1. What is Vision Therapy?
Some people do not naturally develop the foundational skills needed for an efficient visual process, which hinders their abilities such as reading or focusing. Or some people lose their functional visual skills due to a head injury or concussion. It’s like not having the proper tools for the job. Imagine trying to build a house using only a hammer. In order to work effectively it’s necessary to have all the tools required for the job. Vision therapy helps people learn all the visual tools they need to function efficiently. This is done with special therapeutic glasses and/or exercises.
2. What is visual skill or functional vision?
Visual skill and functional vision refers to the neurovisual process of how the brain and eyes coordinate with each other to use the vision, to keep the two eyes focused and working as a team. Such as:
a) Tracking: ability to move the eyes smoothly to follow an object while at the same time think, talk, read, or listen without losing alignment of the eyes. This ability is used to do things like: follow a ball or person, guide a pencil while writing, read symbols on moving objects.
b) Fixation: ability to keep both eyes locked on target together and to efficiently shift gaze to different objects. This is a skill used to do things like: read words from left to right, add columns of numbers, read maps.
c) Focus Change/Near-Far Focus: ability to make vision clear instantly from far to close and easily look between different distances while at the same time look for meaning and obtain understanding from the symbols or objects seen. This ability is used to do things like: copy from the board at school, watch the road ahead while driving, scan around a room, or follow the play from end to end. This skill is also used while reading.
d) Binocularity: ability to coordinate the two eyes together as a cohesive team. This skill allows for accurate depth perception and interpretation of our environment. It prevents us from having double vision. It should work so well that there is no interference between the two eyes that can result in having to mentally block (suppress) the information from one eye. When binocularity is compromised it lowers understanding and performance speed, increases fatigue and distractibility, and shortens attention span. Proper teaming permits vision to emerge and learning to occur.
e) Convergence: In order to see singular and comfortably, the eyes must both converge on the same target. This becomes increasingly important to see close up for things like reading and computers because as the eyes look closer and closer they must converge more and more. When convergence is impaired it can cause double vision, and can also negatively impact neurocognitive ability.
f) Peripheral Vision (side vision):ability to see over a large area around you (in the periphery) while pointing the eyes straight ahead. This is used for monitoring and interpreting what’s going on around you while you are using your center vision for something else. This is critical for things like: locating where things are and directing attention and focus, for moving around in the environment, self-confidence, and efficient reading by knowing easily where words are on a page while reading, and to see what’s happening behind the play and better read the play.
g) Depth Perception: ability to accurately see three-dimensional space and judge relative distances of objects, allowing the ability to see in depth. This skill is important to reach and grab things to pick up, to play sports, to walk around without bumping into things, to drive and park a car.
h) Controlled Attention: ability to sustain and shift visual attention appropriately with ease and flexibility, without interfering with the performance of other skills. This is important to reduce distractibility and maintain visual focus. It’s also important to maintain visual awareness of surroundings without becoming hyper-focused on a specific activity.
i) Near Vision Focus: ability to see clearly within arms length. This is essential for all reading and writing tasks as well as any kind of close up work or activity. The eyes must be able to focus at near point without fatiguing for extended periods of time for reading. When this ability is reduced, people will often disengage from reading.
j) Visualization: ability to form mental images in your mind, either from a memory or a newly created idea, or from words on a page when reading. This is your “mind’s eye”, used to assist understanding and assists in reading comprehension. Also can be used to enhance performance in neurovisual training and sports vision training.
3. What does vision have to do with a concussion or head injury?
Post Trauma Vision Syndrome (PTVS) can result from a head injury or concussion.The visual process is neurological.Vision and coordination of our two eyes happens in the brain.When there is closed head trauma, the nerve cells in the brain can get disrupted that are responsible for coordinating the two eyes and for using and processing the vision.This is a neurological condition that manifests in the ocular and visual symptoms.
4. What is Post Trauma Vision Syndrome (PTVS)?
20% of people don’t recover from a concussion after 3 weeks without intervention. Post Trauma Vision Syndrome is a disruption of the visual process in the brain after an injury or trauma, resulting in problems seeing. Common symptoms of PTVS are: problems focusing, trouble reading, visual fatigue and overwhelm, poor balance, problems with perceived movement and motion. It can be caused by: acquired brain injury, concussion/mild traumatic brain injury, stroke, or whiplash. You don’t need a head injury to have a brain injury or concussion.
5. How can functional vision be impaired by a concussion or head injury?
After a concussion, the following visual skills can be negatively impacted:
focus change/near-far focus
near vision focus
6. What happens when visual skill or functional vision is reduced?
Depending on which visual skill or skills are affected there are a variety of different symptoms that can arise. This is a list of different possible symptoms that can be impacted from reduced visual function:
reduced concentration and attention
reduced side vision
7. Why isn't 20/20 vision enough?
20/20 only refers to eyesight. This only describes the limit of how small detail someone can see. It measures whether or not someone can see as small detail as the average person, and it only applies to when the eyes are still and not moving. In real life, a person’s eyes are moving continually. There are over a dozen different skills that the eyes and brain need to coordinate to keep the eyes focused throughout the day and coordinate the eyes and vision with the rest of the body.
