Re: blurred vision
- From: "Mockingbird" <mockingbirdbrain@xxxxxxxxx>
- Date: 18 Nov 2005 11:10:46 -0800
Spanky Hrothgar @yahoo.com wrote:
> Mockingbird wrote:
> > derdrittemann2003@xxxxxxxxx wrote:
> Mockingbird wrote:
>
> > The Plaquenil side-effect of greatest concern involves the eyes.
>
>
>
> Yeah...in my case however, highly unlikely. Problems I was experiencing
>
> beagn well before the diagnosis or treatment with Plaquenil...and my
> eyesight actually improved slightly once the Plaquenil stopped...so it
> seems as if it had no permanent effect.
>
> In fact, the optometrist says the problems are not particularly
> bad...at all. Of course, he doesn't have to live with it, either.
>
>
> When it was at its worst...the problem seemed to be fatigue...eye
> weakness...just didn't have any strength. Still a problem to some
> extent. Reading for any length of time will cause a need to sleep...to
> recharge. (I remember trying to have an involved discussion here
> concerning US Middle East policy...and I just couldn't keep up...no
> stamina).
>
>
>
>
> - Hide quoted text -
> - Show quoted text -
>
> > > Odd...what seems to cause me lingering problems is rapid motion or
> > > change of focus...as strange as this may seem...it seems I cannot
> > > adjust to, say the jerky movement of a lot of TV commercials...they
> > > almost make me nauseous and I have to turn away.
>
> > > And...the problems are almost exclusively in the right eye alone.
>
>
> > Yes I have a VERY good friend who has this problem. The "llmd"
> > neuroopthalmologist (talk about a LOT of years in residency!!!) we see
> > says that these are "tracking" problems and commonly seen in Lyme. For
> > my friend, this causes severe problems with balance, and my friend is
> > very prone to banging their head as a result and has suffered multiple
> > concussions, which is NOT a good thing (there is something known as
> > repetitive head injury syndrome--basically each successive concussion
> > makes things worse and it is easier to get concussed the next
> > time--this has happened to a number of sports figures, commonly in
> > hockey--Eric Lindross is famous for this problem).
>
>
>
> This is REALLY interesting to me! Thanks very much for this! I think
> this is the first time I have mentioned it to anyone...including
> doctors. It seems to be a really unusual and exotic symptom...one prone
>
> to getting the "psych" tag...but I assure you it is damned real. It
> just hasn't been up there on the list of priorities.
>
> Any thing shot with the hand-held camera...no way. Can't stand to look
> at it. Any sudden, herky-jerky motion...can actually make you feeling
> sick if it keeps up.
>
>
> And...yeah, before the NHL lockout...I gave up trying to watch a game.
> The camera just moves too suddenly.
>
>
> One of the few benefits of Lyme...I don't have to watch my team
> anymore...LOL.
>
>
>
> > There are actually some really decent ophthalmologists and neuro
> > opthalmologists who treat a lot of Lyme patients (LLMDs) at least in
> > the NE US.
>
>
>
> Can they do anything about this stuff, though?
>
> Reply
Vision therapy it is called.
http://www.children-special-needs.org/vision_therapy/what_is_vision_therapy..html
http://www.vision-therapy.com/
http://www.vision3d.com/
WHAT IS VISION THERAPY?
Vision Therapy FAQs
An Eye Doctor Answers Frequently Asked Questions
Dr. Leonard J. Press examines popular and professional opinions with
references to medical literature.
Vision Therapy References, Research, Scientific Studies
Success Stories
100s of Vision Therapy Success Stories by parents, children, adult
patients, and professionals.
Vision and Learning
See articles by PTA, School Nurse News, Web MD, professors, eye
doctors, etc.
Vision, Learning and Dyslexia by the AOA and the AAO.
Other sites with advertising-free patient education on What is Vision
Therapy?
Vision Therapy Links
The information on this advertising-free site is sponsored by
Optometrists Network with special thanks to the following non-profits:
- American Academy
of Optometry (AAO)
- American Optometric
Association (AOA)
- College of Optometrists
in Vision Development
- Optometric Extension
Program (OEP)
Learn more about... 3D Art and Fun 3D Depth Perception Amblyopia
(Lazy Eye) Binocular Vision Choosing Eye Doctors Crossed Eyes About Eye
Doctors Eye Doctors and 3D Eye Exams Eye Muscle Surgery Success Stories
Vision and ADD/ADHD Vision and Brain Injury Vision and Dyslexia Vision
and Learning Vision and LDs Vision and Reading Vision Therapy Vision
Vocabulary
Vision Therapy Is Effective Treatment
Vision therapy -- a type of physical therapy for the eyes and brain --
is a highly effective non-surgical treatment for many common visual
problems such as lazy eye, crossed eyes, double vision, convergence
insufficiency and some reading and learning disabilities. Many patients
who have been told, "it's too late," or "you'll have to learn to live
with it" have benefited from vision therapy.
