her vision did not improve.”

While Jillian loved her Mickey Mouse glasses, her vision did not improve and patching started in her kindergarten year. Initially, Jillian wore the patch for two hours a day after school. Robin could see that Jillian’s vision was improving, something which the ophthalmologist confirmed, increasing the patch-wearing schedule to 11 hours a day. He advised Jillian not to ride a bike or play sports while wearing the patch. And needless to say, the patch did little for her confidence.

Jillian recalls her experience of being ‘different’ from other children. “When I was younger, I thought that everyone saw like I did. Then when I was seven we went to the zoo camp at the Jacksonville Zoo. The zookeeper told us that owls have to turn their heads to see and I realized that I had to move my head the way an owl does. Before I was aware of having a vision disability, I thought that the ability to see without moving your head was a talent. I believed my sister was more talented than me because she could move her eyes instead of having to move her whole head.”

She also recalls that schoolwork became increasingly difficult: “I was always the last or second-last person to complete the work. And when the school gave out awards and treats to kids who had read the most books, I knew there was no way I could keep up with them.” Jillian’s Grade 4 teacher told Robin in an interview that her daughter needed to work faster on her handwriting and that she often left for the washroom during math class. “My brain hurts during math,” Jillian told her mom, who noticed that Jillian would often make mistakes when writing down long numerals.

When Jillian was nine, the ophthalmologist announced that she was finished with the patching treatment. Her right eye had reached an acuity of 20/40 and there was nothing more he could offer except eye drops which blurred the good eye – a drug-induced form of patching. The drops were very difficult to administer for both mother and daughter. When Robin asked the doctor about what else might be done to help Jillian, he was negative, bordering on rude. She then asked about vision therapy, something she had read about on the Internet, but the doctor said he didn’t see much value in it.

Singularly unimpressed by the doctor’s attitude and unwilling to settle for anything but the best for her daughter, Robin did more research into vision therapy and found an optometrist, Dr. James Horning. On examining the girl, Horning quickly realized that Jillian was, in fact, seeing double. She had been doing so all her life and the ophthalmologist had either failed to realize it or, if he had, hadn’t mentioned it.

Shortly afterward Jillian underwent a two-hour evaluation of her vision with Lindsey Hebert, the vision therapist who works for Dr. Horning. Hebert later structured a vision therapy program specifically for Jillian.

The vision therapy began with the development of Jillian’s gross motor skills, working with balls and balloons to learn to identify where objects are in space. And because she didn’t have the same perception on both sides of her body, Jillian worked on her balance by walking rails and doing balance board exercises. “We began this work by patching so the weaker eye learned to process information to the brain,” says Hebert.

After 12 weeks of gross motor work, Jillian began strengthening her weak eye with the use of different optical tools like lenses. These exercises helped Jillian develop better binocular vision. “Making the focusing muscles contract and then relax is a way of strengthening the focusing muscles, much like lifting weights,” Hebert explains.

To improve visual processing in Jillian’s weaker eye, Hebert used a variety of tools that had her use each eye separately and then together. “This can be as simple as using one red and one green lens in glasses. We have her look at a bright light. If she can just see green or red I know which eye is working but if she sees a mixture of the two we know that both eyes are ‘turned on’ at the same time,” says Hebert.

Depth perception is another aspect of good binocular vision, Hebert notes. “Riding a bike, playing basketball, and even playing video games require depth perception. When the eyes aren’t working well together the brain has to work that much harder to make sense of the world. When Jillian did the exercises and practiced them at home, it didn’t take long for her brain to realize that she could function more efficiently with a strong binocular visual system.”

Hebert could see that Jillian initially lacked confidence. “She had poor gross motor skills and hated physical education class. She had been struggling for a long time and was skeptical that I could help her.”

Before long, however, the girl began to emerge from her shell. “She would come bouncing in and say, ‘let’s do something fun’. She would want to try things that were difficult and it was such a joy to hear her say, ‘Look how good I am’,” recalls Hebert.

