Showing posts with label vision therapy. Show all posts
Showing posts with label vision therapy. Show all posts

Tuesday, March 21, 2017

Optometric Management of a Post-Concussion Patient: A Case Report

A case report on the optometric vision therapy treatment of the visual symptoms of a concussion patient was published in the December 2016 issue of the journal, Vision Development & Rehabilitation. We treat many concussion patients in our vision therapy and rehabilitation practice in Vancouver and the results of this case report are consistent with the results that we see in our clinic.

Concussions are a mild injury to the brain which have been known to cause visual problems such as blur, double vision, reading problems, sensitivity to light, visual memory problems and other visual deficits like reductions in contrast perception. It is estimated that 15% of concussion patients experience a visual problem as a result of their concussion.

The patient that was the subject of the case report suffered several sports-related concussions that caused a variety of problems with the patient's visual system. The patient was diagnosed with with low myopic astigmatism, convergence insufficiency, fusional instability, oculomotor dysfunction, and photosensitivity. Treatment included tinted spectacle correction for full-time wear and conventional oculomotor-based vision therapy. 

When vision therapy concluded, the patient was free of symptoms. And this effect was still present at a three-year follow-up appointment. The results demonstrate the efficacy of a comprehensive optometric approach in concussion treatment. The results also demonstrate the ability of the visual system to heal when the proper therapy is used for treatment. 

Monday, March 30, 2015

Behavioural vision training for older adults improves contrast sensitivity and near accuity

Dr. Dominick Maino points out that  "it has taken science/medicine decades to catch up with an approach that functional/behavioral optometry has taken since the early 1900's. The brain can be changed for the better at ANY age!"

This is because the brain maintains significant neuroplacticity, even in older adults.  Neuroplacticity is the reason that the vision training approaches used for decades in vision therapy by behavioural and developmental optometrists help so many patients.

A new study published in Psychological Science supports the use of behavioral visual training to improve sight in older adults.  This has important implications for reducing falls and car accidents that are associated with loss of depth perception and contrast sensitivity.

The researchers used a perceptual-learning task  to improve age-related declines in contrast sensitivity. Older and younger adults were trained over 7 days using a forced-choice orientation-discrimination task with stimuli that varied in contrast with multiple levels of additive noise. The study's authors found that older adults performed as well after training as did college-age younger adults prior to training. In addition, the vision training therapy improved far acuity in younger adults and in near acuity in older adults. The researchers concluded that behavioral interventions can greatly improve visual performance for older adults.

Psychological Science
Improving Vision Among Older Adults Behavioral Training to Improve Sight
Denton J. DeLoss, Takeo Watanabe, George J. Anderse

Friday, August 1, 2014

Vision therapy for saccades improves reading

Dr. Dominick Maino has an excellent post on the blog of the College of Optometrists in Vision Development about a new study published in the journal Clinical Pediatrics by a group of researchers including one from the Illinois College of Optometry that shows that vision training (vision therapy) for saccadic eye movements improves reading in children. Read more

Tuesday, July 22, 2014

Eye movement (oculomotor) rehabilitation

A recent study noted that people with traumatic brain injury often have a constellation of eye movement (sometimes called oculomotor) deficits. The study noted that over 90% of patients with mild traumatic brain injury (sometimes abbreviated TBI and sometimes called acquired brain injury) were found to have one or more oculomotor dysfunctions.

The vision rehabilitation therapy that we provide in our vision therapy clinic, sometimes called oculomotor rehabilitation or oculomotor training, is effective in providing significant improvement in eye motor disorders that result from traumatic brain injuries ranging from concussions, severe head injuries and strokes.

Disorders of convergence and divergence

A study entitled "Effect of oculomotor rehabilitation on vergence responsivity in mild 
traumatic brain injury", published in 2013 in the Journal of Rehabilitation Research & Development examined a group of patients before and after they received oculomotor training and placebo therapy to determine whether there was improvement in their convergence and divergence ability. Convergence refers to the way the eyes move inward or converge when doing near work. Divergence refers to the ability of the eyes to move outward or diverge when focusing on objects that are moving away from the body.

The researchers found that convergence and divergence abilities improved significantly following oculomotor training, as did depth perception and visual attention. No improvement resulted from placebo therapy, suggesting that the the rehabilitation therapy was effective and that no improvement is expected in the absence of therapy.

The authors concluded that there was "overall improvement in nearly all of the critical, abnormal measures of vergence was observed both objectively and clinically. Improved vergence motor control was attributed to residual neural visual system plasticity and oculomotor learning effects in these individuals."