In the case of learning disabilities, vision therapy is specifically
directed toward resolving visual problems which interfere with reading,
learning and educational instruction. Optometrists do not claim that
vision therapy is a direct treatment for learning disabilities.
What is involved in a Vision Therapy program?
Vision therapy is --
a progressive program of vision "exercises" or procedures;
performed under doctor supervision;
individualized to fit the visual needs of each patient;
generally conducted in-office, in once or twice weekly sessions of 30
minutes to one hour;
sometimes supplemented with procedures done at home between office
visits ("homework");
(depending on the case) prescribed to --
- help patients develop or improve fundamental visual skills and
abilities;
- improve visual comfort, ease, and efficiency;
- change how a patient processes or interprets visual information.
Vision Therapy Is Not Just Eye Exercise
Unlike other forms of exercise, the goal of Vision Therapy is NOT to
strengthen eye muscles. Your eye muscles are already incredibly strong!
Vision Therapy is not to be confused with any self-directed program of
eye exercises which is or has been marketed to the public. Vision
Therapy is supervised by optometric vision care professionals and many
types of specialized and/or medical equipment are used in Vision
Therapy programs, such as
prescription lenses (regulated medical devices);
therapeutic lenses (regulated medical devices);
prisms (regulated medical devices);
optical filters;
eye patches or occluders
electronic targets with timing mechanisms;
computer software;
vestibular (balance) equipment
The first step in any Vision Therapy program is a comprehensive vision
examination. Following a thorough evaluation, a qualified vision care
professional can advise the candidate as to whether Vision Therapy
would be appropriate treatment.
Definition of Optometric Vision Therapy
Optometric vision therapy is an individualized treatment regimen
prescribed for a patient in order to:
Provide medically necessary treatment for diagnosed visual
dysfunctions;
Prevent the development of visual problems; or
Enhance visual performance to meet defined needs of the patient.
Optometric vision therapy is appropriate treatment for visual
conditions which include, but are not limited to:
Strabismic and non-strabismic binocular dysfunctions;
Ambylopia;
Accommodative dysfunctions;
Ocular motor dysfunctions;
Visual motor disorders; and
Visual perceptual (visual information processing) disorders.
The systematic use of lenses, prisms, filters, occlusion and other
appropriate materials, modalities, equipment and procedures is integral
to optometric vision therapy. The goals of the prescribed treatment
regimen are to alleviate the signs and symptoms, achieve desired visual
outcomes, meet the patient's needs and improve the patient's quality of
life.
Approved by the American Optometric Association
Board of Trustees
November 1996
What is Vision Therapy
Position Statement on Optometric Vision Therapy
By American Optometric Association
The American Optometric Association affirms its long-standing position
that optometric vision therapy is effective in the treatment of
physiological neuromuscular and perceptual dysfunctions of the vision
system.
The ability to learn in school, achieve on the job, and enjoy sports
and recreation depends upon efficient vision. Optometric vision therapy
assists individuals in developing visual abilities and efficiency most
suited to their needs and enables those individuals to achieve maximal
levels of visual performance. Optometric vision therapy can help
individuals achieve and maintain good vision throughout life.
What is Vision?
Vision is more than the limited concept of sight measured in terms of
visual acuity. Vision is the process of deriving meaning from what is
seen. It involves fixation and eye movement abilities, accommodation
(eye focusing), convergence (eye aiming), eye-hand coordination, visual
perception and visual-motor integration.
What is Vision Therapy (Visual Training, Vision Training or
Orthoptics)?
Optometric vision therapy, also referred to as visual training, vision
training, or orthoptics, is a treatment regimen to correct or improve
specific dysfunctions of the vision system identified by standardized
diagnostic criteria. It includes, but is not limited to, the treatment
of strabismus and other binocular vision or convergence dysfunctions,
amblyopia, accommodation, ocular motor function and
visual-perceptual-motor abilities.
