Like any other therapy meant to rehabilitate a particular problem, vision therapy is one such branch of eye care that aids in rehabilitating an individual’s vision. Before delving into the topic of vision therapy, let us distinguish the term ‘Vision’ from ‘Visual Acuity’ because it is crucial to comprehend the significance of vision therapy.
What is Visual Acuity?
Visual Acuity is a term used to quantify the sense of vision. When you see a measurement like 6/6 or 20/20 in your report, it signifies that you can see things clearly to the maximum potential of your eyes at a measurable distance, meaning you can read even fine print at 6 meters or 20 feet away, which is considered the optical infinity for the human eye. Vision, on the other hand, encompasses a broader and more profound meaning compared to visual acuity. It goes beyond mere clarity at specific distances. Vision includes a spectrum of visual skills, such as contrast sensitivity, depth perception, color vision, focusing ability, peripheral awareness, and many other functions. A person may see everything clearly, but what if their depth perception is affected? What if their focusing ability is weak? What if they experience double vision? What if their eyes are healthy, but their neural processing is compromised? One of the treatment options for addressing these issues is Vision Therapy. It has been suggested that the effectiveness of vision therapy is enhanced when visual acuity is optimized to the best potential of the eyes. Therefore, although we are distinguishing between the two terms, they complement each other.”
What is Vision therapy?
Vision therapy is a term defined by optometrists, who are the primary healthcare practitioners primarily involved in providing vision therapy. Optometrists describe vision therapy as an effort to develop or enhance visual skills and abilities. This includes improving visual comfort, ease, binocular vision (how well both eyes work together), treating double vision, and addressing changes in visual processing and visual information. Typically, these therapies are administered and monitored in a clinical setting. However, certain innovative solutions available today allow patients to engage in therapy at home while regularly visiting their optometrist to track progress. The beauty of vision therapy lies in its customized approach for each patient. Even when two different patients share the same condition, the timeline for symptom improvement can vary, necessitating a patient-centered pace rather than a one-size-fits-all approach dictated by the practitioner.
Who can benefit from Vision Therapy? What conditions does vision therapy address?
Based on the previous discussion, one may have gathered that vision therapy involves a series of exercises aimed at improving specific visual skills. These exercises have defined goals established before the therapy begins. During this process, the optometrist sets realistic expectations for the extent of improvement in the targeted visual skill. It’s important to note that vision therapy does not promise to reverse visual impairments because that is not its intended purpose.
A vision therapy program can be tailored to address a variety of visual problems, ranging from enhancing focusing ability to rehabilitating patients who have experienced a stroke. However, some of the most common conditions treated in clinics include:
Amblyopia or Lazy Eye: Amblyopia occurs when the affected eye has poor visual acuity despite full spectacle/contact lens correction and the absence of any ocular pathology. Research has shown that lazy eye is primarily a neurological issue. Prolonged poor vision in one eye during critical developmental periods can lead to poorly formed neural connections, allowing the dominant eye to take over. Amblyopia vision therapy programs aim to retrain the affected eye to establish new neural connections through a phenomenon known as neuroplasticity.
Convergence Insufficiency: Convergence is the eye movement that occurs when an individual focuses on nearby objects. Both eyes should converge toward the nose to achieve clear focus on close objects. However, sometimes eye coordination is lacking, leading to insufficient convergence. Patients with this condition may experience eye strain, headaches, difficulty focusing on close tasks, and occasionally, blurry near vision. Optometric vision therapy can help train the eye muscles to coordinate properly and focus effectively.
Eye-Hand Coordination: This aspect is crucial in sports and falls under the category of sports vision therapy. Sports vision therapy is designed to enhance sports performance, particularly in dynamic sports like cricket, football, tennis, and others. The therapy serves a dual purpose: improving visual efficiency skills, such as binocular functions, and enhancing complex functions that enable individuals to use both eyes effectively for better sports performance.