Disorders of accommodation

A 2014 study entitled "Effect of oculomotor rehabilitation on accommodative responsivity in mild traumatic brain injury" and also published in the Journal of Rehabilitation Research & Development looked at the effect of vision therapy rehabilitation for a group of oculomotor dysfunctions known as "accommodation". Accommodation refers to the ability of the eyes, through a complex neurological process, to change optical power to maintain a clear image or focus on an object as its distance from the eyes varies.

The researchers looked at 12 patients with mild traumatic brain injury who had vision related symptoms and gave them a program of rehabilitative oculomotor training (lasting six weeks with two three hour sessions per week) as well as placebo therapy. The researchers found that the rehabilitation program produced significant improvement in the patients' accommodation abilities. No improvement was found following placebo therapy. The authors conclude that "[t]hese results provide evidence for a significant positive effect of the accommodatively based OMT on accommodative responsivity. Such improvement is suggestive of oculomotor learning, demonstrating considerable residual brain-visual system plasticity in the adult compromised brain."

The statistic in the graphic that accompanies this post comes from a 2008 study by Ciuffreda et al. published in the journal Optometry which found that  90% of patients with traumatic brain injury who were treated with vision therapy had significant improvement in their eye movement disorders.

Wednesday, June 4, 2014

Eye movement dysfunctions, their treatment and reading related problems in patients with mild traumatic brain injury (mTBI)

We have large vision therapy practice at our Vancouver vision and eye clinic where one category of patients that we treat come to us with traumatic brain injuries that have caused vision problems in the patients, including reading difficulties.  

Reading is a complex task involving a number of functions, abilities and visual skills.  Reading has oculomotor, sensory, cognitive, and attentional components, and all of these must be integrated. If any one of them is affected by a brain injury, they reading is likely to be negatively affected as well.   For example, accurate eye movements are essential for efficient reading. This means that if a traumatic brain injury (TBI) has affected the normal control of eye movements, then reading will likely be adversely impacted.

How can doctors fix these problems?  That was the issue investigated by the authors of a study published in 2007 in the Journal of Behavioral Optometry.  The researchers looked at three studies done by their research group which involved versional oculomotor dysfunctions, their related reading problems, and treatment in a group of patients with mild TBI whose injury affected their vision and reading ability.

Let's take a second to make sure we understand a few of those scientific terms.  A "version" is an eye movement involving both eyes moving together as a team in the same direction.  A "versional oculomotor dysfunction" is a problem in the way the eyes move together as a team.

The results have shown that in a large clinical sample (160 patients), approximately 90% had one or more oculomotor deficits, such as convergence insufficiency or abnormal saccadic tracking- a saccade is a fast movement of the eye like the moments the eye does when tracking words on a printed page.  Deficits in these areas have the potential to interfere with reading performance.  

Out of the 160 patients examined, thirty-three of them completed a program of vision therapy. Of the patients who received vision therapy, an impressive ninety percent of them experienced improvement in at least one related sign and one related symptom. 

The researchers also laboratory-tested 9 of the study subjects who had  eye-movement-related reading problems and found that all of them improved their overall reading performance and versional eye tracking ability after vision therapy.

There are a number of conclusions to draw from this study:
  1. eye movement dysfunctions are common in individuals with mild TBI;
  2. vision therapy can effectively treat eye movement dysfunctions;
  3. the positive vision therapy findings demonstrate that the adult brain can be changed and molded (re-wired) with vision therapy and this shows the presence of considerable neuroplasticity in adults with mild traumatic brain injury;
  4. optometric vision therapy should be used to treat  visually symptomatic patients with TBI who have eye-movement-based reading problems.

More information

To learn more about vision therapy and brain injuries, visit:
Another excellent resource is the website of NORA, the Neuro-Optometric Rehabilitation Association.


Related Articles
Traumatic brain injury often results in convergence insufficiency 
Dec 11, 2012

Brain injuries and vision problems
Nov 04, 2012

Eye movement dysfunctions, their treatment and reading relateed problems in patients with traumatic brain injury
Dec 28, 2012

Vision problems after car accident are caused by brain injury 
Nov 07, 2012

- See more at:

Image courtesy of Victor Habbick /

Friday, April 18, 2014

Strabismus and body balance - vision therapy and the eye-brain connection

Strabismus and body balance - the eye brain connection, cerebellum dysfunctions may contribute to strabismus, esotropia and exotropia.  Vision therapy may help rehabilitate the malfunction.
An important new study appeared in the journal Vision Research. It confirms the approach that we take to strabismus (eye turns, cross eyes) treatment in our Vancouver eye clinic, where we employ non-invasive optometric vision therapy. Vision therapy is based on the concept of neuroplacitity - the ability of the brain to reorganize itself though a program of rehabilitative therapy and fix problems that arise from the failure of the brain and eyes to communicate properly. One such problem is strabismus, a condition where the eye turns in or out (called esotropia or exotropia). These eye turns are usually not caused by problems with the muscle itself. The problem is in the eye-brain connection that controls eye movement. The new study confirms this approach to treating strabismus.