The medical necessity for optometric vision therapy is determined from
a comprehensive analysis and diagnosis of the functioning of the vision
system. Treatment plans are directed at specific diagnosed dysfunctions
of the vision system and encompass the use of lenses, prisms, occlusion
and other appropriate materials, modalities and equipment. Because the
therapy is individualized, the procedures used and the duration of
therapy are dependent upon the nature and severity of the problem being
treated and the specific needs of the patient.
Who Can Benefit?
Optometric vision therapy is effective for patients of any age although
the objectives and outcomes will vary depending on the diagnosis and
circumstances. Optometric vision therapy is effective for the treatment
of many developmental or acquired and some congenital vision
dysfunctions.
Of the entire U.S. population, approximately one half of those three
years or age or over require treatment for a vision problem.1 Among
school-age children, vision disorders affect one in every four.2 While
many of these patients have refractive errors (myopia, hyperopia and/or
astigmatism) commonly treated by compensatory lenses, some have
additional problems in the functioning of the vision system that are
most appropriately treated with optometric vision therapy.
Vision and Learning
Many children who experience academic difficulty may have a treatable
visual dysfunction in addition to their primary reading or learning
dysfunction.1 Vision problems can interfere with the ability to
perform in the classroom or can impair the ability to read with comfort
and efficiency. These treatable conditions include focusing
deficiencies, eye muscle imbalances, motor fusion deficiencies and
refractive errors.2 Although optometrists do not teach reading,
optometric vision therapy programs are used to treat contributory
vision problems thus enabling the individual to take better advantage
of his/her educational opportunities.3
Management of the learning disabled and/or dyslexic child or adult
should be multidisciplinary. Since it is important to deal with any
defect or problem that may be causal or contributory, evaluation of a
learning disabled individual should include a thorough optometric
analysis of the vision system. Interdisciplinary communication and
involvement are essential in helping an individual overcome a learning
problem.
Optometric Education
Doctors of optometry (optometrists) are uniquely qualified to diagnose
and treat vision problems as a result of their seven or more years of
college level education and clinical training. Their undergraduate
education provides a foundation in the basic sciences, while the four
year graduate professional optometric degree program emphasizes the
biological, behavioral and visual sciences, and their clinical
application. New developments and research within the optometric
profession, residency programs and postgraduate education enhance
today's optometrist's ability to provide quality vision care for their
patients.
Research
Extensive research related to strabismus and amblyopia, accommodative
and non-strabismic binocular dysfunction, vision development and
learning-related vision problems is conducted at the schools and
colleges of optometry and other clinical and research settings. These
scientific studies support the effectiveness and value of optometric
vision therapy in the treatment of vision dysfunctions.4-20
Summary
Vision is a complex process.
An individual with good visual acuity and healthy eyes can still have a
vision problem.
Optometric vision therapy is an effective treatment of many vision
problems.
Evaluation of individuals with learning difficulties (i.e., attention
deficit disorder, ad/hd, dyslexia, etc.) should include a thorough
optometric analysis as part of a multidisciplinary approach.
The American Association continues to support quality optometric care,
education and research in the area of vision therapy.
Resources available from the American Optometric Association.
--------------------------------------------------------------------------------
1 Greenstein T. Identification of children with vision problems that
interfere with learning. In T. Greenstein, Vision and learning
disability. American Optometric Association, St. Louis, 1976, p.
95-114.
2 American Academy of Pediatrics, American Association for Pediatric
Opthalmology and Strabismus, American Academy of Opthalmology. Position
statement on learning disabilities, dyslexia and vision. Pediatrics,
90(1):124-125, 1992.
3 Solan HA. Learning disabilities, Chapter 21. In AA Rosenbloom and MW
Morgan, Principles and Practice of Pediatric Optometry. JB Lippincott,
Philadelphia, 1990; p. 486.
4 Ciuffreda KJ, Kenyon RV, Stark L. Different rates of functional
recovery of eye movements during orthopedic treatment in adult
amblyope. Invest Opthal & Vis Sci 18(2):213-219, 1979.
5 Cooper J. Orthoptic treatment of vertical deviations. J Am Optom
Assoc 59(6):463-468, 1988.
6 Cooper J, Selenow A, Ciuffreda KJ, Feldman J, Faverty J, Hokoda S,
Silver J. Reduction of aesthenopia in patients with convergence
insufficiency after-fusional vergence training. Am J Optom & Physiol
Opt 60(12):982-989, 1983.
7 Daum K. Accommodative insufficiency. Am J Optom & Physiol Opt
60(5):352-359, 1983.
