Comprehensive Vision Examination
At InSight Vision Therapy, we take our time to understand the history of each patient related to their development, total-body health, and visual function. The examination will focus predominantly on how the eyes work together. So often, people with 20/20 vision believe they could not have a vision problem. This is simply not true. During the examination, you will play with toys, follow interesting targets with your eyes, grab 3-D objects (hopefully!), see double on purpose, and much more. In other words, the examination will be fun, interactive, and educational for everyone involved.
The following components are evaluated during a typical new patient evaluation:
- Visual acuity – how clearly can each eye see, and both eyes together
- Eye tracking – the ability to move the eyes accurately, independent of head movement
- Fixations – the ability to hold eyes steady
- Pursuits – the ability to slowly track an object
- Saccades – the ability to quickly jump the eyes between objects, used in reading
- Focusing – the ability to make objects clear near and far
- Eye teaming – the ability to point the eyes together at the correct place in space
- Depth perception – the ability to see objects in 3-D
- Glasses prescription evaluation – looking specifically at improving the brain’s ability to use both eyes together
- Pupil assessment – evaluating the neurological system through the pupils
- Eye health evaluation – may include dilation, as needed
- Eye pressure testing – without the air puff!
Strabismus / Amblyopia Assessment
Strabismus (eye turn) and Amblyopia (poor vision in one eye) are disorders of eye teaming, resulting in reduced depth perception. To see properly in 3-D, our eyes need to be aiming at the same place at the same time. In addition, the vision in both eyes needs to be approximately the same for proper depth perception.
A strabismus/amblyopia evaluation may include the following components, in addition to the comprehensive eye examination elements listed above:
- Eye alignment – measuring eye tracking and turn of the eyes in different positions of gaze, near and far.
- Binocular vision – in-depth assessment of eye teaming utilizing red-green and polarized 3-D glasses.
- Glasses prescription – determination of the prescription that gives the brain the best opportunity to use both eyes together.
The results from these testing will help to determine the best treatment options, whether it is prescription glasses or contact lenses, prism lenses, vision therapy and/or eye-muscle surgery.
Read Dr. Carter’s article about current treatments for amblyopia, which do NOT involve patching!
Neuro-Optometric Evaluation
Many patients experience visual problems following brain injury (concussion, injury, stroke, etc). Symptoms such as difficulty focusing, light sensitivity, balance problems, dizziness, and difficulty reading may be tied to visual system deficits.
A neuro-visual starts with a thorough history of the trauma, including previous testing and treatments, and a Brain Injury Visual Symptoms Survey. Take your survey here.
A neuro-visual may include the following components, in addition to the comprehensive eye examination elements listed above. This may be scheduled as a separate appointment, depending on the patient’s fatigue level following the basic testing.
- Visual motion sensitivity testing – patients feel dizzy if the eyes move at a different speed than the head. Lenses or partial occlusion may be utilized to improve this communication.
- Balance assessment – an eye-brain misconnection may cause the patient to lean or fall over to one side. Lenses and prisms may be utilized to restore the patient’s balance.
- Lens assessment – this may include distance, near, and computer testing. Distance evaluation may involve walking in the hallway or observing traffic outdoors. Specific lenses, prisms, or partial occlusion may significantly improve symptoms. Learn more here.
- Light Therapy (aka photobiomodulation) – using specific colors, or wavelengths, of light through the visual system to change how the eyes and brain work together. Learn more here.
- Functional visual field evaluation – after a trauma, the brain often reduces the amount of visual information it processes, causing tunnel vision. A functional visual field checks for these (temporary, stress-related) field changes.
Visual Information Processing Evaluation
Visual perception occurs throughout the brain. To better understand a patient’s visual system, a set of standardized tests is used to evaluate his or her ability to process visual information. Below are the various aspects of vision that may be evaluated. Since vision is a learned process, these areas can be improved through vision therapy. Learn more about the conditions we treat.
This evaluation takes up to two hours and is scheduled as a separate appointment. The following areas may be assessed:
- Visualization – the ability to form a mental image and manipulate details in one’s mind. This is important in reading comprehension and math.
- Visual–Motor Integration – evaluates the ability to match motor output with visual input. It is crucial for handwriting accuracy and efficiency, as well as eye-hand coordination in sports.
- Visual Sequential Memory – the ability to remember objects or words in the sequence they appear. A deficit in this area may result in poor spelling, difficulty copying from the board, or poor recall of recently-seen words.
- Visual Discrimination – the ability to differentiate between two similar-looking objects, shapes, or words, such as ‘horse’ and ‘house.’
- Visual Closure – the ability to have part of the information and infer the rest. This is an important skill in reading speed and math.
- Spatial Relations – the ability to perceive the position of two or more objects in relation to each other and in relation to oneself. This is an important skill in problem-solving, high-level math, and proper spacing between words when writing a sentence.
- Spatial Orientation – required in understanding and recognizing the direction of objects. A deficit in this area leads to letter (b, d, p, q) and number (6 vs. 9) reversals.
- Laterality – the understanding of rights and lefts on the patient and in space. This is the precursor to proper eye tracking and writing ability, and this skill is essential for following navigation instructions while driving.
- Directionality – understanding the proper orientation of letters and numbers. Difficulty with directionality leads to reversals and confusion of letters like b/d.
A consultation appointment will be scheduled following this evaluation to discuss the results and treatment options.
Optics Tracker Assessment
Our office has computerized eye tracking software, which can evaluate the accuracy of eye movements. This can help our office to monitor progress through treatment.
- Fixation: the ability to aim the eyes accurately and hold them steady.
- Smooth pursuits: the ability to follow a slow-moving object horizontally, vertically, and around in a circle. This type of eye movement is used in driving, writing, and sports.
- Saccades: the ability to “jump” the eyes between two targets, horizontally and vertically. This is the type of eye movement we use when we read.
An example of the Optics Tracker assessment is below:
Example: Initial Optics Tracker Assessment (before therapy)
Example: Optics Tracker Assessment (after 10 sessions of Vision Therapy)
Reading assessment: Optics Tracker follows the eyes while the patient reads a developmentally-appropriate passage. The eyes should pause on a group of letters or words (fixate), then ‘jump’ to the next section of letters or words (saccade).
Efficient readers have fewer fixations, as they can perceive several words in a single glance. The software tracks the following:
- Fixations: number of times the eyes pause
- Regressions: number of times the eyes back-track to re-read
- Reading speed: number of words read per minute
- Comprehension: accuracy of understanding the passage