Alternating Suppression

The previous page, Convergence Insufficiency, covered the skill of convergence and how it normally develops in young children, along with how the brain eventually adapts when a genetic predisposition, or possibly some other cause, prevents convergence ability from developing normally. The use of glasses with one red and one green lens was mentioned as well.

Detecting Suppression

To review, a plastic overlay printed with transparent vertical red, green and clear stripes is used along with the red/green glasses to observe suppression. The transparent sheet is laid on a page of print and the glasses are worn. It’s a physical fact that red and green filters used together will filter out all light passing through both filters.

Given that fact, here’s what each eye can see.

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 seen because the entire stripe will appear black since red and green 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 is not seen at all, again because red and green filters together filter all light out.

Now, if the brain of an adult, or even an older child, has given up on the visual system ever developing appropriate convergence ability, sometimes it will adapt by simply choosing to shut down the nearpoint visual input from one eye. If that has happened, such a person viewing print through the red/green arrangement described above will, depending on which eye the brain chose, not be able to see any of the words behind either the red or green stripe on the plastic overlay. If the right eye (behind the red lens) has been shut down, or suppressed, then the red stripes on the overlay will appear black because they are only being viewed by the eye behind the green lens.

If this sounds a bit like science fiction, let me assure you that it is not. As I’ve aged, my right eye has become more comfortable with distance vision and my left more comfortable with nearpoint 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 First Efforts at Resolution

It turns out that when you put these lenses 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.

Now, 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.

In fact, 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 was 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. Thus will the brain have trained his ability to converge.

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 using the input from one eye. And this is why some adults who continue to experience convergence problems can finally enjoy reading. They are only effectively using one eye to read.

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 nearpoint efforts, such as learning to read, will begin to come more easily.

Next, as an aside, I’ll explain why I think so many of these children grow up to be architects and engineers, assuming they manage to make it through school at all, that is. Following that is a page covering a recent study done on treating convergence insufficiency which contains a symptoms questionnaire to help you determine whether this is an issue with your child.