8 Daum K. The course and effect of visual training on the vergence
system. Am J Optom & Physiol Opt 59(3):223-227, 1982.
9 Flax N, Duckman R. Orthoptic treatment of strabismus. J Am Optom
Assoc 49(12):1353-1360, 1978.
10 Garzia RP. The efficacy of visual training in amblyopia: A
literature review. Am J Optom & Physiol Opt 64:393-404, 1987.
11 Kran B, Duckman R. Divergence excess exotropia. J Am Optom Assoc
58(11):921-930, 1987.
12 Liu JS, Lee M, Jang J, Ciuffreda KJ, Wong JH, Grisham D, Stark L.
Objective assessment of accommodation orthoptics: 1. Dynamic,
insufficiency. Am J Optom & Physiol Opt 56(5):285-291, 1979.
13 Rouse M. Management of binocular anomalies: efficacy of vision
therapy in the treatment of accommodative deficiencies. . Am J Optom &
Physiol Opt 64(6):415-420, 1987.
14 Selenow A, Ciuffreda K. Vision function recovery during orthoptic
therapy in an exotropic amblyope with high unilateral myopia. . Am J
Optom & Physiol Opt 60(8):659-666, 1983.
15 Simons H, Grisham J. Binocular anomalies and reading problems. J Am
Optom Assoc 58(7):578-587, 1987.
16 Suchoff I, Petito GT. The efficacy of visual therapy: Accommodative
disorders and non-strabismic anomalies of binocular vision. J Am Optom
Assoc 57(2):119-125, 1986.
17 Weisz CL. Clinical therapy for accommodative responses: transfer
effects on performance. J Am Optom Assoc 50(2):209-214, 1979.
18 Wick B. Accommodative esotropia: efficacy of therapy. J Am Optom
Assoc 58(7):562-566, 1987.
19 Wick B, Wingard M, Cotler S, Schieman M. Anisometropic amblyopia:
Is the patient ever too old to treat? Optom and Vis Science
69(11):866-878, 1992.
20 Wick B, Cook D. Management of anomalous correspondence: efficacy of
therapy. Am J Optom & Physiol Opt 64(6):405-410, 1987.
--------------------------------------------------------------------------------
To locate an eye doctor who provides comprehensive evaluation and
vision therapy, request a referral through our Directory.
VISION THERAPY FAQs
An Eye Doctor Answers Questions on Vision Therapy
The following is an interview of Dr. Leonard J. Press, author of the
textbook Applied Concepts in Vision Therapy, by Rachel Cooper,
co-author and designer of the edutainment science book, Magic Eye: How
to See 3D and founder of Find a Doctor.
In this FAQ interview, Dr. Press examines current questions and
opinions concerning vision therapy and refers the reader to relevant
medical literature and web pages. He also discusses the many
applications of vision therapy to a wide range of visual and learning
difficulties. Questions and answers are presented in a sequential
order.
What is vision therapy?
Are "orthoptics" and "vision therapy" the same thing?
What is the difference between an optometrist and an ophthalmologist?
What should patients or parents keep in mind while researching vision
therapy on the Internet?
Why would some ophthalmologists claim that vision therapy doesn't work?
Does the public assume that ophthalmologists (M.D.s) are the ultimate
authorities about everything in eyecare, including vision therapy?
Can you give an example of a case where the outcome depended on whether
the parent relied on the opinion of an optometrist or an
ophthalmologist?
Can orthoptics or vision therapy help with learning problems?
Is there scientific evidence that vision therapy works?
What's the position of educators regarding vision therapy?
Can special colored lenses or filters be used instead of vision
therapy?
Does insurance pay for vision therapy?
Is it true that there are certain conditions, like lazy eye, where the
patient is too old, or it's too late to intervene with vision therapy?
Concluding thoughts on how vision therapy can help.
--------------------------------------------------------------------------------
What is vision therapy?
You can think of vision therapy as physical therapy for the eyes and
the brain. The neurological aspect is very important because the eyes
are direct physical extensions of the brain. We see with our brains and
minds, not just our eyes. There are plenty of web pages which give
accurate definitions of vision therapy. Let's move on to some
frequently asked questions which aren't covered on lots of other pages.
O.K., are "orthoptics" and "vision therapy" the same thing?
Orthoptics, which literally means "straightening of the eyes", dates
back to the 1850s and is limited in scope to eye-muscle training and
the cosmetic straightening of eyes. Vision therapy includes orthoptics,
but has advanced far beyond it to include training and rehabilitation
of the eye-brain connections involved in vision. Clinical and research
developments in vision therapy have been closely allied with
developments in neuroscience throughout this century.
