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3D Vision Syndrome: What Your Clients Should Know - featured January 11, 2011

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3D Vision Syndrome: What Your Clients Should Know

By: Dominick M. Maino, OD, MEd, FAAO, FCOVD-A

What is 3D Vision Syndrome?
3D Vision Syndrome (3DVS) has all the required qualifications for a new but not yet officially recognized syndrome. As you know, a syndrome is comprised of a group of symptoms and/or physical signs that collectively indicate or characterize a disease, psychological problem, other abnormal condition or, in this case, a functional vision disorder. 3DVS symptoms include but are not necessarily limited to headaches, blurred vision, eyestrain, double vision, dizziness/nausea and vision induced motion sickness. Another unique aspect of this syndrome is that it is induced by state of the art entertainment, gaming, and educational technology.

How many people experience discomfort while watching 3D?
The US Census Bureau notes that there are 310,553,072 people in the USA and 6,890,416,942 in the world. Since 2-6% of the population exhibit either amblyopia or strabismus millions upon millions could have 3D Vision Syndrome and the many symptoms associated with this disorder (amblyopia is a 'lazy eye' where the clarity of vision is typically much better in one eye than the other and strabismus is when an eye is turned in, out, up or down). Both amblyopia and strabismus can totally disrupt the 3D viewing process. This would mean that no appreciation of 3D would occur. Our clients and their families often pay a premium price for seeing 3D movies, watching 3D television and playing 3D video-games. Since a person with amblyopia and strabismus could not see the 3D affect, that would make these activities quite expensive with no benefit to the viewer.
Other vision problems that could detract from using 3D content include Convergence Insufficiency (1-25% of the population with median prevalence of 7%), Convergence Excess (7%), Divergence problems (.03-.1 %), Accommodative/Focusing problems (variable population estimates) and other learning related vision problems (2-10%). (From AOA Optometric Clinical Practice Guidelines for additional information go to and )

What type of 3D content tends to create the most problems?
When various media not originally meant for 3D are reformatted or converted from their original 2D many more individuals seem to have an unpleasant experience. It should also be noted that the appropriate placement of the object of interest (i.e. the actor) on the screen is important as well. You normally want the 'center of attention' at the distance of the actual screen and not being perceived as in front of or behind the screen. Where you sit in the theater or at home also plays a role. You should usually try to sit in the middle of the theater and not too near or far from the screen. Finally, of course, if you have any of the functional vision problems noted above, it will not make much difference where you sit or how the 3D content was produced; because you will not like what you see any way!

If your clients experience 3D Vision Syndrome, what should you recommend?
The very first thing that should be recommended is a comprehensive eye and vision evaluation to make sure that your patient does not need glasses and their eyes are healthy. This initial evaluation should also determine if any functional vision problems are present. If your patient sees clearly and the eyes are healthy, but functional vision problems are suspected; a visual efficiency evaluation is often scheduled with a developmental optometrist. (Developmental optometrists who have been certified in this area can be located at the College of Optometrists in Vision Development website using the Doctor Locator tab.) The visual efficiency evaluation should then determine if there are any functional vision problems present. The doctor will often suggest Optometric Vision Therapy to treat any disorders diagnosed.

What is Optometric Vision Therapy?
The American Optometric Association notes that, "[Optometric] Vision therapy, also called vision training/orthoptics, is an individualized program of procedures used to improve or correct vision problems. It involves a series of treatments during which carefully planned procedures are carried out by the patient under professional supervision in order to improve vision skills such as eye movement control, eye focusing and coordination, and the teamwork of the two eyes.?

The College of Optometrists in Vision Development (COVD) states: Optometric Vision Therapy is:
  • A progressive program of vision procedures
  • Performed under doctor supervision
  • Individualized to fit the visual needs of each patient
  • Generally conducted in-office, in once or twice weekly sessions of 30 minutes to an hour
  • Occasionally supplemented with procedures done at home between office visits
Depending on the case, the procedures are prescribed to:
  • Help clients develop or improve fundamental visual skills and abilities
  • Improve visual comfort, ease, and efficiency
  • Change how a patient processes or interprets visual information

COVD stresses that Optometric Vision Therapy (OVT) is not just 'Eye Exercises' and is not to strengthen eye muscles. OVT retrains the brain so that your visual system can provide you with single, clear, comfortable, two-eyed vision. It should not be confused with any self-directed program of eye exercises which is or has been marketed to the public. Optometric vision therapy is supported by ongoing evidence-based scientific research. The latest research supporting optometric vision therapy includes National Institutes of Health, National Eye Institute randomized, double blind and placebo controlled studies.

How will having 3D Vision Syndrome affect school performance?
Learning related vision problems usually are not the primary cause of academic problems but are often a secondary cause. If you have 3DVS and all of its associated symptoms, it will literally hurt when the teacher uses that 3D experience in a classroom to teach. If it hurts we tend not to do it. If your patient cannot use this technology in the classroom to learn as the other students do, he or she will probably fall behind his or her peers.