Neurological Disorders: Neuro-optometric vision therapy is an emerging subspecialty within optometric vision therapy that aims to rehabilitate patients with visual deficits stemming from physical disabilities, traumatic brain injuries, or neurological insults. Neuro-optometric therapy addresses a range of conditions, including intermittent exotropia (squints), diplopia, binocular vision dysfunction, convergence paralysis/paresis, visual perception issues, and cognitive deficits. Typically, neuro-optometric therapy is administered in conjunction with physical therapy, as visual development depends on the overall health of the patient.
The Role of Vision Therapists
Vision therapists are generally an advanced trained optometrist who diagnoses, treats and provides personalized therapy for the patients depending upon the condition and patient needs. Some key aspects of vision therapists are mentioned below:
1. Assessing visual problem: Vision therapists begin their work by comprehensive eye exam and some more ancillary tests that may help them diagnose a binocular vision anomaly. These tests are important to design the program of vision therapy.
Customized treatment plans: Once the vision therapist has diagnosed your condition, the vision therapist will design your treatment plan. Sometimes they have to collaborate with other healthcare professionals like physiotherapist, occupational therapist, speech therapist to rehabilitate the patients to their full potential.
Vision therapy exercises: These eye exercises are specialized activities with scientific evidence that are performed to improve the aspect of binocular vision that is affected. These exercises are generally performed in the office under the guidance of vision therapists. Some exercises can be performed at home at a patient’s pace. Generally, severe the condition, more number of monitored sessions required.
Patient Education: Certain times, patients may get confused between good visual acuity and vision and perhaps be not aware of their binocular visual functions. So, they help patients understand the condition as well as the therapy prescribed. These aspects are important to make sure there is compliance in performing the therapy.
Enhancing quality of life: Any visual problems affect that particular individual’s overall well being, thus, the ultimate goal of vision therapy is to improve the quality of life and improve performance in school, if children have binocular vision anomalies. This in turn also improves their complaints of eye fatigue, eye strain, etc.
Vision Therapy Techniques and Approaches
Vision therapy techniques and approaches can vary depending on an individual’s condition and goals for therapy. Each patient’s goals are collectively established by the patient and the therapist before therapy begins to ensure accurate expectations. Although the specific approach may differ, they all share a common foundation of scientific principles. Here are some elaborated techniques and approaches:
Eye Exercises and Activities: Vision therapy comprises a series of eye exercises involving various activities and tasks. These exercises require individuals to focus on different objects at both near and far distances. Over the course of therapy, specific lenses may be introduced to increase the difficulty of these tasks.
Prisms: Many binocular vision issues can cause double vision without an apparent squint. To address this, specialized lenses with prisms are used. Prisms are optical devices that shift the image of an object so that it falls on the intended part of the retina, allowing the patient to see a single object. These therapeutic lenses promote binocular vision. Your optometrist may prescribe prism therapy in conjunction with other treatments to improve eye teaming and address binocular vision anomalies.
Visual Therapy Devices: Various vision therapy devices are available, such as the “Brock String,” a 10-meter-long string with attached colored beads, which is used to work on convergence and divergence of the eyes. The “Hart Chart” is employed to enhance focusing speed at different distances. Many other devices serve diverse purposes.
Patching/Occlusion: This treatment is the first choice for amblyopia or lazy eye. It involves patching the good eye, forcing the lazy eye to work and thereby improving visual acuity.
Computer-Based Therapy: Technological advancements, including the COVID-19 pandemic, have prompted the incorporation of telemedicine into vision therapy. Many office-based vision therapy programs have transitioned to home-based therapy. One innovative example is Revital Vision therapy, which allows therapy to be conducted in the comfort of one’s home. Therapists can monitor patients’ progress remotely, ensuring compliance. At regular intervals, patients are called for follow-ups, and the data collected is used to adjust the therapy’s difficulty level using specialized software algorithms.