This study investigated how the information from eye-muscles muscles affects postural stability in adults with binocular vision disorders and demonstrated that those with binocular vision disorders showed significantly worse balance control than those without binocular vision disorder, even when they were only using only one eye. The study showed that inaccurate signals related to the eye muscles impact body balance and that this effect can last into adulthood even where subjects had surgery as children to make the eyes appear straight. The second part of their study shows that specific therapeutic tasks can allow patients with strabismus to develop better body balance.

The study adds to the growing body of research that suggests that strabismus is a whole-body problem that results in impairments, adaptations and compensations on many levels throughout the body, which often last into adulthood.  The researchers suggest that a dysfunction in a part of the brain called the cerebellum may contribute to strabismus. The cerebellum plays an important role in eye movement coordination and alignment. Recent studies have shown that the cerebellum is also involved in cognitive functions including attention. Based on this, the researchers thought that the attentional effort required for the mental task in their study resulted in activation of the cerebellum which decreased inhibition from the strabismic eye, which in turn lead to greater postural control.

Here is a passage form a commentary by Dr. Leonard J Press OD, FAAO, FCOVD and Dr. Joseph D Napolitano MD on why this research is so exiting:

Why is this research exciting? It counteracts the notion that strabismus is an isolated eye muscle problem that has little bearing other than cosmesis. The appearance of the eyes is only one feature of strabismus, better appreciated as a difficulty in multimodal coordination. This presents new opportunities to conceive of the synergy between extra-ocular muscle (EOM) surgery and optometric vision therapy, somewhat analogous to the synergy between orthopedic surgery and physical therapy.
When conceived in this fashion, the cognitive and attentional resources employed in optometric vision therapy help the brain to coordinate both eyes through activities mediated through the cerebellum. Even when [eye muscle] surgery or optometric vision therapy do not achieve bi-foveal alignment or random dot stereopsis, very meaningful gains can be realized in improved head to toe motor control.
The role of vision therapy features prominently in this study.  Here is what the authors say:
These findings emphasize the role of the eye-muscle signals in postural control and suggest that suitable vision therapy can be the appropriate way to improve body balance/motor functions in people with binocular vision disorders.


Vision Research
Impaired Body Balance Control in Adults With StrabismusVision Res 2014 May 01;98(-)35-45, A Przekoracka-Krawczyk, P Nawrot, M CzaiƄska, KP Michalak

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Friday, February 21, 2014

Amblyopia treatment

amblyopia treatment
A large focus of what we do at our Vancouver eye clinic is the treatment of amblyopia using optometric vision therapy.

Developmental optometrists have long used active forms of therapy to rehabilitate the lazy eye that does not see well in amblyopic patients. The advantages of therapy over patching are that therapy is much more enjoyable for children than wearing an eye patch.  Moreover, therapy develops the binocularity (i.e. binocular vision or the two eyes working together as a team) of the visual system.

While optometrists have been doing this for a very long time, only recently have eye surgeons and the wider medical community come on-board with this approach. Dr. Leonard Press has found this passage in a new book on Vision Development by Dr. Daw, Professor Emeritus of Ophthalmology and Neuroscience at Yale University, where Dr. Daw acknowledges that vision therapists have been using effective active forms of therapy for a long time.

“Use of perceptual learning and video games has helped by increasing activity and attention as the therapy is done. Many of the principles have been employed by pediatric vision therapists for some time, but the publicity generated by “Stereo Sue” and others has helped to broadcast them.”
As stated in this passage, much credit goes to Dr. Susan Barry (known as "Stereo Sue") and her book Fixing My Gaze for increasing awareness of vision therapy techniques.  Dr. Barry is a neuroscientist, who was born with strabismus (an eye turn) and had lived all her life without stereo vision, meaning that she could not see in three dimensions. Her case was also the subject of an article in the New Yorker by Oliver Sacks.

