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Vision Therapy is for Adults, too!

“I have been cross-eyed since early infancy and had three surgeries as a child that made my eyes look more or less straight. However, I did not develop stereo vision until age 48 when I underwent optometric vision therapy under the guidance of a developmental optometrist.”

Sue Barry, PhD, author of Fixing my Gaze

Many people think that vision therapy is only for children. However, adults have as much need for this type of vision care as children. Vision therapy is effective for adults because they are often very motivated to improve their visual abilities by seeing the consequences of their visual problems.

When people have trouble using both eyes together or can’t focus for great lengths of time, they do not simply grow out of these problems. Children with visual problems often become adults with visual problems.

Adults will figure out many ways to compensate for their visual problems so that they can continue with any strenuous visual work they need to accomplish. Often, adults come home from work extremely tired when all they did was sit at a desk and do paperwork. Children, on the other hand, will tend to avoid tasks that are difficult or make them feel inadequate.

A developmental optometrist can help to reduce the strain of near work as well as work with any other kinds of visual problems. The proper lenses along with vision therapy make a tremendous difference in an adult’s ability to function at work or sports, just as with children of school age. Clinical results have shown that in-office vision therapy produces statistically significant improvement in vision symptoms for adults.

At our clinic, we have great success with adults at improving their visual comfort and also with adults recovering from visual deficits as a result of a brain injury.

School Days!

School Bus

School is in session! Many families have made their stop at the store to search of school supplies, but do you know the one “supply” that your child may be missing? An efficient visual system!

 

85% of everything learned in the classroom comes through visual pathways!

If we rely on the school eye screening or even a doctor’s wellness visit to catch vision issues we may be missing an important evaluation. These very basic exams often consist of nothing more than reading an eye chart with one eye covered, at a distance of 20 feet. This measurement only gives insight into one small part of the visual system. It doesn’t give information about how the eyes are working together such as how they move across the lines of a paragraph. Limited exam also misses how hard the eyes might be working at closer distances such as when reading, doing desk work or computer work. Since much of learning is done 20 inches from our eyes it’s important to make sure that all the visual pieces are in place.

There are many visual skills that your child will need for reading, writing and learning. Good eye teaming, the ability to smoothly track the eyes across the printed page, and the ability to change focus quickly name just a few. Once visual information is received by the brain, it then has to be quickly interpreted and remembered.

Deficits in the ability to team, track and focus can result in symptoms such as:

  • Difficulty reading – skipping words or lines, substituting words
  • Low reading comprehension
  • Poorly spaced or messy handwriting
  • Poor concentration and attention
  • Letter and number reversals

More severe symptoms may include:

  • Headaches
  • Double vision
  • Anxiety or angry outbursts or feelings of low self-esteem

Without the basic visual tools, a student may struggle academically. Homework is often a battle leaving both child and parents exhausted. Please discuss any classroom issues with your eye doctor.

 

Outside Summer Fun Activities

Outdoor play has immense importance in developing children. Not only has it been linked with less nearsightedness, but the benefit of exploring and interacting with the environment is essential to the brain being able to make sense of all of the sensory information that it is receiving at once. Of course, we also hope to eliminate the dreaded, “I am bored!” statements from our children!

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  1. Paint an old sheet to make lawn art.
  2. Make and hand homemade bird feeders.
  3. Have a read-a-thon outside in the shade or in a tent.
  4. Make homemade ice cream.
  5. Create obstacles to ride their bikes around.
  6. Play drip, drip, slash (similar to duck, duck, goose).
  7. Sidewalk chalk games (use a spray bottle to spray the letters, or spray their shadow).
  8. Play bullseye with a sponge (create a bull’s eye with points using chalk then throw the sponge).
  9. Wrap a piece of masking tape around each child’s wrist with the sticky side facing out. Go on a “Nature Walk” and collect items from nature (leaves, grass, small rocks, flowers, etc) and stick them on your masking tape “bracelet”. Come home and compare bracelets.
  10. Plant a garden and leave the kids in charge of watering, weeding and harvesting.
  11. Make a water balloon piñata.
  12. Make mix and match painted rock faces.
  13. Play angry birds with water balloons (draw the birds with chalk then fire away).
  14. Relay races (egg on spoon, 3 legged race, and wheelbarrow).

