The veil of form deprivation, another layer to the myopia problem.
*for informational and hypothesizing purposes only. Not intended as optometric or medical advice.
It comes to reason that form deprivation is the chief denominator of myopia progression. It is not hyperopic defocus. Hyperopic defocus is a form deprivation and therefore is problematic for myopia progression, but turning peripheral hyperopic defocus into myopic defocus does not always work or work fully; sometimes it does not work at all. Other times it is a miracle and stops myopia in its tracks! Same with atropine, sometimes works partially, sometimes stops myopia innit tracks completely, and sometimes works not at all.
Periphery and peripheral response can be trained at the operational level and this is overlooked in much of myopia management. However, simply training to see as much far out in the periphery is not simply good enough, because that is not the issue. Peripheral form deprivation is on a veil to the real issue. The issue is perceived depth of volume.
Have you as an optometrist tried to train depth perception to someone with a bitemporal visual field defect? Most optometrists have trained anyone at all past VT rotation. Bitemporal defects is the kryptonite of stereo volume perception, and the animal studies on form deprivation show that temporal occlusion yields more myopia progression and nasal occlusion.
So it’s really not about peripheral deprivation, but rather more specifically about spatial volume. My hypothesis is that during accommodation, less volume gets processed visually, atropine lowers this, but in some patients the patient continues to “fight” despite no accommodation and continues to process less spatial volume hence continued progression, unless an increase in concentration. Same for ortho-K or other contact lens. Even for contrast modulation with the SightGlass lens, as one reacts to contrast, less volume is processed from stress of contrast that would otherwise overstimulate central processing pathways which compete for peripheral volume.
When form deprivation is removed from animals, myopia reverses in direction of progression many times, yet doctors continue to say myopia is irreversible, rather than ask “how can we achieve this effect in humans too?”
Humans have high central processing, higher than most animals and anthropoids. Therefore, less central to compete with peripheral
volume. These two are antagonistic with each other like a tricep and a bicep. Remove the deprivers, and the animal returns to processing volume rather central. Btw, cutting an optic nerve does nothing on the brain side of central vs peripheral visual processing. So if you remove a peripheral depriver in a human, an over-habituated central processing pattern could negate any reversal that could be achieved, especially since parents are hell-bent on keeping their children centrally processing all day everyday anyway.
We know minus lenses are deprivers and have been used to induce myopia in animals, which then can have some recovery when removed, the human child does not. In fact, only a human could anxious himself so much as a response to the blur upon removal of the minus lens that he increases further central processing progressing his myopia even faster. And that is exactly what has been observed in children “undercorrected” in myopia. In some patients, a “full correction” (whatever that means 🤨) could produce it faster with the increase in central processing encouraged by the lens.
Rather than think about “full correction” or “under correction” as most in myopia management think, the terms of thinking should be concerning APPROPRIATE correction. That would be the lens that is going to yield the most accommodative eye focusing flexibility movement with the most depth volume processing at a particular difference. There is fine balance between the eye focusing, stereo, eye teaming and clarity function, that if strain is caused between them, a central processor person will just do more of that and therefore increase his myopia with time.
So to find out what is going to be the best approach, the clinicians must test the what the person is actually doing visually and understand the visual actions he is taking both at distance and at near. It will be in the optometric findings, as well is the bodily and facial postures, and even sometimes the way the child speaks. The person must change what he is doing, and that is what all these myopia management interventions do… they induce change…but not always enough.
My hypothesis on my clinical experience is that some people just have no clue at all as to what they must stop doing and what they must do differently, and therefore no amount of atropine, ortho-K lenses or Stellest lens is going to change a thing. The person must be shown exactly what to do, and then he must choose to do it. The parent cannot do it for him, even if the parent removes him from all academics and makes him play outside. The doctor cannot either. I have shown many children something they can do differently, and achieve a better Snellen score, only to come back 1-2 months later and they have practiced it at all. One cannot force someone to choose to see differently and to do so at a rate as to impact his visual findings. A child may be encouraged to change, just as the parents choose to place him in an environment to encourage the visual actions that lead to myopia. Again, this is not about close vs far, but peripheral volume. One can myopitize himself just as well while looking at far as when looking near. It’s not what and where that’s seen, but how it is seen.