There’s no underestimating the commitment involved in completing a course of vision therapy. Jillian’s program took 45 weeks of office visits and she had to practice at home five days a week. Robin took her to all appointments and supervised the home practice. But the rewards have been incredible. Now 12 and a Grade 7 student, Jillian Benoit is a straight-A student. She’s near the top of her class in mathematics and loves science. Most importantly she has a confidence that radiates throughout her life.

Robin Benoit believes that consumers deserve eyecare professionals who make referrals for the good of the patient. “I hope my book will have an impact on the way ophthalmologists, optometrists and opticians work together to serve consumers. I’m sure they all care about the patients they see but they need to look at the big picture. We’re talking about a child’s future and parents need to know what is possible, rather than just settling for the status quo.”

Not one to settle for less than the best, Robin Benoit has, through vision therapy, given Jillian a tremendous gift. While vision therapy isn’t suitable for every vision challenge, Jillian’s story proves that it offers a whole new world of vision – and confidence – for some.

Blind Beginnings: Making a Difference in the Lives of Children and their Families

By Evra Taylor
Altruism is among the qualities that describe what one would call a “good person.” When Vancouver’s Shawn Marsolais founded the organization Blind Beginnings in 2008, she had no idea that her generous heart would touch so many lives, helping countless Canadians deal with the effects of visual impairment.

The stated mission of Blind Beginnings is to provide children and youth who are blind or visually impaired with the necessary opportunities, experiences, services, and family/community support to reach their full potential.

Blind Beginnings offers a broad range of programs, including youth leadership based on mentorship. Marsolais’ philosophy is based in part on the notion of matching newly blind people with those who have been navigating the waters of living with blindness for a while; in other words, those who have walked the walk. She points out that most people don’t know anyone who is blind. As a result, it’s important for them to have a “buddy” who has been there. This adventurous lady knows what she’s talking about. She was born with roughly 10 per cent vision, which is considered legally blind; currently she has 1-2 per cent vision.

Marsolais’ view is that everyone in the family unit is affected by a person’s lack of sight; therefore, the needs of the entire family must be addressed. She stated, “Frequently in what I term ‘new families’ – those in which a diagnosis has just been made – everyone is overwhelmed and devastated.” Blind Beginnings enters the picture and fills the critical need for support and understanding through a parent-to-parent support program in which experienced parents of children who are blind or visually impaired are trained to support parents who are new to parenting a blind child.

Outings called “community discovery” allow children hands-on experiences such as visiting a fire station where they are encouraged to hold a fire hose. Stated Marsolais: “Children born blind require more time to learn certain concepts. This type of activity educates both the kids and the community”. The discovery concept was born of her own journey down the winding road of coping with the challenges she faced as a blind youth. “With Blind Beginnings, I create from my own experiences. After high school, I signed on to do an internship program at a school for the blind in England which matched my life experience to a job. I found the other youths intimidating but the school changed my life.” She was moved by the tremendous potential she saw in the people she met at the school, and she lamented that at that time,British Columbia did not have a school for the blind.

Marsolais moved on to receive her Master’s degree in counselling; she is doing her practicum in the Counselling Department of University of British Columbia. In terms of future plans, stepping away from some of Blind Beginnings’ activities will allow her to pursue counselling, which is her passion.

Early on, Marsolais committed her own savings to the launch of Blind Beginnings. As a start-up, the group does not receive any government funding, although it does benefit from some foundation grants and the proceeds of various fundraising events. This burgeoning non-profit initiative is run entirely by volunteers and, like many charitable groups, it seems that there are never enough resources to meet the need. Blind Beginnings is hoping to find a fund development officer who would lend expertise in fundraising and event planning, two areas whose growth would allow it to expand its reach. In fact, Marsolais’ objective is to be able to provide services outside mainland B.C., her current focus, to include people in rural areas.

Marsolais is an example of a woman who chose to give back to her community and make it thrive, while discovering for herself a vision of life devoted to service and support for the children and youth around her.