This document discusses 3D vision syndrome, a condition characterized by symptoms like headaches, blurred vision, and dizziness that can occur when viewing 3D technology. It presents the case of a 27-year-old female patient who experienced these symptoms when watching a 3D movie. Her exam found convergence insufficiency and accommodative dysfunction. She underwent 8 optometric vision therapy sessions over 3 months using various binocular vision exercises, which improved her symptoms and findings on re-evaluation. The document emphasizes that 3D vision syndrome is a real condition and outlines how it can be diagnosed and treated.

1. Disclosure Statement: Nothing to disclose” Please silence all mobile devices. Unauthorized recording of this session is prohibited.

2. 3D Vision Syndrome A Technologically Driven Visual Impairment

3. 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

4. Introduction: Understanding 3D technology & How it was Developed Photo credit: http://science.howstuffworks.com/3-d-glasses2.htm

5. Simulated 3D vsReal World 3D Why Now?

6. Virtual 3 D: Why Now?

7. 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_Reach_Tipping_Point_on_PC_Market_JPR.html

8. ESPN: 3D Is at the Tipping Point 3D Printing Technology Nearing Tipping PointWill 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 Cellphone 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/

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10. Many activities including: Symposia, 3D Users Experience Tech Summit, The 3Ds of 3D Viewing AOA YouTube Videos 3D in the Classroom: See Well, Learn Well http://www.youtube.com/watch?v=9U4AoDWPEQ0

11. 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 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

12. The Public Health Implications of Virtual 3D - Michael Duenas(http://www.youtube.com/watch?feature=player_embedded&v=howdZm-d7Z0)

13. The Visual System and Virtual 3D - Jim Sheedy, O.D., Ph.D. (http://www.youtube.com/watch?v=ZLpwCC5yxlo&feature=related)

14. 3D: The User Experience Story - Philip J. Corriveau (http://www.youtube.com/watch?v=1IiHNit3RPM&feature=related)

15. Exploring a New Dimension - Chris Haws (http://www.youtube.com/watch?v=4qZw98mkIhI&feature=related )

16. 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)

17. Available from: AOA 3D@Home 3deyehealth.org MainosMemos

18. Binocular Vision Dysfunction as a Medical & Public Health Issue

19. Improving Binocular Vision - Creating a Better Audience

20. Improving 3D Television Technology but Not Creating a Better 3D Viewing Audience 1920’s Image Credit : Baird Television Today

21. Improving 3D Movie Technology but Not Creating a Better 3D Viewing Audience 1953 Image Credit: Mystic Cinema Today Image Credit: Joystiq

22. Improving 3D Gaming Technology but Not Creating a Better Gamer Image Credit: Nintendo Image Credit: Daily Motion 3D

23. Improving Classroom Technology but Have Not Created a Better 3D Viewing Student Image Credit: American Optometric Association Image Credit: mkrstovic.edublogs.org

24. History of 3D 3D in the Classroom: See Well, Learn Well 3D Timeline

25. 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!

26. The first 3D Movies 1950’s The Golden Age of 3D Movies Imax Second Mini-Golden Age Today: Platinum Age!

27. Some of the first 3D Movies included: Bwana Devil (1952 ) starring Robert Stack http://www.youtube.com/watch?v=4oGl_KqTw-M&NR=1

28. House of Wax (1953) starring Vincent Price

29. 13 Ghosts (1960) http://www.youtube.com/watch?v=Zdwq3jdvZD I

30. The Mask (1961) http://www.youtube.com/watch?v=xGTApr_SAts

31. 3D Television Stereoscopic television was first demonstrated by John Logie Baird in 1928 Stereo TV Stereo Receiver

32. 3D Television Stereoscopic television was first demonstrated by John Logie Baird in 1928 http://www.youtube.com/watch?v=O5ZSXPMlumc

33. 3D Education VRMagic Digital BIO

34. 3D Education http://www.3dmedicaleducation.co.uk/index.php/anatomy/lumbar_vertebrae/

35. 3D Video-games

36. 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/watch?v=0U0ZDjnQiXQ

37. 3D Glasses Techniques to Achieve 3D

38. 3D in the Classroom: See Well, Learn Well

39. 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

40. 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.

41. Circularly polarized glasses

42. 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” Dolby uses a form of this technology in its

43. Dolby 3D theatres Complementary color anaglyphs (use red and cyan) 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

44. 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

45. 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

46. 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

47. 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

48. Autostereoscopic displays Auto 3D Almont Green 3D Photography (http://almontgreen.wordpress.com/)

49. 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/

50. 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/features/How_the_3DS_Works/

51. 3D Vision Syndrome What constitutes a syndrome? A group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition

52. 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.

53. 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

54. 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.

55. 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

56. Symptoms of 3D Vision Syndrome asthenopia, headaches, blurred vision, eyestrain, diplopia, dizziness/nausea and vision induced motion sickness …..or …. Image Credit: American Optometric Association Image credit: squidoo.com/3d-animated-gif

57. Symptoms of 3D Vision Syndrome …a happy, actively engaged users of 3D content? Image Credit: American Optometric Association

58. 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.

