Questions and Answers
Contents
Q1. I suffer with Alternating Exotropia or Esotropia how do I set-up Equal-Eyes
If your eyes have equal acuity it can be hard to determine which eye is weaker than the other. You may also be suffering with alternating eso or exotropia, in which case you should perform Step 1.
Step 1.
I would recommend selecting the eye that is the opposite of your right handedness. Eg if you are right handed consider your left eye as the weak eye and vice versa if you are left handed.
In this scenario enter the setup page and reduce the brightness of the right eye until you observe the setup cross as two images, effectively double vision.
If you are already seeing two images ie you suffer with double vision the you may skip the above step and move on to Step 2.
Step 2.
In the setup page, add some error correction in the Horizontal, Vertical and Rotational Planes as per this link https://avalonweb.com.au/demo/home/quest-2-configuration/
Step 3.
Once the error correction has been applied. Remove a small amount of correction in each plane, but only to the point to where you are able to use your eyes to re-align the image.
Over the months, the amount of error correction should be removed as you progress with the therapy.
Step 4.
Perform the various exercises and games within Equal-Eyes.
Q2. What are the limitations for configuration of the image shift. Is there a squint angle the VR app is not able to support?
Below are the measured specs for an Oculus Quest 2.
Although the image quotes 90 degrees, it is closer to 89 degrees
(As specified by Meta).
With Esotropia (Eyes pointing towards the nose) the areas in
orange will be the usable field of view for your condition with
the Quest 2 for each eye.
So Effectively, you have 89 degrees to play with. The useful
amount of the scene you are able to view will be:
89 degrees minus (Your angular disparity).
If you have more than 45 degrees of disparity it will start
becoming more restrictive for peripheral vision. The quest 2 will
work with up to 89 degrees for central vision but of course
provide very little real estate for the exercises.
If you have 45 degrees or less then you will have a reasonable
amount of usable area.
(see the attached image).
Q3. I know my Prism Diopter (PD), how is that handled in Equal-Eyes?
This adjustment has a usable range of up to 45 degrees (effectively 100 PD). See above. Regarding the Inter pupilar distance (IPD) referenced in the above diagram Both the Quest 2 and Quest 3 have adjustments for IPD and can vary from about 5.4 to 7cm. The Quest 2 has 3 fixed positions whilst the Quest 3 has a variable adjustment. Therefore allowances for the PD need to be calculated for higher ranging Prism Diopters (PD)'s
Q4. Does Equal-Eyes utilise Dichoptic Training?
Yes it does. Dichoptic training is achieved by adjusting the brightness of the strong eye to a degree where both eyes are being processed by the cortex. Virtual eye re-alignment is then applied by artificially adjusting the rotational angles of the images applied to both eyes.
This adjustment has a usable range of up to 45 degrees (effectively 100 PD) Horizontal or Vertical planes.
Additionally Rotation error can also be applied.
The amount of error is reduced over time as the eye motor control adapts to the adjustments.
Q5. How Much Error Correction Should I remove as I progress?
This will vary from person to person. A small amount is recommended. As a starting point perhaps 0.5 degrees per month. You may find this is either too much or too little. In which case make the adjustments accordingly.
You should aim to reduce the error correction with comfortable increments. Do not push your eyes too hard, this can lead to discomfort, headaches etc.
The key to any exercise is to do it in bite sized steps. This will help you both psychologically and physically. Repetitiveness and endurance is the key to your success.
Q6. I Wear Prescription Glasses, Can they be used with the Quest 2?
Yes they can. The Quest 2 is supplied with an adapter surround that creates more depth between the Quest 2 optics and the wearer. This does limit the FOV slightly but provides a means to cater for your glasses.
An alternative is to use built in prescription lenses. I have personally used Reloptix Lenses and highly recommend them for ease of use and comfort. Using the above link will provide you with a slight discount on these already affordable lenses.
Q7. I Wear Prescription Glasses, Can they be used with the Quest 3?
Yes they can. The Quest 3 has depth adjusters in the side walls of the headset. Use these to adjust the distance between your eyes and your lenses to make from for you glasses.
An alternative is to use built in prescription lenses. Reloptix are taking pre-orders for Quest 3 prescription lenses. If they are anything like the ones I've tested for the Quest 2 I would highly recommend them for ease of use and comfort. Using the above link will provide you with a slight discount on these already affordable lenses.
Q8. What is the Focal Length of the Quest 2 or 3?
It is fixed at about 4ft or 1.2 metres.
Q9. Are there any known anomalies in VR over real life vision?
