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After the preview, the content will be available exclusively for Surviving Mold Members. This month's topic focuses on the Visual Contrast Sensitivity (VCS) screening, which is an important initial diagnostic test and recovery tracking system used in the Shoemaker Protocol™.
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THE Q&A MEMBER LIBRARY
VCS Q&As, Resources, and General Info
“The visual system is the ideal place to look for evidence of neurotoxicity,” says Hilton Kenneth Hudnell, PhD, the first scientist to use it to measure the effects of biotoxin exposure and heavy metal toxicity, or as a marker for neurotoxic exposures like Pfiesteria. “The retina is a microcosm of the brain; it contains most of the cell types and biochemicals that are in the brain. So the retina is as susceptible as the rest of the brain to neurotoxic effects.”
The online Visual Contrast Sensitivity (VCS) test measures the impact of neurotoxins on brain function. VCS results are valuable diagnostic tools—they can help you detect the impacts of exposure, as well as track progress (or decline) over time.
The VCS screening test and tracking system is available online at Surviving Mold. This 5-minute test can reveal a distinctive visual deficit associated with biotoxin exposure. It is reliably reproducible and can indicate deterioration within 36 hours after the onset of illness.
Relied upon by Dr. Shoemaker, Shoemaker Protocol™ Practitioners, researchers, and health professionals, this test is an extremely valuable tool to detect and monitor exposure to toxic environments for individuals with CIRS.
Early detection of subtle or significant changes in physical symptoms, with the help of VCS tracking, allows the patient to prevent relapse and avoid unsafe exposure.
INDEX:
SECTION I: ABOUT THE VCS, DESCRIPTION
SECTION II: VCS FAQs
SECTION III: MEMBER Q&As BY TOPIC
SECTION IV: SURVING MOLD VCS RESOURCES
SECTION I: ABOUT THE VCS, DESCRIPTION
HOW THE VCS WORKS:
The VCS APTitude test is designed to help identify contrast vision loss from exposure to a variety of environmental sources of illnesses in a non-specific manner.
The Visual Contrast Screening is a measure of one of the neurologic functions of vision known as “contrast.” Biotoxins impair the ability to detect subtle contrast within 24 – 36 hours after exposure.
You’ll receive a pass or fail when you take the test. It is a pass or fail through specific deficits, which can be used to track your improvement over time or worsening with re-exposure.
When you take the VCS test online, you will receive immediate results you can share with your practitioner. Your score is recorded according to published criteria for VCS testing.
The online VCS screening is convenient and affordable, and can be done anytime you question a possible exposure. The instructions must be followed carefully to provide valid results. The online test should be periodically confirmed with an in-office hand-held testing device, conducted by a Shoemaker Protocol™ Practitioner.
WHAT THE VCS DOES, AND DOES NOT, DO:
The VCS will show a visual deficit that in the vast majority of cases signifies there is the presence of biotoxin illness. The VCS also shows changes and any progress that occurs with treatment, or with relapse.
The VCS will not tell us which chronic inflammatory response syndrome you have, but it will give clear direction that you need to be evaluated for CIRS-causing entities such as mold, Lyme, cyanobacteria, and dinoflagellates.
The incidence of false positives is quite low. If you have a multi-symptom, multi-system chronic illness and a VCS deficit, the likelihood that you have a Chronic Inflammatory Response Syndrome is 98.5%.
SECTION II: VCS FAQs
My vision isn’t perfect. Is there a vision requirement for taking the VCS?
Your corrected visual acuity must be better than 20/50. If you normally wear glasses, wear them for the screening. Be consistent with this.
Do I need to wear my glasses (or contact lenses) when taking the VCS?
Your corrected visual acuity must be better than 20/50. If you normally wear glasses while working from your computer, then wear them during the VCS. Be consistent with this.
Using one eye, or if one eye is nearsighted and one is farsighted:
If corrected visual acuity is better than 20/50 in one eye and not the other, use the “good” eye alone.
If your prescription gives one eye near and one eye far correction, the near vision prescription can be used. The far vision cannot. Historically, visual acuity testing using near vision will not be better than 20/50. The remedy is to use the near vision test alone.
What does a failed (or “positive”) VCS mean?
A failed VCS means you need to be evaluated further for a CIRS/biotoxin illness. The VCS gives you a print out so you can see your scores, looking especially in column C and D. The printout can be shared with your attending physician or Shoemaker Protocol™ Practitioner.
With hyperacute exposure, there will be a fail in row E followed by a fail in row D. If associated with a rise of MMP-9, these findings are consistent with intensification.
The Surviving Mold VCS test is an initial screening step in the Shoemaker Protocol™. While a failed test indicates the existence of CIRS, the screening by itself is not a conclusive diagnosis.
Also to note: Occupational exposure to heavy metals, solvents, petrochemicals and hydrocarbons are all known to create deficits in visual contrast. The mechanism for deficit is not well established other than direct neurotoxicity.
What does it mean if one eye passes and one eye fails?
