We are James and Dr. Tran from Vivid Vision. We are back to answer your questions about treating lazy eye with VR.

Dr. Tran, are you a man of action?

Busted!

I need more Dr. Tran in my life. It's been too long.

Here he comes!

Do you have an estimate on the cost of the home version? I was turned down for the UCSF study, as they said my strabismus wasn't bad enough. I'd love to start using your VR setup asap!

A final price hasn’t been determined. A binocular vision specialist will oversee all use of the software, so there will be a price for the software and a separate cost for the consultation.

What do you mean by binocular vision specialist? Optometrist? Vision therapist? Ophthalmologist?

A vision therapist along with an overseeing optometrist.

Do you know if insurance will cover these costs?

Not at the moment.

How do you get a consultation to go with the home version?

It will come bundled

Edit: Found other replies to the question that mention video call based consultation, so excuse my comment below :)

So you are telling me that it will continue to be US only or at least only large cities cause no one around here would even give a shit about new tech. That's not what I understand under home version :/ Been watching you guys progress since the initial campaign, slowly losing hope I'll ever get to change anything about my eyes...

Glad you found the answer! Let us know if you have any further questions.

Well I don't think I have much else to add at the moment. I had corrective surgery for my drifting left eye at the age of 3 or 4, since then I had patches and later a slightly opaque foil on the glasses nearly daily. I'm short sighted, but not much, still wearing glasses. But no stereoscopic vision apart from maybe extreme 3D effects in like an IMAX cinema where I remember seeing 3D but that was like 15 years ago (I'm 25). Left eye has about 80%, right 100% (I don't know how that translates to the 20/20 system, always was told percentages). I pretty much only use my right eye. The left eye picture is there but if I actually want to focus on something be it near or far it's my right eye that takes over.
So yeah I'm hoping that your solution can help me too, would love to see the difference it makes to have stereoscopic vision :) I'll be watching your progress closely and hope to get my hands on it here in good old Germany sooner than later ;) Keep up the great work!

Hey Hans! I hope you're the same one from Germany that James mentioned to me the other day :) Thanks for sharing your experience.

How exactly could this help correct strabismus or the drifting eye? From what i believe, strabismus is weakened muscles in the eye which cause it to drift.

I understand how it could help with depth perception. But helping with the actual eye drifting, i'm not sure how it could help with this.

Also, how many patients have you guys had and what has been the outcome of the majority of them? You've only listed one successful story. I did watch the video and read that article.

If you have a strabismic patient cover their good eye and gaze in all directions, they should not have any restrictions. Now, with both eyes is where they struggle. Strabismus is mostly a perceptual issue, meaning the brain doesn't know how to use both eyes together. We are essentially rewiring the brain on how to gain proper binocular vision.  

As far as the treatment, we start the activities/games at the angle of their eye turn. As they continue to play, the suppression zone starts to shrink as well as the brain understanding how to fuse the images. With each session, the angle decreases until they are aligned straight.  

A small study was done in Europe with 19 adults. It showed that 60% of people improved between 1 and 3 lines on the acuity chart with just 8, 40-minute sessions over a couple of weeks. We are also in the middle of a study at UCSF, a researcher at SUNY is getting ready to start one which uses our software after putting people in the dark, and we will have something else to announce soon as well! The clinics with our device have been successful. Most are seeing at least 5 amblyopic/strabismic patients a month and I haven't heard of one not completing the program.

Thank you for your response.

I look forward to possibly giving this to my girlfriend/Probably wife in the future to help her with her strabismus. She's had numerous surgeries on her eyes to correct her drifting eye. It's a lot better than it used to be when she was a kid, but it does still drift fairly often. It just doesn't do it to the extreme it used to. She also has awful depth perception. As a result, she runs into everything. lol

She can blame her strabismus when bumping into things!

Thank you for this. I have strabismus and went through three surgeries (twice as a toddler and once at 18), wore an eye patch briefly, and even had a prism in one lens once I started wearing glasses. All this has done a lot to improve my condition. I don't have a lazy eye, but I still feel like my vision isn't what it should or could be. I am not confident playing sports because I have trouble with depth perception when objects are moving quickly (and sometimes slowly), though I have never had any issues with activities like driving a car. If you toss me your keys, I'll probably catch them, but I might also miss horribly. I often feel like my brain is just ignoring my right eye altogether, even though it doesn't drift like a lazy eye. It almost feels like I'm looking at a monitor with the brightness all the way down when I just use that eye, so I struggle with things like reading or watching TV if I close my left eye (not that I have a strong desire to watch TV with just one eye open). Sometimes I wonder if I just have the wrong prescription for that eye, but every time I get my eyes checked I bring this up and end up with the same prescription after reading the chart so many times I know each line by heart.