She had three surgeries to "correct" the eye turn cosmetically but she still could not see properly and the eye was still turned, although less than before. She had lived this way for over 40 years until she met optometrist Dr. Theresa Ruggiero. Dr. Ruggiero treated Susan with vision therapy which corrected the eye turn and allowed her see in three dimensions for the first time in her life.

Thanks to vision therapy and the work of developmental optometrists, amblyopia is now widely regarded as a binocular problem, not a monocular problem upon which the old treatment of eye patching was based.  Here is one quotation from a study that makes the point:

amblyopia is an intrinsically binocular problem and not the monocular problem on which current patching treatment is predicated. Thought of in this way, the binocular problem involving suppression should be tackled at the very outset if one is to achieve a good binocular outcome as opposed to hoping binocular vision will be regained simply as a consequence of acuity recovery in the amblyopic eye, which is the current approach and which is often not found to be the case.
Hess, Robert F.; Mansouri, Behzad; Thompson, Benjamin, A Binocular Approach to Treating Amblyopia: Antisuppression Therapy. Optometry & Vision Science:September 2010 - Volume 87 - Issue 9 - pp 697-704

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Risk Factors for Amblyopia in Preschoolers
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Patching alone is not good enough for amblyopia ... - See for Life
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Active therapy is more effective for amblyopia
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Take your kids to see "Thor": doctor's orders!
Thursday, October 25, 2012

Video Game therapy, optometric vision therapy are more effective than patching alone in treating amblyopia
Sunday, November 20, 2011

Is your child at risk for a vision disorder? Take this interactive quiz to find out. Wednesday, February 8, 2012

Vancouver Parents: Amblyopia treatment in a nutshell!
Monday, July 1, 2013

Thursday, February 20, 2014

Vision therapy for vergence and accommodation

Vision therapy success - Dr. M.K. Randhawa
A new case report was published in the latest issue of the Journal Optometry & Visual Performance, which supports the effectiveness of in-office vision therapy for the treatment of vergence and accommodation dysfunctions.

Vergence is the simultaneous movement of both eyes in opposite directions to obtain or maintain single binocular vision.

Accommodation  is the process by which the eye changes its focusing power to maintain a clear focus on an object as its distance from the eye varies.

The case report discussed a patient who was 10-years and 10 months old and underwent 16 visits for vision-based therapy along with home reinforcement (vision therapy homework). The authors used several methods to measure accomodation and vergence before and after therapy, including the Convergence Insufficiency Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence range at near (PFV), accommodative amplitude, and accommodative facility. The measures taken showed decreased symptom severity following therapy.

The in-office vision therapy program used in the study was identical to that used in the well known Convergence Insufficiency Treatment Trial studies and produced measurable changes in vergence and accommodation in the case subject, who also had convergence insufficiency.

The results not only demonstrate the efficacy of vision therapy but also provide an illustration of the plasticity of the oculomotor system, which is not fully developed at 10 years of age and responds well to interventions like vision therapy.


Optometry & Visual Performance
Objective Assessment of Vergence and Accommodation After Vision Therapy for Convergence Insufficiency in a Child: A Case Report Optometry and visual performance 2014 Feb 04;2(1)7-12, M Scheiman, KJ Ciuffreda, P Thiagarajan, B Tannen, DP Ludlam

Saturday, January 25, 2014

What is accomodative esotropia?

At our Vancouver eye clinic, we treat many patients with various types of strabismus.  One of them is accomodative esotropia.  Here is an excellent presentation by Professor Dominick Maino on accomodative esotropia:

Saturday, September 28, 2013

Why Apple's iphone 5s and iOS7 make people dizzy, motion-sick and nauseous - you may have Neuro-Ocular-Vestibular Dysfunction

Motion sickness, dizziness, vestibular treatment in Vancouver, BC
Many Apple iPhone users are complaining that the new iOS7 operating system makes them dizzy, sick and nauseous.  In one article from ABC News, users are reported as experiencing the following symptoms:

One user says "It hurts my eyes and makes me dizzy. So annoying that we can't downgrade!!!!" Another writes, "I had severe vertigo the minute I started using my ipad with ios 7. Lost the rest of the day to it... And not happy at all. It's the transition between the apps flying in and out."
People are experiencing a form of motion sickness caused by the transition animations in iOS7. They may have unwittingly diagnosed themselves with a vision or eye movement problem.  

