Vision training, also known as vision therapy or orthoptics, consists of a variety of programs to enhance visual performance. It includes treatments for focusing, binocularity, and eye movement problems. Vision training is generally provided by an optometrist (O.D.).
While visual acuity refers to how clearly each eye can see, vision training addresses how well the two eyes work together as a team. When looking at an object, the eyes must focus on the object (e.g., focusing for near or far objects). This involves the lens system of the eyes. The eyes must also work as a team and point at the same object so that the person does not see double. Aiming precisely at the same object will aid in depth perception (stereopsis) and seeing objects in three-dimensions (3D).
Although crossed eyes (strabismus) is an obvious condition, many defects in the coordination of eye movement are far less apparent. Even so, they can cause problems in reading, driving vehicles, and other complex tasks that require the integrated function of eyes and body. It is the goal of vision therapy to improve these subtle interactions using carefully devised exercises and devices.
The discipline, called "behavioral optometry," involves a careful evaluation of visual function, concentrating on complex skills such as rapid reading, distance perception, peripheral field awareness, accommodative facility, and the coordinated movement of each eye in relationship to the other. From that assessment the doctor goes on to design a course of exercises to correct the problems discovered. Like any other type of training, success requires practice and persistence until habits and reflexes can be retrained.
There are a number of different techniques and instruments used in vision therapy; the field is evolving rapidly in many directions. Some computerized exercises are being developed that promise better patient motivation. A device called the Dynavision apparatus, has produced positive results in retraining stroke victims to operate motor vehicles. And traditional forms of vision therapy have increased reading efficiency in an older age group (62 to 75 years).
Because the goal of vision training is to improve visual efficiency and visual processing, people having problems reading should consider a vision training evaluation. Children rubbing their eyes while reading, avoiding reading, or getting headaches while reading should be evaluated. Problems with sustaining focusing (accommodative insufficiency) or problems keeping words single (convergence or divergence problems) may be present. A full eye-health evaluation and vision training workup may reveal a problem. Vision training is also appropriate for people learning how to coordinate the eyes after surgery for strabismus. Vision training can also be used in lazy eye (amblyopia) and includes patching the eye and doing various exercises.
Dyslexia is a problem with following the flow of words when reading. Often the order of letters or words is reversed. It is a complex problem involving the way the brain processes the stream of information coming in from the eyes. While vision therapy is not a treatment for dyslexia or learning disabilities, there may be an under-lying visual processing problem that may be present. Vision therapy can be part of a multidisciplinary approach to treating learning disabilities.
Sports vision deals with visual performance in sport-related activities. Protective eyewear is also a large consideration when participating in sports. Basketball, baseball, racquetball, and swimming (and other sports as well) can all cause injury to the eyes. Batting helmets with face shields, protective goggles with polycarbonate lenses, or something as simple as ultraviolet (UV) coatings on glasses to protect the eyes from the sun in out-door sports such as golf can protect the eyes. Hitting a baseball or throwing a basketball into a hoop requires accurate fixation. Golfers need to see clearly and judge distance. Bifocals may need to be adjusted to allow for putting, driving, and reading the score card. While many of these issues (e.g., UV coatings) can be addressed at a regular eye exam, sports vision may be able to help with more specific, individual problems.
Behavioral optometry is a relatively new field of study. Results are mixed. Newer techniques, more refined evaluation methods, and newer pieces of apparatus are continuously being appraised. More study results are needed to define the scope and benefits of this discipline.
Vision therapy is individually tailored to the subject and the discovered problems. It can be a lengthy process with many variations that requires repetition until eye muscles, coordination, reflexes, habits, and the way the brain handles visual input are all retrained. Each program will be individualized. The patient should be aware of the time involved for treatment. Treatment can be from several weeks to several months depending upon the condition. Some insurance plans may cover vision training.
If vision therapy is recommended, the optometrist will discuss thoroughly what is expected and necessary for success. The patient must be prepared to perform some eye exercises at home.
Even after the treatment is successful, it may be necessary to continue the exercises to maintain the benefits. It may be necessary to repeat treatment in the future.
No risk is involved. The treatment is safe.
A carefully and individually tailored program of vision therapy should result in a gradual improvement in whatever complex visual function is being addressed. This progress ought to be measurable by using the same tests that were used to diagnose it. If the patient had symptoms, such as headaches or double vision while reading, it should be alleviated.
Because the treatment is safe, the only abnormal result is failure. At the start of treatment, the optometrist should provide a reasonable estimate of what improvement to expect and how long it will take. Should this prove incorrect, either the treatment needs to be modified or the problem deemed untreatable by that method.
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Klavora, P., et al. "The Effects of Dynavision Rehabilitation on Behind-the-Wheel Driving Ability and Selected Psychomotor Abilities of Persons After Stroke." American Journal of Occupational Therapy 49, no.6 (June 1995): 534-542.
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Wood, J. M., and B. Abernethy. "An Assessment of the Efficacy of Sports Vision Training Programs." Optometry & Vision Science 74, no. 8 (Aug. 1997): 646-59.
American Optometric Association. 243 North Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100. <http://www.aoanet.org>.
Prevent Blindness America. 500 East Remington Road, Schaumburg, IL 60173. (800) 331-2020. <http://www.preventblindness.org>.
J. Ricker Polsdorfer, MD
Accommodation—The focusing of the lens of the eye.
Binocular—Both eyes accurately pointing to the same object.
Stereopsis—The visual perception of depth, or the ability to see three-dimensionally. For this to occur, the person must be binocular.