The VCS test is non-specific. It simply shows a deficit for patients with exposure to biologically produced toxins. Visual acuity must be better than 20/50 for each eye tested. If both eyes have adequate acuity and one eye fails, then the entire test is a fail.
What if I am colorblind?
The VCS test is black and white and has nothing to do with color vision.
GUIDELINES:
1/ The test is taken with one eye covered and one eye open at a distance of 18” from the computer screen. Make sure the distance from the screen stays at a consistent 18”. Cutting a string to a length of 18” helps to keep the distance correct.
2/ Be sure to have adequate light illumination of 70-foot lamberts, a light meter can confirm this. Light from both the illuminated computer screen and an overhead light are usually adequate.
How do I access my VCS results? Sign into your Surviving Mold account and you will see the “VCS” tab. All of your VCS are readily available to download as a PDF.
SECTION III: MEMBER VCS Q&As BY TOPIC
ALL ABOUT TAKING THE VCS
1/ When (and why) take a VCS test
QUESTION: How often should I be following my VCS?
ANSWER: Assuming the VCS test has corrected to normal with treatment, I suggest VCS testing:
1/ After new exposures that are accompanied by any possible symptoms.
2/ Arbitrarily, every three months as a general measure to maintain “a watchful eye” on your condition.
During treatment the VCS is used to check and track progress along the way at every step.
2/ When to take the VCS after suspected exposure
QUESTION: How long after exposure do you need to wait before you can take the VCS?
ANSWER: A decline in Visual Contrast Sensitivity scores can be seen within 24 to 36 hours after acute exposure. The Surviving Mold online VCS system, relied upon by Shoemaker Protocol™ Practitioners and patients worldwide, not only checks but also tracks symptom progression over time.
Early detection of subtle or significant changes in physical symptoms, with the help of tracking, allows the patient to avoid unsafe exposure.
3/ Using VCS for monitoring safe environments/biomarkers
QUESTION: How much exposure is “safe?”
ANSWER: An important way to know that you are in a safe environment is to monitor your biomarkers, physical symptoms, and VCS on a regular basis. While some individuals are able to feel when they have been exposed within minutes of the exposure, others may not have symptoms until hours or days later. Ongoing exposure to a “less sick” building, where symptoms for the patient may be less obvious, will still be harmful over time for the CIRS patient. The VCS can track the progression, revealing changes before the affects are full blown.
4/ What the VCS does, and does not, do
QUESTION: I took the VCS test at home at the end of the weekend and I plan on taking it again after the work week. I suspect my workplace is contributing to my illness.
ANSWER: VCS will show if you have been affected by environmental biotoxins associated with CIRS/mold illness as well as post-Lyme syndrome. It will also show changes and track progress that occurs with treatment or with relapse. If the test is positive at baseline, from an unknown location, it is rarely possible to use VCS to analyze where the exposure is coming from without having had treatment first.
Said another way, if we can show your abnormal VCS has been converted to normal, then we can use your exposure prospectively, monitored carefully, to look to see where you were when VCS relapsed. You will have to be limited in what areas you are exposed to! Simply seeing a change hyperacutely in Column E helps us to understand intensification seen in Post-Lyme syndrome patients but is not as reliable to show additional complications of additional exposures.
The initial diagnostic steps to confirm CIRS-WDB (from water damaged building exposure) include locating the building environment/s affecting you. Sometimes visual inspection is enough at this time, but often water damage is not easily visible and verifiable and will require HERTSMI-2 or ERMI testing (learn more at EnviroBiomics lab about Shoemaker recommended test kits) to show the degree the building is compromised by the biotoxins and bacterias of a moldy environment.
TESTING WITH ONE EYE, CORRECTIVE LENSES, ET ALL:
1/ Criteria for taking the VCS with one eye
QUESTION: Is it possible to do the Visual Contrast Sensitivity test if you have lost vision in one eye?
ANSWER: Yes, the test will use the eye that passes the “better than 20/50” criterion.
2/ VCS, with near and far sighted prescription glasses
QUESTION: My eyeglass prescription gives one eye near and one eye far visual correction. One eye passed and one eye failed. Is this accurate?
ANSWER: The near vision prescription can be used; the far vision cannot.
3/ Testing with one eye
QUESTION: Is it possible to do the visual contrast sensitivity test if you have lost vision in one eye?
ANSWER: Yes, the test will use the eye that passes the “better than 20/50” criterion.
4/ Testing with mono vision
QUESTION: I had eye surgery and have mono vision. Can I do the VCS testing?
ANSWER: Yes, you can do the VCS test with one eye. Use your good eye.
5/ Testing with a lazy eye
QUESTION: My vision can be corrected to better than 50/50 with glasses however, I have a lazy eye and it is weak. Will it affect the test?
ANSWER: Only use the good eye for best results.
6/ VCS, using the test for those with glaucoma
QUESTION: I have damage in my left eye from glaucoma. My left eye fails on VCS. Could the test be inaccurate?
ANSWER: If visual acuity is better than 20/50, we have been able to use VCS measurements despite presence of treated eye conditions such as glaucoma, iritis and cataracts, for example. If visual acuity is not better than 20/50, or if eye condition is still active, then there should be no consideration of use of that eye in scoring the VCS.
