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VISION THERAPY FAQs

How does it help eyesight problems?

Common questions about how vision therapy helps patients discover how to use their vision more efficiently.

1. What does vision therapy involve? What does it do?
2. My child tested as having very good eyesight and healthy eyes after having a standard eye exam with an eye chart. Should I still investigate the possibility of a visual problem?
3. Isn’t this something that we can take care of with glasses?
4. What causes something like this?
5. Can’t we just do this at home?
6. Why haven’t I heard of vision therapy before?
7. Is vision therapy new?
8. Is there any guarantee that vision therapy will work?
9. How long will it take?
10. Will my child still have “reading lenses” after vision therapy?
11. Are the changes from vision therapy permanent?
12. Is there scientific evidence that vision therapy works?
13. Why is vision therapy a well-kept secret?
14. Why would another eye professional such as an eye specialist say that vision therapy won’t help?
15. Is it true that there are certain conditions, like lazy eye, where the patient is too old, or it’s too late to intervene with vision therapy?
16. Why is binocular depth perception so important?
17. I’ve heard a lot about special lenses or filters that can improve reading. Can that be done instead of vision therapy?
18. What is the difference between “orthoptics” and “vision therapy”?

1. What does vision therapy involve? What does it do?

Optometrists who provide behavioural vision care are licensed professionals, focused on prevention and treatment of vision problems, and how vision impacts human behaviour and performance.

In vision therapy we use different lenses and prisms to help you discover how to use your vision more efficiently. We use some lenses that help you understand how to relax your focus and others that encourage stimulation of your focus, so you can develop more flexibility. The same concept works with prisms that influence where you look. We use specially designed lenses, filters and prisms to help you discover how to use the two eyes together most effectively.

In vision therapy you learn how to control the flexibility, accuracy and range of freedom of all eye movements including fixation, pursuits, focus and eye teaming. In the instance of visual perceptual lags, we set up challenges so that the basic skills can be mastered, allowing appropriate development of skills, strategies and understanding of visual perceptual abilities towards more advanced visual thinking. With improved visual understanding a child is better prepared to benefit from educational methods.

Vision therapy in our office is normally completed one-on-one with the optometrist. In addition, homework needs to be completed at home as reinforcement of what is learned during the office therapy sessions. Commitment to the therapy program, and maintaining a schedule of weekly visits, is important in the success of the program. For more information visit our vision therapy page.

2. My child tested as having very good eye sight and healthy eyes after having a standard eye exam with an eye chart. Should I still investigate the possibility of a visual problem?

Being able to read the letters on an eye chart at six metres’ distance does not guarantee adequate visual skills for reading and learning. The children most handicapped by visual sensorimotor deficits often have clear and precise distance eyesight in at least one eye. The problems with eye alignment, eye teaming, focusing, and visual endurance which are likely to affect school work are easily missed in school screenings and conventional eye exams (with the distance Snellen chart).

3. Isn’t this something that we can take care of with glasses?

Glasses can help more than just eyesight problems. But if your child has had vision therapy recommended to them then the option of solving the problem with glasses has normally been explored to its fullest extent. Children who present with difficulties that can normally only be remedied with vision therapy will often benefit from glasses as well as vision therapy.

4. What causes something like this?

Some eye conditions occur in association with disease processes. If this seemed likely then this would have been reported as a possibility at the time of the optometric examination. If disease is not the cause there are commonly other possible causes, such as:

  • Inadequate sensorimotor development.
  • Trauma to the nervous system (e.g. birth injury, brain trauma, closed head trauma, previous illness, etc).
  • Stress and environmental interactions such as inappropriate posture, lighting and task demand.

Some visual problems appear genetic or at least have contributing hereditary factors such as strabismus (crossed-eyes, wandering eyes). Most are a combination of genetic predisposition and environmental influences, though according to most recent studies environment appears to be playing a larger and larger role in our developmental make-up. Sometimes our vision becomes less comfortable as our eye control (such as focusing and eye-teaming) skills have become more conscious and tiring, particularly when we are not performing on a task as well as we should. If we demand more of these skills than we can accomplish, we can develop sub-conscious adaptations to cope – often to our detriment – similar to a person who tries to concentrate harder and finds themselves less successful at performing a task such as reading.