Start with these then use Pinterest or google to help drive your creativity! Have fun outside!

Sensory Processing and Sensory Processing Disorders (SPD)

sensory

A basic explanation of “sensory processing” (also referred to as “sensory integration”) is this — the brain’s ability to understand sensory information coming from all parts of the body in order to be able to use it. The human body takes in sensory input from several different sensory systems. The brain then organizes the information for functional use, and then sends out signals to the rest of the body to activate the appropriate motor, behavior, or emotional responses. In individuals with intact sensory processing, this happens automatically, unconsciously, and nearly instantaneously. A simple example would be when you go to pick up a cup or open a door you think is light (but is actually heavy), you automatically, unconsciously, and nearly instantaneously increase the amount of force you are using in order to actually pick it up or open it.

Sensory systems that provide the brain with information include the following:

Vision: it’s more than just about being able to see clearly. Vision is our dominant sense. Vision engages much of the brain. So training your vision is training your brain, not your eyeballs. Vision is the process of deriving meaning from what is seen. It is a complex, learned and developed set of functions that involve a multitude of skills. About 80% of what we learn from the world around us is due to perception, learning, cognition and activities are mediated through vision. The ultimate purpose of the vision is then to act on what we see and respond to that either with our muscles or through cognitive response (understanding). Our visual system also helps us see what we need to see and filter out what we don’t need to focus on. Visual processing comes into play when tackling tasks such as looking for two matching socks in the laundry pile, scanning a lecture hall or classroom to find an empty seat, or completing a worksheet at school.

 

Vestibular: Sense of balance and motion, located in the middle ear. At the most basic level, the vestibular system is activated any time we move our head, but it is also continuously being activated by the downward force of gravity to give us a sense of where we are in space.

Proprioception: Sense of body awareness. Our body senses proprioception through messages sent from sensory receptors in our muscles and joints. The proprioceptive system is activated any time we push or pull on objects (such as closing or opening a car door), as well as any time the joints are compressed together or stretched apart (such as jumping up and down or hanging on monkey bars). This system helps us understand how much force we are using and whether we need to use more or less force in order to successfully complete the task, such as when coloring, cutting our food with a fork and knife, or opening a door. Proprioceptive input tends to have a calming and organizing effect on the body, particularly when feeling overstimulated or overwhelmed.

Tactile: Sense of touch, located in sensory receptors in our skin and mouth. Our tactile system has two main functions – to tell us when we’ve touched something (being able to “sense” it) and what it is we’ve touched (being able to “discriminate” its features, such as texture, size, shape, or temperature). Think about how, when you’re digging through your purse or pocket, you first sense that you’ve touched something and then, as you feel more closely, you are able to interpret (or discriminate) the properties of what it is you’ve touched without even having to look at it, whether it’s a certain coin, key, or pen. In addition to the two main functions (sensation and discrimination), the tactile system is responsible for processing light touch (such as when the cat walks by and grazes you with her tail) as well as deep touch (like with a firm handshake or a massage). Light touch tends to be alerting and, for some, alarming. However, deep touch (also called “deep pressure”) tends to be calming and organizing, especially when feeling overstimulated or overwhelmed.

Auditory: Sense of hearing but, again, it’s more than just being able to hear accurately. When we process auditory information, our brain has to be able to determine what sounds are important and what sounds can be “tuned out”. It also has to be able to locate where sounds are coming from (Are they in front of me? Behind me? To the side? Nearby? Far away?) and what they mean so we can act or react accordingly. The auditory system is a survival system, and when auditory processing is disordered, it can make people feel disoriented, disorganized, and overwhelmed.

Olfactory: Sense of smell, influences sense of taste, and is the only sense that is directly tied to the part of the brain responsible for emotional memories (think of the emotions you feel when you smell a familiar smell, whether a positive one like grandma’s cookies baking in the oven, or a negative one like the smell of cologne/perfume that a previous boyfriend/girlfriend used to wear).

Gustatory: Sense of taste, responsible for detecting all the different flavors that come in the mouth.

One of the simplest ways to describe this is to say that, with SPD, the body can respond to sensory input in one of three ways. It can under-respond to sensory input, over-respond to sensory input or seek/crave sensory input. Therapy can help the brain interpret sensory information and put it together with the other senses for accurate responses for the body. Talk with your pediatrician regarding any general concerns and talk to your eye doctor for any vision related concerns.