7/ VCS with an enucleation
QUESTION: Can a person who has had an enucleation do the VCS test with one eye accurately?
ANSWER: Yes, you can get an accurate result with one eye.
8/ VCS, use of contact lenses.
QUESTION: I have contacts, with my left eye being used for far vision and right eye for near vision. Will the far vision affect my VCS?
ANSWER: Historically, visual acuity testing using near vision will not be better than 20/50 when contacts are set for far vision. You will have to use just the near vision test alone without the contact lenses.
WHAT DOES AND DOES NOT AFFECT VCS TESTING
1/ What affects VCS testing
QUESTION: Is it true that column E on the VCS will change if you use cigarettes, alcohol, organic compounds, or socioeconomic status?
ANSWER: No. There is no data or research to support these findings, nor have they proven true with the data we’ve accumulated over the years.
2/ VCS, color blindness
QUESTION: I know VCS does not involve color but I am color blind, hence find it difficult to see light shades.
ANSWER: Rarely does color blindness affect the VCS test as color vision is carried by different fibers other than those involved in the contrast.
3/ VCS/color blind
QUESTION: Does the VCS test show abnormalities if a patient is color blind?
ANSWER: The VCS test is a black and white test and has nothing to do with color vision. As long as the patient has a visual acuity of better than 20/50 in each eye that is being tested; together with the ability to perform the test, using the near card for FACT at 18 inches; and having adequate light illumination of 70 foot lamberts; there is no reason to withhold VCS testing from those who have color blindness.
4/ VCS, aging, cataracts
QUESTION: What changes occur in visual contrast with increasing age?
ANSWER: We do not see any differences in control populations in Row C and Row D when sorted by age. We also do not see difference in treated patients in Row C and Row D when sorted by age. There is a definite fall in contrast scores in Row E sorted by age but that fall in Row E does not occur until after 60 years old.
What these results mean is that the changes of greatest importance, column C and column D, are not affected by age. Interestingly, we also do not see a significant fall in visual contrast in people over 70 with cataracts or without in column C and column D.
5/ VCS, using adequate lighting
QUESTION: I recently learned about the VCS test on your SurvivngMold.com website… In my professional experience, different screens and monitors have different levels of contrast settings; some are adjustable and some are not. So if you are on a screen with the contrast set low, do you find some test-takers miss some of the very faint or narrow lines? Is there any way to adjust for that?
ANSWER: Column C&D are used for scoring. With the screen contrast set to low, we do find takers miss faint or narrow lines. There is no way to adjust the test results for that. The solution would be to make sure there is adequate lighting in the room and to use a computer that has the option to set the screen contrast higher.
6/ Testing children, age requirement
QUESTION: I would like to do a VCS on my 3.5-year-old son. Is the VCS reliable on this age?
ANSWER: The visual access of contrast has not matured adequately to do VCS on a 3.5-year-old. A few 6-year-olds can do VCS; usually 8–9-year-old is the youngest we can rely on VCS.
7/ VCS; Viruses making ionophore neurotoxins
QUESTION: A physician from Germany asks can EBV or CMV or HHV6 cause a positive VCS?
ANSWER: To date, we have seen no patients with positive titers for EBV, CMB or HHV6 have a positive VCS unless they also had an illness acquired following an environmental exposure or other known source of CIRS. Please consider looking for amplification of fungal DNA in the homes where patients have these positive VCS tests independent of positive tests for viruses.
Significant environmental exposure is part of the differential diagnosis of chronic fatiguing illnesses although the role of CMV, EBV or HHV6 has waxed and waned in professional opinion regarding causation of chronic fatigue in the past.
8/ VCS, non-neurotoxins
QUESTION: Can VCS abnormalities be induced by the antigen/inflammation without evoking neurotoxins?
ANSWER: This is an excellent question. We see inflammatory responses creating capillary hypoperfusion as a basic mechanism of VCS deficits. We don’t see VCS deficits in patients with non-neurotoxin illness with any significant frequency. Indeed a false positive VCS, not due to a biotoxin exposure, is extremely rare.
The problem with this analysis is that inside a building that has water damage will be a variety of toxins, including endotoxins, not to mention inflammagens. How can we assess specific causation when there is no single causative agent in a mixture of what is inside a building in Nature? At one time the National Toxicology Program proposed to do isolated studies in animals looking at the effect of a unique presence in an environment and not a mixture in an effort to short cut which member of the mixture did what. This research went no where
as NTP focused on looking at allergy and IgE and not inflammatory markers as a source of analysis.
INTERPRETING THE VCS
1/ VCS scoring
QUESTION: I have taken three VCS tests with indicators scores, 73, 63 and 52. Are these high results?
ANSWER: A VCS is positive or negative. There is no gradation. A 73 sounds like it should be a higher score than 52 but the issues are more complex than just a single indicator score. If you pass the test, good; if you didn’t pass the test the likelihood is high that you need additional evaluation.