59. How to Dx an Individual with 3D Vision Syndrome Examination Sequence Comprehensive Visual Efficiency/Strabismus/Amblyopia Special Testing (Visagraph, TOVA, etc)

60. How to Dx an Individual with 3D Vision Syndrome Case Hx Salient Findings

61. How to Tx an Individual with 3D Vision Syndrome We really don’t know the best methodology/approach.

62. How to Tx an Individual with 3D Vision Syndrome Use what we do know Rx/Prism Optometric Vision Therapy

63. These are your eyes…. These are your eyes On 3D!

64. 3D Vision Syndrome Single Subject Design Research Study Patient #1 Symptoms: blurred vision, double vision, nausea, headache, dizziness while watching 3D movie

65. 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

66. 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

67. 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

68. 3D Vision Syndrome Patient #1 Initial Findings Accommodative Facility diplopia MEM variable Ocular health mild allergic conjunctivitis

69. 3D Vision Syndrome Patient #1 Diagnosis Convergence insufficiency Accommodative dysfunctions Headache Diplopia Allergic conjunctivitis

70. 3D Vision Syndrome Patient #1 Plan Obtain past records Start Optometric Vision Therapy

71. 3D Vision Syndrome Patient #1 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

72. 3D Vision Syndrome Patient #1 Optometric Vision Therapy Phase 1Phase 2Phase 3Phase 4 Mono Biocular Binocular Integration Oculo- add anti- add Stabilization Motor, suppression vergence HE, Acc 3 month post OVT maintenance Tx and final progress evaluation

73. 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

74. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #2 Reviewed HVT Vision Builder (saccades Franzblau Red Rock Brockstring

75. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #3 Reviewed HVT Minus lens dips HC accom rock Vision Builder (binoc reading) Quoits

76. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #4 Reviewed HVT Vision Builder Randot vergence Eccentric Circles Quoits Photo credit VisionHelpBlog

77. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #5 Reviewed HVT +/- Flippers (mono) Eccentric Circles HTS autoslide vergence Jump vergences (vectos) Brockstring (bug on a string) HVT ECC BO/Brockstring, HTS jump vergences

78. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #6 Review HVT ECC Vectogram Jump Vergence Lifesaver Cards

79. 3D Vision Syndrome Patient #1 Optometric Vision Therapy Progress evaluation #1 20/15 BVA, RE/LE CL OR RE +1.00-.50X180 20/20 LE +1.25 20/20 MR RE -3.25-.25X175 20/20 LE -3.250.75X005 20/20 Pursuits +4 Saccades +3 CT 2EP (near) W4D 4 at all distances Random dot 20 ‘ NPC TN no pain BI 12/9 near BO > 45 Amps 7 D RE/LE Facility 8 CPM RE, 11 CPM LE, 10 CPM OU MEM +.75 each eye During evaluation no diplopia, pain, suppression stable findings Symptoms improving, not all resolved

80. 3D Vision Syndrome Patient #1 Optometric Vision Therapy OVT #7 Clown vectograms (push BI) Chicago Skyline (jump)

81. 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!

82. 3D Vision Syndrome Patient #1 Optometric Vision Therapy Progress Evaluation #2 1 month later Majority of symptoms resolved BVA 20/20 RE, LE Slight + CL OR CT ortho/2 EXO NPC TN After 5 trials TN NPC with RL 7/10 cm Vergence dist BI x/14/10 BO X/30/25 Near BI 16/12 BO 35/25 W4D 4 all distances Random Dot 25’ Pur/Sac +4 Amps 8.33 RE/LE NRA +2.50 PRA -2.25 Facility 6 RE, 7LE, 8 OU CPM no suppression MEM +.50 RE, LE RTO 6 mos CEE, intermittently do HVT

83. Ended Here: Majority of symptoms resolved BVA 20/20 RE, LE Slight + CL OR Pur/Sac +4 CT ortho/2 EXO, NPC TN After 5 trials TN NPC with RL 7/10 cm Vergence dist BI x/14/10 BO X/30/25 Near BI 16/12 BO 35/25 W4D 4 all distances, Random Dot 25’ Amps 8.33 RE/LE NRA +2.50, PRA -2.25 Facility 6 RE, 7LE, 8 OU CPM no suppression MEM +.50 RE, LE Started Here: 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 NPC 2/6/4” After 5 attempts pain noted PFV/NFV @ near could not do/diplopia W4D Fusion Variable Random Dot 100” (?) - Lens amplitudes could not do NRA +2.00 diplopia PRA -1.00

84. 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!”

85. Computer Programs Used in Optometric Vision Therapy Computer Aided Vision Therapy Home Therapy Solutions

86. 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

87. 3D in the News ABC Chicago http://abclocal.go.com/wls/story?section=news/health&id=7298893

88. NBC News Broadcast http://www.wlbz2.com/news/local/story.aspx?storyid=145741&catid=9

89. AOA TV http://www.iwantmyaoatv.com/

90. Diagnosis Maino D. Brock String Debuts at 2011 Consumer Electronics Show. Optom Vis Dev 2011;42(1):6-9.

91. Print /Digital Media

92. Blogs

93. MainosMemos.blogspot.com

94. Radio

95. The 3D’s of 3D Viewing: Discomfort, Dizziness and Lack of Depth Discomfort Dizziness Lack of Depth

96. The 4th D of 3D Viewing The fourth “D” of 3D Viewing should be to call your…. Doctor of Optometry

97. 3D in the Classroom: See Well, Learn Well

98. 3D Resources AOA http://www.aoa.org American Academy of Optometry http://www.aaopt.org 3D Eye Health.org http://www.3deyehealth.org/ COVD http://www.covd.org OEPF http://www.oepf.org Optometrists Network http://www.vision3d.com/ Berezin Stereo Photography Products http://www.berezin.com/3d/

99. 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.eduMainosMemos.blogspot.com www.ico.edu nw.optometry.net