So how to change? Take this picture below 👇 as an example.
Do you see two squares connected by diagonal line segments or picture frame?
If you said either, then you are this time not processing much spatial peripheral volume.
Do you looking around this fixating all the crevices and lines going back and forth? Not much volume if you do that. That’s what I call “cursoring” as if you had some sort of computer curosor in your vision fixating everything. I regard such a practice as high central processing.
If you say a pyramid? Or something else I’ve heard, a keyboard button. You have a little more volume. Do you see the the central square “pop out”? Then good, you have a little more volume.
It should “feel” different somewhat to see that than to see a flat squares or worse just a bunch of lines.
But what if I tell you to see it has a room. To view the room as one object that is viewed rather than lines in a room. So rather not cursoring/fixating the lines, but simply seeing the room.
There are two ways to appreciate this. You can either see the central square “go inward” further back, or you can see the larger peripheral square and walls come forward. Although these may sound like the same thing, they are different visual experiences. I would rather direct the attention to perceive the peripheral square and walls come forth instead of the small square going. Now this should provide a “weird” feeling I would encourage one to learn to seek.
What if we do an other, one with smaller door and more windows. Now I’m sure even if you let the larger peripheral square and walls come forth, the visual experience should be different than the first room. Maybe more open or bigger?
If one was to repeat this process again with a ring or a circle, one could perceive a float experience as if one sees the room and the circle or ring is suspended in the middle of the room rather fastened to the back wall. If one can perceive this “float” on the room, then one has significantly more volume than the first example mentioned.
Once one can achieve this float reliably, what if you were to place one that has a letter, similar to a Snellen, right at a distance that is known tm be blurry, but not overwhelmingly blurry. To see the room with the letter suspended rather than looking at the letter and just resting there. Valuing that spatial peripheral volume change rather than the clarity of the letter maintaining that “weird” feeling.
Does the clarity of the letter change or fluctuate? Can you not tell? Some people cannot tell at all their are obviously to their own visual changes. I have found that some people can do techniques and achieve as much as 2 lines improvement and yet say they do not notice a change of perceived clarity. I postulate that is due to an over-habituation and therefore an over-valuing of central processing and detail. The vision is therefore very “zoomed-in.”
So then I say, “okay, forget seeing the room, go back to looking at the letter “normally” again, and do you notice and increase in blur or decrease in blur?” And if the person was actually volumeously viewing the Volumeous Viewing Box (the VVB) [as I call it], the answer will be an INCREASE in BLUR as the person returned from doing something more visually proper to doing something visually improper. It is common most people cannot or understand a change to the positive, but people most certainly will see and understand a change to the negative. However, logic indeed dictates that if there is an increase in blue, there was a before a decrease in the blur and therefore a decrease in the blur is the same relatively as an increase in clarity.
Now can this be done further back?
Can one actually perceive the real room one occupies are in this way? What if one was to simply view it so “zoomed-out” for a straight 10 minutes refusing to “zoom-in” on detail.
Not only would I have someone do this, but also practice outside. Rather than see the sky as a flat wall, can one view the sky as a ceiling coming-forth just like the ceiling in my illustration. Sky ceiling, ground floor far wide to the left and to the right—to see the great “room” of the outside?
To understand and perceive that large cloud at the top of the photograph to be coming foward along with the grass at the bottom. One must be able to see this zoomed-out room view anywhere and everywhere.
I wiuod also pontificate that one should not only change the way things are viewed, but also the way things are thought and when correctly and appropriately thought using peripheral volume, one could get similar experiences visually before his own sight. At least that has been the experience of some who have been able to successfully demonstrate these changes to themselves.
The problem is not near or far, but rather it is volume. As people tend to get closer to their book, page or screen, they tend to perceive less volume. It’s not simply about spreading out one’s awareness, for if you did the same motion with your hands or fingers on an iPhone or iPad, that would zoom the display in: the same would be so for the visual perception. One must instead mentally gather vision for volume. Volume is the gold here.
“In the volume of the book, it is written if me” -Psalm 40:7-