We treat many patients for a problem called Neuro-Ocular-Vestibular Dysfunction (also known as "see-sick syndrome" or "supermarket syndrome") where they experience motion sickness like symptoms arising from dynamic visual stimuli, even when they are not in a vehicle.  The visual stimulus of a super-market, stripes on a shirt and now perhaps even the iPhones iOS7 operating system can trigger motion sickness type symptoms. 

The problems often arises from binocular vision disorders - eye movement problems where the eyes do not work together as a team properly. Studies have shown thatvertigo and dizziness is an underestimated symptom of eye and vision disorders.

The fact that vision and eyes are an under-recognized cause of dizziness, vertigo and motion sickness means that many people spend a year or more seeking help from various doctors who fail to diagnose the problem before finding an eye doctor who can zero in on the cause. One recent case found us one when she went to her optometrist after consulting various doctors for over a year. The optometrist found that the patient's eyes were misaligned, a condition that commonly causes the dizziness and vertigo-like symptoms she was experiencing. The patient was referred to our Vancouver eye clinic for treatment.

Dynamic adaptive vision therapy is an effective treatment for see-sick syndrome. Vision therapy relies on the principle of neuroplacticity and involves a doctor and therapist treating the patient with exercises and special equipment to "re-wire" the eye-brain connection and improve visual skills. In this way, vision therapy is similar to speech therapy or occupational therapy but focused, of course, on the eyes and visual system.

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MSNBC recently did a story on adult onset motion sickness. One of the doctors interviewed for the article was optometrist, Dan L. Fortenbacher, O.D., FCOVD, who treats motion sickness using vision therapy. Here is an ...

Vertigo is often a symptom of eye disorders - See for Life
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As we see more and more patients in our Vancouver optometry clinic with vertigo caused by eye disorders, we are reminded of an important study that was published on the topic over a decade ago by researchers from France ...

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Apple customers have taken to Apple message boards and Twitter to complain that the flashy graphics in the new operating system for the ...

Apple iOS 7 Literally Making Some Users Sick
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Make iOS 7 less nausea-inducing
  1. Macworld (blog)

Wednesday, September 18, 2013

Eye tracking problems and reading - pursuits and saccades

Some students have reading problems because their eyes cannot properly track the words on the page.

There are two types of basic movements that eyes make when reading.  The first type is called a pursuit.  Imagine a baseball field, imagine the pitcher throwing the ball to the batter.  As the batter's eye follows the ball, the eye is performing a pursuit.

The second type of eye movement that is critical to reading is a saccade.  In baseball, if you quickly look from fist base to second base to third base, that is a saccadic eye movement.  To read properly, your eyes must have very precise and accurate pursuit and saccadic eye movements.  People with problems with pursuits and saccades often miss words, loose their place when reading and have to re-read sentences.

Problems with pursuits and saccades can be effectively treated with vision therapy.

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Sunday, September 8, 2013

Vision problems resulting from head and brain injuries - what we can learn from the way the US Army uses vision therapy

Recently an interview appeared between Dr. Kathy Freeman and Dr. Randall Beatty, an assistant professor in ophthalmology at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania, about his experience treating combat eye injuries.

Dr. Beatty served as a colonel in the US Air Force Reserve Medical Service in Irag and Afghanistan, where he treated American service members and Iraqi and Afghan military and police personnel, as well as civilians, who experienced traumatic eye injuries during the course of the wars.

Below is the portion of the interview where the doctors talk about vision problems that arise from brain injuries. Dr. Freeman specifically mentions vision training (vision therapy) as a treatment. There is tons of evidence on the effectiveness of vision therapy in treating vision problems that result form brain injuries.  We have had considerable success in our Vancouver eye clinic treating vision problems that result form brain injuries sustained in car accidents, sports and falls.

