PATIENT INFORMATION

OMD occurs when a patient has difficulty tracking a moving target in space (pursuits) and/or moving the eyes quickly and accurately from one target to another (saccades). This condition relates directly to the eye movements associated with reading. The most efficient way to track a moving object in space is to do so with only the eyes, and no associated head movement. Whenever there is a moderate amount of supporting head movement involved in tracking moving objects, tracking is not as accurate and the person must use an abnormally large amount of effort to perform the task. In reading, this is generally associated with loss of place, re-reading lines or words, skipping lines, words or parts of words, and other small miscues.

Literature:

• This details 27 different studies that show support for the link to vision and learning, as well as the support for vision therapy to improve reading and academic achievement.
• Research on Visually-Based Reading Disability
• The efficiency of optometric vision therapy
• The link between learning disabilities, dyslexia, and vision

Accommodation refers to the amount of ability an eye has to focus on near targets. Children normally have a great ability to focus clearly on reading material and other near tasks. However, if a patient is unable to keep these things in focus for a sustained amount of time, words and objects may become blurry. In addition to blur, other symptoms include headaches when performing near tasks. This is a result of the eyes working extra hard to try and clear the material in front of them. If the amount a patient can focus up close is less than expected for his/her age, it is called accommodative insufficiency.

There are a couple of other conditions that involve the eye-focusing system. Sometimes, patients can focus really well up close, but have a hard time “letting go” or relaxing their eyes to see clearly again in the distance. This is either known as accommodative excess or accommodative spasm, depending on results seen when testing. Other times, a patient can have difficulty going back and forth between distance and near targets. This is known as accommodative infacility, and can cause issues in the classroom when having to switch back and forth between seeing the board and then a book/notes.

Convergence Insufficiency (CI) is a common condition characterized by a difficulty or inability to effectively converge or align both eyes together to perform near oriented visual tasks, like reading and computer work. CI may occur in children and adults. Symptoms often include difficulty reading and concentrating on reading tasks, avoidance of near work, ADD and ADHD characteristics, double-vision (overlapping words) while reading, words moving around on the page, eye strain, headaches and rubbing or closing of one eye while reading.

Research has shown that when children have difficulties with reading or learning, their struggles are frequently linked to CI. The symptoms can directly impact reading performance as well as attention and concentration. Once treated, reading, attention and other school performance problems often dramatically improve.

Studies have been done to compare different methods of treatment for convergence insufficiency. Based on this scientific evidence, the research shows that office-based vision therapy is the most effective and consistent treatment for CI when compared to all other methods, including an exclusively home therapy approach.

Literature:

• Convergence Insufficiency Treatment Trial - Evidence supporting office-based vision therapy with home reinforcement as most effective in treating CI.
• Convergence Insufficiency segment from the National Institute of Health.
• Granet D.B., Gomi C.F., Ventura R, Miller-Scholte A. The relationship between convergence insufficiency and ADHD. Strabismus. 2005 Dec;13(4):163-8. Details the overlap in patients with CI and those with ADHD.
• Improvement of Vergence Movements by Vision Therapy Decreases K-ARS Scores of Symptomatic ADHD Children. Lee SH, Moon BY, and Cho HG. J Phys Ther Sci. 2014 Feb; 26(2): 223-227.

The way our eyes team together and focus directly affects our ability to read, process, and understand information. Eye teaming difficulties can occur when the eyes like to rest outward or inward more than desired at a given distance, or if the ability to point the eyes accurately at near and distant targets is reduced.

When our two eyes don’t work together properly to make a single, clear image, it can lead to general discomfort, double-vision, headaches, poor concentration, and reduced depth-perception. A patient might tend to re-read certain sections of lines or words, or skip over words or lines during reading. He or she may be taking a long time to finish reading a passage because of working so hard to overcome this teaming difficulty. As a result, it can cause significant difficulties with reading and learning.

The goal of vision therapy in these cases is to correct and improve the patient’s eye teaming abilities, which makes them more effective at reading, learning and many other areas of productivity.

• View Additional Literature

Strabismus, frequently known as crossed eyes or an eye turn, can affect one or both eyes. The eye(s) may turn in, out, up, or down. These signs may always be present, or they may occur only sometimes. If an eye is constantly turned, it can cause what is called a lazy eye, where vision is not correctable to 20/20. This will also affect binocularity including 3-D vision, as the eyes are not working together as a team. Depending on the frequency and size of the eye turn, the prognosis can vary.

