About Vision Problems

Do you or your child struggle with reading?

Are you an athlete looking to improve your game?  

Do you have a condition such as computer vision syndrome (CVS), amblyopia (lazy eye), strabismus (turned eye), or a brain injury?



Vision plays a critical role in our learning, working, and recreation. Vision is more than just having 20/20 eyesight. Vision is the ability to take in information through our eyes and process the information so that it has meaning.

It is essential that our visual system is efficient because two-thirds of all information we receive is visual and 75%-90% of classroom learning comes through our visual system. The visual system is composed of 20 visual abilities. These visual abilities are:

These visual abilities are basic skills used to perform tasks such as reading and using a computer. According to the American Optometric Association, "Among school-age children, vision disorders affect one in every four. While many of these patients have refractive errors (myopia (nearsightedness), hyperopia (farsightedness), 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". About 40% of all Americans have functional vision deficits. Vision problems not only affect an individual's ability to perform tasks, but it can also affect his/her self-esteem as well.

Reading requires an individual to use visual abilities such as distance and near acuity, accommodation (eye focusing), binocularity (eye coordination/eye teaming), oculomotor (eye movement), peripheral vision, and visual perceptual skills such as figure-ground, form constancy, spatial relations, visual closure, visual discrimination, visual memory, and visualization. For an individual who is Learning Disabled, Dyslexic, or has Attention Deficit Disorder, he/she faces yet another obstacle when poor visual abilities are present. Sometimes children who are having visual problems may be mis-labeled as Learning Disabled (LD), Dyslexic, Attention Deficit Disorder (ADD), or Attention Deficit Disorder with Hyperactivity (ADHD). 

Visual abilities such as visual acuity, accommodation (eye focusing), binocularity (eye coordination/eye teaming), oculomotor skills (eye movement), eye hand coordination, depth perception, peripheral vision, and visualization are all very important skills that are used in sports such as archery, baseball, basketball, football, golf, gymnastics, hockey, racquetball, shooting, skiing, soccer, tennis, and volleyball.

Computer vision syndrome (CVS) is a condition that affects many computer users. Approximately 70% of computer workers are reported to having vision problems. The symptoms CVS include eyestrain, dry or burning eyes, blurred vision, headaches, double vision, distorted color vision, and neck and backaches. The condition is caused by various factors. One factor is poor visual skills such as accommodative (eye focusing) skills or binocularity (eye coordination/eye teaming) skills. Another factor is the tendency of computer users to stare at monitors for long periods without changing eye focus from time to time. The dist ance between a computer user and a monitor is another factor. Room lighting, monitor glare, screen color, print color, and print size can also be contributing factors to this condition.

Medical conditions such as amblyopia (lazy eye), strabismus (turned eye), and brain injuries can have a major affect on your vision. Amblyopia causes reduce acuity in the affected eye, poor eye hand coordination, and poor depth perception. Strabismus can cause double vision and poor depth perception. Brain Injuries, such as Traumatic Brain Injury (TBI), Mild Acquired Brain Injury, Mild Closed Head injury, Post-Concussive Syndrome, Cervical Trauma Syndrome, Post Traumatic Vision Syndrome, Stroke, Cerebral Palsy, and Cerebral Vascular Accident, can cause a reduced visual field (reduced peripheral vision), double vision, and other vision problems. 
 

Visual skills such as accommodation (eye focusing), binocularity (eye coordination/eye teaming), oculomotor (eye movement skills), and eye hand coordination are neuro-muscular abilities. These visual skills are controlled by the muscles inside and outside of the eye and are networked with the brain. Neuro-muscular abilities are learned and are developmental in nature. Weak visual skills will not go away with time and without treatment. Binocularity (eye coordination/eye teaming), oculomotor (eye movement skills), and eye hand coordination can be retrained to perform more efficiently at almost any age. Accommodation (eye focusing) can be improved until around age 40.

Optometric vision therapy is a set of procedures that are individualized and prescribed by an optometrist to teach a patient how to improve a weak or nonexistent visual skill or processing skill through the use of lenses, prisms, special computer programs, and other treatment techniques. 

Please note that vision therapy is a treatment to improve a specific vision disorder; it is not a treatment for dyslexia, learning disabilities, or attention deficit disorder. To learn more about vision and learning, please click here. 

When weak visual and processing skills are present, an individual's ability to quickly and accurately comprehend reading material may be reduced. Once these skills have been improved through the treatment of vision therapy, reading and learning will be easier. 

