Vision therapy is a type of physical therapy for the eyes and brain. It is a highly effective, non-surgical treatment for many common visual problems such as lazy eye, crossed eyes, double vision, convergence insufficiency and a few reading and learning disabilities.
Many patients who have been told, "it's too late," or "you'll have to learn to live with it" have benefited from vision therapy.
In the case of learning disabilities, vision therapy is specifically directed toward resolving visual problems which interfere with reading, learning and educational instruction.
Vision Therapists, however, DO NOT CLAIM that vision therapy is a direct treatment for learning disabilities.
Vision Therapy may be of significant benefit in the following areas:
- • Disorders of Ocular Binocularity, like Convergence Insufficiencies and Squints
- • Anti- Suppression Therapies, in Lazy Eye Syndromes or Amblyopia
- • Focusing Disorders like Accommodative Insufficiencies
- • Neurological Conditions, following Cerebrovascular Accidents (CVA or Strokes), Cerebral Palsies and other related conditions
- • Special Disabilities like Dyslexia, Attention Deficit and Hyperactivity Disorders and other childhood learning and behavioural disorders
- • Sports Vision Therapies, to significantly improve hand- eye co-ordination
"Many parents today are under the impression that the vision screening their children receive in school is sufficient,"
"The screening [at school] will determine the child¹s distance vision but what is missing is the near vision, muscle balance and binocular function. Very few eye screenings include this much-needed exam. Just as children should visit the pediatrician and the dentist, they should also see a licensed eye care provider to screen for vision problems."
The first step in any Vision Therapy program is a comprehensive vision examination. Following a thorough evaluation, a qualified vision care professional can advise the candidate as to whether Vision Therapy would be appropriate treatment.
A comprehensive eye exam includes testing and evaluation of visual skills (function, performance, etc). In the absence of complete testing, common pediatric vision problems can go undetected, and, in some cases, can be misdiagnosed as a learning disability or behavioral problem. This page lists some of the visual skills which need to be evaluated as part of a child's comprehensive vision examination.
IMPORTANT NOTE: Many school eye or vision screening optometry exams test only one of the visual skills listed below -- that is, Acuity-Distance (clarity of sight in the distance, 20/20 eyesight as measured by the standard Snellen eye chart).
A child's comprehensive eye examination should include testing of the following visual skills, ALL of which are important aspects of normal, healthy human vision.
Acuity - Distance Vision: visual acuity (sharpness, clearness) at 20 feet distance.
Acuity - Near Vision: visual acuity for short distance (specifically, reading distance).
Focusing Skills: the ability of the eyes to maintain clear vision at varying distances.
Eye Tracking and Fixation Skills: the ability of the eyes to look at and accurately follow an object; this includes the ability to move the eyes across a sheet of paper while reading, etc.
Binocular Vision or Fusion: the ability to use both eyes together at the same time.
Stereopsis: binocular (two-eyed) depth perception.
Convergence and Eye Teaming Skills: the ability of the eyes to aim, move and work as a coordinated team.
Color Vision: the ability to differentiate colors.
Reversal Frequency: confusing letters or words (b, d; p, q: saw, was; etc.)
Visual Memory: the ability to store and retrieve visualinformation.
Visual Form Discrimination: the ability to determine if two shapes, colors, sizes, positions, or distances are the same or different.
Visual Motor Integration: the ability to combine visual input with other sensory input (hand and body movements, balance, hearing, etc.); the ability to transform images from a vertical to a horizontal plane (such as from the blackboard to the desk surface).
Remember: an eye exam that tests distance vision only is NOT an adequate evaluation of a child's visual development. The visual skills listed above contribute significantly to a child's success with reading and school achievement.
Below are some common pediatric visual conditions which are not detected through the 20/20 eye chart test done by optometrists alone where Vision Therapy can play a significant role :
According to the American Optometric Association, 1 in 4 children have a vision problem that affects their ability to learn, which in turn may affectdevelopmental milestones Many of those problems are vision problems which aren’t detected during typical vision screenings performed by schools, paediatricians or even ophthalmologists.
