Visual Management of Binocular Vision Disorders Affecting
Attention Deficit Disorders, Sensory Processing Disorders and Reading/Learning Abilities
What Is Vision Therapy?
Vision therapy has a long history and evolving model for optometrists. Far more than just "fixing the eyes," vision therapy recognizes that vision is a function and extension of the brain, innervated through procedural learning and synaptic growth.
Our procedures, all specifically geared towards an individual's needs and goals are designed based on neuroplasticity. Selecting the appropriate task for each patient and presenting them in a developmental sequence, is both an art and science that requires knowledge of human development, physiology and the psychological needs of the individual.
When designing a patients therapy program, our providers consider the following questions:
-What is the demand of the task being presented to the patient? The task must be consistent with a patient's physical, developmental and visual abilities.
-Does the task have meaning to this particular patient? How will this procedure transfer and be meaningful in this patient's life?
-Can this task lead to a higher level of proficiency?
Who Benefits from Visual Management Therapy?
Even within the general population, vision deficits are surprisingly common. Some individuals can relate to mild reading (or re-reading), comprehension or writing issues, while others may sense a buildup of visual stress when focusing, driving, or even socializing with peers, family members or colleagues. Also included within this "normal" population are those who may suffer from headaches, migraines, motion sickness or vertigo. This is not to imply that everyone in the general population is in need of vision therapy, however, those who benefit most are usually individuals whose impairments are interfering with their everyday life.
Now, let’s consider special health or learning needs populations—including individuals with binocular vision disorders, like strabismus or amblyopia, or others with learning disabilities, developmental delays, autism and other neurodevelopmental conditions. The rate of visual problems is sizeably higher. Visual deficits, left untreated, impair the abilities of affected individuals, impacting their sense of body in space, the world around them, processing speed, as well as the ability to integrate visual stimulus with input from other sensory systems—all which are crucial skills to function physically, academically and emotionally.
Our experience tells us that incorporating yoked prism lenses with a visual management program typically results in rapid generalization of new and higher ordered skills, and leads to great automaticity of gains in performance and behavior.
Physical Manifestations of
□ Toe walking
□ Head tilts & Postural shifts
□ Motor planning delays
□ Low muscle tone
□ Hand-flapping, finger flicking
□ Grazes wall when walking
□ Bumps into objects or falls frequently
□ Trouble going up/down stairs
□ Teeth Grinding
□ Frequent stomach ailments
Visual processing, if developing normally should follow a sequential and/or orderly maturation, beginning in infancy and with toddlers. At this stage, vision and motor come together and the construction of our world begins. By the school aged years, developmental demands shift further into cognitive demands. If delays in the visual-motor system, perception or sensory integration are unresolved, consequences in learning, attention and maturation are to be expected.
Binocular vision disorders, including convergence insufficiency, amblyopia, strabismus, ocular-motor dysfunction, accommodative dysfunctions and double vision interfere with the unconscious abilities to organize the material one is visually presented with (such as following a line of print without having to reread it several times). Delays in visual performance often interfere with our conscious knowledge; including, comprehension, long or short term memory, decision making, creativity and problem solving. As a result, confidence in how one sees themselves, how they view their world and in turn, how they think and behave in it can strongly be impacted.
The role of visual management is to first, identify the degree of a visual processing disorder and secondly, to design a program utilizing performance enhancing lenses and procedures to reorganize visual efficiency. The goal is to return to a sequential and orderly maturation of reading, learning and cognition.
Our providers are comfortable examining and providing services to infants as young as six months old.
Visual, DEVELOPMENTAL & EDUCATIONAL Services for your entire family
Impact of Visual Delays on
Cognitive, Social & Emotional Dvlpmt.
□ Low visual memory
□Receptive processing delays
□ Expressive language delays
□ Low academic performance
□ Difficulty performing daily routines
□ Difficulty with close relationships
and recreational activities
□ Avoids interaction with other adults or children
□ Trouble maintaining eye contact.
