Alternating Suppression

The page Convergence Insufficiency explained the visual skill of convergence, how it normally develops in young children, and how the brain eventually adapts when convergence ability fails to develop sufficiently. One of those adaptations is alternating suppression.

Detecting Suppression

A common method of showing someone he is suppressing the input from one eye, either all the time or intermittently as is the case with alternating suppression, a plastic overlay with transparent vertical red, green and clear stripes is used along with red/green glasses to observe suppression. The glasses have one red lens and one green lens. The transparent sheet is laid with the stripes oriented vertically on a page of print and the glasses are worn when reading the page.

Now, it’s a fact that red and green filters used together will filter out all light passed through both filters. Given that fact, here’s what each eye sees in the above situation:

Right eye behind a red lens: Sees the print behind the clear stripe and the red stripe. Both appear red, but the light coming through the clear stripe will appear brighter than the light having to go through both the red stripe and the red lens. The print behind the green stripe will not be visible. The entire stripe will appear black because the red lens and green stripe acting together filter out all transmitted light.

Left eye behind a green lens: Sees the print behind the clear stripe and the green stripe, again with the clear stripe somewhat brighter. Here the print behind the red stripe will be blacked out, again because the combination of a green lens and a red stripe filter out all the transmitted light.

If the brain of an adult, or even an older child, finally gives up on the visual system ever developing appropriate convergence ability, sometimes it will adapt by consistently ignoring (suppressing) the near visual input from one eye. If that has happened, a person viewing print through the red/green arrangement described above will, depending on which eye the brain chose to suppress, not be able to see any of the words behind either the red or green stripe on the plastic overlay. If the input from the right eye (behind the red lens) is being suppressed, then the red stripes on the overlay will appear black because the brain is only accepting input from the eye behind the green lens. Note that the right eye still sees; it's just that the brain ignores the input from that eye. However, if the input from the left eye is manually suppressed, say with an eye patch, then the input from the right eye will again register and be processed by the brain.

If this sounds a bit like science fiction, let me assure you that it is not. In fact, as I’ve aged, my right eye has become more comfortable with distance vision and my left more comfortable with near vision due to a combination of nearsightedness and astigmatism in one and farsightedness in the other. When I put on the glasses, one of the colored stripes appears much darker than the other one, though I can, with effort, clear the image and read the print behind it. Which brings us to the phenomenon called alternating suppression.

The Brain’s Attempts to Deal with Convergence Insufficiency

It turns out that when you put these red/green glasses on children with convergence problems, you often find that their eyes are alternately suppressing. What this means is that for short periods of time, the brain is refusing input from one eye. Then, a bit later, it refuses input from the other eye. In between, input from both eyes is being received and processed.

When the visual input is being alternately suppressed, first one eye's input is being processed, then both, then the other

If a child has poorly developed convergence ability, during the time that both eyes are functional the brain is receiving conflicting information because usually the child fails to have both eyes centered on the same spot on the page. In other words, the child sees double, especially if he’s been at it for a bit. Then, the brain shuts down one eye, say the left one, for a second or two. All of a sudden the page makes sense, because the brain is finally seeing a single image. Then the suppression stops and doubled vision reappears.

Next, the right eye suppresses and all is well again, maybe. Or maybe not, since the child might well have been following the lead of the right eye for the past several seconds, even during the period of doubled vision, and all of a sudden that eye has suppressed. But the left eye is focused two words over, or even one line higher or lower in rare cases.

Or if not two words over, maybe it’s just a letter or two over, in which case the world just became verery confusing. No, that’s not a typo. It’s what very would look like if your vision suddenly shifted back two letterers or even threhree. Do you see why learning phonics might be a bit of a challenge? And don’t forget, when the eyes switch back the other way, your child mit suddenly miss two letters or posly even three, or just jump a word or two.

I have personally observed a child reading whose eyes were not even tracking on the same line. Every few seconds, he would suddenly be reading a word one line lower or one line higher on the page. While this is a less-common phenomenon, it can occur if the child is undergoing alternating suppression of his vision. Incidentally, he wasn’t doing well in school and had become something of a behavior problem besides. Should this be surprising?

Alternating suppression is a real phenomenon, and it’s common in cases where a young child’s brain is still attempting to develop convergence ability. It seems to me to be the mechanism by which the brain attempts to train the child’s convergence ability. It does so by continually demonstrating clarity (when one eye is suppressed) alternated with confusion and resultant discomfort (both eyes being used simultaneously) while keeping both eyes in the game for the time being (the alternating process.) In time, if a child occasionally achieves clarity with both eyes simultaneously, he will find that to be the more comfortable situation and subconsciously work toward achieving that situation more frequently. If all goes well, the brain have trained his ability to converge his eyes to a single near point consistently and accurately.

Compensating Behaviors

If, however, the brain fails in this endeavor, a compensating behavior can occur. The brain eventually gives up and picks one eye to do the near work. The result is that the child, by then possibly even near adulthood, becomes functionally blind in the other eye. The vision is still there when examined, but when both eyes are open the brain is only accepting the input from one eye at near point. This is why some adults who continue to experience convergence problems can finally enjoy reading. They are using only one eye to read, usually with no idea they are doing so.

The process of alternating suppression can train convergence ability. Once that ability is in place, the suppression can end.

Incidentally, another obvious compensating mechanism is far less subtle, though usually still a subconscious event. If your child covers one eye consistently with his hand, or turns his head sideways to read so that his nose is blocking the print from one eye, then he’s figured out that he is more comfortable seeing print with only one eye at a time. He probably isn’t even aware that he’s doing it, although I do know one child who flat out stated that he takes his written tests with one eye closed because he does better that way.

Of course, neither the clumsy compensating techniques of the young child nor the subtle compensating done by the brain of a young adult are desirable outcomes. It is far more preferable to fix the issue by getting it properly diagnosed and treated. Along the way, you are likely to find that other higher-level visual skills also failed to develop appropriately and these can be addressed as well. And, of course, you will also hopefully find that other near efforts, such as practicing handwriting, will come more easily.

On the next page, Does Vision Therapy Work?, I explain why you might be misled by answer to that question if you ask it of your family eye doctor. He won't intend to mislead you, of course, but I've seen many parents draw the wrong conclusion from what they hear.