- • Crossed or lazy eye
- • Frequent tilting of head to one side or one shoulder is noticeably higher
- • Excessive squinting, blinking, and/or closing of one eye
- • Places head close to book while reading
- • Poor visual/motor skills (“hand-eye coordination”)
- • Problems moving in space, frequently bumps into things or drops things, is “clumsy”
- • Difficulties catching and/or throwing airborne objects
- • Appears to favour the use of one eye
- • Burning or itching eyes, reddened in appearance
- • Headaches in forehead or temples
- • Exhibits posture problems
Behaviour-related
- • Short attention span
- • Nervous, irritable, or quickly fatigued while reading, looking at books, or doing close work
- • Displays signs of emotional or developmental immaturity
- • Low frustration level, doesn’t get along well with others
- • Experiences blurry vision
- • Nausea or dizziness
- • Motion sickness
- • Double vision
Work Skills Related
- • Repeatedly confuses left and right directions
- • Holds the book or object unusually close
- • Twists or tilts head toward a book or object to favour one eye
- • Frequently loses place when reading or copying from the board or paper
- • Difficulty remembering what was read
- • Difficulty remembering, identifying and reproducing geometric shapes
- • Often reverses words
- • Uses finger to read
- • Rubs eyes during or after short periods of reading
- • Frequently skips words and/or has to re-read
- • Repeatedly omits small words
- • Struggles with handwriting
- • Moves head back and forth (instead of moving eyes)
You can also spot vision-related problems in infants and pre-schoolers.
An individualised program is critical for effective treatment.
Vision therapy is a progressive program of vision "exercises" or procedures; performed under medical supervision;
individualised to fit the visual needs of each patient; generally conducted in-office, in once or twice weekly sessions of 30 minutes to an hour;
occasionally supplemented with procedures done at home between office visits ("home reinforcement" or "homework")
Depending on the case, the procedures are prescribed to:
- • help patients develop or improve fundamental visual skills and abilities;
- • improve visual comfort, ease, and efficiency;
- • change how a patient processes or interprets visual information.
It is important to understand that Vision Therapy Is Not Just Eye Exercises:
Unlike other forms of exercise, the goal of Vision Therapy is not to strengthen eye muscles. Your eye muscles are already incredibly strong. Vision Therapy is not to be confused with any self-directed, self-help program of eye exercises which is or has been marketed to the public.
In-office Vision Therapy is supervised by optometric vision care professionals and many types of specialised and/or medical equipment can be used in Optometric Vision Therapy programs, such as:
- • Corrective lenses (regulated medical devices);
- • Therapeutic lenses (regulated medical devices);
- • Prism lenses (regulated medical devices);
- • Optical filters;
- • Occluders or eye patches
- • Electronic targets with timing mechanisms;
- • Computer software;
- • Balance boards (vestibular device)
- • Visual-motor-sensory integration training devices
A typical Vision Therapy treatment program includes the following:
- • Activities to build or improve visual skills. Patients perform certain visual activities and procedures that will help correct the visual functioning of their eyes. These will be performed both in our office and at home. Newly acquired visual skills will be reinforced and made automatic through repetition and by integration with motor and cognitive skills.
- • Office visits to build visual skills and keep patients on track. For best and most efficient progress, regular visits to the office are required. There are many important visual activities are done in the office with a vision therapist that cannot be done at home. Proper performance of supportive home activities is also monitored. Office visits are generally 45 minutes in length. Many patients come weekly but frequency of the visits will depend on the diagnosis and severity of the problem.
How long will the program last?
The length of the treatment will vary, as will the exercises required. We will be building your visual-motor skills and endurance through the use of specialised computer and optical devices. Therapy programs can range in length from one session to 2-3 years. Most programs last between 3-9 months.
What about self-guided vision therapy programs?
In order for the therapy program to be effective, it must be directed by an expert in the field of developmental optometry. A person’s visual system is very complex, and only a doctor with the appropriate training is qualified to determine which techniques should be used for your vision problem.
Are glasses prescribed?
In some cases, prescription lenses may be required for certain refractive conditions.A developmental optometrist’s approach to prescribing lenses is different than that taken by general optometrists or ophthalmologists. This approach is functional and focuses on the underlying visual problem. When we prescribe lenses, they may serve any of the following functions:
- • Preventive lenses: To prevent a vision problem from developing further.
- • Development lenses: To support developing visual skills and help cope with visual stress.
- • Remedial lenses: A temporary fix for a specific problem; designed to provide a stopgap measure until the therapy can be completed.
DYSLEXIA
Symptoms of dyslexia may be correctable with vision therapy.
Fact: If you exhibit symptoms of dyslexia, you may just have a correctable vision problem, not dyslexia.
Fact: If you do have dyslexia, vision therapy is not a cure.
We see many patients who exhibit symptoms similar to dyslexia. If someone is exhibiting these symptoms and doesn’t have dyslexia, they are likely suffering from a vision problem and we can help.
If a person experiencing these symptoms does have dyslexia, we can help improve their visual efficiency and visual processing, but we do not treat the dyslexia. Our approach, however, will allow a person to be more responsive to educational instruction.
What are the related symptoms?
The symptoms that are shared by people with dyslexia and people with vision problems include poor eye teaming, poor eye tracking and perceptual problems. These problems can cause words on a page to appear to move or be reversed.