5. Can’t we just do this at home?

Vision therapy programs are individualised and sequenced for the patient, and professional guidance and frequent monitoring is required for success. You also need to be able to modify certain procedures when they cannot be done efficiently or effectively. When attempted by patients without guidance, poor visual habits may actually be reinforced. Trying to do vision therapy exclusively at home is like walking into a classroom and working out from notes and exercise books how to do mathematics. You have no idea of the sequence of the exercises, whether you are getting the right answer, when to increase the difficulty of the tasks and whether you are tackling the tasks the right way. Once a professional guides you, it becomes reasonable to reinforce what you have learned on your own.

6. Why haven’t I heard of vision therapy before?

Vision training or vision therapy is a speciality procedure. Not all optometrists are trained in it. Patients are often referred to our practice by other professionals who are conversant with vision therapy, or by other patients who interact with people who have similar difficulties.

7. Is vision therapy new?

Although Vision therapy is currently an Optometric speciality, it is actually an outgrowth of orthoptics, developed initially by physicians. As physicians became more focused on eyeglasses, medication , and surgery, the benefits of orthoptics were taught to fewer and fewer practitioners. However, optometrists in the mid 1900’s took from orthoptics and pioneered the development of vision therapy.

8. Is there any guarantee that vision therapy will work?

Since we are dealing with human function, there can be no guarantee of absolute success. I believe that you will get out of vision therapy what you put into it. Those patients who are motivated, and who are consistent with their office visits, typically do very well. While vision therapy has been extremely effective for many individuals, no guarantee as to the effectiveness in any specific case can be made. Patient outcomes can vary widely from individual to individual, and as such, no warranty is stated or implied.

9. How long will it take?

Many training programs can be accomplished in 15-20 sessions. If the difficulties are severe or complicated by involving more than one area of visual skills or abilities then the program time will often be longer, and you will have been informed. It is fine to do sessions on two consecutive days, so that you can stay on schedule.

The length of the therapy program varies with the condition treated. For example, a three year-old child with amblyopia, or “lazy eye”, might have the better eye patched for a short period of time. An eight year old with strabismus “crossed eye”, may require therapy for a period of a year to gain BOTH cosmetic and visual benefits (the two eyes will appear straight AND will be used as a binocular team for normal vision). A 30 year-old computer programmer may require three to six months to solve a visual problem causing significant eye strain. A 30 year-old with strabismus that had two or more unsuccessful surgeries as a child might require two or more years of therapy.

There is an informal evaluation after 10 sessions to assess progress and to plan future visits. Home vision therapy provides reinforcement and support.

However, if you don’t do your homework, you should still keep your office appointments. If you were a student in school, you wouldn’t skip a class because you didn’t complete your homework.

10. Will my child still have “reading lenses” after vision therapy?

The type of prescription that is commonly supplied to a child for near work helps preserve the gains that the child has made through vision therapy.

11. Are the changes from vision therapy permanent?

Most healthy vision therapy patients enjoy long term resolution of their visual problems. Generalising the newly acquired visual abilities to the activities of daily life allows these new visual skills to become self-reinforcing.

The extent to which the new visual abilities acquired through vision therapy last are related to a couple of key factors. If vision therapy visits are consistent, and the skills are reinforced, then they should operate subconsciously and automatically at a reflex level. If maintenance activities have been assigned at the end of training (as they often are), then monitoring yourself at periodic intervals will help you maintain your abilities.

If glasses have been prescribed, their proper usage will be important in maintaining your level of improvement. Ultimately, you may need a booster or tune-up. This typically involves a maximum of a few sessions if monitoring has occurred.

12. Is there scientific evidence that vision therapy works?

Yes. Studies on vision therapy are on a par with the published literature in parallel rehabilitative interventions such as physical therapy and occupational therapy. Furthermore, the data which supports vision therapy is considerably more impressive than the data which has substantiated other forms of visual intervention before these were put into public use by eyecare practitioners.

See visiontherapy.org for vision therapy references, research and scientific studies.

13. Why is vision therapy a well-kept secret?

The media rarely brings in the cameras. Most of us have seen dramatic camera footage of people struggling in physical therapy, being taught to walk again after a stroke or other traumatic accident. Watching a child doing vision therapy would not make such a dramatic picture – most of the action is happening inside the child’s own eyes and brain and can’t be picked up by the eye of a camera.

