Vision Training

If your optometrist finds a binocular vision problem during your eye examination, it could be improved with the use of vision training. These problems are often found in children but can be present in adults. At Innovative Eye Care, both our Adelaide and Henley Beach practices are equipped to prescribe vision training for a variety of paediatric vision issues.

The human visual system is complex. Some visual conditions such as short-sightedness (myopia), long-sightedness (hyperopia) and astigmatism can be corrected through the use of spectacles or contact lenses. Other problems with a patient’s vision can arise from poor binocular vision skills. These skills relate to how well a patient’s two eyes are working together. Symptoms commonly described by patients relating to dysfunction of these skills include:

• Blurred vision (particularly after prolonged near work)
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• Difficulty reading
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• Poor concentration
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• Headaches or eye strain
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• Double vision
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• Words moving a page
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• Sensitivity to light

Vision Training Exercises

Vision training involves a series of activities which are individually prescribed in order to develop or improve a patient’s visual skills. These important visual skills include accommodation (eye focusing), vergence (eye alignment) and eye movement.

Accommodation (Eye Focusing)

Accommodation refers to the eyes ability to focus clearly when looking from distance objects to near objects and vice versa. It is controlled by the ciliary muscle inside of the eye which changes the shape of the internal lens. Vision training specifically targeted for improving eye focusing aims to improve and develop good control of the ciliary muscle. Exercises includes VT with focusing flippers and VT with Hart charts.

Vergence (Eye Alignment)

Vergence refers to the ability of the eyes to turn in and out in order to avoid seeing double. If the object moves closer to us, the eyes need to pivot in (towards the nose) which is known as convergence. If the object moves further away from us, the eyes need to pivot out (away from the nose) which is known as divergence. While there are 6different muscles responsible for eye movement, convergence and divergence are controlled by a specific few. Vision training specifically targeted for improving eye alignment aims to improve and develop the brain’s control of these eye muscles, so they are able to move accurately and stay aligned. Exercises include VT with loose prisms, VT with binocular string and VT with pen push-ups.

Eye Movements

Eye movements refer to the ability for the eyes to move accurately from one point to another. These skills are especially important for reading, which involves scanning across a page and then finding the next line below. Vision training specifically targeted for improving eye movement aims to improve and develop the control and accuracy of these movements. Exercises include VT with saccade pyramids, VT with saccade pens and VT for near motility.

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How effective is vision training?

Vision training has been highly researched. Strong evidence exists regarding its effectiveness at treating binocular vision problems. Specific treatment of eye focusing and eye teaming problems results in reduced symptoms and improvement in visual function.^1-4 Other studies have shown that vision training can result in improvements in school performance such as reading comprehension, reading speed and fluency as well asattention.^5-7 Importantly, vision training exercises also have cross-over benefits whereby exercising your eye focusing can have beneficial effects on your eye turning skills.⁸

The success of vision training has been shown to be affected by participant effort. Improvements in a patient’s binocular system are seen in patients who demonstrate commitment to theirexercises.⁸

Who benefits from vision therapy?

Binocular vision problems are quite common in the general population. Studies have shown that poor eye alignment is found in around 13% of patients and poor eye focusing is found in around 21% ofpatients.^9-10 One study screened over 1,500 kids and revealed that around 53%of children had some degree of binocular vision problem.¹¹ These rates increase even further in children who have reading difficulties where higher proportions of binocular vision problems are seen.¹²

Adults can also benefit from vision training, not just children. Due to the increased usage of computer screens in an occupational setting, people working in front of computer screens can experience ocular discomfort or blurred vision. These symptoms can be linked to problems with a patient’s binocular vision which can be trained and improved through vision therapy.¹³

How long does vision therapy take?

The length and course of vision training can vary and is dependent on multiple factors including, but not limited to, the severity of the condition and the rate of improvement. Training usually ranges from several months to more extended periods of training. After the initial period of therapy, the optometry will re-evaluate the patient’s binocular vision system and assess for signs of improvement. Even after full recovery, exercises may still be needed occasionally to keep your eyes well-trained and working effectively.

Forms of vision therapy require specialised equipment in order to train and develop a patient’s eye focusing or eye alignment. These are available at both our Adelaide and Henley Beach practices.

Contact us to see one of our friendly optometrists regarding vision therapy.

References

1) Abdi S, Rydberg A. Asthenopia in school children, orthoptic and ophthalmological findings and treatment. DocOphthalmol Adv Ophthalmol. 2005 Sep;111(2):65–72

2) Convergence Insufficiency Treatment TrialStudy Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol Chic Ill 1960. 2008Oct;126(10):1336–49

3) Scheiman M, Cotter S, Kulp MT, MitchellGL, Cooper J, Gallaway M, et al. Treatment of Accommodative Dysfunction inChildren: Results from a Randomized Clinical Trial: Optom Vis Sci. 2011Nov;88(11):1343–52.

4) Sterner B, Abrahamsson M, Sjöström A. The effects of accommodative facility training on a group of children with impaired relative accommodation—a comparison between dioptric treatment and sham treatment. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt Optom. 2001Nov;21(6):470–6.

5) Dusek WA, Pierscionek BK, McClelland JF.An evaluation of clinical treatment of convergence insufficiency for children with reading difficulties. BMC Ophthalmol. 2011 Aug 11;11:21.

6) Stavis M, Murray M, Jenkins P, Wood R,Brenham B, Jass J. Objective improvement from base-in prisms for reading discomfort associated with mini-convergence insufficiency type exophoria in school children. Binocul Vis Strabismus Q. 2002;17(2):135–42.

7) Borsting E, Mitchell GL, Kulp MT,Scheiman M, Amster DM, Cotter S, et al. Improvement in Academic Behaviours After Successful Treatment of Convergence Insufficiency: Optom Vis Sci. 2012Jan;89(1):12–8.

8) Horwood A, Toor S. Clinical test responses to different orthoptic exercise regimes in typical young adults. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt Optom. 2014 Mar;34(2):250–62.

9) Duke-Elder S, editor. The physiology of the eye and of vision. Reprinted. St. Louis: Mosby; 1958. (System of ophthalmology).

10) Bennett GR, Blondin M, Ruskiewicz J.Incidence and prevalence of selected visual conditions. J Am Optom Assoc.1982;53(8):647–56.

11) Lieberman S, Cohen AH, Stolzberg M,Ritty MJ. Validation Study of the New York State Optometric Association (NYSOA)Vision Screening Battery. Optom Vis Sci. 1985 Mar;62(3):165–168.

12) Dusek W, Pierscionek BK, McClelland JF.A survey of visual function in an Austrian population of school-age children with reading and writing difficulties. BMC Ophthalmol. 2010 May 25;10(1):16.

13) Wimalasundera S. Computer vision syndrome. Galle Med J. 2009;11(1).