Do I have any hope? I've been told by several doctors that I'm just too old to do much at this point, but I see so many success stories in the comments here, you have me wondering.

If you are unable to judge depth, then it seems like you either have a lot of suppression or a micro-eye turn. This is still a form of lazy eye, but cosmetically it appears straight. In theory, it is able to regain binocular vision. Due to the history, it will likely be a challenge.

Has anyone shown any adverse effects to using the software? And how long does it take on average before any benefit is shown?

We haven't had any reported adverse effects by clinics or researchers. The average time really depends on the degree of the condition. A refractive amblyopic individual, meaning they have a much larger prescription in one eye than the other, typically will take a shorter time to treat than someone who has a constant eye turn.

Which VR tech are you guys going to launch with? Oculus is the big one that comes to mind, but is there another manufacturer?

We are currently planning on supporting Oculus Rift, HTC Vive, and Gear VR.

Is this home region locked? any chance i can use it no problem in Mexico?

It will be licensed to your PC/device. So you shouldn't have an issue traveling with it.

Are you still going to support the DK2? Or should I be pre-ordering the CV1?

We will still support it.

Is there a possibility for a PS VR version later?

James will be here shortly. I'll be sure to have him answer your question!

I'm 51 and am legally blind in my left eye. My amblyopic eye has never strayed. It tracks perfectly with my right eye. Is it possible that this therapy will give me normal vision? I would love too try this. I live in Oregon.

It's difficult to give an answer without knowing the medical history of that eye. If its pure amblyopia and no physiological disease of the eye, then you would be a good candidate for the software.

I am assuming that when you refer to a physiological disease of the eye, that would be something like Duane Syndrome? I have Duane Syndrome and I assume that there would be no benefit to any kind of VR treatment since there is a physical defect that cannot be overcome? I'm actually not even sure what type of VR experience someone with Duane Syndrome could expect.

The only reason I ask is that I have noticed that from day to day the positioning of my eyes seem to change, sometimes the strabismus is worse than other days. I'm assuming there must be some cause for that and I am curious if there could be some small benefit to some treatment like yours.

Either way, I think it's great what you're doing and I wish you the best of luck and I hope you can help a lot of people!

You're correct. Thanks for your support!  

One thing I recommend for people with Duane Syndrome is to work on tracking. It won't be perfect, but doing activities that require you to quickly search and identify objects will benefit your visual system.

I've got a friend that had the same issue. She had LASIK performed on her "bad" eye and she now has normal vision in both eyes. She highly recommends having it done if you have this issue.

Just to clarify, LASIK is the essentially the same thing as using a contact lens. So if she was able to achieve binocular vision, then it would have naturally progressed even with contact lenses. This would also depend on the state of suppression, as the brain still tend to ignore the amblyopic eye even fully corrected.

Do you have any plans for an international release this year or will it only be limited for North America ? I live in Europe and I suffer from pure adult amblyopia on my right eye and I wish to start the treatment as soon as the technology is ready...will it be possible to use the software alone with the help of your instructions or is there always a mandatory direct supervision by a specialist? Thanks.

We plan on releasing it to other countries this year. There will be an option to consult with a specialist online to monitor and answer your questions. It will likely be mandatory for you to get an eye exam so we can be sure that its amblyopia/strabismus causing the vision-related issues.

I'm glad to know this. Could you describe a bit more the progress you made on your own amblyopia ? Do you think you could be able to somewhat read over time for example thanks to your treatment if your lazy eye wasn't almost blind at the start and it's purely a neurological cause? Also, is there still a lot of room for research and improvement to do in the coming years about curing a lazy eye through VR which would help to heal more severe cases in the future or do you think most of the "potential" and thus limits of this tech specificaly for this disease has been already discovered ?