Behavioral Vision Therapy: There is now substantial evidence linking vision and overall personality development. Behavioral optometry explores how a child’s behavior is influenced by their vision. Vision can significantly impact a child’s academic performance, ultimately affecting their overall quality of life. Therefore, specific therapy programs are designed to enhance functionality in daily life.
Visuo-Motor Integration: Various forms of vision therapy focus on connecting visual processing with motor tasks, such as playing sports and maintaining balance. Poor hand-eye coordination can negatively impact an athlete’s performance. Thus, the goal of vision therapy is to improve visual processing skills and, in turn, enhance eye-hand coordination.
Process of Vision Therapy
Importance of Vision Therapy in Pediatric Care
Early Detection and Intervention: Vision problems in children often go unnoticed and undiagnosed because they are too young to communicate their symptoms. Therefore, routine comprehensive eye exams can help detect these problems early and initiate treatment to prevent complications.
Academic Success: Vision therapy in children enhances their overall functioning, leading to improved academic performance. Managing conditions such as amblyopia, strabismus (squint), convergence insufficiency, and others contributes to academic success and boosts self-esteem.
Improved Concentration and Attention: Children with binocular vision problems often experience attention deficit symptoms and struggle to concentrate on tasks that require focus, such as studying. Numerous scientific studies have demonstrated that vision therapy training procedures help children focus better during their studies. Additionally, it enhances their visualization skills, enabling them to imagine themselves performing better, further supporting their academic success.
What does a vision therapy session at Eye Solutions entail?
We offer a computer-based vision therapy session called Revital Vision, which is the only FDA-approved, software-based vision therapy for treating lazy eyes, not only in children but also in adults. Refer to the following picture, which illustrates a “Gabor patch”—basically a grating with dark and white bands that are blurred out. The patient patches the sound eye and performs the therapy with the affected eye from 1.5 meters away from the screen. These Gabor patches are displayed to the patient, who is then asked to either select the darker patch among the two presentations, choose the presentation in which they see three patches, or opt for the presentation in which the middle patch is shifted either to the left or right. The patient provides responses using a wireless mouse. The total duration of therapy is 45-50 minutes and varies based on the severity of the condition.
Eye Solutions is an authorized ophthalmology practice that prescribes and provides Revital Vision therapy licenses. You can find further details about Revital Vision at Eye Solutions here: https://www.eyesolutions.in/revital-vision/
Choosing the Right Vision Therapist:
Selecting the right vision therapist is a crucial aspect of successful treatment. Their approach and techniques can significantly impact the outcome. Consider the following points when choosing a vision therapist:
Credentials and Training
Experience and Specialization
Referrals and Recommendations
Reviews and Testimonials
Communication and Progress Updates
Comfort and Trust
Frequently Asked Questions
1. What activities are involved in vision therapy?
Vision therapy includes eye exercises, home-based activities, prism prescriptions, computer-based vision therapy like Revital Vision, visuo-motor integration skills, and visual information processing skills.
2. Is vision therapy actually effective?
Vision therapy exercises involve activities that have been developed and supported by extensive scientific evidence. Like any other therapeutic modality, vision therapy requires FDA approval, which means its effectiveness and efficacy are proven before it is implemented in practice.
3. At what age is vision therapy most suitable?
Generally, vision therapy requires the individual’s attention and a basic understanding of instructions. Sometimes, it even involves the use of computers. Therefore, vision therapy is typically suitable for individuals aged 7-8 years and older.
4. Who can experience benefits from vision therapy?
Vision therapy includes but is not limited to intermittent exotropia (squints), diplopia, binocular vision dysfunction, convergence paralysis/paresis, visual perception and cognitive deficits.
5. Is vision therapy helpful for adults?
Recent innovations like Revital Vision have received FDA approval for adult vision therapy.
6. How much time does it typically take for vision therapy to show results?
Vision therapy is a process, so patience is required to start seeing results. The duration of therapy can vary, with severe conditions often requiring a longer duration. Generally, it is recommended to undergo 6-8 weeks of therapy for optimal results.