Dr. Freeman: What are your thoughts on the traumatic brain injury that might be associated with these injuries?
Dr. Beatty: Well, traumatic brain injury was one of the things that kept us busy. A recent review of the VA literature reports that over 250,000 US service people have been diagnosed with some form of traumatic brain injury.2 The symptoms of those patients who have suffered traumatic brain injury are very similar to those associated with migraine headache—visual distortion, headaches, and extreme photosensitivity, not only to sunlight but even to lights inside. Some patients are very sensitive to the flickering of fluorescent lights. These are some visual disturbances that you won’t pick up just by having someone read an eye chart. The symptoms may be episodic, depending on how the patient is recovering from the post-concussive events, which can take quite a while; some may not really ever recover.
Dr. Freeman: How do you think eye care practitioners can best serve these veterans?
Dr. Beatty: I think that, overall, anyone who has been in a combat zone, and especially anybody who has had a concussion or suffered a concussive force by a nearby IED, will need to have very complete eye examinations on an ongoing basis. Dr. Glen Cockerham, at the VA Hospital in Palo Alto, California, did a study of returning veterans3 and, although the number was small, he found that a very high percentage of those veterans had some sort of ocular abnormality that could be attributable to their time in the combat zone. And that’s where we think that there may be problems with late-onset glaucoma as the years go by and as these veterans get older. In summary, very careful and complete eye examinations are necessary, and the emphasis cannot only be on detecting ocular pathology. It is essential to talk with these patients to determine what bothers them about their visual system—for example, do they experience photophobia or double vision? And, then, institute not only medical treatment but nonmedical as well—such as different types of eyewear that have tints, prism; low-vision devices that address the visual impairment; non-optical aids that can help with the distortion. In addition, there may be some need for different types of visual training. There should be attention to visual field analysis, detecting areas where there may be scotomas or blind spots.
And all of these things may be complicated by the fact that these patients also have cognition problems, deficits of short-term and long-term memory, which impacts their ability to handle low vision devices. Some of them have lost limbs or have other limitations that make it difficult to hold things and that complicate their visual rehabilitation. We’re now saving people on the battlefield with brain injuries and other types of trauma who, in the past, did not make it back to the trauma centers, and they are surviving and undergoing rehabilitation. This will result in more challenging long-term rehabilitative care, which is going to involve extensive physical and occupational therapy. And, in addition to those therapies, there should be visual rehabilitation.
The US army uses doctors of optometry to provide vision therapy to soldiers who have sustained brain injuries.  Here is a video:


Traumatic brain injury often results in convergence insufficiency
Dec 11, 2012

Brain injuries and vision problems 
Nov 04, 2012

Vision problems after car accident are caused by brain injury
Nov 07, 2012

Motion sickness and vision therapy - see sickness syndrome
Apr 18, 2012

Image courtesy of koratmember /

map | directions | FREE parking | book an appointment 

Tuesday, July 9, 2013

Developmental optometrists in Vancouver treat adults with convergence insufficiency

Some people are are wondering about whether vision therapy is as effective for adults with convergence insufficiency, as it is for children.  

The developmental optometrists at our Vancouver eye clinic have successfully treated many adults with convergence insufficiency using vision therapy.

And, if that clinical experience were not enough, the scientific research backs it up.

In 2005 Scheiman et al. published a clinical trial in Optometry and Vision Science on the vision therapy treatment of convergence insufficiency in young adults ages 19-30.
Basically, the results were that vision therapy was an effective treatment for convergence insufficiency in this age group and that pencil push-ups were not effective.  Here is a quote from the study where the authors state their conclusions:

"This first multicenter, randomized clinical trial of the treatment of symptomatic CI in young adults demonstrated that of the three treatment modalities, only vision therapy/orthoptics was effective in achieving normal clinical values for both the near point of convergence and positive fusional vergence. Patients in the pencil pushups group achieved normal values only for positive fusional vergence at near and patients in the placebo vision therapy/orthoptics group did not achieve normal findings for either the near point of convergence or positive fusional vergence at near.Therefore, the effectiveness of vision therapy/orthoptics in improving the near point of convergence and positive fusional convergence values at near in adults cannot be explained on the basis of a placebo effect. Based on the results of this preliminary study, it would appear that pencil pushups, the most popular treatment for CI, is not effective for achieving clinically significant improvements in symptoms or signs associated with CI in young adults." [emphasis added]

You can learn more here:
and here:

Saturday, July 6, 2013

Vision Therapy improves reading comprehension and overall classroom attention

A study of  students with below average reading scores found that providing visual attention therapy can significantly improve their attention and reading comprehension.  Visual attention is one component of a group of skills related to visual information processing- the way the brain takes in and makes sense of the images received by the eye.

The developmental optometrists at ourVancouver eye clinic have witnessed this improvement first hand.  Kids who hate reading, can't do it very well and read a below grade level have improved following therapy to become kids who love reading and often can read at above grade level! Read more...

Sunday, June 9, 2013

If your child has reading problems, treatable vision and eye movement disorders may be the reason

The evidence on eye problems associated with reading difficulties and learning problems continues to accumulate.  At our Vancouver eye and vision clinic, we treat many students with eye movement and vision problems who are struggling in school and who read below grade lever.

We use ocular motor therapy, vision therapy and eye-brain rehabilitation to get both eyes working together properly.  Often the students who we treat experience a huge jump in their reading abilities, improving by 4 or five reading levels following therapy.

