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Making Sense of Vision Therapy by Dr. Daniel Press [Spark 2(1), p. 3-4]

March 01, 2014 8:42 PM | Deleted user

Dr. Daniel Press, O.D., FCOVD is the clinical director of pediatrics, binocular vision and vision therapy at North Suburban Vision Consultants located in Park Ridge and Deerfield, IL. He is board certified in vision development and vision therapy by the College of Optometrists in Vision Development (COVD). He serves on the board of directors for COVD and enjoys writing and speaking on all topics related to vision.


Modern Optometric Vision Therapy (OVT) stems from the prac­tice of orthoptics − literally, straightening of the eyes − which was pioneered in the second half of the 19th century by the French ophthal­mologist, Louis Émile Javal. Widely considered to be the founding father of orthoptics, Javal sought more effective treatment modalities for strabis­mus, the medical term for an eye-turn, after he became dissatisfied with the outcome of invasive surgery which was the only available therapy at the time.


The intent of orthoptics was to establish a non-invasive form of treatment for strabismus, the most obvious condition in which vision is askew. As modern medi­cine advanced in the 20th century, eye surgeons aban­doned the concept of vision therapy as an alternative treat­ment to surgical intervention because of value judgments about the time, intensity, resources, and commitment involved in delivering the service. However, as knowledge about the visual system advanced in the mid-20th century it became obvious that OVT can be utilized to treat forms of visual dysfunction beyond overt eye turns.


When the medical field aban­doned educating medical students on the benefits of vision therapy, the optometric field became heavily involved in education and research in this area of eye care, which holds true to this day. According to ophthalmologist, Dr. Robert Abel, in his book The Eyecare Revolution: "Vision therapy is taught at optometry schools; ophthalmologists know very little about it … It can change people’s lives, as it has for Presi­dent Lyndon Baines Johnson’s daughter, Lucy, whose dyslexia was helped greatly by vision therapy.”


OVT is defined by the College of Optometrists in Vision Develop­ment (COVD) as a progressive program of vision procedures that is performed under doctor supervision and individualized to fit the visual needs of each patient. OVT is performed to help patients develop or improve fundamental visual skills and abilities, improve visual comfort, ease, and efficiency and to change how a patient processes or interprets visual information.
OVT is used to treat specific visual dysfunctions diagnosed through the use of normative testing performed during an optometric evaluation. A common point of confusion is what is defined as “normal vision.” Most lay-people and even certain eye care providers would equate vision with clarity of eye sight. The truth is that vision is a process that is much more elaborate than seeing a small object 20 feet away. Seeing 20/20 tells you little to nothing about how a person functions when reading or doing close work. Additional visual functions that comprise the visual process are: tracking, focusing, eye-teaming, visual perception, and visual integra­tion. If these areas are not probed, then the status of the visual system has not been fully assessed.


Unfortunately most children do not volunteer this information because they feel the way they process information is normal. Vision is a learned process. As a child develops, so does the visual system. If there is a visual dysfunction identified along the way, OVT has the ability retrain the brain to use the visual process more efficiently which lessens symptoms and creates an opportunity for a better learning experience. OVT is applied visual neuroscience, utilizing the principles of neurol­ogy research to affect change in the visual system.


Signs that a visual dysfunction is present:
- An unexplained gap between performance and potential
- A discrepancy between intelligence and academic performance
- Language skills seem superior to reading skills
- Performance when completing near work starts out strong and then suffers with time

 

If the visual system is not functioning efficiently then certain symptoms are common, including:
- Fatigue
- Instability of print
- Intermittent blurred vision
- Eye strain
- Headaches
- Difficulty concentrating when reading
- Double vision
- Avoidance of sustained reading

So what are other medical doctors saying about OVT? Brock Eide, M.D., M.A. and Fernette Eide, M.D., leading clinicians and writers on learning disabilities particularly involving gifted children, state, "In spite of the very positive research findings validating the role vision plays in learning, some are still claiming visual dysfunction plays little or no role in the reading challenges that dyslexics face. This is a shame. When we look specifically at the results of stud­ies performed to address specific visual issues, the evidence supporting visual therapy is quite strong.” Oph­thalmologist Dr. Bruce Sumlin writes, "Optometric vision therapy makes sense. It is very similar to other kinds of treat­ment and therapies we provide in the medical disciplines which help to develop neural connec­tions in the brain.”


There are multiple clinical trials that support the effectiveness of OVT. One of the most highly regarded studies done in any therapy field was published in 2008 in Archives of Ophthalmol­ogy. The National Institute of Health-sponsored research is titled “Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children.” This elaborate study included children diagnosed with symptomatic convergence insufficiency split into multiple groups. The treatment options included pencil pushups, home based computer therapy in addition to pencil pushups, office based OVT with home reinforcement, and placebo office based OVT. The results of the study show that office based OVT results in a significantly greater improvement in symp­toms and clinical signs than the other treatment options.


The bottom line is that visual problems, which are not uncom­mon in struggling students, are amenable to therapy. Eye doctors vary in their expertise in the field of vision development. The first step to determining if a child has a visual problem is to have an evaluation completed by a qualified developmental optometrist. For additional infor­mation, or to find a doctor knowledgeable in vision devel­opment, visit www.covd.org or www.visionhelp.org.

 

Contact:
Dr. Daniel J. Press
303 N Northwest Hwy Park Ridge, IL 60068
T: 847-823-8283
Email: djpress@nsvc.com 

 

Posted retroactively on March 13, 2015. 

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