What can be done to distinguish the two? A functional vision exam will establish whether the problem is a visual one. There are cases in which a person has both dyslexia and a vision problem. In these cases, vision therapy should be part of a multi-disciplinary approach, one that also involves special education and counselling.
ADD/ADHD
Symptoms for ADD/ADHD and vision problems are often the same.
The symptoms of ADD/ADHD and vision problems are very similar. In order to determine if a vision problem is causing some or all of these symptoms, a functional vision exam should be performed. When a vision problem is identified, it can be treated with vision therapy, glasses or both. In order to determine which symptoms are attributable to each condition, the vision problem must be eliminated.
| # | Symptoms | ADHD* | Visual Problems** |
|---|---|---|---|
| 1 | Inattention | ||
| 2 | Often fails to give close attention to details or makes careless mistakes | ||
| 3 | Often has difficulty sustaining attention in tasks or play activities | ||
| 4 | Often does not listen when spoken to directly | ||
| 5 | Often does not follow through on instructions or fails to finish work | ||
| 6 | Often has difficulty organising tasks and activities | ||
| 7 | Often loses things | ||
| 8 | Often distracted by extraneous stimuli | ||
| 9 | Often forgetful in daily activities | ||
| 10 | Often avoids, dislikes or is reluctant to engage in tasks requiring sustained mental effort | ||
| 11 | Hyperactivity and Impulsivity | ||
| 12 | Often fidgets with hands or feet or squirms in seat | ||
| 12 | Often has difficulty remaining seated when required to do so | ||
| 13 | Often runs or climbs excessively | ||
| 14 | Often has difficulty playing quietly | ||
| 15 | Often “on the go” | ||
| 16 | Often talks excessively | ||
| 17 | Often blurts out answers to questions before they have been completed | ||
| 18 | Often has difficulty awaiting turn | ||
| 19 | Often interrupts or intrudes on others |
“An athlete who is not visually fit, is not physically fit,”
Quality sports performance requires a positive attitude, determination and maximum effort. However, giving 110% doesn’t always yield superior results when vision skills are lacking.
If your child is involved in sports, you know the importance of good hand-eye coordination. Without it, your child cannot cleanly catch a ball, throw an accurate pass, put the bat on the ball, or swish consecutive free throws.
How well that skill is achieved depends on the strength of the visual connection from your eyes to your brain to your hands.
Practice and hard work can improve that connection for some athletes; vision therapy can improve it for all of them.
Vision therapy, similar to physical therapy for a sports injury, trains the brain to control the eyes to work together at optimal capability. Athletes with good skills can also benefit from improving vision efficiency and hand-eye skills.
The results are improved grades in school, and later, the ability to play your sport better than most people.
Whether the sport is cricket, baseball, soccer, volleyball, basketball, softball, football, hockey or golf, athletes are discovering the benefits vision therapy can have on their performance.
Public misconception is that 20/20 eyesight is “perfect vision”, but it actually refers only to distance eyesight. There are approximately 15 near-vision skills needed to read, as well as succeed in sports.
Those skills are not tested for in a basic eye examination by most doctors. However, a Vision Therapist can test them in a developmental vision evaluation
Vision skills needed to play sports include focusing, eye teamwork, depth perception, eye tracking and peripheral vision.
If these skills are deficient, a child might frequently:
- • Strike out in baseball
- • Drop passes in football or basketball
- • Miss short putts in golf
- • Throw inaccurate football passes
- • Have a poor shooting percentage in basketball
- • Trip over his skates in hockey
- • Consistently misjudge hitting a tennis ball
General indications a child may have a vision problem are:
- • Poor balance, clumsy or “accident-prone”
- • Slow steps, reflexes not sharp
- • Rhythm and timing off
- • Poor hand-eye coordination
- • Reduced concentration
- • Inconsistent performance
- • Headaches, fatigue, frustration when playing sports
- • Little improvement with practice
- • Routinely makes errors
- • Often sits on the bench
If any of these situations apply to your child, a vison therapist can test for vision problems which may be contributing to sports woes.
Problems focusing, one eye overworking, misaligned eyes or eyes not working together are possible issues.
Once a diagnosis is made, our team will recommend a program of vision therapy which can include computer games, drills with balls and other objects, as well as activities with prisms and lenses.
Syntonic Phototherapy is also proving helpful for athletes. This involves wearing various coloured lenses at certain times daily. Light therapy helps relax and retrain the eyes to work together better.
Most athletes evaluate their sports adeptness on a regular basis and are always looking for ways to tweak it. Vision therapy can help improve skills for all sports and can even be tailored to the individual sport.
If your child enjoys athletics but struggles with some key performance abilities, consider having him evaluated by a developmental optometrist.
It may be that an undiagnosed vision problem is keeping him from being the best athlete he can be.
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