Vision Therapy

Vision therapy is a structured treatment process that utilizes skilled therapists, specialized equipment and a carefully planned progression of activities to modify the visual system at the neurological level. Vision therapy improves the speed, flexibility, endurance and accuracy of the visual system's accommodative response (eye focusing), vergence response (eye teaming) and oculomotor skills (eye tracking). Vision therapy also helps develop higher level visual skills, such as visual processing speed and visually-guided motor responses (visual reaction speed or eye-hand coordination).

Vision therapy is a treatment method that develops, maintains and restores visual skills that are required to perform visual tasks during a typical day. These visual skills include:

• Accommodation (eye focusing)
• Binocular Vision (eye teaming)
• Oculomotor Skills (eye tracking)
• Visual Perception (extracting information from visually-presented material)
• Visual Processing (quickly being able to 'make sense' of one's visual environment)

Vision therapy systematically eliminates visual barriers to clear, comfortable, binocular vision while simultaneously developing the proper visual coordination required to maintain stable visual skills throughout life. This process is most effective when overseen by an optometrist with residency-training in vision therapy to ensure proper diagnosis and treatment of your vision conditions. Vision therapy may be used in isolation or in conjunction with other treatments, such as prism glasses or strabismus surgery. Specific recommendations are determined during a Binocular Vision Assessment.

Kids Struggling with Reading or Academic Performance

Vision plays a central role in the learning process. In fact, more than 80% of classroom learning occurs through the visual system. Imagine trying to take notes when the board at the front of the classroom is blurry, or attempting to read when the words appear to move on the page or become double. Studies have shown that something as simple as an uncorrected refractive error can impact learning and emerging reading skills.

Some reports in literature estimate that as many as 1 in 4 children have a vision condition significant enough to impact learning. It is important to remember that not all vision conditions result in blurry vision (many children who need vision therapy can see 20/20) and not all conditions are corrected with glasses. The presence of eye tracking, eye teaming, eye focusing and visual processing deficits can have significant impacts on the learning process and should be treated as soon as possible.

People with a Signifigant Developmental History

Several vision conditions occur at higher rates for people with developmental conditions. While having autism, cerebral palsy, trisomy 21 or developmental delay does not mean that you have a vision condition, it does carry a higher risk. Given the role vision plays in overall development, it is especially important that all vision conditions be detected and treated. Vision conditions of concern for people with developmental conditions include:

• Significant refractive error (high prescription)
• Amblyopia (lazy eye)
• Strabismus (eye turn)
• Accommodative dysfunction (eye focusing)
• Binocular vision dysfunction (eye teaming)
• Oculomotor dysfunction (eye tracking)
• Visual perceptual & processing deficits (extracting visual information)

While glasses are important to establish clear vision, they do not treat all vision conditions. Vision therapy is extremely effective in treating many conditions that impact functional vision. Providing clear, comfortable, consistent vision allows someone to be more successful in their visual environment. Vision therapy can be a critical part of a greater plan to help an individual reach their potential.

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Which Conditions are Treated with Vision Therapy?

Vision therapy may be used in isolation or in conjunction with other treatments to successfully remediate many vision conditions. These conditions include:

Accommodative Dysfunction (Eye Focusing Deficits)

Eye focusing conditions can result in blurred or fluctuating vision. These conditions are especially frustrating for individuals as they experience blurred vision but can often read 20/20 on the eye chart. This occurs because accommodative dysfunction frequently affects vision during sustained near tasks (such as reading or computer work) or causes blur when quickly changing focus (such as when taking notes in class). This creates a situation where a student may report blurred vision in class, however when they present to the doctor they are seeing clearly (which may mistakenly lead the doctor to think that everything is fine).

Vision therapy improves the amplitude (strength), flexibility, speed and accuracy of accommodation. This allows the individual to maintain clear vision throughout various activities, whether sustaining clarity during reading or being able to see clearly while transitioning between the front of the classroom and their desk.

Amblyopia (Lazy Eye)

Amblyopia is a vision condition that occurs early in life when barriers to clear vision go uncorrected; typically a high prescription, certain types of strabismus (eye turn), or a condition obstructing vision (such as congenital cataract). Improper development of the visual pathway results in blurred vision (inability to see 20/20) as well as deficits within the binocular vision system.

Vision therapy is often used in conjunction with glasses, surgery or patching to treat amblyopia. Vision therapy treats the underlying binocular vision dysfunction and improves the success of patching or strabismus surgery alone. Including vision therapy as part of a comprehensive amblyopia treatment plan allows for improvement of vision at any age and improvement beyond the plateau experienced with patching alone.

Binocular Vision Dysfunction (Eye Teaming Deficits)

Binocular vision refers to the ability to use both eyes in a coordinated manner. Deficits in binocular vision can result in a number of symptoms, including: double vision, headaches, eye strain, dizziness, poor depth perception and difficulties with visual-motor tasks (such as sports). Additionally, binocular vision dysfunction can impair related visual skills, such as eye tracking.

