Is Vision Therapy the Missing Piece to Your Eye Care?
Do you or your child
- dislike or avoid reading?
- get tired or fall asleep when reading?
- find it difficult to concentrate on reading or near work for long periods of time?
- have to re-read the same line of words when reading?
- close an eye or cover an eye when reading?
- get headaches when reading or doing near work?
You may have a vision problem that cannot be treated with glasses alone.
Many people think the only thing that determines how healthy the eyes are is how well you see. While good vision (ie 20/20) is important, it is only one small component of how well these incredibly complex organs function. There are so many working parts that contribute to our ability to achieve our maximum visual potential. Our eyes must focus properly (accommodation), move properly (oculomotor skills) and coordinate together (binocular vision skills) to be able to see clearly and comfortably. It is then up to our brains to properly interpret what we see (visual perception). So how do each of these areas work?
The ability to properly focus the eyes for different distances
Not only is sharp distance vision important, but so is clear vision at near distances. Our ability to accommodate (focus up close) has become even more important in the wake of the electronics revolution. Computers and other electronic devices have significantly increased the need for proper sustained near vision (accommodation). The ability to accurately copy notes from a board or projector screen demands that the eyes be able to quickly focus between distance and near objects. This skill is called accommodative facility. Proper accommodation and accommodative facility rely on the ability of our eyes to automatically change the focusing power of our intraocular lens. In essence, our eyes are like very sophisticated autofocus cameras. Children and young adults are expected to be able to maintain near focus and change their focus between distance and near with ease. When the eyes cannot focus up close the condition is known as accommodative insufficiency. When the eyes cannot switch between distance and near focusing tasks it can be due to conditions known as accommodative spasm or accommodative insufficiency.
Oculomotor Skills: Saccades and Pursuits
The ability of the eyes to track objects as they move
Proper oculomotor skills allow us to accurately track objects with our eyes. We have two main types of eye movements: saccades and pursuits. Saccades are rapid eye movements between different points of fixation. Saccades are important for activities such as reading, copying from the board, and sports. Pursuits are smooth eye movements that allow us to keep our eyes on and follow a moving target. Just like saccades, pursuits are also important in sports. They are also important in judging distance and speed and are necessary for driving.
The ability of the eyes to work together
The fact that we have two eyes that point forward provides us with the wonderful skill of depth perception. As we did with accommodation, let’s think of the eyes like cameras. For us to see an object as clear and single, and be able to judge its depth, both eyes must point to it. Two major types of misalignments can affect the ability to appropriately fixate both eyes on an object. These disorders are referred to as strabismic (usually when an eye turn visible) and non-strabismic (when the eyes appear straight but struggle to line up) binocular vision disorders.
Strabismus: Strabismus (an eye turn) can be easy to see. This type of eye turn is often called a lazy eye. Depending on the type and degree of the eye turn the eye may or may not actually be “lazy” (have a decrease in vision or amblyopia). Some types of strabismus can be corrected with vision therapy alone. Others may require vision therapy before and/or after surgery to achieve the best potential.
Non-Strabismic Binocular Vision Disorders: In these cases, the eyes often appear straight and have 20/20 vision. However, because of the misalignment of the eyes, the eye muscles and brain must work harder to keep the eyes focused on an object. Common forms of non-strabismic binocular vision disorders are convergence insufficiency (the inability to properly turn the eyes in up close) and convergence excess (the tendency of the eyes to turn too far inward when looking at close targets). Again, the eyes can appear “normal” in both of these disorders and patients can often show some normal depth perception. These disorders can affect reading, schoolwork, sports, and driving.
Did you know that we do not see with our eyes? You may be thinking “how can that be?” Or you may be asking, “then why did we just go over all of this information about how important or vision skills are?” Our eyes take pictures and pick up information that is sent to the brain. The brain then processes this information allowing us to understand what is going on around us. Our ability to properly process and interpret what we see is known as visual perception. Visual perception skills include but are not limited to the ability to tell similarities and differences between objects, memorize a target or pattern, and find an object hidden in a busy background. Visual perception skills are very important in nearly every aspect of our daily lives. Without proper visual perception skills we would have a hard time learning to read, spelling, and even driving.