 

 

 

 

A Functional Vision Problem Can’t Be Detected by Typical Vision Screening

1 in 4 children has an undetected vision problem that affects their ability to learn. They’re “undetected” because typical school vision screenings only screen for acuity, or seeing clearly. They don’t test such skills as eye teaming, tracking, focusing and visualization.

drandchild

How does Vision Therapy work? Using optical devices, patients engage in activities that help the visual system correctly process the visual information that the brain receives from the eyes. A person will practice these activities at home for approximately 20 minutes a day, 4-5 days a week. These activities at home are combined with weekly office visits, and a typical program lasts 6-9 months. After that, the functional vision problem should be corrected.

When functional vision problems resolve, the child experiences improvements in speed of reading, hand-eye coordination, reading comprehension and many other skills led by the visual system.

 

Syntonics: Optometric Phototherapy

Syntonics or optometric phototherapy is a branch of ocular science that deals with selected light frequencies viewed through your eyes. It has been used in optometry for over 70 years to treat a variety of visual dysfunctions. These dysfunctions include strabismus, amblyopia, convergence problems, vision-related learning disorders, and traumatic brain injuries.

SyntonicsStars

Syntonics improves vision problems by balancing the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is stimulated by the yellow, orange and red ends of the spectrum and the parasympathetic is stimulated by blue, indigo and violet end. Green will stimulate both systems equally.

Visual dysfunctions can be related to difficulty in the brain processing what information that the eyes are bringing in. The theory behind Syntonics is that by applying certain frequencies of light through the eyes, one can restore balance within the brain and directly affect the source of certain visual dysfunctions. Vision therapy is often used after the light therapy to strengthen individual visual skills that may be dysfunctional.

Before, during and after syntonic therapy the pupils and functional visual fields are tested, along with symptoms, to determine the effectiveness of therapy. Therapy can be done in the office or with a portable system that is given for home use.

What is “Myopia Control?”

myopia diagramMyopia or nearsightedness is a refractive condition where the light entering the back of the eye is focused in front of the retina. When this happens, targets seen at a distance (across the room) appear blurred. Treatment includes minus lenses or contact lenses to shift the focus of the light back towards the retina. When this happens, clarity is improved. Of great consideration is the fact that a lot of school age children progress yearly or even quicker in the power that is needed to keep the world clear. Much thought and research is taking place to see how this progression can be slowed or stopped. Myopic eyes are more susceptible to eye disease, so there are benefits to slowing the progression other than having thinner spectacle lenses.

There are no shortage of theories on the mechanisms of myopia development and progression. Infant development, genetics, near work, time indoors, artificial lighting, diet; all these factors have been investigated as potential causes of/correlates to myopia.

The rapid increase in prevalence alone answers the nature vs. nurture question. Myopia genes didn’t suddenly come out of hiding and turn half the population into myopes. We do know that myopic parents have children who are more susceptible to becoming myopic.

Another fact is there isn’t “one flavor” of myopia, and this is why we don’t have one simple answer that fits all children. Fortunately, there are a number of strategies you can take advantage of to help slow her progression without knowing exact mechanism you’re acting on.

Below are treatments that should be considered:

  1. Ortho-K or corneal refractive therapy: These are contact lenses worn during the night to re-shape the front surface of the eye.
  2. Bifocal contact lenses
  3. Bifocal spectacles
  4. Atropine drops
  5. Active vision therapy

Each treatment has pro’s or con’s and should be discussed in depth with an eye care provided experienced in myopia control.

