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Posted on 09-16-2013
Introduction to Vision Therapy
First a bit of housekeeping. Personally I prefer the label visual training, but vision therapy is apparently more familiar to the general public, and perhaps more official sounding. One reason I prefer visual training is the word visual. Visual is a descriptive word; vision is a noun, a thing. A noun is fairly fixed and rigid; descriptive words feel more flexible and action oriented. I also prefer visual because the work I do pertains to the visual process as opposed to vision. My biggest problem with the word vision is that it has a long history in common usage as an alternative for eyesight. Many people, most eye care professionals included, use the phrase “20/20 vision” when talking about how clearly someone sees, as in, “I have excellent vision – I don’t need to wear glasses,” or, “There is nothing wrong with your child’s vision – it is 20/20.” The formal definition of vision also equates it with eyesight.
The visual process is a dynamic and complex process that involves the mind, the body and the nervous system. The visual process develops throughout our lives as we grow and develop, and as the visual demands we face also change. Vision/eyesight is a very small, and actually fairly insignificant aspect of this complex process. Very few people suffer developmental delays and/or learning difficulties as a result of substandard eyesight – even if it is “uncorrected.” Countless people suffer development-related, learning-related and work-related challenges as a result of substandard visual abilities like poor eye teaming, poor eye movement/tracking skills and inefficient focusing. In any event, for the time being I will continue to use the phrase vision therapy because it remains more easily recognized by the general public.
Vision therapy means different things to different people. It even means different things to different behavioral optometrists. To behavioral optometrists it generally means a program of activities – either in or out of the office, or both – intended to help a person improve eye movements, eye teaming and focusing skills…at least. Some believe that computers are an integral part of the therapy process, some do not. Some believe that lenses are an integral part of the therapy process, some do not. General optometrists and ophthalmologists typically believe that vision therapy is not helpful – some believe this very strongly. They do not have any facts to back up these negative pronouncements, but they act like they do.
My practice of twenty-three years was built on the philosophies, concepts and practices of my early mentors – behavioral optometrists present at the infancy of the profession. My philosophy includes the importance of thinking developmentally, and understanding and making use of the significant influence of movement in the development, function and usage of the visual process. I also understand the importance of lenses to promote proper visual development, protect the visual process from the stress of modern visual demands and to prevent visual difficulties from ever occurring when prescribed and used in a timely manner. This gives a pretty good idea of the basis of my approach to vision therapy.
I became a vision therapy patient for the first time when I was in my thirties, in part because I wanted to know first-hand what it was like to go through a vision therapy program before I could feel comfortable asking other people to do it. I also had a feeling I had a long-undiagnosed visual problem – which turned out to be true. My time as a patient was spent working with a therapist (not the doctor) who had a program already planned out before I ever showed up. This vision therapy program was designed based on a particular diagnosis. There were other pre-planned programs designed for other diagnoses. The vision therapy program I did resulted in the elimination of the symptoms I came in with, and improved my visual function overall to some degree. This type of vision therapy program, which is quite common these days, does have its successes, but I found that it was just not the way I wanted to practice.
I also did some vision therapy with other doctors a few years later, mostly to see how these practitioners viewed and carried out vision therapy in their offices. All my therapy was done with the doctors in these practices. I decided I preferred being the one providing the therapy in my office and have done so throughout my years in practice. This is extremely uncommon these days. There are many very good therapists overseeing vision therapy programs everywhere, but I value my vision therapy so highly that I want to be directly involved with every patient as they navigate the vision therapy process.
What is Vision Therapy?
Vision therapy is a program of activities designed to teach and train to brain to use the eyes and the visual process more effectively and efficiently. Vision therapy for me is an active process. I want to engage the brain and the body – the whole person – with the visual process leading the way. The visual process it has been said is the result of a simple eye and a complex brain. In fact, the visual process does involve a large portion of the brain, not just the eyes. There is also a great deal of give-and-take from the body since the visual process is intimately involved in balance and movement at every level.
The primary purpose of the visual process is to direct action and the development of the visual process requires movement, as does the remediation process. There is excellent scientific research from outside of optometry to back this up. It stands to reason that vision therapy should include movement and action. Most visual difficulties involve delays or gaps in visual development unless we are dealing with post-concussive syndrome or traumatic brain injury. People suffering from acquired brain injury often benefit from vision therapy in any event. The vision therapy process needs to address the issue of movement to best help people fill in those gaps and move forward developmentally.
I believe that vision therapy should incorporate lenses and prisms. Most doctors see lenses as strictly compensating devices. Lenses are frequently used to improve the clarity of eyesight and/or the apparent alignment of the eyes when an eye turn is present. Lenses can do much more than that since they change the feedback to the brain. Behavioral optometrists can take advantage of this understanding and use lenses in more dynamic ways to promote improved output, which after all is the goal of any vision therapy program. Properly used, lenses can help reduce stress, improve coordination, depth perception and visual stamina.
I do not base my vision therapy program on a person’s diagnosis. In fact, I don’t have a program set up ahead of time for anyone. My vision therapy is based on the needs of each individual and the program follows the changing needs of the person as their visual system responds to the program. One reason I like being in the therapy room every day is the ability to change what I do with a particular person as needed.
I am not a proponent of using computers in vision therapy. The human visual process was not created with computers (or the persistent use of written material of any kind) in mind. Computers are a major cause of visual stress, visual fatigue and breakdown of the visual process for many people. I understand that computer-based therapy can be useful. However, there is little opportunity to observe the process while someone is engaged with a computer. I want to be able to see how a person is doing things, not just how they came out. Vision therapy is more about process than product. It is about changing the way a person does things, not about what things a person does. The computer program presents new activities, but does not provide the kind of immediate feedback that helps me guide that particular person ‘s progress like working with them directly does.
I prefer working directly with people, allowing them to use real movement to stimulate the development of better visual skills. This approach tends to create a broader type of improvement, which is likely to last for many years without need for further therapy in the vast majority of cases. In fact, it has been my experience that most people continue to show improvement in their level of visual ability long after finishing a vision therapy program.
To recap, vision therapy is at its best when the doctor is directly involved in the therapy, when there is plenty of movement incorporate into the vision therapy program and when lenses are not only used directly in the therapy, but also prescribed for use in specific everyday activities.
Next time: Closed Head Injury, Concussion and The Visual Process
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