I'll be sure to have James go over his history when he gets back into the office. As far as research goes, there is still a lot to be discovered. This was one of the reasons why we went with the clinical and research versions prior to releasing a home version. It's allowed us to experiment with new features, see what works best, and back it up with research. We have an exciting collaboration that I will share with you in the future.

Are clinical trials full? Any trials in Boston area?

Right now the only trials going on are in NYC and San Francisco.

How will the 'consultations' work? Will I need to physically come in to one of your clinical offices to get started? I live in Austin, TX and it looks like you only have clinics in NYC and SF. Will I need to travel to SF just to get started on this?

It will be web based video consults. There will be no need to go to a physical location.

Would the software be just for 'lazy eye' as it is commonly defined or would it work for refractive amblyopia as well? Additionally, would it help correct problems of one eye "dominating" vision signals?

It will work for refractive amblyopia as well. You pretty much described it in your second sentence :) It is meant to allow the brain to use both eyes together instead of having one dominating.

Do you package any of those stereographic images with the software? I want to see the secret dolphins and space shuttles! Seriously though, I have ambylopia. In addition, one eye is near sighted and one is far sighted. Will this software have the ability to correct my vision? I don't feel like I'm missing much (F*** paying 4 bucks for movie theatre sunglasses) but I feel less confident driving because of my eyes' inability to work together effectively.

James made a game for fun. You use a sling shot to hit sharks. It hasn't been released yet because of, well, you're virtually hurting animals.  

We have patients with the same condition as yours (one eye farsighted and the other nearsighted). The most important thing is to wear your full prescription at all times. Then of course, start the therapy. One of our beta users sent us an email with this:  

Nearly every year since I turned 16, I've tried to take the learners driving test around my birthday and failed the vision component of the test every time. I just turned 31, and figured why not give it one last shot. After 11 failures over 15 years, I finally passed.

That's me! James is my hero.

You are awesome! Be sure to contact us if you have any questions :) You have inspired us to work even harder.

Hi. Would this help at all with intermittent exotropia?

Yup

That's awesome! My 12 yo son has it but not that bad. We didn't want to go the surgery route so this is very encouraging news.

Surgery typically isn't recommended for an intermittent strab :)

So back in 2007 I had surgery so that my eyes would line up. Would that affect my chances of being able to see with both eyes equally?

I'm 22 if that matters though I saw you answered an earlier question saying that the "critical age" we were told about is probably just a myth now.

It will require additional information for us to assess :)

What information would that be?

Mostly has to do with anomalous retinal correspondence and the degree of the deviation.

Sorry, I will probably be no help there. I do not know what those words mean and I probably don't have the answer readily available anyway.

Which is partly why we are making sure that people get the correct diagnosis before starting the treatment.

Wait, you're telling me I can fix my lack of stereovision, but I can fix it with video games? That's amazing.

So is there a difference in the chances of recovery of stereovision related to any previous corrective work done on the eye? I had corrective surgery to attempt to realign my eyes when I was younger, and while it did help cosmetically, it didn't fix the issues with depth perception.

You would likely be a good candidate.

What's the transition like from complete stereoblindness to stereovision? How does it feel, is there any reports of eye strain or nausea during or after treatments? What about people getting used to having stereovision in general? How does the brain treat depth perception after never experiencing it before?

I have so many questions to ask, and no idea how to word them. This project is literally the only reason I would pay $600 for an oculus. I don't think I could turn down the ability to see normally.

I'm just going to answer this, not part of Vivid Vision, just a beta tester. Mono to stereovision is like looking at the world, verses being in the world. The sense of space is beautiful, everything feels more free and less cluttered.

I do have eye strain sometimes, I assume it's due to basically atrophied muscles being used. I like it because it means the muscles are strengthening!

Thanks for answering it so beautifully :)

What would the best corrected vision in the patient have to be to become candidate? And what if the patient has A standard or multi focal IOL? Would it still work? Would having any previous retinal surgery opt the patient out?

These are all factors that will require a thorough health check to better understand if the patient is a good candidate.

It seems to be a largely accepted truth that VA's cannot be improved where amblyopia is concerned after mid teenage years. How does this treatment achieve results where occlusion or standard correction struggle?
I speak as an amblyope who only received correction in my mid thirties for the first time. I had a sustained improvement to VA's for approximately 4 years and then they levelled out and I actually suffer from bad diplopia now when I try to wear correction.