Both optometrists and paediatric ophthalmologists (using orthoptics) practise vision therapy, but you or your family may not be informed of this treatment option. There are several reasons for this. Paediatric ophthalmologists are trained as specialists and surgeons. Their practices concentrate on the use of drugs and surgery to treat eye disease and trauma. The majority of paediatric ophthalmologists have not set up therapy rooms as part of their own practices. Likewise, many optometrists do not maintain active therapy practices.

14. Why would another eye professional such as an eye specialist say that vision therapy won’t help?

It is unfortunate that many eye professionals are not trained in vision therapy. Progressive eye professionals who follow current research in learning, neurology and physiological rather than just pathological (disease) visual processes understand the potential role of vision therapy.

The public needs to be aware that ophthalmologists are not the ultimate authorities in all areas of visual function. Ophthalmologists are often brilliant surgeons and normally the highest authorities on eye disease, but as a rule they rarely study subject areas such as, visual perceptual processing, accommodation and vision therapy. Some ophthalmologists concede this.

See also children-special-needs.org/parenting/preschool/pediatric_eye_exams.html.

15. Is it true that there are certain conditions, like lazy eye, where the patient is too old, or it’s too late to intervene with vision therapy?

What is commonly called “lazy eye” is technically amblyopia where one eye doesn’t see as clearly as the other eye even with proper glasses or contact lenses. Amblyopia can occur with or without strabismus, which is a crossing or turning of the eyes. Strabismus is sometimes attributed to one or more weak eye muscles, however the problem is normally (initially at least) a defective neurological signal to the involved muscle(s) rather than to an actual muscular abnormality.

With later amblyopia training you commonly won’t have as much improvement as you would have had at a younger age (but success can come easier when you can appreciate the results and you’re motivated).

16. Why is binocular depth perception so important?

Depth perception is an important aspect of normal, healthy vision; a result of good stereoscopic vision; the ability to visually perceive depth and three dimensional space; the ability to visually judge relative distances between objects; a perceptual skill that aids accurate movement in three-dimensional space.

The web site of the American Academy of Ophthalmology stated in August, 1996: “many occupations are not open to people who have good vision in one eye only [that means no stereo vision, no binocular depth perception]” Here are a few examples of occupations that depend heavily on stereo vision:

  • Cricketer: throwing, catching or hitting a ball.
  • Waitress: pouring into a container.
  • Driver: driving and parking a car.
  • Architect: planning/building a three-dimensional object.
  • Surgeon: precise cuts and stitching up incisions.
  • Dentist: fine control of probes, needles and other instruments.

The loss of binocular depth perception means more to someone than just losing the possibility of being a professional athlete or dentist. Loss of binocular vision can decrease quality of life as well as life choices. Reaching out to shake another person’s hand or threading a needle and sewing benefit from depth perception. Ask anyone who has had a head injury and lost depth perception about stepping off a curb or step and they will tell you about the challenges they now have to overcome. Parents and patients need to be informed about early detection of these conditions as well as the full range of treatment options.

17. I’ve heard a lot about special lenses or filters that can improve reading. Can that be done instead of vision therapy?

Irlen Tinted Lenses are not a substitute for vision therapy, though some people feel they can cope better with their visual difficulties. Many of the symptoms that wearers of Irlen Tinted Lenses have overlap with visual dysfunction such as instability of print, loss of place when reading, and difficulty concentrating when reading.

Helen Irlen, an educational psychologist, wrote that individuals interested in being screened for Scotopic Sensitivity Syndrome (colour influenced readers) should first see a vision specialist for a complete visual examination.

Irlen recognised the difference between routine eye examinations and a vision therapy evaluation. She noted: “When individuals take a routine eye examination, the vision specialist normally assesses acuity, refractive status, and binocular function. When the exam is more than routine, additional tests will analyse the visual system in greater detail and will also evaluate focusing ability and tracking skills. The doctor will also check for the presence of eye diseases. For Scotopic Sensitivity Syndrome treatment to be successful, existing visual problems need to be treated first. Perceptual skills are based on a solid visual foundation. It is essential for individuals to eliminate all visual problems prior to getting treatment for perception or other learning difficulties.”

18. What is the difference between “orthoptics” and “vision therapy”?

Orthoptics, which literally means “straightening of the eyes,” dates back to the 1850s and generally limits its scope to eye-muscle training and the cosmetic straightening of eyes. Vision training includes orthoptics, but has advanced to include training and rehabilitation of the eye-brain connections involved in vision. Clinical and research developments in vision training have been closely allied with developments in neuroscience throughout the 20th century.