Yes there are
Resolution is limited to about 20 pixels per degree of eye movement. In real life your visual resolution in theory is a lot higher this is due the the fovea which covers about 2 degrees of the high resolution of our eyes is processing the scene in very high detail typically equivalent to a 9 mega pixel camera. On top of that slight movement of the eye increases this resolution by combining the images seen with tiny alterations in angle to form a very detailed analogue image as opposed to a digital image.
VR is fundamentally alien to our eyes. There is a system where the eyes not only converge on a subject but also focus on a subject. For near objects the lens will adjust to focus as well as converge. AC/A Ration. When switching to distant objects the eyes will diverge slightly to effectively converge on the distant abject. The focus will also change.
The relationship between focusing and converging is known as the Accommodative Convergence to Accommodation Ratio (see AC/A Ratio). As the focal length of the VR Headset is typically 1.2 metres and fixed, the brain will try to adjust focus as VR objects vary in distance and will cause the brain slight confusion. This can lead to blurry vision, motion sickness or headaches.
Q10. A primary problem I’ve had for several years and what’s led to buying Equal-Eyes and the oculus is being unable to get the vision in both eyes to align, then to remain aligned. Is this typical and can I proceed anyway, doing my best with semi-alignment?
The reason I developed EE from the outset was because of my
alignment issues. Using EE you can remove the miss-alignment to
force convergence. Convergence is required to allow the brain to
receive two subtly different images that it can decode into a 3D
Image.
Without this convergence the brain cleverly disregards one image,
a process known as occlusion. This is done to prevent confusion in
the visual system.
By aligning the images you are providing the correct stimulus.
However it will take time before the brain starts accepting the
previously occluded eye.
Inclusion of the Eye can be assisted in EE by reducing the
brightness of the strong eye and/or even adding some blurring to
the strong eye.
The whole process can take months to years depending on the individual. It is important to note, as you progress you reduce the penalisation of the good eye by re-applying the brightness and removing the assistance in geometry/alignment provided by EE over the course of the exercising.
Q11. Will Equal-Eyes work on the Quest 3?
Yes it will.
Q12. How much storage does my Quest need to run Equal-Eyes?
Equal-Eyes works on the basic model requiring less than 2G of storage. Therefore a 64G Quest 1,2 or 3 is more than adequate.
Q13. How do I know what exercises to do?
You need to obtain an understanding of what exercises are
suitable for you. If you do, that's great, however if you don't this can be achieved through a Vision Therapist.
It would not be ethical to provide guidance as a non-optometrist. However, Equal-Eyes is packed with exercises provided by Visual
Therapist and more.
I have personally used the Ball exerciser for ocular muscle exercising (eye geometry alignment convergence) and the Dark Room
for Amblyopia. The Brock String with the quoits I found also to be
very powerful. There is a section on my website discussing the
Quoits.
With the Ball exercise, your eyes should track the ball. Start of
with a little swing applied and over time increase the swing. It's
important to maintain both eye tracking. Because I had amblyopia I
had to reduce the brightness of the Strong Eye in order to see
double vision. Once I had the double vision I was able to use
setup to calibrate that out. I then backed off the assistance so I
had a little double vision and used my brain to bring the ball
back into convergence.
Over Many months I was able to reduce the assistance offered by
the calibration until I gained full control of my convergence.
I personally found out how my eyes operate and what I required
through experimentation. However, with litigation being what it is
these days. I really can't provide one-on-one advice simply
because I'm am not qualified and obviously cannot run tests on you
geographically.
It's certainly worth joining the AvalonWebVr Facebook group and
having discussions with people that you will meet that may have a
similar condition to you.
There are videos on YouTube created by my affiliates that can help. Search Equal-Eyes on YouTube and you will find some good video's there.
Q14. I am interested in starting your program. I have Esotropia and I have just went through strabismus surgery. I also have an oculus, I wanted to see if I can complete the program virtually?
I am not a doctor and do recommend some consultation with a Visual Therapist to at least provide some guidance in using the application. The app as you will see is very self driven.
Please register with the Facebook Group (linked in the footer at the base of this page)
and speak to the many end users for an unbiased view and perhaps
some advice on what exercises may be best for you.
There is a demo version available on the Sidequest website. Install the Sidequest app in your headset (Instructions on their site). Search for Equal-Eyes and feel free to try the demo for yourself. If you like the demo, you may return here to purchase the license to convert the demo into the full featured app..
Q15. My child has Esophoria and Divergence Insufficiency Can EE help?
You need to obtain an understanding of what exercises are suitable for you. If you do, that's great, however if you don't this can be achieved through a Developmental Vision Therapist. It would not be ethical to provide guidance as a non-optometrist. However, Equal-Eyes is packed with exercises provided by a Visual Therapist and more.