□ Emotional outbursts
□ Commonly nervous/anxious
What's vision got to do with it?
Though physiology, emotions and cognition are best
thought of as separate functions, those in integrative
medicine and the cognitive neurosciences understand
well that these systems are interacting functions
mediated by separate, but interactive brain systems.
This model best explains certain health issues,
balance issues and affective, social-emotional
behaviors. The medical histories of patients suffering
from uncorrected visual and perceptual problems,
including severe anxiety often reveal childhood
symptoms, which evolved.
Disturbances in our visual processing system, can
begin in childhood or adolescence, and go on to trigger
physiological or emotional reactions before the brain
has even fully processed the stimulus.
This, in turn effects the individuals perceptions or feelings towards the object or person he or she is viewing. Some individuals become frustrated, anxious or even explosive, while others retract into themselves and seek isolation.
These disturbances in processing effect the total physiological organization of the person. Visually induced stress can create issues of headaches and migraines, motion sickness, frequent stomach ailments, trouble with eye contact or generalized or social anxiety.
As this further effects function, a person now starts asking themselves, "why can I no longer walk through a department store?" "why am I so anxious driving?" "why do I get migraines after every family affair I go to?" or even "why do I no longer want to go out and socialize?"
Of note, however, what is learned by experience, can be changed through new experiences, therefore visual management has been effective in treating adults with long standing, progressive perceptual concerns.
The role of visual management is to change the manifestation of these conditions. Procedures are designed starting with awareness of the visual impact of their symptoms, then moving the individual to a level of relaxed attention and perceptions and finally, establishing permanence.
Most individuals with neurodevelopmental disorders, including but not limited to autism, cerebral palsy or downs syndrome suffer from visual perceptual dysfunction. This is not to suggest that these
patients cannot "see" in the traditional sense of the word; many in fact demonstrate normal visual acuity, as measured by the standard eye chart test.
Visual processing involves far more than visual acuity, however-- it is the process of receiving, integrating and interpreting visual stimuli. A lack of integration between the visual and vestibular systems, or an inability to orient ones self in space and adapt to
changes in the visual environment are some examples of a visual perceptual dysfunction. Visual perceptual dysfunctions can produce symptoms of physiological and emotional distress, as well.
Common Symptoms of
Visually & Perceptually Related Disorders
□ Headaches and/or migraines
□ Sensitivity to light
□ Reduced attention or awareness of the environment and visual fields
□ Motion sickness or vertigo
□ Trouble with eye contact or social interactions
□ Eye turns or other involuntary eye movements, like quivers or twitches
□ Delays in timing and depth perception
□ Difficulty with night vision
□ Double or blurry vision
□ Early onset fatigue
□ Frequent nervousness or stomach ailments
□ TMJ or frequently clenched jaw
□ Anxiety, mood swings or depressive thoughts
□ Unstable balance
□ Poor posture and feelings of weakness
Visual Concerns Affecting
Health, Balance, Mood & Emotions
How Many of the Following Symptoms
Do You or Your Child Exhibit?
