Some of the medical orders for outpatients are for eye movement training. Why is oculomotor training necessary? How does it relate to binocular vision? What should I be aware of? The human eye is governed by 12 eye muscles, which maintain normal eye position and movement. The precise cooperation of the eye muscles is required when the eye turns to a certain direction or when the point of gaze changes. It is important to maintain accurate eye position and to ensure that the visual axes of both eyes are aligned. This places strict demands on the function of the eye muscles, requiring accurate judgment, strength and command. The innervation of the eye muscles in the studio ophthalmology Xu Yuan requires impulses from the superior neurons, impulses from the superior neurons require instructions from the center, and instructions from the center are given with feedback from the visual system. A problem with any part of this system can affect judgment and command. Failures in both judgment and command can result in oculomotor impairments. These motor impairments first affect simultaneous binocular perception (referred to as simultaneous vision). Ocular muscle disuse, congenital abnormalities, inflammation, trauma, abnormal blood and oxygen supply, metabolic diseases, occupying lesions, central abnormalities, etc., may affect the muscle strength of the ocular muscles. If one or more of these 12 eye muscles are not strong enough to make an effort when it should, the movement of one eye will not be in place. As a result, double vision can occur. When double vision appears, the visual center has to turn off the afferent impulse of one eye in order not to affect the judgment, so as not to be troubled by double vision temporarily. However, many problems can occur in the long run. In younger children, when one eye is often turned off, the center does not receive visual afferent impulses from this eye, the electrical activity of the center is reduced, and the vision in this eye decreases and cannot be corrected, which is amblyopia. Binocular cross-suppression can likewise reduce visual acuity in both eyes, and normal corrected vision cannot be obtained. This can eventually affect stereopsis and possibly strabismus. Giving up one eye in older children may not affect vision for a while. However, the burden of learning can cause tasks that should be performed by both eyes to fall on one eye. This makes it easier to tire, to injure, and to build the eye up to strength. The eye grows one millimeter to get -3.00D myopia, which in turn becomes myopia. Again, stereopsis is lost and strabismus occurs. Adults also give up one eye. The same inhibition occurs when an eye muscle or group of eye muscles on one eye does not function properly, i.e., one eye is often shut down. Amblyopia does not usually occur in adults, and the chances of myopia are less likely. However, the tasks of both eyes are always performed by one eye, which may manifest as visual fatigue. Continued use of the eye under fatigue may also lead to a series of changes such as high intraocular pressure and dry eye syndrome. Even the occurrence of cataracts, macular degeneration and other disorders may occur. The problems and subsequent changes caused by the eye muscles go far beyond these. In order to prevent these problems from occurring or having secondary effects on the eye, it is important to first find the cause and treat it symptomatically. As mentioned earlier: ocular muscle dysfunction, visual imbalance, congenital anomalies, inflammation, trauma, abnormal blood and oxygen supply, metabolic diseases, occupying lesions, and central abnormalities can all cause ocular muscle dysfunction. In children and adolescents, ocular muscle dysfunction is the most common factor. It may be associated with visual imbalance, refractive error, regulatory collection dysfunction, and masking in amblyopia treatment. The initial cause may be partial or monocular masking. Improper pencil grip accounts for the majority of these occlusions. Why does an improper pencil grip cause problems with the eye muscles? The correct pencil grip is one inch from the tip of the pen with the belly of the pen to the right and about 45° up from the table. If the pen is held too close, the thumb is leaning forward or the pencil is pointing toward the head and face, it may partially obscure the right eye so that the right eye cannot see the pen tip at all times. When the pen tip is not visible for a long time, the gaze activity of the right eye may be affected. With prolonged disruption, the coordination of the eye muscles will be weakened. The most likely to be affected is the superior rectus muscle of the right eye. If the obscured right eye still wants to see, the only way is to tilt the head. Long-term tilting of the head for writing may in turn have an effect on the function of the left eye muscle. The effect on the superior rectus of the left eye and the inferior oblique muscle of the left eye is second only to the superior rectus of the right eye. Correcting the pencil grip can have a positive impact on the development of these problems. However, direct correction of problems that have already occurred is not possible. This requires early detection and early management. How is ocular muscle insufficiency detected? How is it resolved after