Occlusion only promotes the use of one eye at a time. It never teaches the brain to receive inputs from both. Our device requires the use of both eyes to be turned on at the same time. So not only are you working on improving your acuity, but you are also rewiring the brain on how to handle stereopsis and all the nice things that comes from binocular vision.

Does it work better on certain types of squint, eg one that drifts inwards or one that drifts outwards?

Exotropia (outward) tend to be easier to treat than esotropia (inward) from my clinical experience.

I'm 31 and my amblyopic left eye has been interesting. Although patched as a kid, and regained binocular vision - when I switched to wearing contact lenses, the condition returned. I've dealt with it as an adult ever since.

I'm hopeful I can find someone in my area to help me treat the condition. Is it planned that there will be general availability- or is there going to be a specialist subscription model? I guess what I mean is if I cannot find a Dr. in my area - what are the chances I can find one that will be willing to invest in the treatment, short of me traveling for sessions?

I've been eager to have 2016 approach for this treatment to come out. I've been following for quite some time - thank you for your innovation in treatment for these conditions.

There will be a home version where you wouldn't need to see a clinic unless it's to do progress evaluations to ensure your vision is heading in a positive direction.

My daughter has convergence insufficiency. Not a lazy eye, but she sees double. She's only 7, but she has to close one eye to read or focus up close. Is there any chance that she could be helped, preferably without having to wear special glasses?

Yes, there will be a feature that works on convergence demands! We are working on it at the moment and have been testing it on a few of our beta users.

I cannot wait to get my hands on this software! Do you foresee this as something that could be potentially be covered by optical insurance?

If anything, it will be through your medical insurance. We hope to try to get some kind of reimbursement, but it is a lengthy process.

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Palsys are a different beast, as this is a damaged nerve that is causing a lack of innervation to the eye muscle.

While looking for something like this a while ago, I stumbled upon AmblyoTech. Are you associated or familiar with their research?

They are a different company and using a different kind of platform.

So I stumbled onto this and I can't deny that it has me excited. Here is my story:

I was born with esotropia in both eyes and had corrective surgeries at 3 years old, 2 at 8 years and a final one at 14years old. My eyes are still straight at 34 but I have virtually no depth perception. I do not have issues driving, I drive a truck for work atm, but I cannot catch much of anything and current 3d movies give me headaches.

Could this technology potentially help me gain depth perception or would it just be more headaches?

It seems like you do have some binocular function, but it is very limited. 3D movies could be overwhelming for the brain to process, thus causing the headaches. It should work, and our system starts at a very basic level and slowly increases the difficulty.

dr tran

in the treatment of vincoular problems, how would VR related to the visual space? we certainly know about accommodation and converging having an established relationship, true? so what would happen with the VR training for vision in the real world where things occur in different planes?

Ah, do you happen to be in eye field? :)  

We can set the objects in the games to be in virtual space that corresponds to where it will be in real life. One feature we did was incorporated the LEAP motion device. This allows you to use your hands to give a sense of where the objects are located. By integrating other senses, we believe it helps increase the effectiveness.  

The device can already do vergence tasks. There's a few companies out there already working on the accommodation factor, so we are already on the watch for that.

Will this be effective for adults as well or just children? As far as I know its not a fixable issue after a certain age / development.

There's been a lot of research coming out saying the critical age thing isn't entirely true. Age does play a role as how quickly they will progress, but it doesn't exclude them from regaining normal vision. Our research includes patients in their 40s, and we have clinic using the device on people much older than that.

Sorry to have missed the AMA. I struggled with a lazy eye and stereo blindness my whole life. I'm 36. I've been following closely the progress of your software. I went for a lasik evaluation recently in anticipation but discovered I have keratoconus in both eyes. My uncorrected right eye is near sighted 20/25, left is far sighted 20/60. I'm hoping collagen cross-linking will improve my vision and perhaps my bad eye can be improved with a gas permeable lens. Am I still a candidate?

It depends on the status of the KC. The best vision we can correct you to will also depend on the best vision glasses/gas permeable lenses. It does put a more difficult level to the case.