What will be the leading application for 3D content in the future?
I would like to see 3D content used as a part of a world-wide public health vision screening tool. This is a major opportunity for the 3D Entertainment-Education-Techno-Industrial-Complex to work with optometry for the benefit of the consumer. If done wisely, companies such as SONY, Panasonic, Samsung, and even Disney can use this new technology as a public health screening for the presence of binocular vision dysfunction in the general population. The good news is that functional vision problems associated with 3D Vision Syndrome can be treated effectively and that this treatment lasts.
The use of 3D in the classroom will expand significantly. It will become more important than ever that students have single, clear, comfortable, and binocular (two eyed) vision. Students that have poor binocular vision will be at a major disadvantage. In the not too distant future, we may even begin to see 3D realistic holographic images in the middle of our living rooms! (Think Star Trek holodeck.)

How will 3D change the way we do things?
It is very likely that in the future we will learn by manipulating 3D images in real space so that visual motor abilities, good depth perception skills, and all the other aspects of vision that support binocularity will become critical for success in all we do at work, school, and play. Those with difficulties seeing in 3D will be at a major disadvantage.

What about the warnings from Nintendo and other 3D Content Providers?
In a recent news release the American Optometric Association says,
"It is not enough to have 20/20 visual acuity. Eye muscles must be coordinated well enough to experience single, clear and comfortable vision by maintaining alignment of both eyes. The brain must also match appropriate focusing power with where the eyes are aimed. Often, subtle problems can lead to rapid fatigue of the eyes and loss of 3D viewing, but also loss of place when reading or copying, reduced reading comprehension, poor grades and increased frustration at school. Difficulties with appreciating 3D in movies, TV and Nintendo's 3DS, or discomfort when engaging in these activities may be an important sign of undetected vision disorders. Parents should be aware that current vision screening technologies employed in schools and pediatricians' offices cannot substitute for comprehensive eye examinations that detect and treat these problems."

And that "Nintendo has issued a warning that children under 6 should not use the 3DS in 3D mode. While studies on the effects of prolonged 3D viewing on young children remain to be done, leaning toward the side of caution is advisable in guiding children to use these devices in moderation". children younger than 6 can use the 3DS in 3D mode if their visual system is developing normally."
The bottom line here is that parents should follow the AOA and the American Public Health Association (APHA) recommendations that encourage a comprehensive eye examination for all children at approximately age 6-12 months, 2-3 years, and by 5 years of age. I recommend that vision examinations should be scheduled yearly until the child no longer attends school. Unfortunately the Centers for Disease Control and Prevention (CDC) reports that less than 15% of all preschool children receive a comprehensive eye examination

If your clients experience the "3Ds of 3D viewing" Discomfort, Dizziness, or lack of Depth it is crucial to have a comprehensive eye examination by a doctor of optometry as soon as possible.

Resources for Additional Information and Doctors who can Help

For a great introduction to 3D Vision Syndrome see the AOA Video at:

No cost vision assessments are available for children 6-12 months of age through the AOA's InfantSee program.

A presentation that discusses the treatment of an individual with 3D Vision Syndrome can be accessed on SlideShare.

American Optometric Association:

College of Optometrists in Vision Development:

Optometric Extension Program Foundation:

Neuro-Optometric Rehabilitation Association:


Optometrists Network:

Children with Special Needs:

All About Vision:

The scientific basis for and efficacy of optometric vision therapy:

International Resources
International and Australasian College of Behavioural Optometrists, European Society of Optometrists, Danish Optometric Association, Congresso Mexicano de Optometria Funcional, and the British Association of Behavioural Optometrists

This Week's Featured Author:Dr. Dominick Maino, OD, MEd, FAAO, FCOVD-A

Dr. Dominick Maino is a Professor of Pediatrics/Binocular Vision at the Illinois Eye Institute/Illinois College of Optometry in Chicago, Il and an Adjunct Professor of Pediatrics at the Centro de Optometria in Madrid, Spain and is in private practice in Harwood Heights, Il. (Northwest Optometric Associates. He currently serves as the American Optometric Association's spokesperson on 3D Vision Syndrome and is an internationally recognized expert on eye and vision problems of children and those with developmental disability. He is the editor of Optometry & Vision Development, the official journal of the College of Optometrists in Vision Development. His other interests include music (sings tenor and plays trumpet in his church choir) and photography. He has exhibited his photography at the Cook County Treasurer's Office Chicago, the Italian Cultural Center at Casa Italia, Nine2Five Gallery in Kansas City and the Gallery ABBA in Wisconsin. He is also the webmaster for his choir's website, his private practice website and various blogs. His latest book on the vision problems of patients with special needs will be published by Lippincott in 2012.

Tags: Article Visual Perception Newsletter 14 January 2011