detection? Many methods of examining binocular vision function will give hints about these problems. The red glass test can directly detect damaged eye muscles. In combination with a trinocular lens, a quantitative diagnosis can be made. When ocular muscle insufficiency is found, it needs to be looked at, with or without prismatic correction. The principle of prism correction is to create an opportunity for both eyes to see at the same time. The prism is able to refract light, and if the eye muscle is not strong enough to tug the visual axis together, giving a little prismatic compensation where it is most lacking can solve a point of simultaneous vision. There is a point of simultaneous vision, and through training, it is possible to achieve a face of simultaneous vision. With the simultaneous vision of one face, through various training, it is possible to have simultaneous vision of all faces. How to compensate with prism? Does every patient with oculomotor insufficiency need prism compensation? When ocular muscle insufficiency is detected, it is important to look at whether the red glass test complex appears to be central or peripheral. If you find a central complex image that does not disappear with training, you need to consider trying prismatic lenses to see if prismatic lenses can correct it. Generally eye movement training for 3 to 10 days does not eliminate the central complex image, try prism again. Continued training with prisms will also remove the prism in most patients. If the central compound image disappears and the compound image appears only in the periphery, prism correction is not necessarily needed. With consistent training, it is possible to completely eliminate the compound image and perfect binocular simultaneous vision. Why can training improve binocular simultaneous vision? How is training done? Most of the abnormalities in simultaneous vision are caused by problems with the eye muscles, but they are also related to other factors. Four-fifths of a person’s ability is potential and can be brought out through training. A person who can carry 100 pounds, through training, can carry 500 pounds. If the person’s strength is weak, can only carry up to 20 pounds, let him work with normal people, the time when he makes the strength, it shows the defect. If we let him train with a large group, as long as he does not give up, regardless of the cause of the problem, only need to work out close to 100 pounds of strength, you can work with everyone. When the strength of each eye muscle can accurately govern the eye movements, good binocular coordination will soon be acquired through training. The training is easy, just need to turn the eye as much as possible, keep both eyes can be fresh to look at an object, you can perfect the function of the eye muscle. However, there are many conditions that can affect the effectiveness of training. If the compound image is always present in the red glass test and both eyes are gazing, there is always one eye that is always closed, or alternately closed one eye, even if the strength of the eye muscles has been trained in place, simultaneous vision will not occur. The eye that is closed will not follow or follow in place during training, and the training will not be effective. Therefore, the results of the red glass test need to be observed every month during training. Once the central complex image appears at both distance and near, it must be combined with prism or adjust the prism degree. Some compound images occur at a distance, and others at a close distance. Some compound images occur at both far and near. The training must find a position where no compound image occurs. Only by doing training in this position will you have a chance to use both eyes. This is usually tested at 750px, 1500px, 1m and 1m away. 750px double image disappears and can only be trained at the near location. The patient is instructed to look at 42 cynical sodium paddle Mi bridal veil at 750px. The diagonal intersection point is flush with the eyes. 1500px, look at 57 count paddle Mi bridal veil embraces four corners, 1m at 1m x 1.5m, 1m away from the four corners of a wall in a 12-15m2 room. If there is no central compound image far and near, it is recommended to look at the far side. In principle, both eyes can see the target at the same time for the training to be useful. When the compound image appears, often turn off one eye, the eye will not necessarily be able to follow in time, and the eye muscle may not be able to use the strength. The training effect will be greatly reduced. In addition, the speed of eye rotation should prevail to see clearly, not too fast. When the eyes turn, half clockwise and half counterclockwise, should avoid turning in one direction. Also need to pay attention to a very important issue, is the choice of time. Generally choose morning and noon, evening is less effective. Consider in relation to the time to keep after training. At night, you go to sleep after training, there is no opportunity to use both eyes at the same time. By the time you wake up the next day, the effect of training disappears and you use your eyes with one eye turned off all day, which of course will not do much good. Is it possible for everyone to eliminate compound images through training? Numerous observations have shown that the