Vision Therapy

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Vision Therapy

• Cathy Chang

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What is Vision Therapy?

• Vision therapy (visual training, vision training)
  is an individualized supervised treatment program
  designed to correct visual-motor and/or
  perceptual-cognitive deficiencies

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Why Vision Therapy?

• Behavioral Optometrists believe that vision is a
  learned skill Vision plays the largest role in
  learning.
• There's more to vision than just having 20/20
  eyesight.  A strong visual system is needed for
  reading, using a computer, and playing sports.

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Vision Related Learning Problems

• Physical Symptoms Jerky eye movements, one eye
  turning in or out Squinting, eye rubbing, or
  excessive blinking Blurred or double vision
  Headaches, dizziness, or nausea after reading
  Head tilting, closing or blocking one eye
  whenreading

• Secondary Symptoms Smart in everything but
  school Low self-esteem, poor self image
  Temper flare ups, aggressiveness Frequent
  crying Short attention span Fatigue,
  frustration, stress Irritability Day dreaming

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Vision Related Learning Problems

• Performance Clues Avoidance of near work
  Frequent loss of place Omits, inserts, or
  rereads letters/words Confuses similar looking
  words Failure to recognize the same word in the
  next sentence Poor reading comprehension
  Difficulty copying from the chalkboard Book
  held too close to the eyes Inconsistent or poor
  sports performance

• Social Labels Lazy Dyslexic Attention
  Deficit Disorder Slow learner Behavioral
  problems Working below potential

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Amblyopia (lazy eye)
Normal Vision Lazy Eye Vision

• A condition in which one eye has reduced vision
  Theres a difference in visual acuity between the
  two eyes

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Causes

• An obstruction of vision within one eye due to
  injury or disease
• Significant differences between the clearness of
  the images seen by each eye due to
  farsightedness, nearsightedness or astigmatism
• Misaligned eyes or crossed eyes (strabismus)

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Clinical Symptoms

• Frequent squinting or closing one eye to see,
  poor visual acuity, eyestrain, headaches
• Lack of brain stimulation from the weaker eye
  causes the strong eye to become dominant. The
  amblyopic eye is suppressed and may even become
  blind.
• While an amblyopic eye may look normal, it is not
  being used normally.

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Early Diagnosis

• Amblyopia can be prevented through early
  diagnosis and treatment. Without treatment, an
  amblyopic eye may never develop properly, and
  even become blind. Some vision loss can be
  restored if the diagnosis is early enough,
  usually before age 5. This early treatment is
  necessary because an amblyopic eye has problems
  in its connections with the brain, rather than in
  and of itself.
• Often, it is first necessary to treat the
  underlying cause of amblyopia before
  strengthening the childs weaker eye.

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Treatment Options

• Wearing eyeglasses or contact lenses to align or
  focus the eyes
• Wearing a patch on the stronger eye for weeks or
  months, which forces the amblyopic eye to work,
  developing more connections with the brain.
• Surgery on the eye muscles
• A program of Vision Therapy to help equalize
  vision in both eyes, improve eye coordination,
  and restore clear single vision.

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Strabismus (crossed eyes)

• the inability to point both eyes in the same
  direction at the same time.

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Causes

• Inadequate development of eye coordination in
  childhood
• Excessive farsightedness (hyperopia) or
  differences between the vision in each eye
• Problems with the eye muscles that control eye
  movement
• Head trauma, stroke, or other general health
  problems.

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Symptoms

• One eye may appear to turn in (estropia), out
  (extropia), up (hypertropia), or down
  (hypotropia).
• The eye turn may occur constantly or only
  occasionally (intermittent).
• Eye-turning may change from one eye to the other
  (alternating).
• Eye-turning may only appear when a person is
  tired or has done a lot of reading.
• Double vision may occur.
• To avoid seeing double, vision in one eye may be
  ignored resulting in a lazy eye (amblyopia).

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Treatment

• Eyeglasses
• Vision Therapy
• Eye muscle surgery.

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VT Approach Techniques

• Best Diagnostic Approach Combined Programs and
  Homework
• Therapy Sessions include Home Checks, Diagnosis,
  Tutoring, 30 minute sessions each
• Therapeutic lenses (regulated medical devices)
  
• Prisms (regulated medical devices)
• Filters
• Occluders or patches
• Electronic targets with timing mechanisms
• Computer software
• Balance boards

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VT Approach Techniques

• Monocular activities designed to equalize the
  focusing, tracking and pointing of each eye.
• Binocular work to improve eye-teaming efficiency.
• Visual-spatial tasks to develop integrated
  sequential and directional concepts.
• Form training stressing visual discrimination,
  spatial relationships, form constancy,
  figure/ground relationships and visual closure.
• A visualization program to improve the speed and
  span of visual recognition as they pertain to
  short and long-term visual memory.
• Visuo-motor tasks to improve body awareness and
  control, and visually directed fine motor skills.
• Inter-sensory integration skills through
  visualauditory-verbal matching.