The visual abilities, which are needed in sports, can be trained through vision therapy to reach their maximum potential. To learn more about the role of vision in sports, please click here. For a few tips on how to improve visual abilities that are used in sports, please click here.  

Computer vision syndrome (CVS) may be improved by vision therapy, prescription glasses, or modifications to a computer workstation. Consult an optometrist to determine if your accommodative (eye focusing) or binocularity (eye coordination/eye teaming) skills are adequate.

Research studies have shown that children and adults with amblyopia (lazy eye) and strabismus (turned eye) may be able to improve their visual performance and function through vision therapy. For many years, it was thought that amblyopia (lazy eye) and strabismus (turned eye) was only amenable to treatment during the "critical period". This is the period up to age seven or eight years. However, recent research has demonstrated that effective treatment can occur at any age, but the length of the treatment period increases dramatically the longer the condition has existed prior to treatment. To learn more about amblyopia and strabismus, please click here. For more information about treating amblyopia (lazy eye) and strabismus (turned eye) with vision therapy, please click here. 

The prognosis for strabismus can vary from very poor to excellent depending on the type of deviation, type and number of visual adaptations (suppression, abnormal retinal correspondence, or amblyopia), duration of condition, and prior interventions. A study by Dr. Gary Etting, O.D., F.C.O.V.D. in 1978 showed that 57% of patients with constant esotropia and 82% with constant exotropia had a functional and cosmetic cure with vision therapy. The cure rate was 100% for patients with intermittent esotropia and 85% for patients with intermittent exotropia. Individuals with mild or no amblyopia, normal retinal correspondence, some depth perception, and a deviation that remains essentially the same in all positions of gaze will have a better prognosis than someone who does not. Please consult an optometrist who specializes in vision therapy to determine if this would be an effective treatment option for you. 

Vision therapy can be beneficial for those with brain injuries and certain types of vision problems. For more information about vision problems associated with brain injuries, please click here. Consult an optometrist who specializes in optometric rehabilitative therapy to find out if you would benefit from vision therapy. (The Neuro-Optometric Rehabilitation Association International, Inc. (NORA) website provides more information about various treatment options available for those with vision problems and brain injuries.)

Vision therapy is not new. Physicians in the mid-1800s originally introduced many of the techniques that are used today. Modern Optometric Vision Therapy was pioneered in the United States in 1928 by optometrist A. M. Skeffington. Throughout the years, vision therapy has been called various names such as visual training, orthoptics, or eye exercises. Today, optometry students are required to take an introductory course in vision therapy.

For those optometrists who wish to specialize in vision therapy, they must receive postdoctoral training in functional / developmental / behavioral vision care. Many optometrists that specialize in vision therapy may be known as a Behavioral, Developmental, Functional, or Neuro-Rehabilitation Optometrist. To be a certified vision therapy specialist, an optometrist must receive postdoctoral education, complete a guided study program, and pass a rigorous written, oral, and clinical examinations. This certification process generally takes three years to complete.

To determine if an individual is a candidate for optometric vision therapy, a Comprehensive Vision Evaluation should be given. This examination is more comprehensive than a routine eye exam. Like a routine eye exam the optometrist will be evaluating the health of the eyes and determine if the patient has 20/20 eyesight. Unlike a routine eye exam, this examination will evaluate all of the patient's visual abilities, not just visual acuity. Standardized tests can be given to evaluate the patient's focusing skills, eye teaming skills, eye tracking skills, visual-motor skills, and visual perceptual skills.

If vision therapy is indicated from the examination as a necessary treatment, then the optometrist will prescribe it for the individual. Generally, the length of a vision therapy program will range from several weeks to several months. The nature and severity of the disorder being treated, the specific needs of the patient, patient compliance, and the patient’s medical history affect the duration of treatment. Typically, treatment is administered in the office under the supervision of the optometrist. During the program, home activities are usually given to reinforce the developing skills. The goals of vision therapy are to improve the patient's visual function, relieve associated signs and symptoms, meet the patient's needs, and improve the patient's quality of life. 

A few insurance companies cover optometric vision therapy, if it is addressing a condition that is classified as a disease such as convergence insufficiency. Vision therapy falls under the area of Major Medical. Insurance companies classify vision therapy as “Orthoptics” with a CPT code of 92065. If this treatment procedure is covered, the percentage of coverage and the number of sessions covered can vary greatly. Vision therapy is not generally covered by vision care plans that simply cover eye examinations, eyeglasses, or contact lenses.

For more information about vision therapy, please click here.