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David Shanahan Blog

News and updates from the world of optometry and opthalmology

Vision Therapy

Orthoptics is another term often used in conjunction with vision therapy. Orthoptics is one part of a specific vision therapy program directed at improving binocular alignment and visual acuity in individuals with strabismus (crossed eye) and amblyopia (lazy eye). 1

i) Vision Therapy for computer users

Look away now! It has probably taken you a few minutes to get to this page so it is theoretically time for a 'visual break'.

Experts agree that extended periods of concentrated close work can contribute to eyestrain. Eyestrain can cause short-term visual difficulties and may contribute to long-term deterioration specifically some types of myopia. Symptoms of eyestrain may be obvious such as blurred vision, headaches and also loss of concentration. If you find yourself drifting off or staring into space, it may be that your visual system is not efficient.

Many computer users report eyestrain symptoms but often consider the ergonomic factors of glare, posture and their monitor size etc before they consider their vision. In many cases glasses may assist computer users and in some cases vision training will allow the eyes to work at their peak efficiency. Improvements in how the eyes aim and focus together can lead to greater concentration and increased efficiency for near work.

ii) Vision Therapy for Children and for Learning Difficulties

Each child's development varies immensely and this goes for vision as well. Vision can be taught & learnt through appropriate structured vision therapy.

Unfortunately, like all skills and for various reasons, there is sometimes a delay in a child’s course of development of their visual skills. These delays can cause problems with a child's learning ability. In fact in some cases children are not visually ready to read until well after 5 or 6 years of age. 

Your child's vision may be clear enough but they may not have developed the appropriate visual skills for reading. When reading, it is necessary for a child to keep their place along a line of text (tracking skills) as well as keeping the page in focus at the same time (focusing skills). A child with tracking or focusing difficulties is therefore more likely to have difficulty with reading.

To read left to right also involves visual-spatial skills. It is important to understand that reading from left to right is actually a culturally and educationally imposed requirement. In many cultures, reading is vertically arranged or in some cases, is arranged from right to left. A child who has not understood the necessary aspects of this will most likely have difficulty learning to read and the level of demands on visual skills required for reading increases throughout a child's learning years. This means it is better to identify and treat these deficiencies as early as possible.  

Early readers require the following primary visual skills:

Tracking and Saccades: The ability to scan from letter to letter, word to word, looking ahead and predicting text and moving from one line to the next.

Visual Memory: The skills required for word recognition and copying tasks, for example in writing, spelling and reading.

Short Term Visual Memory: Recalling information presented quickly.

Sequencing: Recognising the order of number or letters in words. Left to right progression when reading and writing.

Visual Discrimination: Recognising subtle visual differences in letters (b/d) and words (was/saw or big/dig). Reversals are common in younger children, however if a child has persisting reversal issues a Behavioural Optometrist assessment should be considered to see if vision therapy can assist.

Focusing Skills: The ability to maintain clear focus at a particular point (a word on a page) and the ability to rapidly change focus from one point to another (copying from the board to the book).

Vision Therapy can assist, overcome or minimise some learning difficulties by reducing visual inefficiencies.

iii) Vision Therapy for sports

Commentators often describe a player's ability to accurately judge where other players or the goals are without looking, as 'great vision'.This ability has nothing to do with the player's 'clarity of vision'; it is about peripheral awareness and efficient visual function. Some people have these skills naturally, others need to learn to develop them.Vision training activities are a structured series of exercises designed to maximise the efficiency of specific visual skills required for all different types of sports.

Below are some examples of how vision therapy can assist your game:

Tennis: overhead shots require locating exactly where the ball is while looking upwards and aiming the eyes in this position; this is not a natural skill but it can be improved. Vision therapy can also assist your general ground strokes and eye-hand coordination is directly related to calculating the length of shots.
Cricket: Vision therapy may be utilised to increase visual efficiency of one or both eyes. Many players have found improvements in fielding (judging the flight of the ball). Some batsmen have also noted improvements in seeing the ball more clearly as it leaves the bowler’s hand.
Football: peripheral (side) vision awareness can be developed with sports vision therapy. Activities involve improving central visual skills and then coordinating these skills with peripheral awareness.

So if your sport involves vision (and let’s face it - most do) then consider a vision examination and talk to us about your specific sport and its visual requirements.
If you want to improve your sporting abilities, first try to improve your visual abilities!

iv) Vision Therapy for turned eye (strabismus)

Eye coordination difficulties may manifest as strabismus (turned/crossed eyes).
There are many types of strabismus. Some forms are best treated by vision therapy used in conjunction with spectacle aids and prisms. Others are best treated by surgical intervention. Strabismus is one of the most complicated visual adaptations that can occur in the human binocular system. It is not always simple to treat and treatment may be lengthy and require a number of different approaches.

Typically, vision therapy for such patients will progress through a series of activities such as monocular (using one eye) and bi-ocular (using both eyes) skills and then fusion (putting the images from both eyes together) and binocular (using both eyes together in all directions of gaze) skills.

v) Vision Therapy for Rehabilitation

One of the most common complications secondary to a head injury can be visual difficulties. These problems may be related to blurred or double vision but often headaches and eye coordination problems occur.

Fortunately, some visual functions recover within a few weeks or months of the injury but often residual problems including a loss in side vision can occur. Vision therapy is an effective tool in regaining control of eye position and eye co-ordination. This combined with the appropriate spectacle prescription can minimise the effect of a field loss.

Vision is responsible for providing much of the information we receive. If the quality of visual input has changed due to an injury, vision therapy can be employed with some patients to teach them how to optimise their visual skills.

This may enable the individual to be able to access communication devices or to move around more confidently without walking into objects like door frames etc.
Depending on the nature and severity of the injury, improving visual skills can lead to improved recovery and quality of life. 

1(Reproduced in part from the Journal of Australasian College of Behavioural Optometrists)

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