Why is it so hard to READ LARGE PARAGRAPHS?

[tjj3761]

I have been wondering what the medical term is for the eye problems associated with the difficulty in reading large paragraphs.

My neuro has said I do not have nystagmus, but when I am trying to read large paragraphs, it feels like my eyes are all over the place and I just cannot read them.

One other question related to the eyes, after I am trying to walk for exercise and after about 15 minutes, my vision either gets blurry or slight double vision, I am not exactly sure.  I almost feel an out of body feeling.

I go to my neuro next week and want to let him know this as well.  Thanks..........

terri

[tjj3761]

Hello to all,

Quix had suggested that I look up OCULAR DYSMETRIA.  I have found the below (2) descriptions, which also explains my difficulties in judging distance when driving.

*Internet Site 1) Dysmetria (English: difficult to measure) refers to a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye. It is sometimes described as an inability to judge distance or scale.[1]

As dysmetria can refer to more than just a motor problem, an overlying definition that encompasses all forms of it is “the inability to receive and process information rapidly, to retrieve the relevant associated constructs, and to produce a well-modulated and fine-tuned response.

*Internet Site #2) Dysmetria is lack of coordination of movement typified by under- or over-shooting the intended position with the hand, arm, leg or eye. Dysmetria of a hand can make writing and picking things up difficult or even impossible. Dysmetria that involves undershooting is called hypometria and overshooting is called hypermetria.

Dysmetria is a closely related condition to intention tremor, where the constant overshoot causes shaking when performing fine movements. Ocular dysmetria, where movements of the pupil of the eye constantly overshoot, can make it difficult to fix your gaze on an object. Nystagmus, shaking eyes, is a related condition to ocular dysmetria.

In Multiple Sclerosis, dysmetria is usually caused by lesions in the cerebellum, the region of the brain responsible for coordinating movement, though it can also be caused by lesions in sensory nervous pathways leading to the cerebellum or the motor pathways leading from it.

Dysmetria is a difficult condition to treat although Isoniazid and Clonazepam work for some.

Terri

[PastorDan]

It makes a diffeence in all forms of written communication, too.  E-mails with long paragraphs can seem interminable, and very often get an oblique reply at best.  Careful presentation makes a big difference.

[essdipity]

Extremely interesting.

Long ago, in another lifetime, it seems, I wrote a lot of computer manuals for a research university while I was a manager there. Mostly this was a seat-of-the-pants operation, since I'd had no formal education in cognitive psychology.

I did read up on things as best I could, and looked at lots of manuals that I considered good. From this I learned that successful output is often directly related to how much white space is included. This means not only margins, but also length of paragraphs and space between paragraphs.

The best and most logical presentations could be sabotaged by long blocks of text. I learned  that totally normal people are put off by that, especially when the subject is technical and/or requires concentration. Now I know that those with tracking problems or attention/processing issues are just extreme cases of this general phenomenon.

I realized that otherwise good writers about computer technology did not necessarily understand such cognitive principles, including professors of English whose abilites I greatly admired in general.

When the forum's CLs were putting together the current Welcome post at the top, we wanted to emphasize the need to use short paragraphs and lots of white space because many of our members are stymied by big blocks of text. Some newcomers may not read that post, and that's unfortunate, since they are likely to get fewer replies and less info. We do appreciate it when others ask them to break up their material. It's amazing what a difference that makes, no?

ess

[Audrey_M]

Dennis had a similar post and this was my response to him:

The difficulty you are having with long paragraphs is probably due to visual processing

deficits.

When my son was young, this was a huge problem. Too much print on the page was

overwhelming. Double spaced printing was easier for him, as well as larger print. Using

a guide or window to follow lines of print helped. You might want to google visual

processing deficits to come up with accommodations to help make things easier for

you.


Here's some info from the American Academy of Neurology:

NEUROLOGY 1995;45:809-815
© 1995 American Academy of Neurology

Multiple sclerosis can cause visual processing deficits specific to texture-defined form.
D. Regan, PhD, DSc and T. Simpson, OD, PhD

Article abstract-We performed the following tests in 25 patients with multiple sclerosis

(MS) and 25 age-matched control subjects: recognition of texture-defined (TD) letters;

recognition of motion-defined (MD) letters; and recognition of luminance-defined (LD)

letters of 96% and 11% contrasts. Six patients with normal visual acuity were abnormal

on recognizing TD letters, of whom one gave normal results on all other tests. Eleven

patients were abnormal on MD letter recognition, of whom four gave normal results on

all other tests. Visual acuity for letters of 11% contrast were abnormally low in seven

patients, of whom two gave normal results on all other tests. We conclude that the

neural mechanisms underlying recognition of TD, MD, and low-contrast LD letters in

subjects with normal visual acuity are sufficiently different that they can be differentially

damaged by MS. Therefore, TD, MD, and LD letter tests provide complementary

information. We suggest that the detection of TD letters can be disrupted by

demyelination of long-range horizontal connections between orientation-tuned neurons

in the striate cortex.

Audrey

[tjj3761]

essdipity,

Very interesting eye appointment.  Very happy that you like the doctor.  Thanks for all the information.

meg321,
It does make perfect sense.  I know exactly what you mean.  I do the same thing--I just give up on reading large paragraphs as I feel that I cannot process it.  I also get a numb and dizzy feeling that comes over me, like whoosh, then I have to stop.  This is crazy and sounds crazy.....