What is the difference between an optometrist and an ophthalmologist?
In the United States, there are two different types of licensed vision
care professionals: the optometrist and the ophthalmologist. The
optometrist is a doctor of optometry (O.D.) who diagnoses and treats
visual health problems as dictated by state law. Some optometrists
specialize in vision therapy. The ophthalmologist is a doctor of
medicine (M.D.) who specializes in surgery and diseases of the eye. A
small number of ophthalmologists work with or refer to vision
therapists or orthoptists. To read some special educators' statements
regarding differences between optometrists and ophthalmologists, see
Choosing an Eye Doctor.
What should patients or parents keep in mind while researching vision
therapy on the Internet?
As with any subject matter, the public must be careful to consider the
source. Vision therapy is a well established field within the
optometric profession. I would, therefore, recommend that the reader
place most credence in information acquired from optometric web sites
or from patient or parent advocate sites which look at the subject
objectively. Readers need to be aware that some web pages are
misrepresenting vision therapy.
Can you be more specific?
Let's say you were seeking information on the Web about treatment of a
hip problem. If you had a question about physical therapy, you would
look to a physical therapist (P.T.). For information on surgery, you
would rely on an orthopedist (M.D.). In this particular example, you
could get accurate information about either treatment options from both
professionals. That's because orthopedic surgeons and physical
therapists have learned to work together in the best interests of the
patient. Unfortunately, this is not the case in vision care where
optometrists and ophthalmologists don't always agree on vision therapy.
Some ophthalmologists have even taken it upon themselves to post
unjustifiably negative information on vision therapy on the Internet.
Why would some ophthalmologists and their organizations claim that
vision therapy doesn't work?
In 1993, Paul Romano, MD, the editor of Eye Muscle Surgery Quarterly,
conducted a worldwide survey of eye muscle surgeons. He asked surgeons
to indicate whether they would favor a surgical or non-surgical
approach to the treatment of intermittent exotropia (a form of
strabismus). 85% of the international group recommended non surgical
approaches, as compared with only 52% of the American surgeons. Dr.
Romano postulated three important reasons why this might be so:
Insurance companies and single-payer systems outside of the U.S. have
stricter medical standards in regards to approving payment of eye
muscle surgery. Also, they do not pay as well for eye muscle surgery as
insurance companies in the U.S.
Non surgical therapy isn't as economically rewarding for the surgeon in
the U.S. due to the personnel and fees involved.
Due to his lack of training in this area, the surgeon is reluctant to
acknowledge the benefits of non surgical therapy for fear of losing
patients.
Does the public assume that ophthalmologists (M.D.s) are the ultimate
authorities about everything in eyecare, including vision therapy?
The public needs to be aware that ophthalmologists are not the ultimate
authorities in all areas of visual health. Ophthalmologists are
wonderful surgeons and excellent authorities about eye disease, but as
a rule they're under informed about subject areas such as, visual
processing, convergence, accommodation and vision therapy. Some
ophthalmologists concede this. In the medical journal, Transactions of
the American Ophthalmological Society, eye muscle surgeon and
researcher David Guyton, M.D., states: "We [ophthalmologists] have
probably abdicated the study of accommodation and convergence to the
optometric profession. A perusal of the literature will reveal that
most of the advances in this area are being made in the optometric
institutions by vision scientists who use definitions and terms with
which we are not even familiar."
So, if an ophthalmologist says, "Vision therapy doesn't work", remember
that this is an opinion from a professional who has little knowledge of
the subject. Many of the M.D.s who criticize vision therapy have not
done their homework. As I said before, it is important to consider the
source of information. Optometrists who specialize in vision therapy
are the authorities regarding developmental vision and vision therapy.
Can you give an example of a case where the outcome depended on whether
the parent relied on the opinion of an optometrist or an
ophthalmologist?
Yes. This is just one example among many. Lauren, a nineteen year-old,
was referred to me by an occupational therapist. Lauren had initially
been prescribed glasses and patching for a lazy eye. When she reached
age nine, an ophthalmologist assured her mother that Lauren no longer
needed glasses and that her lazy eye would not worsen further.
To make a long story short, Lauren had multiple problems throughout the
years. Reading fatigued her. As she read, print jumped around, words
went uncontrollably in and out of focus and she skipped lines. Her
mother observed that Lauren's lazy eye would turn inward when she was
tired. Each year, her mother took Lauren back to the ophthalmologist,
only to be told that everything was fine.
