Vision Therapy

Vision therapy is a term that describes a number of procedures that stimulate vision, and enhance visual skills that allow effortless, efficient vision. Many of these procedures have been with us since the late nineteenth and the early twentieth centuries. Some say vision therapy is like physiotherapy or occupational therapy for the eyes. Others may use the term eye exercises or vision training.

Vision is intimately connected to the senses of balance, touch, and proprioception, thus during vision therapy the patient must learn to use these senses harmoniously. The term sensory integration is used to describe how we use these senses together. Moreover, control of our muscles (motor control) including fine motor, gross motor, speech, and oculomotor (eye movement) must work together with all of the senses including vision.

During vision therapy we may use a balance board, lenses, pencil, ball, bean bag, as well as complex specialized equipment to help use our vision, including integration of vision with the other senses, and coordinate our senses with our movement.

Orthoptics is a specific form of vision therapy that enhances binocular vision. In other words, a series of procedures are used to encourage our two eyes to work as a team. This may be a simple matter of alternatively looking at a near and far target, looking at 3D pictures, or using specialized equipment such as our computerized orthopter that encourage the crossing and uncrossing of the eyes.

Patching the dominant eye to make the other eye "work" is done in many instances, especially in the case of amblyopia (lazy eye). The patch might be variations of the traditional pirate patch. The patch might be adhesive tape applied to the nasal portion of the lens otherwise known as a bi-nasal patch. The patch might be in the form of specific eye drops in one eye only that deliberately blur the dominant eye by dilating the pupil and relaxing the focusing mechanism. Recent studies show this can be an effective alternative with increased compliance over the traditional patch.

Syntonics or photolight therapy is a vision therapy procedure that is the application of selected wavelengths of light or colours to stimulate the eyes. The theory of syntonics is based on the premise that the sympathetic and parasympathetic branches of the autonomic nervous system are not synchronized and unbalanced in some people. Syntonic therapy begins to balance these two systems. In practice, peripheral vision is affected when these two systems are not in balance. This in turn causes difficulties with the other visual skills especially tracking, fixation, and binocularity.

The reasons for an unbalanced system can be due to toxicity (e.g. history of fevers, physical trauma, or psychological trauma). The specific patterns of peripheral vision loss are best determined using kinetic field tests. These patterns of peripheral field loss are not always easily interpreted on automated static field testers. The literature describes these as functional or hysterical field losses. For most cases, the term “hysterical” may be too strong, misleading or inaccurate. The functional field losses seem to be related to either hypo or hyper arousal of the sympathetic nervous system.

In-office therapy is often suggested due to the availability of specialized equipment, the course of treatment can be changed in progress, and compliance can be monitored closely. This can be done as little as 3 times per week, and as much as 10 times per week. If the latter intensive option is selected, the sessions are twice per day and 4 hours apart. Some people from out of town may choose to stay in a hotel or stay with friends to cut down travel time.

Home therapy is helpful when travel distances are great and there are time constraints. Home therapy is also useful when there is a history of good self-discipline in other activities. Two or three office progress evaluations are required to determine the effectiveness of treatment and to modify the program as needed. It is important that careful records are kept at home if home therapy is elected.

Home therapy consist of individual procedures that may required simple equipment such as a mirror, ball, bean bag, or pencils, instruments that can be rented out, or purchase of specialized computer programs that provide the appropriate stimulation. One example of at computer program is produced by HTS which can be found at: www.homevisiontherapy.com.

For more information about vision therapy in general, go to http://www.visiontherapy.org.