Step Away From The Computer And Keep Your Eyes Where I Can See Them, Part 2
Computers and related devices are important in relation to the visual process. There is considerable evidence that prolonged, repeated use of these devices puts stress on the visual system. Some people handle the visual stress better than others. It is inevitable that we will be using this technology more and more. I imagine it is also inevitable that computers will continue to play a role in vision therapy designed to alleviate the symptoms caused by spending long periods of time at the computer. I’m just hoping to try to lay all the cards on the table where everyone can see them. Many people have complaints related to working at the computer, especially those recovering from concussions and other acquired brain injuries.
As I mentioned in Part 1 many of my colleagues use computers as at least part of their typical vision therapy and many have therapists carrying out their therapy sessions. My mentor and colleague, Dr. Barry Cohen is among those few who spend a great deal of time personally providing vision therapy. Dr. Cohen also has considerable experience working with brain injured patients, including those with concussions. He is not convinced that computers are the best approach for this population. Most brain injured people with whom I have worked report great difficulty sustaining the same level of performance on the computer that they commonly managed to before the injury. I agree with Dr. Cohen that testing people who have sustained concussions or more serious brain injuries on the computer and asking them to engage in ongoing therapy on the computer may not be a great idea. Dr. Cohen explained his thinking to another colleague who asked for his input:
The problem I have is that people with concussions should NOT be using a computer for rehabilitation vision therapy. It will ramp up their headache, and make them disoriented. I was quite unimpressed with the Impact Test, but it has become a standard test for concussion and for checking the progress/improvement of the patient with their concussion symptoms.
I really don’t like the idea of using computers, especially in the absence of real-space therapy for people recovering from concussion. What concussed people need is vision therapy that involves movement in real space, and therapy that is very gentle. Computer programs are very heavy handed, and if one listens to the concussed patient, he/she will almost always tell us that they can't watch TV or look at a computer. So what do some doctors do? They use computer vision therapy, and I believe it is the worst thing! I have a great deal of testimony from patients that have been given a computer vision therapy program, and it devastates them. They not only hate it, but they go looking for someone else.
The vision therapy process for traumatic brain injury is purposefully slow, and both doctor and patient need to take things easy. Little by little patients become better able to converge their eyes and do close work, like the computer, without pain, and are able to track better; they also become more able to use both eyes together in the distance. The last and most difficult thing to overcome is accommodation [focusing]. It hurts, and it is very difficult to start to focus their eyes again. I am extremely gentle with that. I always prescribe mild therapeutic near lenses to get them more comfortable and efficient looking at near. Many can't accept it at first, but I work with eye movements and eye teaming skills, and they start to learn how to handle the lenses better.
One important goal is to get rid of their headaches. This can be difficult, but I always keep in mind not to do what ramps up their headaches whenever possible. Vertigo is another big difficulty, and I am often able to lessen the degree of their vertigo. I start with lower amounts of yoked prisms on the walking rail, which is slightly raised off the floor, and often have to start with walking along a line on the floor instead of being off the ground.
This sort of approach seems to help without causing too much discomfort. I am very much against the use of computer as a training tool for these reasons. Hope this helps, and if you wish, please feel free to forward part of this email to others.
Feel free to continue this dialog with me, and ask questions, or throw in your two cents. It would be welcome. Hope you're doing well.
This pretty well sums up my thinking on this issue. I'm not saying that computers have no place in vision therapy. I'm just saying that their use holds little interest for the way I practice. In many ways it's not the equipment that matters as much as it is the thinking behind the way the equipment is being used. However, the fact that spending time on the computer is frequently one of the activities that creates stress on the visual system - even for those without complicated visual issues - makes me hesitant to incorporate computers into my vision therapy. As I have said before, the primary purpose of the visual process is to direct action. The primary purpose of the computer is to minimize action.
Next time: The Strange World of Progressive Addition Lenses