Vision therapy is an effective treatment for many conditions of binocular vision dysfunction. Rather than 'putting a band-aid on the problem' or embedding splinter skills, vision therapy addresses the underlying deficits within the visual system. Vision therapy develops coordination of the visual system as a whole, which provides a permanent solution.

Convergence Insufficiency

Convergence insufficiency is a common vision condition that describes difficulties or an inability to use both eyes in a coordinated manner during near tasks (such as reading or computer work). In order to comfortably look at near objects (such as a book), one must converge their eyes. Those with convergence insufficiency often experience headaches, eye strain, blurred vision or double vision while performing near tasks, such as reading. This can result in difficulties concentrating during this tasks or trouble remembering what has been read.

Vision therapy is extremely effective in treating convergence insufficiency. In fact, the Convergence Insufficiency Treatment Trials found in-office vision therapy to be themost effective treatment for convergence insufficiency. Vision therapy develops coordination of the binocular vision system, which improves the convergence response, while also improving foundational visual skills necessary to maintain clear, comfortable, single binocular vision.

Oculomotor Dysfunction (Eye Tracking Deficits)

Eye tracking deficits are common among struggling readers. Efficient eye tracking is necessary for fluent reading, scanning our visual environment (ex: driving) and while playing sports. It is important to note that oculomotor skills are dependent on a stable binocular vision system. For this reason, eye tracking deficits must be evaluated in conjunction with underlying binocular vision and accommodative abilities.

Vision therapy is the best approach to remediate oculomotor dysfunction as it is the only treatment method that addresses both the foundational visual abilities and higher level eye tracking difficulties. This is in stark contrast to 'eye tracking' or reading programs that assume an intact binocular visual system while taxing higher level skills – limiting success for the child and increasing frustration.

Strabismus (Eye Turn)

Strabismus describes a group of conditions in which an eye 'turns' in (esotropia), out (exotropia) or up/down (hypertropia). Treatment of strabismus can include prism glasses, strabismus surgery, vision therapy or a combination of the three. The optimum treatment approach depends on the specific characteristics of the strabismus - for example, the size (how far the eye turns) and frequency (how often the eye turns) of the strabismus influences treatment decisions.

Vision therapy is a valuable component of strabismus treatment as it addresses the underlying sensory deficits in the binocular vision system. Whereas surgery can 'move the eye' to improve alignment, vision therapy improves the ability for the visual system to coordinate the right and left eyes. In some cases vision therapy can be used as the sole treatment for intermittent strabismus, while in others it is used following surgery to improve sensory abilities (similar to physical therapy after an orthopedic surgery).

Vergence Dysfunction (Convergence Insufficiency, Convergence Excess, Divergence Deficits)

Vergence is a visual skill that allows one to maintain binocular vision. Convergence describes the crossing of the eyes to view objects at near (reading, computer, etc) while divergence describes uncrossing of the eyes to look in the distance. Convergence and divergence skills must be fast, accurate and consistent to maintain clear, single vision. Vergence dysfunction can result in double vision, blurred vision, headaches or visual discomfort. Additionally, vergence dysfunction disrupts the visual-vestibular system, which can cause dizziness and balance difficulties.

Vision therapy improves the amplitude (strength), flexibility, speed and accuracy of the vergence system while reducing the latency of the vergence response. Enhancing one's vergence abilities in turn promotes clear, comfortable, single binocular vision.

Visual Perceptual Deficits (extracting information from visually-presented material)

Visual perception is a skill set that allows one to interpret visual information; it plays an essential role in the learning process. Many people with visual perceptual deficits are described as auditory learners; they learn well when they hear things but cannot seem to produce the same results with visual material.

Vision therapy develops both the underlying 'mechanics' of the visual system (binocular vision, accommodation, etc) as well as visual perceptual skills. This is important as poor visual input can cause performance that looks like visual perceptual deficits. Once underlying binocular vision dysfunction has been addressed, vision therapy then develops the visual skills necessary to extract visual information and support efficient visual perceptual skills.

Visual Processing Deficits (quickly being able to 'make sense' of one's visual environment)

Visual processing speed allows one to quickly interpret visual information and make split-second decisions. Visual processing can be thought of as 'visual reaction speed'. Visual processing speed allows one to keep up with the pace of class, engage in sports and be a safe driver. Poor visual processing abilities require one to slow down and have repeated presentation to understand visual concepts.

Visual processing therapy, which is an aspect of vision therapy, improves visual processing speed. Advanced Vision Therapy Center is unique in offering advanced biofeedback therapy as part of a comprehensive visual processing therapy program. This allows for functional changes in visual processing at the neurological level.

Distinguishing the subtle differences between various vision conditions is a critical first step in the treatment process; the right diagnosis leads to the most appropriate treatment option and greatest success. A Binocular Vision Assessment with an optometrist with residency-training in binocular vision, neuro-optometry or vision therapy is the best way to evaluate the need for vision therapy. Working with a residency-trained optometrist ensures that your care is being provided by a doctor with advanced training specific to binocular vision dysfunction.

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