A new study entitled Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls published in the May 2012 issue of the journal Graefes Archives of Clinical Experimental Ophthalmology adds to the evidence of the connection between eye and vision problems and learning.

The researchers were struck by the fact that in Ontario, Canada, approximately one in ten students aged 6 to 16 in Ontario have an individual education plan (IEP) in place because of various learning disabilities.  May of those learning problems were specific to reading.   They wanted to investigate the relationship between reading vision problems and binocular vision problems.

The researchers measured the visual acuity and eye movement measurements of students that had an IEP and compared those results with students in a regular education program.

The researchers found that the IEP group had significantly greater hyperopia, compared to the control group on cycloplegic examination. Vergence facility was significantly correlated to (i) reading
speed, (ii) number of eye movements made when reading, and (iii) a standardized symptom scoring system. Vergence facility was also significantly reduced in the IEP group versus controls. Significant differences in several other binocular vision related scores were also found.

Here is the study's conclusion:

This research indicates there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination (including cycloplegia), in addition to a comprehensive binocular vision evaluation.

Saturday, June 1, 2013

The ultimate amblyopia infographic

The amblyopia experts at Vision Help have created this helpful info-graphic to help spread the word on the latest science in treating amblyopia (lazy eye).  We are re-posting it here to help spread the word on the latest treatments and the important information that patching for many hours a day is an out-dated and unnecessary practice.

Advanced treatments are available at our Vancouver vision clinic at at the clinics of developmental optometrists across North America.  To find a doctor near you, visit the College of Optometrists in Vision Development.

Related articles:

Tuesday, April 23, 2013

Strabismus surgery rates in decline because of non-surgical treatment approaches

strabismus surgery
We came across this article that reports on a study that was published in a recent issue of the British Journal of Ophthalmology that looked at strabismus surgery rates in children up to the age of 15 from 1963 to 2010 (519,089 children in total).  The study found the rate of strabismus surgery in the United Kingdom had dropped from 189 per 100,000 in 1968 to 64 per 100,000 in 2010, a threefold decrease.

According to the article, the major reason was non-surgical treatment approaches:

A switch from surgical to non-surgical treatment approaches, rather than a genuine fall in the prevalence of strabismus was likely to explain a large part of the decline in procedure rates, said the author, who suggested regional variations may reflect differences in strabismus prevalence.

We have not had a chance to read the study, but we have written extensively on this blog about non-surgical alternatives to strabismus surgery:

Non-surgical treatment alternatives to strabismus surgery - the risk of a single childhood exposure to anesthesia 
Jan 23, 2013
The saftey of using anesthesia in surgery on children is questioned by new scientific evidence. Non surgrical alternatives to strabismus (eye muscle) surgery.

Vision therapy or surgery for strabismus (esotropia, exotropia)
Jan 17, 2013
We here at Vision Source Vancouver think that it makes good sense to use effective non-surgical vision therapy to treat strabismus (sometimes called cross eyes, eye turn, esotropia, exotropia). The reason is that strabismus or ...

Alternatives to strabismus surgery - vision therapy is 87% effective
Oct 28, 2012
Vision therapy is a highly effective non-surgical treatment for strabismus that has been validated in numerous studies.

Another risk of strabismus surgery? 
Mar 07, 2012
Strabismus - a condition where the eye abnormally turns in or out due to one or more of the eye muscles malfunctioning - is often treated with surgery in which the properly functioning muscle is cut and re-attached so that it ...

How vision therapy worked where strabismus surgery failed
Nov 14, 2012
How vision therapy worked where strabismus surgery failed - the story of Dr. Susan Barry and her book, Fixing my Gaze.

After three unsuccessful strabismus surgeries, patient says enough
Nov 19, 2012
Repeat strabismus surgeries are common and are a reason parents seek non-surgical alternatives like vision therapy. ... Vision Therapy is an effective alternative to strabismus surgery. Here is a recent comment by a reader ...

Saturday, April 20, 2013

The US Army uses vision therapy to treat traumatic brain injuries

The United States Army uses vision therapy to treat traumatic brain injuries and has developmental optometrists on staff to provide the therapy.  It's no surprise since vision therapy is the most effective way to treat the vision problems that are the result of traumatic brain injury.  Vision therapy can be though of as neuro-ocular rehabilitation or rehab for the eyes and the brain.