2/ VCS deficits – what they mean
QUESTION: I took your VCS test online with a passing score in my left eye but my right eye failed. I am positive for mold related illness and have several cases of Lyme.
ANSWER: The VCS test is non-specific. It simply shows a deficit for patients with exposure to biologically produced toxins. The VCS test must include passing in the both the left and the right eye. If one eye fails, the entire test fails.
There are many causes of failing VCS, including but not limited to, CIRS from exposure to water-damaged buildings, Post Lyme Syndrome, dinoflagellate illness and more. If there is a history of occupational exposure to hydrocarbons, solvents and petrochemicals there can be a VCS deficit as well. This deficit will not respond to treatment for biotoxin agents; the biotoxin patients will show improvement in VCS.
In your note you didn’t tell me how you were confirmed to be positive for mold related illness with multiple cases of Lyme disease. I would hope that your diagnosis has been made in a rigorous fashion and is not relying on an antibody test which may or may not have been reproducible.
3/ Scoring of the VCS APT test
QUESTION: I don’t understand the scoring for the VCS test. Some patients passed and missed more total than others who failed. Do only rows D and E count in the scoring? When you say to follow the VCS results to monitor improvement, what do you follow? The number to D/ E that are missed or the total missed?
ANSWER: Only rows C and D count for scoring pass or fail. You must see beyond 6 in each eye on C and beyond 5 on D. We look for
improvement beginning in the high frequencies (E) marching on to D and C.
4/ VCS, change over time
QUESTION: How can I tell if there has been degradation/improvement from test to test?
ANSWER: The VCS test gives you a print out so you can see your scores, looking especially in column C and D. With hyperacute exposure there will be a fall in row E followed by a fall in row D. If associated with a rise of MMP9, these findings are consistent with intensification.
5/ Visual and question/answer criteria, both assessed
QUESTION: Are the VCS results based on the visual answer only or are the answers to the questions considered?
ANSWER: No, the results are not based on visual answers only as the questions are considered as well.
6/ Row E on the VCS
QUESTION: I am passing the VCS but notice I am missing 4 E’s on the right side and 1 on the left. What are E’s indicative of?
ANSWER: Column E is not involved in scoring. It does not indicate pass or fail. It is used for other purposes and other entities besides CIRS. (See the above questions in this section for more information.)
PASS, FAIL, FALSE NEGATIVES AND POSITIVES:
1/ What does pass and fail mean?
QUESTION: Hi, just to confirm, if my VCS eye test result is fail (for both eyes) does that mean a positive result i.e. I have a problem (and if I got a pass would be a negative result)? Or is it the other way around and a fail = negative test result = no problem?
ANSWER: A failed test means you need to be evaluated for a possible biotoxin illness. For more information, review our VCS information page.
2/ Why false negatives happen
QUESTION: How many people will have CIRS and yet still pass the VCS test?
ANSWER: Using data that consistently show presence of 8% false negatives seen in VCS testing over the years, we have looked to see who those people are. There is a disproportionate increase in teenagers, especially teenage woman, in those that have normal VCS but abnormal laboratory studies in the presence of multiple symptoms.
The other groups of people that have routinely preserved contrast vision show a
significant increase in particular occupations such as artists, photographers, interior designers, baseball players and tennis players. These individuals might have a physiologic basis for their “good eye.”
3/ Chance of false positives, what failing means
QUESTION: I just took the VCS test, failing in both eyes. Does this mean I have a good chance of having mold exposure?
ANSWER: The incidence of false positives in VCS is quite low. If you have a multi-symptom, multi-symptom illness and a VCS deficit, the likelihood that you have a chronic inflammatory response syndrome is 98.5%. This means there are 1.5% of patients who will be normal despite a “failed” outcome on VCS.
In this group we find some known confounders as people with occupational exposure to heavy metals, hydrocarbons and solvents can acquire a VCS deficit that never corrects. VCS will not tell us which chronic inflammatory response syndrome you have, if indeed you have it. It will give clear direction that you need to be evaluated for entities such as cyanobacteria, dinoflagellates, Lyme and mold.
4/ Urinary testing; false-negatives on VCS tests
QUESTION: Hello. When someone tests positive for mycotoxins and CIRS symptom assessment score is 13/13 or 34/37 but their VCS is not positive for columns typically affected by biotoxin illness, how does one assess for the possibility of a false-negative test? Should the test be repeated?
ANSWER: Let me be clear. Testing for mycotoxins makes absolutely no difference to management of cases. Urinary mycotoxins should not be accessed as the test is not a viable indicator of CIRS. We don’t use urinary mycotoxins in the Protocol.
8% of CIRS cases will have a normal VCS test (or false-negative) even though they do in fact have CIRS. This is not affected by CSM but the net score. Negative as it might be, you can still track your treatment progress as the VCS score will improve with treatment. The test should be repeated once a month to consistently track your improvement (or decline if there is re-exposure) during treatment.
5/ Failing, understanding results
QUESTION: Why do my VCS results show that I failed. I missed one before row 6 but then got one right after. I have all but one correct in both Columns of C in D I have six correct with both eyes. But it is still not showing that I passed.