One approach to correct strabismus is eye muscle surgery, which intends to correct the cosmetic realignment of the eyes after one or multiple operations. However, it is important to note that only repositioning the eyes does not necessarily tell the brain and the eyes how to communicate properly and work together. As a result, symptoms of a poor binocular system may persist. Vision therapy intends to build up the eye teaming and communication with the brain. This is done a number of ways, including using filters to make sure both eyes are turned “on” and working throughout activities. This is a really important aspect when working with eye turns or a lazy eye. If a surgical option is chosen, vision therapy still helps significantly before and after surgery to build up the eye teaming system.

Amblyopia is a disorder of binocular vision where reduced eyesight is seen in one (and occasionally both) eye(s) in the absence of any other disease process. This condition originates in the brain rather than the eye itself, where one eye communicates more effectively to the brain. The other eye “shuts off” in a way as it becomes overshadowed by the more dominant eye. Amblyopia can be caused by strabismus (eye turn) or from the prescriptions between the two eyes being very different.

Other common findings in a patient with amblyopia include a decrease or loss of depth perception, delays in visual information processing, decreased visual-motor coordination, weaker focusing skills, and poorer reading eye movements. These are all a result of the eyes not working efficiently as a “team”, and can have numerous quality of life consequences.

One of the most common approaches to treating amblyopia is through correcting the refractive error with glasses and then patching the better-seeing eye. The amount of patching can vary based on the amount of vision in the amblyopic eye. There are also different types of patching that some doctors may prefer, as we use Bangerter foil occlusion here at Colonial Eye Care. This type of occlusion only blurs the better-seeing eye to just more than the amblyopic eye, and allows for peripheral fusion between both eyes. In other words, both eyes are open and working together at the same time, but the advantage is given to the amblyopic eye. It is important to note that if an eye is being entirely occluded, both eyes are NOT being given the chance to work together.

Another very important treatment approach if there are still issues or decreased vision after wearing glasses and patching is active vision therapy. Vision therapy gives the skills and tools to improve the above deficits and ultimately allow for a more efficient binocular system. Please see the links below to find research that has been done to show vision therapy’s efficiency in treating amblyopia.

Literature:

• Stereopsis and amblyopia: A mini-review
• Research showing the importance of using 3-D experience for the treatment of amblyopia.
• Prentice Award Lecture 2011: Removing the Brakes on Plasticity in the Amblyopic Brain
• Research showing that the brain remains plastic and gains can be made treating amblyopia at any age.
• Amblyopia and Binocular Vision
• Effective treatment for Amblyopia using binocular vision vs patching.
• A binocular approach to treating amblyopia: anti-suppression therapy
• Research that supports treating amblyopia through a binocular approach is better.
• Binocular vision in amblyopia: structure, suppression, and plasticity
• Demonstrates the importance of binocular vision therapy instead of occlusive patching for amblyopia.

Binocular vision problems and double vision is not just limited to pediatric patients. Many adults have similar struggles that can decrease productivity in work and with daily activities. Even though patients that are really young have a brain that is able to adapt quickly and results may be seen faster, the brain does remain plastic throughout life and gains can be made at any age.

Vision is critical when it comes to playing sports, and sports vision works on enhancing an athlete's vision abilities to take their performance to the next level. Eye-hand coordination, dynamic visual acuity, depth perception, tracking, focusing, visual reaction time, and peripheral vision are some skills needed to be a superior athlete. The testing and therapies may vary depending on a specific sport or an individual’s needs, but the end result is an improved ability to control vision with better efficiency and accuracy.

According to the American Optometric Association, a child should have three comprehensive eye exams before entering school. The first is recommended at six months, the second at three years, and then again at five years old. The reasoning is to ensure that the eyes and vision are developing properly and that issues are caught at a time early enough in life that treatment options are more effective.

Often, children do not understand what “normal” vision is, so they do not understand what or how they may be seeing may be different from others around them and therefore may not complain of symptoms.

When learning becomes difficult, frustrations during homework may surface as well as poor attention/concentration in the classroom. Since these behaviors commonly link with ADD and ADHD, many doctors’ misdiagnosis the patient with this behavioral condition and exclude crucial vision screenings.