At our Vancouver optometry clinic, we have the largest vision therapy practice in the city and we treat many patients who have vision problems as a result of traumatic brain injuries.  Most of the injuries resulted from car accidents or concussions sustained in sporting activities.  If you are reading this because you have vision problems arising form a brain injury, you can find a developmental optometrist near you at the website of the College of Optometrists in Vision Development.

For a list of scientific studies on vision therapy treatment of vision problems caused by brain injury, click here.   Here is a video on how the US army uses vision therapy to treat brain injuries (I bet you've never seen a doctor of optometry in camouflage before!):


Related Articles

Traumatic brain injury often results in convergence ... - See for Life
Dec 11, 2012
Brain injuries often result in vision problems like convergence insufficiency and other vision problems according to a December 2012 study.

Brain injuries and vision problems - See for Life
Nov 04, 2012
Brain injuries cause vision problems and disorders that are treated by Vision Source Vancouver optometrist, Dr. Mini Randhawa.

Eye movement dysfunctions, their treatment and reading related
Dec 28, 2012
Eye movement dysfunctions, their treatment and reading related problems in patients with mild traumatic brain injury (mTBI)

Vision problems after car accident are caused by brain ... - See for Life
Nov 07, 2012
Vision problems caused by brain injury in a car accident are treated with vision therapy even a decade after the accident.

Wednesday, April 17, 2013

Visual processing and learning disorders

A recent study published in the journal Current Opinion in Ophthalmology called "Visual processing and learning disorders" came as a surprise to developmental optometrists who have been diagnosing and treating visual information processing disorders for decades.  The main treatment modality is vision therapy, which is neuro-ocular rehabilitation or rehabilitation for the eyes and brain working together.   

The study confirmed what has always been obvious to optometrists - that if the brain cannot properly process visual information, a child will have trouble reading and learning - even if he has 20/20 visual acuity.  The surprise was that the study was  published by ophthalmologists, who for too long have denied that vision had anything to do with learning.  For example, see this 1996 study from the field of rehabilitation medicine published in the journal NeuroRehabilitation by Raymond et al., where the authors advise that patients with potential visual information processing deficits should be referred to a behavioral or neuro-optometrist" and noted that "referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only."

Another word of advice comes from a recent family advice column from the Washington Post, where the writer said:

how well your son can see, it usually takes a developmental or behavioral optometrist to tell you how well his eyes are working when he reads or when he looks back and forth from the blackboard to the printed page. Some children get headaches because they can’t focus well or their vision is blurry, but they don’t complain because they think that heads are supposed to hurt or that the world is a blur for everyone.
If your son has these or other vision problems, don’t despair. Vision therapy is to the eyes what physical therapy is to the body, and it’s effective 90 percent of the time. He’ll just have to wear special glasses for a little while every day, do some eye exercises every day and maybe play a couple of video games. To learn more, go, the Web site for the College of Optometrists in Vision Development.

Unfortunately, that incorrect approach has denied many patients treatment and diagnoses that would have improved their lives. Thankfully, ophthalmologists have now come around to common sense. The study encourages ophthalmologists to take visual information processing seriously:

Visual processing is the main brain function allowing normal perception of what is being viewed. Ophthalmologists as well as patients must realize that with normal 20/20 eyesight interpretation of what is seen may be dysfunctional because of faulty brain processing of that which is seen by normal eyes. Abnormal Visual Processing as well as auditory processing disorders eventually lead directly to learning disorders in children and young adults.

The study also emphasizes and important point.  Just because a child can see clearly or has 20/20 vision, does not mean that her entire visual system (including the brain) is functioning properly.  For eye doctors to say that nothing is wrong with a child just because she does not need glasses, gives the child and her parents a false and dangerous sense of security.  Moreover, it is irresponsible for a professional to say that there is nothing wrong with a patient when all tests have not been performed.    For that reason, we advocate that only a comprehensive eye examination with a full developmental vision investigation should be performed on a child and "quick-and-dirty" school screenings are not much help and may even be harmful for what they miss. 

 For more information on visual information processing, visit our visual information processing page where you can download our Fast Fact Sheet.

At Vision Source Vancouver, our eye and vision clinic we successfully treat dozens of patients every year for visual information processing disorders.  

Related articles on vision and learning

More visual symptoms means lower academic performance ... - See For Life
Feb 29, 2012

Vision therapy for convergence insufficiency improves academic performance ...
Jan 16, 2012

82% of teachers report an improvement in students after vision therapy - See For Life
Jun 16, 2012

Binocular vision dysfunctions ate my homework - See For Life
Mar 31, 2012

Study proves that vision problems interfere with learning - See For Life
Apr 25, 2012