When I asked my ophthalmologist about vision therapy to improve my stereovision, she said that it would be more likely that I'd end up with permanent double vision due to lack of follow-through than get any success out of it, and that I was better off not even trying to fix it at all. She said I was lucky that I was an alternator who didn't suffer from double vision, and that my brain was very good at blocking out one eye or another, and to mess with that would be like playing with fire. I had surgery when I was an infant, my eyes are mostly well aligned though they drift when I'm tired or reading up close. I usually don't see double, and can see out of either eye when I choose, but I'm finding I'm increasingly relying on my left eye as I get older. These are my questions:

Is your therapy recommended for all people with strabismus, or are there certain patients who would benefit more than others?

What happens if people start the therapy and don't follow through? Was my ophthalmologist right -- would we risk developing double vision?

In the vision therapy world, double vision usually is an indication of a good thing. This means that the patient is able to turn on both eyes at the same time. During this crucial phase, the brain learns how to fuse and in turn will experience stereopsis. So far in our clinical and research setting, we have yet to have someone with constant diplopia.

Theoretically though, if you achieved double vision, could it be possible that you never reach the final step of fusing the images together, resulting in constant double vision? I think this is what my ophthalmologist was trying to warn me about -- if the therapy isn't followed through to completion or isn't successful, you end up with double vision which would be worse than where you started from if your brain was previously ignoring one eye or the other.

Anything is possible. I just haven't come across a case of a patient with amblyopia/strabismus under the proper care of a physician having constant double vision :) Now, if they stop while having double vision, the brain will go back to suppression after a few days to weeks.

Hey again,

So James did not have binocular vision/eye teaming/stereopsis before using your game right?

How long did it take, playing the game, to go from 2d mode to 3d mode? First time playing? A couple of sessions?

Was it a sudden "pop" like other stereopsis recovery stories seem to describe it, like Stereo Sue/the guy who watched Hugo 3d, or did it feel like more of a gradual transition over time? I understand that it has gradually improved over time, but I'm thinking more of that first moment.

I'll sent this question over to James.

Hi! I'm using this to help with amblyopia: http://www.i-see.org/rizzi_charts.pdf

Basically it's using 3d cross eyed or parallel viewing. Any opinion or advice?

Also definitely looking forward to the international release, although I don't have the hardware.

This is actually one of the more difficult activities to do, and I suspect that only patients with mild amblyopia/strabismus can accomplish it. It requires them to already have the ability to control their convergence, divergence, and fuse along with stereopsis. If you can already do this, then you're already ahead of the ball game!

Incredibly cool stuff. i just recently had strabisimus surgery to correct a lazy eye due to not having a lens in my left eye for about 35 years. Need anymore people for clinical trials?

You can contact us through seevividly.com. There is research going on in NYC and SF.

Alas I am in Canada. But after having my lens replaced and the corrective surgery, i've gone from having pretty much immeasurable vision in my left eye to some where around 70/20, I'm wondering if this kind of therapy will help to increase acuity, or in my case help to speed up the time it takes the brain to 're-activate' the circuits needed to bring an eye that hasnt been that involved over the years back into practical use.

We've had some success with people with muscle surgery. I haven't worked on or am aware of any patients in clinic with lens replacement surgery (cataract/AC IOL/etc). In theory it should work, but may take longer.

Hey, I am cross eyed on my left and that eye is basically useless...would this help my eye ?

If it is truly due to amblyopia/strabismus without any other physiological eye disease, then you would be a good candidate.

Thank you for doing this AMA!

I tried your doctor locator, but it listed none within 100 miles of me (I'm in NY). Is there another way you might suggest to find a recommended optometrist/vision therapist familiar with these conditions?

Send us an email through our contact page at www.seevividly.com. There is research going on in NYC and I can try fitting you into the trials if you qualify. Otherwise, keep an eye out on the home version.

Dr. Tran, do you guys have any data on improvement with this device for amblyopes that have already undergone occlusion therapy?

James has done patching in the past along with a few of my patients who are consulting with me. So far, I have seen improvements.

How is that different from occlusion of the normal eye? I mean, in children I'm 100 % positive that it'll work but in adults I have my doubts since the primary an association visual cortex aren't developed in the Ill eye

Good question! Patching only works on improving vision in the amblyopic eye. What it doesn't do is promote binocular vision (the use of both eyes). That's part of the reason why children who stop patching regress. If you never full understand how to see with two eyes, then the brain will go back to shutting off the amblyopic eye on removal of the patch.