□ Short attention span/easily distracted
□ Avoids close up work
□ Can read but doesn’t
□ Low comprehension
□ Fails to complete assignments
□ Frustrated with school
□ Subvocalizes when reading
□ Loses place, skips line and uses finger to read
□ Re-reads words or entire paragraphs
□ Word or letter reversals
□ Poor copying abilities from chalkboard to desk
□ Reading at a close distance
□ Rapidly fatigues, in general
□ Uncontrollable movements/ticks of the body
□ Intermittent double vision
□ Eye strain
□ Rubbing eyes/Tearing
□ Light sensitivity
□ Blur of one eye in particular
□ Crossing of one or both eyes
□ Hiding, covering, squinting of one eye
□ Low visual memory
□ Receptive processing delays
□ Difficulty performing daily routines
□ Difficulty with close relationships
□ Difficulty with recreational activities
Visual Management of Concussion, Stroke
& Other Traumatic Brain Injuries
Traumatic Brain Injury Checklist
Most obvious symptoms
□ Loss of consciousness
□ Change in mental state
□ Dizziness or balance problems
□ Blurred sight/other cranial nerve problem
□ Loss of consciousness (seconds-minutes -hours)
□ No loss of consciousness, but in a daze
□ Nausea or vomiting
□ Fatigue or drowsiness
□ Difficulty sleeping
□ Dizziness or loss of balance
□ Double vision
□ Seizures or abnormal twitching
□ Loss of independence in daily routine
□ Blurred vision
□ Ringing in the ears
□ A bad taste in the mouth
□ Changes in the ability to smell
□ Sensitivity to light or sound
□ Poor spatial judgment/flattened depth perception
□ Perceptual changes, such as tunneled vision, or reduced visual fields
Cognitive & Emotional Changes
□ Reading problems
□ Memory or concentration problems
□ Speech or language changes, ie stuttering
□ Mood changes or mood swings
□ Feeling depressed or anxious
□ Loss of social skills
□ Irritability/quickly angered
□ Flat emotional affect (showing little emotion)
□Emotional liability (quick fluctuations in emotions)
Visual Management of Neurodevelopmental Disorders including
Autism, Cerebral Palsy & Down Syndrome
Vision Deficits in Autism &
□ Poor visual attention
□ Lacking eye contact
□ Strabismus (eye turn)
□ Double Vision
□ Side viewing/”Peripheral viewing”
□ Lacks depth perception
□ Light sensitivity
□ Squints or rubs eyes frequently
□ Tunneled/compressed vision
□ Eye tracking deficit
□ Convergence (aiming) deficit
□ Accommodative (focusing) deficit
FOSTERING Clinical EXPERTISE, RESEARCH & EDUCATION
Sensory & Behavioral Adaptations
□ Self-stimulatory or repetitive behaviors
□ Unable to imitate adult facial expressions
□ Less interested in playing with toys
□ Trouble focusing with competing noise in the background
□ Over-responds to sensation
□ Finds clothing, physical contact unbearable
□ Finds light or sound unbearable
□ Under responds – little or no reaction to stimulation
Vision is a complex, learned and developed set of functions that involves a multitude of stimulus and organization between the eye and brain. Visual impairments and consequences to one's everyday life are sometimes obvious, but other times inconspicuous, therefore a
patient can live with visual disturbances that have not been recognized or treated for weeks, months or even years.
At The Center for Visual Management, a complete visual-
perceptual analysis is conducted, which evaluates in depth,
the visual, mechanic and sensory apparatuses.
In cases of concussions, stroke or other traumatic brain injuries, the goal of a visual management program is to restore normal daily function to the affected individual. Ambient prism lenses, a powerful tool in perceptual reorganization are often implemented in a patients treatment program.
Frequently, children or adults with neurodevelopmental disorders respond to the confusion and fear created by visual impairment by developing symptoms that most see as “problems”--- rocking, hand-flapping, toe-walking, poor eye contact, social withdrawal, tantrums, odd posture, rituals, hyperactivity. The philosophy established by our center, however, asks you to consider seeing these symptoms not as problems, but as solutions to problems.
By viewing these behaviors as clues, and allowing these clues to guide you, it first leads to an understanding of the patients needs, as well as an appropriate treatment plan for him or her.
Our clinical experience and research studies have demonstrated that visual management can reduce or eliminate visual perceptual dysfunctions and improve the patient's ability to function at school, work and play. The first step in the process is identification of the problem. This necessitates treating the individuals visual processing apparatus as a whole, rather than focusing on the eyes alone, which are simply just the organ for sight and processing. This entail continual evaluation of seated, standing and movement based tasks which involve attention, eye movements, depth perception, posture,
gait, mood and fight or flight responses to various visual tasks.
Our office has great success in treating such cases through the use of yoked prism lenses, which transform light and space, in combination with visual management exercises designed to enable the patient to process visual stimuli in an organized, integrated fashion. Such therapy can allow the patient to achieve harmony with their world and reduce the panic responses to visual information.