ANSWER: The computer is programed to fail anyone who cannot see 7 in row C and 6 in row D. If there is a miss on C or D, and the test is being done in person, seeing a correct image in C and D can be credited by the examiner.
In your test, you missed 6 in row D in the left eye and 5 in row D in the right eye. But you saw 7 in row D in the left eye correctly and 6 in row D in the right eye. This creates what we call a false fail. The computer cannot correct false fails but your test is a false fail, which is also a passing score. Column E is not involved in scoring.
6/ Passing, false cases
QUESTION: Does passing the VCS mean that I could not have a biotoxin illness?
ANSWER: No. We typically see visual contrast sensitivity defects in affected patients in 92% of all our cases. That means that 8% of cases do not have a positive VCS. This interesting finding is usually seen in younger patients, especially young woman, as well as people who have an “eye” for a given job. For example, we often see a normal VCS despite illness in photographers, interior designers, artists as well as some professional athletes like baseball players and tennis players who need to “see” the ball well in their sport. If
you are not ill, we expect a normal VCS. False positives are quite unusual, understanding that the computer test is a screening device.
7/ Other reasons for a failed test
QUESTION: A physician writes, is there any reason to fail visual contrast testing other than biotoxins.
ANSWER: Occupational exposure to heavy metals, solvents, petrochemicals and hydrocarbons are all known to create deficits in visual contrast. The mechanism for deficit is not well established other than direct neurotoxicity. There is no benefit in treatment of patients with an occupational visual contrast deficit with medications like cholestyramine or Welchol. Curiously, non-occupational mercury exposures almost never produce VCS deficits.
8/ VCS, one eye fails
QUESTION: My son and I have both taken the VCS test and one eye fails for both of us. Does that have any meaning?
ANSWER: Visual acuity must be better than 20/50 for each eye tested. If both eyes have adequate acuity and one eye fails, then the entire test fails.
9/ One eye passed, one eye failed. Instructions for accuracy.
QUESTION: My doctor feels that I have Lyme disease. He sent me to take the VCS. One eye passed and one eye failed, what does this mean?
ANSWER: VCS is graded as pass or fail. To pass, both eyes must meet visual acuity requirements of better than 20/50 and there must be adequate responses in column C and D. If one eye fails even just on patch in one column the entire test is a fail. Since you had one eye pass and one eye fail your test
is graded as a fail. Don’t forget that you must have adequate illumination on the computer screen and the test must be taken at 18 inches.
10/ VCS and Bells Palsy, false positive
QUESTION: I took the VCS test and passed in one eye and failed in one eye. What does this mean? Could Bell’s Palsy cause a false positive?
ANSWER: In order to pass the VCS test (which means not showing a deficit), each eye must meet criteria. If you fail with one eye then the entire test is graded as a fail.
Possible confounders include occupational exposure to hydrocarbons, solvents and petrochemicals. If visual acuity is not better than 20/50 for one eye, that eye can not be tested. If visual acuity is better than 20/50 then that eye can be tested. Bell’s palsy should not affect visual acuity although a dry cornea could affect visual acuity.
11/ GI tract toxicity
QUESTION: Can patients fail VCS because of generation of endotoxins from bacteria in the GI tract?
ANSWER: This remains a question of great interest to us even though we have no data to support its presence. Use of cholestyramine can bind to a variety of toxins in the GI tract, most notably the toxin(s) made by C. difficile. We do not have any data suggesting that toxin production in the large bowel contributes to VCS deficits.
Cholestyramine will not eradicate bacteria in the gut so that it remains possible that an ongoing VCS deficit could be related to GI tract colonization and production of endotoxins. A far more likely explanation however, is that there is ongoing exposure to a water-damaged building.
12/ VCS test normal, hair loss
QUESTION: I am ill from working in the basement of a water-damaged building. My colleague works along side me and has significant hair loss and severe neck pain. Her VCS test is normal. Should she be worried about CIRS?
ANSWER: The case definition for presence of an inflammatory illness related to exposure to the environment of water-damaged buildings includes (1) presence of exposure to water-damaged buildings; (2) presence of a multi-system, multi-symptom illness similar to those reported in peer-reviewed literature; (3) presence of lab abnormalities found in patients reported in peer-reviewed literature; (4) response to therapy. Simply having neck pain and hair loss will not meet the symptom criteria. If there are additional symptoms present in your colleague which are consistent with multiple organ/system involvement then I would proceed to have laboratory testing done. Significant hair loss is often due to elevated levels of TGF beta-1 (see TGF beta-1 in catagen hair loss bibliography enclosed). Severe neck pain has its own differential diagnosis that would tend to take me away from considering biotoxin illness. Presence of a normal visual contrast test is found in over 99% of non-cases and only 8% of cases.
13/ Neurologic problems; VCS now negative
QUESTION: I have been living in a water-damaged building with an ERMI of 8. Fortunately, my VCS, which had been positive in the past, have now converted to negative. Unfortunately, I still have evidence of peripheral neuropathy. Is it possible to pass the VCS test and have neurologic problems?