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Demonstrations

• Pencil Tracking, Ball Tracking
• Blocks
• Eye Patches
• Prisms
• Visual-motor Task
• Body Balance
• Paper Tearing

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Research Studies

• Binocular Dysfunctions
• BACKGROUND Although vision therapy has
  reportedly been very successful in elimination of
  asthenopic symptoms (excessive tearing, itching,
  burning, visual fatigue, and headache) in adults
  with convergence insufficiency, controlled
  studies have not been performed, and a clinical
  bias exists against prescribing vision therapy
  for adults with convergence insufficiency.
  METHODS Sixty adult males over the age of 40
  years (median age, 65 years) with convergence
  insufficiency were divided into three treatment
  groups office-based vision therapy with
  supplementary home therapy, home therapy only,
  and a control group. RESULTS Vision therapy was
  successful in 61.9 of patients who received
  in-office plus home therapy, in 30 of patients
  who received home therapy only, and in 10.5 of
  the control group. The success rate for patients
  who received active in-office vision therapy
  supplemented with home procedures was
  significantly greater than that for controls.
  Home therapy alone was less successful than
  in-office therapy. The success rate obtained with
  home therapy alone was not significantly greater
  than that demonstrated by controls. CONCLUSIONS
  Vision therapy is effective in eliminating
  asthenopia (eyestrain) and improving convergence
  function in adult patients. In-office therapy
  combined with home therapy tends to produce
  better results than does home therapy alone.
  (Birnbaum MH, Soden R, Cohen AH. Efficacy of
  vision therapy for convergence insufficiency in
  an adult male population. Journal of the American
  Optometric Association, April 70(4) 225-232,
  1999.)

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Research Studies

• AmblyopiaBACKGROUND The pediatric clinic of the
  SUNY State College of Optometry/University
  Optometric Center (New York) develops a yearly
  quality management plan to monitor patient care.
  One of the areas retrospectively reviewed for all
  outcomes is refractive amblyopia. METHODS A
  retrospective review of records was performed on
  patients diagnosed with refractive amblyopia.
  With the use of a prescribed protocol, each
  patient's progress was tracked for a period of 6
  months. Major emphasis was placed on outcome as
  related to treatment modality. Treatment
  alternatives were optical correction alone,
  optical correction in conjunction with patching,
  and optical correction and patching with vision
  therapy. RESULTS Improvement criteria included a
  2-line increase in visual acuity on the Snellen
  chart and an increase of 20 seconds of arc of
  stereopsis, as measured by the Wirt circles. The
  groups that patched with correction and those
  that received vision therapy had similar visual
  acuity improvement's however, the latter group
  had a significantly greater improvement in
  stereopsis. Both groups performed significantly
  better in both categories when compared to the
  group receiving optical correction alone.
  CONCLUSIONS Though patching alone may be
  sufficient for improvement of visual acuity,
  binocular performance is significantly better
  when vision therapy is included in the treatment
  regimen. (Krumholtz I, FitzGerald D. Efficacy of
  treatment modalities in refractive amblyopia.
  Journal of the  American Optometric Association,
  June 70(6) 399-404, 1999.)

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Research Studies

• StrabismusBACKGROUND Occasionally,
  co-management involving both optometry and
  ophthalmology is needed to optimize treatment
  outcome for the strabismic patient. METHODS JB,
  a 47-month-old consecutive esotrope presented to
  our clinic (Southern California College of
  Optometry). Two previous attempts to surgically
  correct her exotropia had failed and the parents
  sought another treatment approach. We recommended
  optometric vision therapy (VT) to improve
  sensorimotor fusion before any further surgery.
  After 31 VT sessions (bi-weekly for a time, then
  weekly), before a third scheduled surgery,
  sensorimotor fusion was good in the amblyoscope,
  but unstable with neutralizing prism in
  free-space. We recommended surgery be postponed,
  but the family proceeded. Esotropia recurred with
  constant suppression. After additional VT, JB
  developed stable sensorimotor fusion and random
  dot stereopsis in free-space with neutralizing
  prism. A fourth surgery was then performed
  resulting in esophoria at all distances with good
  sensory fusion. RESULTS Twenty-one months
  postoperatively, JB remains nonstrabismic with
  good sensory fusion. CONCLUSIONS Clinicians
  should understand the roles and limitations of
  available treatment options. Surgery reduces the
  magnitude of the deviation, whereas optometric VT
  (vision therapy) provides the unique role of
  establishing normal sensory processing. (Garriott
  RS, Heyman CL, Rouse MW. Role of optometric
  vision therapy for surgically treated strabismus
  patients. Optometry and Vision Science,
  April74(4) 179-184, 1997.)

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References

• About vision problems Vision-Therapy January
  2005 lthttp//www.vision-therapy.com/About_Vision.h
  tmgt
• Vision Related Learning Programs Insight Vision
  Center lthttp//www.insightvision.org/vrlearningpro
  grams.htmlgt
• What is Vision Therapy? College of Optometrists
  in Vision Development lthttp//www.covd.org/od/vt_w
  hatis.htmlgt
• Unite for Sight Amblyopia Module Unite for
  Sight lthttp//www.uniteforsight.org/course/amblyop
  ia.phpgt
• Strabismus/Crossed Eyes COVD lthttp//www.covd.or
  g/od/strabismus.htmlgt
• Strabismus What is it? Optometrists Network
  lthttp//www.strabismus.org/gt
• Introduction to Vision Brain Injury NORA
  lthttp//www.nora.cc/patient_area/vision_and_brain_
  injury.htmlgt
• Research Studies Vision Therapy
  Vision-Therapy lthttp//www.vision-therapy.com/vt_r
  esearch_studies.htmBinocular20Dysfunctiongt