Vision Therapy, also known as vision rehabilitation, vision training, or developmental optometry, is a field in which a specific series of exercises, often using lenses, colored filters, and prisms, are practiced to improve the visual system of a patient. These exercises are often reinforced at home 4-6 days a week to improve specific skills and re-train the brain to use the eyes efficiently. While it is a common thought that vision is only related to acuity and needing glasses, there is far more to vision than just seeing 20/20. Functional vision refers to the way an individual uses the vision they have. Eye teaming, tracking, focusing, and visual processing are all areas of functional vision that can be improved with proper training. Symptoms such as headaches, double vision, eye-turns, reversals, poor eye-hand coordination, poor peripheral vision, poor school performance, poor attention, and difficulty reading are all often indicators of functional vision difficulties.
In our Nashville office, we start therapy by practicing simple eye movements to set a foundation for our journey. Fixation (keeping your eyes on a fixed target), Saccades (quick movements from target to target), and Pursuits (smooth movements following a moving target) are the big 3 we emphasize. Can you think of times throughout your day where you may use Fixation, Saccades, and Pursuits? Perhaps playing soccer when you have to follow a moving ball, jump your eyes to each of your players, and watch the ball when you kick it. If speed and accuracy of these eye movements aren’t perfected, this and many other sports can be tough. Reading a book requires quick jumps from word to word and line by line. Without the ability to quickly and accurately move those eyes, reading becomes a lot more challenging. This results in skipping lines, re-reading, and often results in poor reading comprehension. We use these eye movements throughout every day life and many struggle because they lack accuracy with their eyes. During this phase in therapy, we often work one eye at a time to see if there is a difference in performance. We want both eyes working equally before we start binocularity (using both eyes together). If there is an eye-turn (strabismus), or lazy eye (amblyopia) present, we will remain in this stage longer and add more complex therapy procedures involving prisms to help re-train the brain to be ready to use both eyes together.
It may seem that since we have two eyes, and can see clearly with or without glasses, that the eyes must be working together. Unfortunately that is often not the case. Using both eyes together is a complex process because each eye sees an individual image, and then the brain works to help the eyes fuse those images together to make a single and clear image. Since a slight misalignment can cause double vision, the brain will occasionally suppress one of the images to maintain single vision. While this is helpful in functional day to day tasks, it also compromises depth perception and often leads to visual fatigue and headaches. When your eyes are having a tough time working as a team, many tasks throughout the day require more work than those who use their visual system efficiently. In therapy during binocular training, we often use colored filters to ensure that both eyes are in fact working when doing tasks such as eye movements, convergence (bringing eyes in), divergence (bringing eyes out), and accommodation (eye-focusing).
As the patients gain control over their new skills, we emphasize visual processing exercises in their curriculum. Visual processing involves how we interpret the information that they eyes see. Patients who struggle with this may have low self-esteem in school, reverse letters, have a poor memory, and show learning difficulties. Since the eyes should be working more efficiently, adding skills such as visual memory, visualization, visual-motor, figure ground (finding objects in busy background), discrimination (finding differences in similar objects), visual closure (finding objects in a busy background), and other “thinking activities” are beneficial practice for real world training. Towards the end of therapy, we hope to see positive changes inside and outside of the classroom based on their improved visual system.
During our journey through therapy, awareness and feedback from the patient is imperative. As therapists, we come across problem areas and spend extra time guiding the patients through their struggles so they can be successful. As the patient gains control, basic exercises can be loaded to be more challenging. At the same time, if something is too challenging, therapist can un-load the exercise. Knowing the struggles of the patient and the goals of all involved, set our expectations throughout the journey. All of the feedback from patients and parents helps mold their individual curriculum for the best experience they could have. When therapy is completed, we find many improvements in not only the patient goals, but often in seemingly unrelated parts of life that vision has affected.
For more information about our Vision Therapy Program please call 615-386-3036 to schedule a comprehensive vision exam.