ANSWER: Yes. Use of cholestyramine or Welchol will help remove the source of the inflammatory burden but not the entire inflammatory burden. The reason there is a 12 step protocol for treatment (see the VIP paper published in March 2013 found in “Resources” on this site) is that we have been able to show over the years that persistent abnormalities in inflammation often require a series of
sequential interventions to bring resolution to multi-faceted symptoms. Documenting what’s wrong with you with lab tests is essential as those test results guide treatment interventions.
GENETIC SUSCEPTIBILITY, NEXT DIAGNOSTIC LABS & TESTS
1/ VCS, conclusive diagnosis, with and without genetic susceptibility, labs and tests
QUESTION: Does the VCS tell you if you have the CIRS gene? Can I have CIRS if I don’t have the gene? Will I still need to follow the Protocol?
ANSWER: You cannot conclude genetics through the VCS. The VCS does assess your symptoms and it determines if your vision has been affected by environmental biotoxins or not, indicating that CIRS and/or Lyme is present.
The online eye test has an 8% false positive rate. If you are questioning the results and you have evidence your home or place of work has been compromised by water intrusion, and your chronic symptoms are consistent of those found in CIRS, it is highly recommended to follow up with a Shoemaker Protocol™ Practitioner and a handheld VCS test in office. Also begin the next diagnostic tests and labs in the Shoemaker Protocol™ which will more conclusively confirm if you are experiencing the effects of CIRS, or not.
Among the labs required is the HLA-DR. This test identifies the genetic susceptibility to CIRS. It is rare to have CIRS-WDB (from water-damaged building exposure) if you do not have a susceptible gene. This lab can be ordered by your primary care practitioner, or in consultation with your Shoemaker Protocol™ Practitioner. The additional recommended labs, as well as the appropriate tests for differential diagnosis should also be scheduled.
IT IS IMPORTANT TO NOTE: These labs and tests are not part of routine lab screening profiles. Unless your practitioner is specifically looking for CIRS using the Shoemaker Protocol™ lab and test roster, these labs will not likely be ordered.
These biomarkers will help to confirm the diagnosis and also help in monitoring your progress with the treatment Protocol.
Finally, although it’s rare, people without the gene can also get sick from repeated exposure to heavily water-damaged building interiors. And yes, the testing pathway and the treatment steps for all patients will follow the Shoemaker Protocol™ tailored to each case, with or without genetic susceptibility.
2/ Passing the VCS; Treatment for those without the mold gene
QUESTION: If I passed the online VCS, I guess that means I probably do not have the mold gene, is that right. Is the treatment the same if you have the mold gene or not?
ANSWER: The online eye test has an 8% false positive rate. It is important to note that you cannot determine genetic susceptibility based solely on the Visual Contrast Sensitivity (VCS) test. If you pass the VCS, there is a strong possibility that you do not have Chronic Inflammatory Response Syndrome (CIRS) or the related genetic predisposition. However, if you are experiencing multiple chronic symptoms commonly associated with CIRS, it is advisable to continue with diagnostic testing through the necessary labs outlined in the Shoemaker Protocol™. Comprehensive genetic testing is an integral part of this diagnostic pathway. Mold-related genes play a crucial role in the immune response and are particularly relevant in discussions about children and their parents, especially in cases of susceptibility. Lastly, the Shoemaker Protocol™ applies equally to individuals dealing with the effects and symptoms of rexposure to moldy environments. Each step of the Protocol will be tailored to individual needs, with the severity of exposure also guiding the appropriate treatment pathway.
3/ VCS and lab normalization
QUESTION: Does VCS normalize if one of the three inflammatory markers of TGF beta-1, MMP-9 and C4a normalize? Does VCS normalize if VEGF normalizes?
ANSWER: VCS deficits are not caused by TGF beta-1, MMP-9, C4a or VEGF alone. The inflammatory response is the sum of all of these entities. VCS can be positive (showing a deficit) in the presence of normal TGF beta-1, MMP-9 and C4a.
4/ Distant past positive; next steps for diagnosis
QUESTION: My daughter and I have had significant illness symptoms since we were exposed to moldy environments two years ago. My VCS test and that of my daughter is now positive. I am trying to decide what should I do?
ANSWER: If you have similar, multiple symptoms throughout multi-body systems, together with a positive VCS, the likelihood that the illness that you have is going to be a chronic inflammatory response syndrome is over 98.5%. I do urge you to have subsequent testing following the Shoemaker Protocol™ diagnosis labs before initiating treatment.
The labs and tests are listed in the diagnosis section of the Surviving Mold website underneath laboratory orders. I recommend finding a Shoemaker Protocol™ Certified Practitioner or Proficiency Partner to work with you. Or point your attending physician to the Physician Resources section and the lab roster on the home page. The Shoemaker Protocol™ essays by our Certified Practitioners may also be of help for amore thorough explanation of the treatment protocol.
See also the related questions above.