Because the ophthalmologist said that everything was fine, Lauren's
avoidance of reading was determined by the school to be due to
laziness. Her aversion to reading was so strong that the school
suggested to the family that she was dyslexic, and needed large print
books and taped material.
Lauren's mother finally decided to seek a second opinion from a vision
specialist. I tested Lauren on the Visagraph, a standardized computer
which records and analyzes eye movements while the patient is reading.
Results showed that Lauren, age nineteen, was reading at a 4th grade
level. At this point, I tested her eyesight with eyedrops in place and
discovered that Lauren did not really have a lazy eye! Lauren's
so-called lazy eye could see 20/20 with the proper prescription lens. I
prescribed glasses for reading, and a vision therapy program and Lauren
has made great improvements. It is unfortunate that Lauren went so many
years without proper treatment. In a perfect world, the ophthalmologist
might have said: "Although I do not find any eye health problems or the
need for glasses or medication, Lauren has significant problems and
does not seem to be psychosomatic. Therefore, I will refer her to a
vision specialist for more extensive testing."
Can vision therapy help with learning problems?
Vision problems often can and do interfere with reading and learning.
Optometrists do not claim that vision therapy is a direct treatment for
learning disabilities, such as LD, dyslexia or ADD. Vision therapy is
directed toward resolving visual problems which interfere with
educational instruction. The statement on vision therapy and learning
disabilities by the American Optometric Association and the American
Academy of Optometry makes it clear that a multidisciplinary approach
to learning disabilities is recommended, and that vision is but one
aspect of the overall picture. Statements to the effect that vision
therapy has no place in the treatment of learning disabilities are
inaccurate and misleading.
Vision therapy can improve visual function so the patient/student is
better equipped to benefit from educational instruction. In 1991,
Firmon Hardenbergh, M.D., the Chief of Ophthalmology at Harvard
University Health Services, had this to say regarding a double-blind
scientific study of children with reading disability and convergence
difficulty:
"The application of orthoptics [included in vision therapy] to all
learning/reading disabled or deficient children who manifest
convergence insufficiency should be the first line of therapy."
Regarding visual processing and learning disabilities, Corinne Smith,
Ph.D., Associate Dean of Education at Syracuse University, noted in her
1997 text on Learning Disabilities, that students with visual
perception disabilities have trouble making sense out of what they see.
"The problem is not with their eyesight, but with the way their brains
process visual information."
For interested parties, there are many references which touch on the
subject of visual processing and learning disabilities, see Vision
Therapy References. For web sites offering accurate and useful
information on this subject, see Vision Therapy Links.
Return to Top
Is there scientific evidence that vision therapy works?
In a word, yes. Studies on vision therapy are on a par with the
published literature in parallel rehabilitative interventions such as
physical therapy and occupational therapy. Furthermore, the data which
supports vision therapy is considerably more impressive than the data
which has substantiated other forms of visual intervention before these
were put into public use by eyecare practitioners. The same profession
(ophthalmology) which calls for "more scientific" studies of vision
therapy had no qualms about recommending elective procedures such as
eye muscle surgery or refractive surgery prior to any scientific study
whatsoever.
The most concise source of information re: scientific studies on vision
therapy can be found at the Indiana University School of Optometry web
site. See Vision Therapy References for other publications.
What's the position of educators regarding vision therapy?
According to law in many states, if a child is classified as having a
specific learning disability, the school is required to either provide
the necessary therapy, or to pay for the parents to obtain the
necessary help not provided by the school. This puts educators in a
tight spot. Funds are limited, so schools understandably try to
minimize expenditures. Regarding perceptual impairment or visual
processing disorders, educators are sometimes faced with two basic
choices:
have someone already on staff provide the therapy necessary or
deny that the therapy has anything to do with the child's learning
problems.
Some school systems try to adopt the latter approach, which leaves more
money in the pot for services which are provided within the school
system.
In the case of the former, the school might assign the child to a staff
Occupational Therapist. OTs are highly skilled in helping children with
developmental, gross motor, and fine motor activities particularly
handwriting, but they are not trained or licensed in vision therapy.
Specifically, occupational therapists can not administer important
vision therapy procedures which involve lenses, prisms, and devices
which insure that both eyes work together as a synchronous team.
Fortunately, we are seeing an increase in schools which recommend that
parents of children with visual problems seek evaluation and treatment
with a licensed optometric vision therapist.