Vision Therapy Myths

  1. Vision therapy is too expensive.
    1. Like all services, each family needs to decide if whatever service provided is worth the cost of their time and money. Tutoring can be a much “needed” service, but if the problem with learning is due to a deficit in a visual skill, tutoring is not the most effective service to correct the problem. Our office thoroughly discusses the patient’s goals to make sure they can be accomplished before therapy is started. Progress is monitored throughout the therapy.
  1. Glasses will fix my vision problem.
    1. Glasses can be a good start to improving binocularity. Some visual skills, such as eye movements (pursuits and saccades) are not significantly affected by glasses. In therapy, the brain is taught to coordinate the eye movements more accurately and to make sense of the visual information received by the brain.
  1. I am doing vision therapy with school or during occupational therapy.
    1. Occupational therapists can provide many benefits to a patient who needs vision therapy. The important thing to remember is what specific visual deficit that is being corrected. Many visual problems require the use of lenses or prisms in therapy and this cannot be done in occupational therapy.
  1. Only surgery can correct misaligned eyes and my medical Doctor agrees.
    1. In most cases, the efficiency of surgery is based not on one, but multiple surgeries to correct the misalignment of eyes. Even then, effective surgery only refers to the cosmetic appearance of the eyes, not how they function together. Patients who are post-surgical can benefit from vision therapy to improve binocularity and visual comfort. According to Dr. Benjamin Winters, OD, FCOVD, “even if the eyes are aligned surgically, the brain has to learn how to overcome adaptations in order to put those two images together into something meaningful.”
  1. Research does not prove vision therapy is successful.
    1. If you’re looking for the research and results behind the success of Vision Therapy please visit:http://www.visiontherapy.org/vision-therapy/vision-therapy-studies.html or http://www.covd.org/?page=Research

People of all ages can be candidates for vision therapy. Email us the rumors that you have heard and we are happy to discuss them with you!

 

 

 

 

 

 

 

 

How can light affect me and my family??

Are you one of those individuals that feel jittery, fragmented or irritable under certain lighting? In sensitive individuals, certain lights can trigger nervous system events like migraines, tics, or seizures. Some people simply feel uncomfortable.

This discomfort could be due to fluorescent bulb (tubes or CFLs) emitting a “flicker.” Or is it something about the light quality itself that irritates brain cells, either by electrical excitability or by a general physiological stress (fight or flight) response—or both. Examples of stress response is reduced heart rate variability, raised blood pressure, increased skin conductance, stronger startle response, reduced drop in body temperature during sleep, increased cortisol hormone, and reduced slow wave stage 4 (the deepest) sleep.

Numerous studies point to light quality, color temperature, or certain spectral patterns inducing a stress response. Interestingly, the effects are non-visual, meaning they are caused by light signals that hit the eye’s retina but that do not travel from the retina to the visual cortex (where we perceive images), but rather to the circadian pathways (regulating our sleep/wake cycle by reducing melatonoin, and influencing stress hormones, emotions, arousal levels, and muscle tension tone). Fluorescent light by nature emits blue and red “bursts” vs. the smooth and continuous full spectrum output of incandescent light. This makes fluorescent light more difficult for the eyes and brain to process. Thus, one hypothesis is that the spiked nature causes erratic pupil constriction, alternating between constriction with blue spectral spikes or bursts and relative dilation from red light bursts, which then agitates the brain. Based on this hypothesis, it could be the reason that children and adults with autism are more often sensitive to fluorescent lighting. Environmental factors in a holistic view of the functioning individual can often be overlooked. The healthiest light is sunlight or candlelight, followed by incandescent, then halogen, then LEDs, then CFLs. It would make sense to switch out all CFL’s in the home, work or school for incandescent or halogen bulbs, especially with symptoms in that specific lighting. Specific consideration should be given to children with psychiatric, neurological, learning, or chronic medical conditions.

Patching is in the past!

An article this year in ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY was published to update all eye care providers in advances in the treatment of binocular vision disorders.Untitled

Clinical research in neuroscience is advancing the understanding of brain plasticity at any age. We now know that it is never too late (assuming there is no eye or brain disease) to improve a patients binocular system to provide comfortable vision. Undatitled

Along with this, we have new therapeutic applications of patient-engaging vision-therapy computer-based programs including virtual reality (VR). In addition to the proper application of prescription lenses, prisms, and filters, using advanced methods of office-based vision therapy, including VR programs, can have a positive effect on patient outcomes in their vision rehabilitation treatment plan. This VR system can be used in the therapy clinic, at home or both settings.

The VR treatment includes several principles. The principle of engagement is used, meaning visual attention is required for the games (as it is in learning) and this increases the signal-to-noise ratio of visual representations within the cortex. Hand-eye coordination, use of peripheral vision and balancing the left and right eye input are also used in the VR customizable settings.