5/ Tight on funds; Streamlined labs/tests after negative or positive VCS
QUESTION: We had ERMI testing on our crawl space and air conditioning system confirming presence of Cladosporium cladosporioides 1 and Epicoccum nigrum. We have discarded porous material, put in all new ductwork and put a new carpet in. We feel somewhat better. Is there a reduced panel of lab tests that we can do at this time as funds are quite tight?
ANSWER: Historically, the two organisms that you mentioned are not players of concern in evaluation of a water-damaged building (WDB). They are in ERMI Group II and are not in HERTSMI-2. In order to assess the potential for exposure more will need to be done to confirm that you are indeed reacting to a water-damaged building.
The case definition requires that there be a multisystem, multisymptom illness once the potential for exposure has been confirmed. I am glad you are feeling better with the changes you have made but there is insufficient information in your question to get to the next step of laboratory testing.
For those involved with cutting costs, the most effective cost saving is to determine whether or not you meet the first several tiers of the case definition. For example, if your VCS is normal and you do not have a multisystem, multisymptom illness, I would not suggest doing any lab testing at all. If your VCS is positive and you do have a multisymptom, multisystem illness, then the testing that confirms each of the 11 steps of the sequential protocol are included, because they all are important.
Certainly the first several steps would include: HLA DR by PCR; MSH (done at LabCorp, not at Quest) C4a (done at Quest not at LabCorp) MMP-9, TGF beta-1, anti-gliadin antibodies (done on serum not on saliva or stool), VEGF and a nasal culture. I would further recommend testing of ADH and osmolality as a pair (done simultaneously). The balance of the tests can be done once we see what parameters are needed to go further.
VCS during CSM/WELCHOL/TREATMENT
1/ VCS results during CSM/Welchol treatment
QUESTION: Do you generally expect to see improvements in the VCS with CSM or Welchol even if there's still mold exposure? Also, is a one row improvement in rows C or D significant or do you want to see at least a 2 row improvement?
ANSWER: The first element of treatment is removal from exposure. While some patients improve with cholestyramine and Welchol, despite exposure, the rate of improvement is markedly reduced. In terms of VCS testing, or rise of one block in one column is not significant but a rise of one block from each of five columns is significant. A rise of two blocks (or a fall in two blocks) for any one column is significant.
2/ CSM treatment when VCS normalizes
QUESTION: I have a number of patients with abnormal C4a, TGF, VEGF, MMP 9 but a normal VCS. If I have a patient who can see rows 8 in both columns C & D prior to treatment, how do I know how long to give CSM?
ANSWER: VCS will show typical deficit in 92% of patients. If the patient is a case with normal VCS, you can still see interval improvement in VCS although going from 8 to 9 is a stretch. Follow labs and symptoms re the clinical time to stop CSM or switch to Welchol. If you are suggesting stopping meds, then verify ERMI or HERTSMI-2 in the home is safe.
3/ VCS, passed with CSM treatment
QUESTION: I have been using cholestyramine as part of my treatment protocol and have now passed the visual part of the test. I still have symptoms and ongoing exposure.
ANSWER: Visual Contrast Sensitivity remains an excellent test to look at the potential for untreated toxin exposure. Use of cholestyramine is an effective mechanism to bind ionophore and amphipathic toxins but at the same time it is only the first step of interventions that we use. Cholestyramine alone is not a complete mechanism to return you to health. At this point the VCS is used to track progress and coordinating labs will provide the more complete recovery picture. As multiple body systems are affected and as a result there are multiple symptoms, each must be addressed as necessary. Please review the Shoemaker Protocol™ 11-step treatment pathway listed in multiple areas of this website.
4/ VCS change on CSM/Welchol while still exposed? How do you read the rows?
QUESTION: Do you generally expect to see improvements in the VCS with CSM or Welchol even if there's still a mold exposure? Also, is a one row improvement in rows C or D significant or do you want to see at least a 2 row improvement?
ANSWER: The first element of treatment is removal from exposure. While some patients improve with cholestyramine and Welchol, despite exposure, the rate of improvement is markedly reduced. In terms of VCS testing, a rise of one block in one column is not significant but a rise of one block from each of five columns is significant. A rise of two blocks (or a fall in two blocks) for any one column is significant.
5/ VCS/MARCoNS
QUESTION: Is it possible for VCS to recover if MARCoNS are still present?
ANSWER: Yes.
VCS VALIDITY & CONFIRMING WATER DAMAGED BUILDING (WDB) EXPOSURE
1/ Symptoms, but home inspectors say no mold
QUESTION: If I pass the VCS test should I still pursue the possibility of mold toxicity? Two mold inspectors have come to my house to tell me I don’t have mold in my home.
ANSWER: 8% of people known to be cases of CIRS will have a normal visual contrast sensitivity test. If you have multiple common CIRS symptoms without relief, than continuing the Protocol’s diagnostic lab pathway is recommended.
As far as the home inspection, I have less confidence in visual inspection than I do in DNA sampling in settled dust via HERTSMI-2 or ERMI. Others I respect do not agree. As part of the case definition for a CIRS-WDB, one must satisfy the requirement that there be the potential for exposure, and then remediate or move. I would suggest that a HERTSMI-2 or an ERMI be done at your home at earliest convenience to answer the question whether your home is at risk or not. It could also be a building you frequent such as a place of work. In order for the Protocol to take effect one must be removed from the moldy environment.