I've heard a lot about special lenses or filters which can improve
reading. Can that be done instead of vision therapy?
You're probably referring to Irlen Tinted Lenses and no, they're not a
substitute for vision therapy. Experiments continue to try to look for
passive means such as filters to improve vision and reading. What
sources tend to overlook is Irlen's caution when she introduced the
concept of SSS, or Scotopic Sensitivity Syndrome, as a possible basis
for reading difficulty with some dyslexics. Many of the symptoms of SSS
overlap with visual dysfunction such as instability of print, loss of
place when reading, and difficulty concentrating when reading. This
prompted Irlen, in her 1991 book: "Reading by the Colors", to write
that individuals interested in being screened for SSS should first see
a vision specialist for a complete visual examination.
Irlen, an educational psychologist, recognized the difference between
routine eye examinations and a vision therapy evaluation. She noted:
"When individuals take a routine eye examination, the vision specialist
normally assesses acuity, refractive status, and binocular function.
When the exam is more than routine, additional tests will analyze the
visual system in greater detail and will also evaluate focusing ability
and tracking skills. The doctor will also check for the presence of eye
diseases. For SSS treatment to be successful, existing visual problems
need to be treated first. Perceptual skills are based on a solid visual
foundation. It is essential for individuals to eliminate all visual
problems prior to getting treatment for perception or other learning
difficulties."
Does insurance pay for vision therapy?
In this era of insurance cost cutting measures, it can be difficult to
receive adequate insurance coverage. Patients are much more effective
in getting reimbursement when they pursue their claims directly, armed
with knowledge and facts from the doctor's office. There are national
optometric guidelines formulated for covered conditions and length of
treatment. The College of Optometrists in Vision Development
(888-268-3770) has an insurance committee that offers to conduct peer
review of claims when it becomes obvious that the individual or
individuals reviewing the claim are not optometrists. Ultimately the
patient must consider the following:
What problems or concerns are you having with your vision or
performance?
What options have you tried other than vision therapy, and what has
been the result?
If you have not had success pursuing other interventions, and the
doctor's diagnosis and treatment proposal make sense, what value would
you place on improvement?
Vision therapy is rarely the first form of help that patients discover.
If the patient or family is struggling, and other suggestions have not
borne fruit, investing in vision therapy makes sense. Insurance
reimbursement is helpful, but not all our decisions about our welfare,
or our children's future, are made based on someone else paying for it.
Is it true that there are certain conditions, like lazy eye, where the
patient is too old, or it's too late to intervene with vision therapy?
First, let's define the terms. What the public knows as "lazy eye" is
technically amblyopia. A diagnosis of amblyopia means that one eye
doesn't see as clearly as the other eye even with proper glasses or
contact lenses. Amblyopia can occur with or without strabismus, which
is a crossing or turning of the eyes. Strabismus is sometimes
attributed to one or more weak eye muscles, however the problem is more
often due to a defective neurological signal to the involved muscle(s)
rather than to an actual muscular abnormality.
Secondly, allow me to emphasize that, in regards to amblyopia and
strabismus, the eye muscle training benefits of vision therapy are
medically proven. There is no controversy there. Where eye doctors do
not always agree is in regards to this question you have asked. There
are eye surgeons who promote the idea that if a child has an eye turn,
you must operate by age two to get meaningful results, and if there is
amblyopia, or lazy eye, intervention of any kind is only meaningful
before age 6 or 7. There are many scientific articles in optometric
journals which prove that it's never too late to treat a lazy eye, but
I'd like to refer to an study by an eye surgeon.
In the American Journal of Ophthalmology, von Noorden, a well-known
strabismus surgeon and researcher reviewed the records of 408 patients
who had eye turns shortly after birth, and divided their surgical
outcomes based on age at the time of surgery:
AGE Surgical Outcome Percentage
4 mos.-2 yrs. Optimal 24%
Desirable 4%
Acceptable 36%
Unacceptable 36%
--------------------------------------------------------------------------------
2 yrs. - 4 yrs. Optimal 15%
Desirable 5%
Acceptable 44%
Unacceptable 36%
--------------------------------------------------------------------------------
Older than 4 yrs. Optimal 16%
Desirable 14%
Acceptable 42%
Unacceptable 28%
Re: surgical treatment, the data above shows that useful results can be
obtained by intervening after age 2. The data also shows that there
should be no rush to go to surgery after the age of 2, because the
outcomes don't differ that much after that age. By the way, the
positive outcomes measured above include cosmetic improvement ONLY.