vast majority of patients are satisfied or more satisfied with their training. There is also a small percentage of patients who not only do not make a difference, but may be worse. In about 10% of patients, very good results were obtained (within 1 month, the distant and near compound images disappeared, maintained for 2 months, no recurrence). About 70-80% of patients recovered basically or got better than before with one year of training (disappearance of peripheral complex image or change from central to peripheral complex image; in patients with prismatic correction, reduction of prismatic degree or disappearance of peripheral or central complex image after de-prismatic). Approximately 5% of patients have no response. A further 10% of patients may show a more aggravated condition (central complex in patients with peripheral complex, and both distal and proximal complex in patients with distal or proximal complex). What happens to these patients who are more aggravated after training? If we continue training, there is still a possibility of aggravation. If we give up, we can only see the loss of synoptic function. In this case, it can only be considered that one or more of the eye muscles are too deficient to keep up with the training and have voluntarily given up. While the other eye muscles are still making efforts, their gap will grow wider and wider. It is because there is a way that this training can be carried out. In fact, the solution is very simple, just give the eye muscle that can’t catch up a helping hand so that it can keep up. Or always let it lead, and everyone run after it, and it will not happen again. The prism, is a very useful helper. He can compensate part of the defect of the eye muscle, even if it finds a point where the compound image does not appear, and does not turn off one eye in training. The training will allow this eye muscle that is functioning too poorly to do some work. Given the opportunity to exercise, each eye muscle has the potential to return to normal function. So, if the eye muscles are functioning properly, does that mean that both eyes are functioning properly? Not necessarily. It is habitual to give up one eye for a long period of time, and even if you train the eye muscles to function so that there is no longer a compound image and both eyes can see an object at the same time, this is only the completion of simultaneous vision. It does not necessarily restore fusion perception (fusion for short) in both eyes. Fusion is the second level of visual function in the human eye, which requires not only simultaneous seeing, but also the fusion of two different defective planes of imaging in the center. There are so many factors involved in fusion and having become accustomed to monocular use, re-establishing a normal habit is not something that can be done overnight. The factors that affect fusion include visual acuity, eye position, accommodation, refractive status, etc., etc. We must allow these factors to be addressed before we can consider addressing habitual factors, and habits are not formed immediately. The right conditions, correct induction, normal use, and long-term maintenance will give us a chance to perfect it. The only way to really keep it down is to stick with it for 3 years without repeating it. Normal fusion is a range that requires at least -5° to +25° or more, and individual children can reach -25° to +45° or more after training. To see far away, one needs to integrate -5° or more into the eye position. To see near, you need to integrate +25° or more into the eye position in order for both eyes to have the opportunity to see far and near at the same time. Failure to achieve this standard of fusion range will either give up one eye for near viewing or one eye for distance viewing. It seems that if the eye muscle function is in place, but the fusion range is not, one eye will still be abandoned and the above mentioned problems will occur. Not only that, but stereopsis (stereopsis for short) can be lost. Stereopsis is the third level of visual function of the human eye, and the highest level of vision of the human eye. Without it, a person’s ability to work and safety is reduced. There is another problem that cannot be ignored, and that is strabismus. If the range of fusion is reduced to the point where it cannot be incorporated into the occluded strabismus position, the occluded strabismus may gradually change to a dominant strabismus. Conversely, with training that expands the range of fusion, some of the dominant strabismus may also be converted to cryptorchidism. This has the potential to avoid the surgical risk for some patients who need strabismus. Therefore, the ability to fuse should be given adequate attention. There is a whole range of training methods to restore or establish normal fusion mechanism, which will be introduced later. In conclusion, oculomotor training creates the conditions for establishing or restoring simultaneous vision, fusion and stereopsis (these three functions are collectively called binocular vision). Understanding and mastering the essentials of oculomotor training is the only way to reduce errors. Being able to know all aspects of training well will further enhance the effectiveness of treatment. We hope to see many eye diseases addressed in this free home training.