8. How does vision therapy work?
Vision therapy works through neuroplasticity; your brain’s ability to grow and change. Since vision is a learned process that develops in your brain at infancy along with your primitive reflexes and sensory-motor systems, our vision therapy program involves this necessary motor and reflex work to build the foundations for visual skill to emerge. Therapy procedures can involve whole body physical exercises, eye-hand activities, visual perception and awareness, peripheral vision and eye muscle control activities. Therapy works by arranging visual conditions and activities such that the task is novel but related to a visual skill used in daily life. We make changes in the brain through the visual process and the visual process then improves. As the visual process improves, we see changes in the affected behavior accordingly.
9. Will my child outgrow this?
One does not outgrow a neurovisual skill dysfunction on their own. This is because in daily life you use your vision the same way everyday, so the brain will continue to use the same inefficient path. Someone may find new and inventive ways of compensating which will not serve them long term or give them the efficiency they could be capable of.
10. What's the evidence?
The Convergence Insufficiency Treatment Trial (CITT) a level one study, validates the effectiveness of Optometric Vision Therapy for treating convergence insufficiency.
Studies show when visual skill is enhanced through vision therapy, learning is easier, reading levels rise and, in some cases, IQ scores can increase.
Many of the visual signs and symptoms associated with concussion are linked to a dysfunction of the oculo-vergence system. The incidence of vergence dysfunction following head injury is 38-59%. Optometric Vision Therapy has been demonstrated to improve patient’s signs and symptoms significantly, and has become the preferred method of treatment for visual disorders following TBI. Recently the Ontario Neurotrauma Foundation released Guidelines for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms (Adults). Within this guideline, it is recommended that patients with persistent visual symptoms resulting from head injury undergo vision therapy for treatment.
Please see our resources section for a complete list of references to the scientific literature, as well as links to compilations of studies.
11. What's the success rate for kids with reading and academic concerns?
Studies show that success in vision therapy depends on an appropriate program prescribed by the Optometrist and on an individual person’s cooperation, participation and motivation.
At NeuroVision we have the following benchmarks for success:
95% report an improvement in reading or academics
12. What is the success rate for post concussion and TBI recovery?
At NeuroVision we have the following benchmarks for success:
97% report an improvement in symptoms
13. How do Optometrists become qualified in Vision Therapy?
Optometrist providing Vision Therapy services spend years in continued post-graduate education to further their knowledge in vision development, as well as visual function, visual skill, and visual rehabilitation. We study how to further assess visual processing, visual perception and master the complex visual programs prescribed to enhance visual skill and performance.
14. How does our NeuroVision evaluation differ from a routine eye exam?
We offer different types of evaluations for different conditions, such as: Vision and Learning, Concussion/TBI, Strabismus/Amblyopia, Visual Skill. These are in depth appointments to assess how the brain and the eyes are cooperating, including assessing over a dozen ways the two eyes need to coordinate with each other. We also evaluate how the brain is interpreting the visual information, the impact that this is having on your life, how to rehabilitate the system, and how to accommodate for deficiencies. Depending on the type of assessment needed it can range from 1.5 hours to 5 hours spread over several days. Routine eye exams are necessary to monitor the health of your eyes, assess your eye muscles, and determine changes in eyesight or refractive error (nearsightedness, farsightedness, astigmatism).
15. Is this due to an eye muscle problem?
Our doctors assess the status of all your eye muscles. Sometimes there is an actual physical muscle problem, however, usually this is not the case. Most often the muscles all have sufficient strength and range of motion to move the eye ball where it is supposed to go. When all the muscles are in tact and capable of doing their job, and the two eyes still aren’t moving together properly, then it’s a brain problem. The brain doesn’t know how to steer each eye to coordinate with each other. It’s like trying to drive a car with a separate steering wheel for each tire.
16. What does it cost?
The cost of an evaluation varies depending on the type of evaluation and how many appointments are needed. An evaluation can range from $300 to $2000. The type of evaluation you need is determined at your time of booking.
17. How long does it take?
Every brain and every person is different. Each person will progress at their own rate, however, on average our NeuroVision program for Vision and Learning is 48 weeks. For our Concussion and TBI population, 90% are in Vision Therapy between 24 to 48 weeks, and 10% are longer than 1 year.
18. Can’t I do this at home myself?
The Convergence Insufficiency Treatment Trial (CITT) concluded that home vision therapy was not effective. In order to be successful in vision therapy it requires a doctor to oversee the program and prescribe the appropriate exercises, as well as regular instruction and monitoring by a vision therapist who is highly trained in vision development and rehabilitation. It takes an in depth knowledge of how the visual system works as well as in depth knowledge of how to use the techniques and tools we use in vision therapy. You need a therapist to teach you the exercises, how to use the various tools, and also a therapist is needed to modify and customize the exercises for each person so that they will benefit appropriately. Not every exercise is right for every person, and different people need to have the exercises individualized to get the brain into higher level learning.