Vision therapy aims to do more than simply straighten the appearance of
the crossed or turned eyes. It aims to help patients develop useful
binocular (two-eyed) vision.
You can learn more about eye muscle surgery as a treatment for lazy eye
or eye turns, etc. by visiting www.strabismus.org, the web site of Dr.
Jeffrey Cooper.
Re: vision therapy treatment, you'll always get the best results if you
intervene at a young age, IF you can get a child's cooperation. But,
children have little motivation to cooperate. It's been proven that a
motivated adult with strabismus and/or amblyopia who works diligently
at vision therapy can obtain meaningful improvement in visual function.
As my patients are fond of saying: "I'm not looking for perfection; I'm
looking for you to help me make it better". It's important that eye
doctors don't make sweeping value judgments for patients. Rather than
saying "nothing can be done", the proper advice would be: "You won't
have as much improvement as you would have had at a younger age; but
I'll refer you to a vision specialist who can help you if you're
motivated."
Return to Top
Any concluding thoughts?
With the advent of computers in the work environment, we're seeing more
adults with eye strain-related vision problems which can be improved
through vision therapy. Also, there are special needs patients with
developmental or head injury problems which neuro-optometric diagnosis
and vision therapy treatment can uniquely help. Still, the majority of
my patients continue to be children with learning or reading problems
who have been through all kinds of interventions. These children have
been told that their eyes are healthy and that glasses aren't
necessary, but they continue to struggle with visual processing. Their
visual processing problems or developmental vision problems can't be
detected unless the eye doctor specifically tests for them. I'd like to
sum up with a quote from the web site of one of the world's leading
vision companies, Ciba Vision:
"Because reading problems usually have multiple causes, treatment must
often be multidisciplinary. Educators, psychologists, eye care
practitioners and other professionals often must work together to meet
each person's needs. The eye practitioner's role is to help overcome
any vision problems interfering with the ability to read. Once those
are addressed the student is better prepared to respond to special
reading education efforts." (www.cibavision.com, 1999)
--------------------------------------------------------------------------------
All About Strabismus
by Dr. Jeffrey Cooper & Rachel Cooper (no relation). © 2001-2005
Treatment Options
Strabismus Surgery
Orthoptics -- Pre- and/or post-surgical
Vision Therapy --Non-surgical or in conjunction with surgery, as
appropriate.
Orthoptics
Orthoptics is a medical term for the eye muscle training programs
provided by orthoptists and optometrists. Vision therapy programs
include orthoptics, but, technically there are broad distinctions
between vision therapy and orthoptics. Orthoptics, which literally
means "straightening of the eyes," dates back to the 1850s and is
limited in scope to eye-muscle training and the cosmetic straightening
of eyes. Orthoptics treat muscle problems only in regard to strength
and do not focus on neurological and visual-motor issues in the
comprehensive way in which vision therapy does. Treatment is home
based.
Vision Therapy
Vision Therapy is an individualized, supervised, non-surgical treatment
program designed to correct eye movements and visual-motor
deficiencies. Vision Therapy sessions include procedures designed to
enhance the brain's ability to control:
eye alignment,
eye teaming,
eye focusing abilities,
eye movements, and/or
visual processing.
Visual-motor skills and endurance are developed through the use of
specialized computer and optical devices, including therapeutic lenses,
prisms, and filters. During the final stages of therapy, the patient's
newly acquired visual skills are reinforced and made automatic through
repetition and by integration with motor and cognitive skills.
While vision therapy includes the eye muscle training methods of
orthoptics, it has advanced far beyond it to include training and
rehabilitation of the eye-brain connections involved in vision.
Clinical and research developments in vision therapy were closely
allied with developments in neuroscience during the twentieth century.
Research continues in the 21st century.
In vision therapy programs, optometrists look at the neurological
control system and thus are treating the whole visual-motor system and
altering reflexive behavior, which results in a lasting cure. Also,
most optometrists rely on office based therapy, which they believe is
more accurately performed and monitored.
Vision Therapy for strabismus generally consists of either weekly or
bi-weekly office based therapy. Some doctors reinforce in-office
therapy with home therapy. This is based upon a case-by-case
determination. Milder intermittent cases may be handled with home
therapy. Older children are generally more cooperative and thus obtain
a greater benefit from therapy.
To learn more about vision therapy, go to: Interview with an Eye Doctor
and What is Vision Therapy.
You are also invited to read one mother's story regarding her choice of
vision therapy over strabismus surgery.
.
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