Vision Therapy / Neuro-Optometric Rehabilitation

What is Vision Therapy?

Vision Therapy (VT for short) helps to build the eye-brain-body connection in patients with binocular vision dysfunction or visual-perceptual challenges.

Who needs Vision Therapy?

• Patients of any age with eye-teaming problems, such as strabismus (eye turn), amblyopia (“lazy” eye), or binocular vision dysfunction (BVD)
• Children who struggle with learning, such as difficulty with reading, writing, spelling, or attention. This is often seen with developmental delays, eye-teaming disorders (strabismus, amblyopia), underlying neurological conditions, or sensory processing challenges.
• Patients of any age who have suffered neurological damage affecting visual processing ability. This includes head trauma (TBI), concussion, stroke, or progressive neurological conditions.
• Adults with decompensation of visual skills (double vision, headaches, eye strain with computer use)
• Athletes with a desire to enhance visual function

How does it work?

We do this through the following methods:

• Awareness & Monitoring – Learn what the eyes and body are doing.
  • We use open-ended questions to guide the patient’s awareness
• Correction – Understand how we can use our eyes more accurately and efficiently
• Reinforcement – Practice new skills so they become the new normal
• Loading – Combine visual skills with other sensory systems, like auditory, speech, motor or cognitive processing. This helps to integrate the visual skills. Examples include:
  • Reading letters on a chart to the beat of a metronome
  • Remembering a sequence of blocks while reciting the alphabet
  • Tapping a hanging ball, saying a color on each tap
  • Walking on a balance beam wearing prism glasses
• Application – Apply this new way of using the eyes, brain, and body in real life: school, work, athletics, or simply watching a 3D movie

What does a vision therapy session involve?

1. A vision therapy session is an hour long.
   1. For children, parents may be in the room if they desire.
   2. If the parent chooses not to be in the room, we request they return for the last 10 minutes of the appointment to review home therapy activities.
2. The first day of vision therapy helps to set the patient up for success by:
   1. Providing the necessary equipment for the vision therapy
   2. Documenting the patient’s goals for vision therapy
   3. Describing how home therapy integrates skills faster
   4. Reviewing the tips for success with home therapy
3. Each vision therapy session starts with a review of the previous week’s home therapy exercises.
   1. Did the activities improve from harder to easier throughout the week?
   2. Could the patient “level up” any of the activities?
4. A therapy session typically involves several different activities intended to change how the patient is using their eyes, brain and body. Our patients will THINK THROUGH…
   1. Movement
      1. To improve coordination, balance, self-awareness and correction
      2. To reduce visual overwhelm
   2. Near-far focusing
      1. To improve clearness & stamina of vision
      2. To reduce headaches and eye fatigue
   3. Eye tracking and eye-hand coordination
      1. To improve visual accuracy for reading, writing and sports
      2. To reduce mistakes when reading (skipping lines, losing place)
   4. Eye teaming and depth perception
      1. To straighten eyes, improve spatial judgement and stabilize vision
      2. To reduce eye fatigue and double vision
   5. Left-right concepts
      1. To improve eye tracking and writing
      2. To reduce letter and number reversals
   6. Visualization and visual memory
      1. To hold information more efficiently in long-term memory
      2. To improve recall of words, spelling, math facts, lists and schedules
      3. To reduce frustration
   7. Combining the senses
      1. When ready, we add sound, rhythm, movement, and thinking to the above activities, because real life can be busy, loud and stressful!
      2. To integrate the visual skills into real life!

Examples of Vision Therapy Activities

Our motto is simple: Start where the patient is successful and build the visual skills from there. For this reason, many activities appear easy, but they should still challenge the brain.

We have hundreds of activities! Here is one activity from each category:

1. Movement
   • Exploring Balance: Learning to use peripheral vision to improve balance
2. Near-far focusing
   • Near-Far Rock: Understanding what it feels like to “flex” the focus for near vision and “relax” for distance vision
3. Eye tracking and eye-hand coordination
   • Four Corner Fixation: Realizing how to accurately “jump” the eyes between targets; becoming aware of eye, head, and/or body movement
4. Eye teaming and depth perception
   • Vectograms: Using 3-D targets to improve the brain’s perception of where things are in space
5. Left-right concepts
   • bdpq Jumping: Solidifying the concept that the ‘bubble’ in each letter is always in the same place; ie: the bubble in a ‘b’ is on the bottom right
6. Visualization and visual memory
   • My Ape Is: Using mental imagery to change the appearance of an imaginary ape, then remembering its different outfits
7. Combining the senses
   • Hart chart: Calling letters on a chart to the beat of a metronome, then adding movement forward and back

What steps do I take?

1. Comprehensive visual evaluation. If you were referred by another doctor, Dr. Jo will review that information prior to the examination.
2. Visual Information Processing Evaluation
3. Consultation. This is a separate appointment to discuss the results of the evaluations and provide an estimated timeline for therapy.
4. Schedule the therapy sessions.
5. Mid-therapy evaluations. These are done about every 8-10 weeks to assess progress in both examination findings and real life. A detailed report is given after each evaluation.
6. Graduate! When goals are met, we celebrate! All vision therapy graduates put their handprint on the wall to commemorate their achievement.
7. Post-therapy evaluation. Three months after graduation, the patient returns for their final evaluation. After creating a “new normal” for our patients, they are typically the same or better than when they graduated!