2/ Validity of the VCS
QUESTION: I have performed a VCS screening test but would request references to validate use of visual contrast sensitivity.
ANSWER:
“The visual system is the ideal place to look for evidence of neurotoxicity,” says Hilton Kenneth Hudnell, PhD, the first scientist to use it to measure the effects of biotoxin exposure and heavy metal toxicity, or as a marker for neurotoxic exposures like Pfiesteria. “The retina is a microcosm of the brain; it contains most of the cell types and biochemicals that are in the brain. So the retina is as susceptible as the rest of the brain to neurotoxic effects.”
There are multiple papers showing the benefits of visual contrast sensitivity in assessment of functional vision. In my last count there were over 4,000 references in PubMed. Please see the early papers on Pfiesteria and mold discussing visual contrast sensitivity in the resources list under published papers.
3/ VCS in comparison to other mold tests
QUESTION: My test failed, should I take another test to confirm? How does the VCS test compare to the available lab tests for mold issues?
ANSWER: This is a very understandable question. It’s a test that we take at home, a test that takes little time and is not administrated to us by scientists in lab coats. It also feels non-specific and throws up the all-important question, “how can we trust it?” The ease, low expense, and instant results can also be considered big plus’s when assessing various tests.
One of the first steps following a failed VCS test is to undertake an inspection of the client’s local environment. This always means home and often means work. Around 70% of people who fail the VCS test quickly find the source of mold (which is often obvious to the naked eye, yet I still recommend HERTSMI-2 environmental testing to confirm).
When the presence of mold is so clear, clients very rarely undertake further testing because there is no longer any need. Why spend time and money on a urinary test, which does not conclusively diagnose CIRS, let alone what type of CIRS it is (from Water Damaged Building exposure, Lyme, or other environmental exposure). When you can already see a colony of black mold under your sink or in a closet… why confirm with testing?
Sometimes mold is not apparent to the naked eye, and performing building or home testing is necessary. On these occasions where we cannot immediately corroborate the results of the VCS test, there is obviously a great benefit in running back-up tests. The recommended Shoemaker Protocol™ labs and tests include an HLA-DR which identifies the genetic susceptibility to CIRS. Because CIRS is complex affecting multiple systems, and can be from various environmental offenders, testing beyond the VCS is necessary. The VCS serves as a highly convenient, proven effective, initial step in the screening process. Through collecting data of thousands of cases, I can tell you the percentages of false findings is extremely low, as well as why this can happen and to whom.
The VCS will also give you the ability to track your progress or relapse. You’ll be able to determine changes over time, which is highly beneficial in the diagnostic and recovery process. It also helps you nip potential relapse in the bud. For all these reasons, the VCS is to be considered a vitally important tool in every CIRS patient’s toolkit.
(For more information see the Q&A category titled “PASS, FAIL, FALSE NEGATIVES AND POSITIVES” above. You can also learn more at the VCS ABOUT PAGE.)
TAKE THE VCS NOW >>
SECTION IV: SURVIVING MOLD VCS RESOURCES
1/ THE VCS INFO & GET STARTED PAGE
This comprehensive overview VCS page gives you the information you need to understand the screening process and get started.
Use your free membership sessions, or for a nominal fee, get started with a single session or purchase packages.
2/ DR. SHOEMAKER’S VIDEO: VCS IN TREATMENT
Learn more about the use of the VCS in various treatment settings in a live presentation by Dr. Shoemaker.
https://www.youtube.com/watch?v=8GfDYIIkRWg
3/ DR. SHOEMAKER’S STUDY: THE EFFICACY OF THE VCS
This paper by Dr. Shoemaker examines the validity of using the VCS as a quick, non-invasive, reliably reproducible, effective, at-home initial diagnostic test to screen for the effects of environmental neurotoxins on vision.
4/ SURVIVING MOLD BLOG: HOW RELIABLE IS THE ONLINE VCS TEST?
How likely is it that your passed or failed test could be wrong? Can you trust a test that takes minutes, without the oversight of a physician? This article gives you the highlights of Dr. Shoemaker’s meticulous research and data collection, which pinpoints the reliability of the VCS, down to precise percentages, and more.
5/ THE VCS HAND HELD DEVICE
The VCS hand held APTitude test is used by practitioners for in-office testing with immediate results. Hand held kits with various eye cards have been reliably used for over 60 years. The kits on the Surviving Mold site include:
- One VCS APTitude card
- One calibrated holder
- One near point visual acuity card
- One set of scoring sheets (100 sheets)
- One eye patch used to cover a given eye.
6/ RESEARCH PAPERS
There are also multiple papers showing the benefits of visual contrast sensitivity in assessment of functional vision. At one count, there were over 4,000 references in PubMed. You can view Dr. Shoemaker’s early papers on Pfiesteria and mold discussing visual contrast sensitivity on the Surviving Mold site.
