Mirror Superimposition

Jen Simonson, OD, FCOVD
Boulder Valley Vision Therapy

Course Objectives:

1.  Build sensory fusion using the mirror superimposition technique.

  1. Luster
  2. Simultaneous Perception
  3. Anti-suppression (peripheral to central, vertical to horizontal)
  4. Flat Fusion
  5. Stereopsis

2.  Build motor alignment control of eye position using the mirror superimposition technique

  1. Looping
  2. Target placement
  3. Voluntary alignment

3.  Advanced techniques using mirror superimposition: mazes

4.  Mirror septum techniques

  1. Symmetry Drawing
  2. Cheiroscopic Tracing

Course dedication to Ron Bateman, OD, FCOVD and his 2014 COVD Course: Strabismus presented 10/24/14.

This set of vision training procedures is commonly called “mirror overlap” and “mirror superimposition”

Mirror Superimposition Procedure Instructions

Adapted From: http://drboulet.com/mirror-superimposition/
Purpose: To stimulate simultaneous binocular response

Method:

1. Patient stands to the side of some bright, highly visible target like a flashlight, a window, a picture on the wall or a TV picture.

2. Hold hand mirror at a 45 degree angle before the eye on the side nearest the bright target. Lightly rest the mirror against the side of the nose.

3. Adjust the angle of the mirror so that the bright target to the side is seen in the mirror.

4. The reflection in the mirror should be seen as though it were out in front, superimposed on objects in the room directly in front of the patient.

5. Patient should become aware that two things are now seen in the same place–the bright target reflected in the mirror seen by one eye and the objects straight ahead in the room seen by the other eye.

6. Try to keep seeing both targets simultaneously.

7. He rotates the mirror slowly and places the projected target on different objects in front of him. He learns to move it right and left, up and down.

Luster

For variation, tack a sheet of red and a sheet of green construction paper at eye level on adjacent walls at a corner of a room. Each sheet should be about one foot from the corner. While patient stands facing one of the sheets and directly opposite the other sheet, he repeats steps two through six, placing the colored paper seen in the mirror partially, and then wholly, upon the sheet directly in front and observing the color mixing of the red and green.

Aspects to be emphasized:

1. Ability to see with each eye simultaneously. If mirrored image tends to disappear, try jiggling the mirror.

2. Ability to see the mirrored image as if it were out in front.

3. Ability to see the red and green colors blend and mix.

Mirror Superimposition Workshop Activities:

Goal #1: Luster: the state of shining by reflecting light; sheen or gloss. http://squintyjosh.blogspot.com/2011/03/what-is-fusion.html

Goal #2: Sensory Fusion – Simultaneous Perception: perceiving an image from each eye and combining them into a single perception.

Bird in Cage - this may have too much detail and cause suppression or alternation in the brain.

Anti-Suppression Technique: Start with “clouds”

1.  Amorphous shape

2.  Peripheral

3.  Contrast

Next: Increase Number, Peripheral to Central location, Add to direct and reflected views

First Degree Fusion Activities: Simultaneous Perception

Car in Garage
Car along a vertical road
Car along a wide horizontal road
Car along a narrow horizontal road
Car along a winding road
Car along an angular road

Bird in Cage
Dog in Doghouse

Note – two dissimilar images, no common borders

Second Degree Fusion Activities: Flat Fusion

Pumpkin
Fish

Note – two similar images, common borders, details unique to each piece to get feedback on anti-suppression.

Third Degree Fusion: Stereopsis

Eccentric Circles

Note – two similar images with common borders, the details need to have disparity to create depth perception.

Instructions:

1.  In a corner of the room, you will place a target on each wall at the same height.

2.  Stand in front of one chart. The eye away from the corner will directly view this chart.

3.  The eye closest to the corner will view the image of the chart on the other wall in the mirror. Hold a hand mirror at a 45 degree angle on the side of your nose (it will aim towards the corner).

4.  Overlap the image in the mirror and the chart in front of you.

Visually-guided motor procedures –

Where is it? Where am I? How do I line up the images from both eyes into the same visual direction?

  1. Looping – Loop the Goop procedure
  2. Target placement – Felt shapes placed in correct locations
  3. Voluntary alignment – convergence/divergence to align images

From: http://squintyjosh.blogspot.com/2011/01/vision-therapy-week-5.html

“The illustration on the left is method given in the OEP instruction sheet for mirror overlap. Place an object to your side. Angle a mirror 45 degrees over your eye, so that the object appears in the mirror. Stare straight ahead. Do something magical with your brain, fuse the images, and make the object appear as if it is located on the wall in front of you. Move the mirror around to make the object move around on the wall in front of you.


The illustration on the right is the way that my vision therapist taught me, and the method which I prefer. Place the object in front of you. Put the mirror over one eye. Move the mirror around and make the object travel around the room.”

Mirror Superimposition: Mazes

Notes: Creating corners: presentation board, doors, cabinets

Mirror Septum Techniques:

Place locker mirror (rectangular) on a piece of paper. The mirror will act as a septum, so that one eye will see the paper directly, but will not be able to see the image on the other half of the paper. The other eye will look in the mirror to see the image is projected to the opposite side of the page.

·  Symmetry Drawing

·  Cheiroscopic Tracing

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