Here are the steps I recommend and points of discussion with your
eye doctor.
First, Configure the application so that your child can only see
one ball in the target. You may have to adjust the brightness (X/Y
buttons), blurring (Left Right Thumb-stick Click action) to aid
the child seeing two balls and displaced (double vision) targets.
Note: Be careful with the thumb-sticks because as you click them
to adjust blurring, you may accidentally push them and cause
inadvertent adjustment of the geometry. So I recommend adjusting
blurring, if required, first and then setting the
geometry.
In Setup, the Left Hand Thumb-Stick does not need to be used as
that is for Hypo/Hypertropia and Cyclotropia. If at any stage the
child sets the geometry wildly out this can be reset by pressing
the zero buttons in the scene.
The child can use the Right Hand Thumb-Stick to align the targets and ensure that the two balls (one in the left eye and the other in the right eye) are aligned and on top of each other so that the child can only visualise one ball and no double vision.
Take a note of the values in the headset once the child has done
so. Also press the A button to store the settings in the headset.
That way this adjustment is stored and you will not need to continually enter setup to make the
offset adjustments.
For Esophoria, the correction on the horizontal axis will be
negative in value eg. -10.0 degrees. Her long term target is to
get this back to zero ie No correction.
This will give the child a goal to aim for to try and converge the
target with her eyes.
Once done enter the ball exerciser scene and adjust the ball motion so that the child can track the ball with both eyes. Your child should do this for 5 minutes. This will loosen up the ocular eye muscles and also provide vision stimulus for the brain regarding tracking etc.
The Brock string exercise can be used. With esophoria, your child
will be able to converge with ease on the nearest ball. She
should see an X formed by the ropes crossing though the ball.
She should hold the gaze for 5 seconds and then do the same
with the next furthest away ball.
Again hold for 5 seconds and then move his/her gaze to the next ball until the last ball is reached.
This should be done 5 times.
For the moment the child can then play one of the games, Froggit is recommend to start.
When she becomes familiar with the sensation of Vr, then over time, with her eyes relaxed, I would then back of the setting slightly so that the Left Eye Target (marked with an L) is slightly to the Left and the Right Eye Target (marked with an R) is slightly to the right, not too much, but give her just enough double vision so that she can remove it with concentration (using her own visual system).
I would also suggest initially taking the headset to your Visual
Therapist and let her guide you as to which other exercises are felt to bemore beneficial for you child.
As her vision improves the geometry correction can be gradually removed and returned to zero on the affected axis.
For online guidance, as a starter I would recommend visiting.
https://avalonweb.com.au/demo/home/quest-2-setup/quest-2-configuration/
https://avalonweb.com.au/demo/home/vr-therapy-for-children/
https://avalonweb.com.au/demo/home/features/
Also for some great video's and online consultation have a chat to Melissa Daniels of www.strabismussolutions.com
She offers some very good consultation initially for free and if
you are interested a longer one on one course at a very modest
price. She has also produced some online video's on how to use
Equal-Eyes on YouTube.
Again, it's important to get advice from a practicing eye doctor that specialises in Vision Therapy.
Absolutely, but preferably not multi-focal.
Q16. I have had Lasik Eye Surgery. Can I use Equal-Eyes?
Absolutely you can!
Q17. I am having trouble enabling Developer Mode
Other than my instructions here. There are some alternative video's below.
Q18. Will Equal-Eyes be available for the Apple Vision Pro?
Due to the red tape involved with developing on Apple, I am afraid
to say I don't have a solution for Apple Products.
Maybe one day in the future.
Q19. Equal-Eyes crashes or no longer runs on my Quest ?
A) Ensure your headset is up to date. (Meta regularly update the
OS)
B) Perform a soft reset
Soft Reset and Cloud Backup:
Simply press and hold the power button for about 10 seconds until
the headset restarts.
If the device is unresponsive, press and hold both the power
button and the volume down button for about 10-15 seconds to force
a restart.
If this doesn't work, use these methods allowing you to reset or refresh your Meta Quest without performing a full factory reset and losing all your data
Put on your Meta Quest and do the following:
open the universal menu by pressing
the home button on the right controller.
Navigate to Settings > System > Backup.
Toggle Cloud Backup to enable it.
Uninstall Equal-Eyes.
Download the latest version of Equal-Eyes (Either directly from the SideQuest Website or from the link provided in your previous email)
Re-install Equal-Eyes.
Note: You may need to apply for a new Authorisation Code, I will need your original receipt of purchase or PayPal email address.