[meg321]

This is interesting, I have the same problem, I can't read too much at once or longer paragraphs.  

Plus after reading a fairly long message, I don't quite know what I am reading, I stop understanding anything so just have to stop.  Its almost my brain has blocked it from coming through. Feels like i am reading nothing...

I hope that makes sense...

hugs, meg

[essdipity]

Back from the ophth. appointment. This guy readily concedes he doesn't know a lot about optic nerve problems, but he's on the staff of Hopkins' Wilmer Eye Institute, so I guess he knows what he's doing. At any rate he's very laid back. I like him.

I asked several questions I've been saving up for over a year, including ones about nystagmus and smooth pursuit. He held up a big Q-Tip-like thing and had me follow it. He moved it very slowly, much slower than the neuro moved his finger. He said I do have some tracking issues, not terrible (which I certainly knew), and that sometimes this can be due to nystagmus. Not in me, though. At least during the exam, I showed no evidence whatever of nystagmus. So obviously these conditions are separate but can converge.

I also asked his opinion on the state of my optic discs. He did a careful exam and said they are perfectly pink and otherwise perfect as well. Good. This type of exam is not the same as OCT, though I don't know much about that at all. Since I've had an abnormal VEP outcome in my right eye, that apparently indicates I've had ON, so I'm wondering about the optic nerve. Any damage could well be much further along the nerve than an ophth. can see.

We didn't get into that part, though. It's not his specialty, and I don't think he knows a lot about it. Quix has been working on a health page about eyes, specifically ON, and I'll be very glad when it's done. Of course she hasn't been up to writing much in the recent past, so that's very understandable. I don't think anyone else here has the knowledge for this type of HP. I find eye issues extremely confusing, from both a vision and a movement standpoint, and so many different things can happen to MSers. If there's a website called Eyes for Dummies, would someone let us know?

ess

[PastorDan]

My troubles sound like a blend of some of the above, but mostly like ess's.  She's right: Interesting thread.

Never had any of the five neuros or three ophthalmologists (including one neuro-ophthalmologist) find anything wrong with the eye tracking.  However, the neuropsychologist identified what he described as a substantial weakness in the area of "visuomotor processing speed."  Sounds like something DQ named up above, kinda.

Oh, drat, Windows Update's insisting I reboot.  Peace.

[essdipity]

Very interesting thread!

My neuro has noted a couple of times that I have a 'breakdown in smooth pursuit.' Doesn't that sound like the name of an old Western?  Love it.

Anyway, it's a problem with tracking. He would have me following his finger back and forth and up and down. Today, coincidentally, I see my ophthalmologist (not neuro-ophth.) and will ask him about this. I believe that lack of good tracking is not the same as nystagmus, but will ask.

In any case I'm not aware of eye movement problems. I do have trouble with big blocks of text, especially on the computer screen, and tend to skip them. I think that's normal to a certain extent, but much more prevalent in MSers.

If I get good info today I'll report back.

ess

[Quixotic1]

This can be a result of a large number of things, most of them having to do with smooth tracking of the eyes, vestibular (balance) problems, and visual processing.

People with MS often have subtle problems keeping the eyes moving smoothing in exactly the way we want them to.  Ideally, they will sweep along the written words exactly at the speed we need them to in order to read and to process the information.  But, just the smallest brainstem lesion can cause one eye to not move along with the other eye.  We may get brief double vision, or a feeling that the words are jumping around.  Or we might have problems controlling where the eye(s) move.  We tell them to move down one line and the next thing we see is the middle of the fifth line down.  It's a problem called Ocular Dysmetria or Past Pointing with the eyes.

Another problem is one suffered by people with ADD.  By the time we get to the end of a line we have forgotten what we were reading and started thinking about something else.

Or, because of gray matter lesions, we might have trouble understanding simple words and still be processing the first line when the eyes have moved well into the second line.

Nystagmus is a rhythmic movement of one or both eyes in a given direction, with a quick snap back to the starting position.  When you were a kid and used to spin around, when you stopped you would feel like the world would continue to spin briefly and then snap back into place.  This sometimes would occur over and over.   That was nystagmus.  It is a normal part of stimulating the vestibular or balance centers.  But, when an MS lesion involves the nerves of the vestibular center, we can have nystagmus occurring when it shouldn't.  You can have it and just not have the doc see it during the exam.

What you are describing does sound like problems with your eyes not "tracking" properly.  

Yes, you should tell your neuro this.

The problems after exercising certainly could be subtle lesions of the brainstem that appear when you are lightly overheated.

I agree with both Tonya and Jen.  Tell your neuro.  Walk in the coolest part of the day.  And try marking your place while reading with a post-it or a piece of paper.  It is this very problem that causes us to request that people write in short paragraphs.

Quix (hopefully on the rebound)

[jensequitur]

It actually sounds like you do have nystagmus.  Even if you don't, it's possible you're having blurry vision and double vision.

One thing to try is to take a piece of blank paper and underline each line that you're trying to read.  This will help you focus better.

[tonyad]

   Could the Blurry Vision thing be related to a possible increase in body temp while excercising...Bringing on a PseudoExacerbation?  then when body temp goes back down and rest a bit it gets better??

   Not sure though...Just a thought.

~Tonya

[PastorDan]

My grammar used to be better, too.

[PastorDan]

Can't answer your questions, but I'd be interested to know what the answers are.