When any one or more of these systems do not function properly the following symptoms can occur:
- blurred vision at distance and or/near
- loss of place when reading
- occasional double vision
- poor depth perception
- eye strain and fatigue
- difficulty copying from the board
- reversal of letters
- poor handwriting
- poor posture with reading and near work
- ADD or ADHD like symptoms
It’s no wonder that children and with these disorders can appear disinterested or inattentive when reading or doing school work. As a result, it can make these children appear to have ADD or ADHD like behaviors. Clinical research in vision therapy has greatly expanded in recent years. Like other areas of medicine, we are learning more and more what the brain and visual system are capable of. Researchers are beginning to analyze the effects of vision therapy at the neurological level using special types of MRI’s. They are now able to compare the way the brain functions before and after vision therapy-and they are seeing changes! Even with this wonderful research and the remarkable things vision therapy can do; it is important to distinguish between vision disorders and separate learning and developmental disorders.
How are these vision-related learning disorders detected? These disorders can often be missed by standard school screenings. The detection process starts with a comprehensive eye exam by an optometrist who has been trained to evaluate patients with these disorders. The comprehensive eye examination, combined with evaluation of symptoms, will help determine if a full developmental visual assessment is needed.
What should I expect with my customized Vision Therapy treatment plan?
We’re here to be your guides. Vision therapy is and should always be a personalized experience. The first step in your vision therapy journey is evaluation and diagnosis. The evaluation process consists of three visits. The Ocular Skills Assessment will look at clarity of focus, eye coordination, tracking, depth perception, and suppression. The Developmental Assessment will determine if the brain is properly processing what is seen. The third visit is the Report Consultation. Dr. Shasteen will review your diagnosis and thoroughly explain your vision therapy treatment plan.
Vision therapy sessions are typically scheduled once a week for an hour with a vision therapist. Modern Heritage Eye Care utilizes the most advanced vision therapy treatments such as Vivid Vision. This fully immersive virtual reality program helps increase patient success. Progress checks with Dr. Shasteen are scheduled periodically to ensure goals are being reached.
Weekly home therapy exercises are assigned to supplement in-office therapy. We ask that patients complete at least 15 minutes of homework 5 days each week. Assignments are sent home through a coaching app. This app guides you through your home assignment with detailed instructions, photos, and videos. Completion of these tasks is an integral part of successful treatment.
Dr. Shasteen believes that all patients learn and progress at different rates. She does not offer any standard packages or cookie cutter treatment plans. All vision therapy programs are individualized treatment plans designed to help you or your child succeed. Dr. Shasteen will discuss the estimated treatment program length with you following your full evaluation. We stress the importance of not missing a single session. It is possible you or your child may complete this program in more or less time than scheduled.
Following graduation from office based vision therapy, you or your child will continue with home maintenance therapy. This stage is just as important as office based therapy. Continuing your home maintenance therapy will prevent regression and help reduce the need for repeated therapy in the future.
About Dr. Shasteen:
Dr. Shasteen believes in providing the highest standard of evidence based vision therapy treatments to her patients. Dr. Shasteen’s commitment to quality vision therapy began with her decision to pursue a 2-year advanced practice fellowship in pediatrics and binocular vision at The Ohio State University College of Optometry. This training is completed by less than 10% of optometrists nationwide. During the fellowship, she conducted research on vision therapy and accommodative insufficiency (the inability of the eyes to focus up close). She further committed herself to lifelong learning by becoming a Fellow of the American Academy of Optometry. She has had her research presented at meetings of the American Academy of Optometry and the 2017 meeting of the Association of Research in Vision and Ophthalmology. She continues to attend lectures focusing on pediatrics and binocular vision disorders. She has presented lectures on pediatrics locally to ophthalmic staff, pediatricians, and medical students.