If this doesn't work perform a Factory Reset
Partial Factory Reset with Cloud Restore:
You can reset your Meta Quest back to its default settings without a full factory reset using a couple of methods, depending on your needs:
If you don't want to lose your game data or settings, you can use the cloud backup feature. mentioned above.
With cloud backup enabled, your app data will be saved. You can then perform a reset through the settings:
Method 1:
Go to Settings > System > Factory Reset.
Confirm the reset. Your headset will be reset to default settings. You can now restore your data from the cloud afterward.
Method 2:
Using the Meta Quest Mobile App
You can reset your device through the Meta Quest app on your smartphone, which can be useful if you can't access the settings directly on the headset:
Download and Open the Meta Quest App for your phone: It's available on both Google Play Store and App Store.
Open the app and sign in with your Meta account.
Factory Reset Through the App:
Tap on the Menu icon (three horizontal lines) at the bottom right.
Select Devices, then choose your Meta Quest 3 headset from the list.
Scroll down to Advanced Settings and tap Factory Reset.
Confirm the reset. This will reset the device to its default settings, and you can set it up again through the app.
Finally Re-install Equal-Eyes.
Note: You will need to apply for a new Authorisation Code, I will need your original receipt of purchase or PayPal email address.
If that still doesn't work there may be a problem with the settings. In which case perform the factory reset without the cloud backup.
Perform a Factory Reset
Re-install Equal-Eyes first as mentioned above. Run Equal-Eyes to ensure all is well.
Re-install your other apps.
Q20. Why do the setup adjustments change every time I calibrate my eyes?
As a sufferer of strabismus, what you are experiencing is not unusual but classic symptoms of strabismus. The brain does not have the ability to co-ordinate your eyes in unison.
When you have Esotropia, Exotropia or other alignment ailment, your brain will 'never' be presented with an image that can be fused to create the realisation of 3D. As a consequence the brain will ignore the weaker eye and over time amblyopia will develop, reducing the vision of the weaker eye.
One solution to this is the use of prism glasses. The prisms refract the image passing through them to bring the images into correct alignment enabling the brain to develop the neural pathways required for stereoscopic fusion.
The initial hurdle to overcome here is that there is very little feedback to the brain as to the position of the weaker eye. In other words, while the strong eye is fixed on a subject or target. The weak eye will arbitrarily point in some relatively uncontrolled position. This is often referred to as an open loop system. Some may be able to alternate to weak eye. In this scenario feedback is lost on the stronger eye producing a similar mis-alignment.
For the eyes to work together, the brain will need to understand where both the weak and strong eyes are pointing concurrently (at the same time). When the brain has this ability, only then will it be able to ensure that the weak eye is rotated to the correct position to form alignment with the strong eye: i.e. when both eyes are looking at the same part of a subject. A capable (normal) cortex working in this mode forms a "closed loop system".
In this closed loop system, when you direct your gaze, the brain processes both eyes causing each eye to turn to the their exact individual "target locked" positions. In this scenario both eyes will maintain convergence and track the target, no matter if either the the head or target is stationary or moving.
This occurs because both eyes are being adjusted by the brain, subconsciously to remove error in the direction of gaze.
Coming back to the question raised: while you are suffering with "sadly" an open loop system, your weaker eye will not necessarily track with repeatable results even after prismatic or other alignment. The brain will ensure the strong eye rotation tracks the target. Of course! this is the eye you are using. The weak eye however is just idly pushed into the approximate zone, while being completely ignored visually by the brain.
Therefore even prisms which are set by the prescription are not 100% perfect every time and your weak eye is likely to settle in it's relaxed muscular position anywhere in a zone defined by the brain.
To develop fusion between left and right eyes in the vision cortex, the brain will need to be trained. In some cases this training will require that the eyes are stimulated with pre-aligned images over a long period of time. This can be weeks or even months depending on your own visual health. In essence it is nurturing the visual cortex with ideal imagery to form the linking.
Once that is achieved for some, only then can the brain start closing the loop and control the rotational position of the eyes.
Where does Equal-Eyes stands out over prisms?
There are two major advantages of Equal-Eyes over prisms and one disadvantage.
Advantages
- This can arguably be that Equal-Eyes can simulate prismatic correction with the advantage of being continuously adjustable
- Equal-Eyes can reduce the vision of the strong eye to force the brain to give controlled attention to the weak eye.
Disadvantages
- Prisms can be worn during your normal days activity, even though they may be unsightly, they do provide a reasonable amount of correction, whilst of course, a VR headset is impractical.
Conclusion
In the early days of therapy, it will be difficult to gain repeatable alignment. Within setup this can be catered for on a per session basis and over time this should improve to the point where fusion is attained.