What is vision therapy?

Simply speaking, vision therapy is a preparing you to learn or improve your visual abilities. It allows you to quickly take in, use, and understand more information over a large area of space. It also allows you to use vision to learn more and succeed better at work, school, or in athletics. Rather than only exercising your eyes, it also involves an awareness of movement and control of movement. The result leads to smooth and automatic movement of eyes coordinated with movement.
It is of course primarily targeting an existing dysfunction o the vision system. Optometric vision therapy can thus be understood as a treatment plan used for correcting these dysfunctions, which includes – but are not limited to – the treatment of strabismus, amblyopia, accommodation, ocular motor function and visual-perceptual-motor abilities.

Among different visual abilities and skills that vision therapy can help improve are the following:ability to follow a moving object smoothly, accurately and effortlessly with both eyes while also performing other activities (thinking, talking, reading or listening);ability to quickly and accurately fix the eyes on a series of stationary objects;ability to change focus quickly without blur from far to near and near to far;ability to team two eyes together;ability to see over a large area (periphery) while pointing the eyes straight ahead;ability to see and recognize objects in a short look;ability to see in depth.

Vision therapy is one of the most successful methods for treatment of visual dysfunctions. Recent study which looked at different empirical studies showed, that vision therapy yielded positive results in 61%, compared to 39% for occlusion therapy, 23% for overminus lens TX and 24% for prism therapy.

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How to tackle lazy eye and win? Easy!

Were you ever told your child with lazy eye is too old to have his or her vision improved? If the answer is yes, then someone was either giving you false information or was just not willing to give you enough of their time to really give you the help you deserve!

The reason why such information is circulating is based in outdated studies that negate the ability to improve visual function after the age of 10. These studies originate from the middle of 90s when neurologist Sue Barry conducted a research in which strabismus, lazy eye and other visual problems were declared as developmental problems that cannot be improved later in life if we miss the early developmental stages of child’s life. Interestingly enough – these findings were derived from studying TWO CATS with unaligned eyes. Neither of the cats developed depth perception, but many scientists believe that cats never develop stereo vision or depth perception!

In case of amblyopia or lazy eye one eye has better visual acuity than the other. On top of that, problems with depth perception may occur.  Often kids who are diagnosed with lazy eye are reporting troubles with throwing and catching objects, are generally clumsier or are tripping over objects. Many doctors were giving out information to parents of such kids that there is no chance for their improvement based on the “cat study”!

Latest studies have found completely the opposite! Scientists found that problems with lazy eye, strabismus, convergence insufficiency etc. are neurological first and foremost! As such, they can be tackled even later on: the brain is one of the most adaptable body parts and can be retrained and rewired with right approach, correct stimuli and regular exercises. With these exercises we can teach the brain how to operate both eyes together and create a clear binocular vision!

With these new findings in mind, many specialists started using vision therapy to address these issues. Together with good refraction, regular vision therapy exercises with either an eye patch or glasses with colored filters can provide great results!

Because the vision therapy exercises are often quite dull, a lot of attention is lately given to the gamification of vision therapy: an approach where kids train their vision through engaging games and exercises. It was shown what vision therapy really can offer great results, but it all depends on how consistent we are with going through daily vision therapy routine.

We will touch more this aspect in our next blog, but for now – we are looking forward to receiving your feedback and contributions at info@amblyoplay.com!

Deviation of the eyes – How much is too much?

When starting examining visual system at the eye care specialist it is very important to start with anamnesis. It is one of the most important starting points of the thorough eye exam. The chance that an anomaly is found is often connected to the family ocular history.

For example, if a parent used to occlude one of the eyes as a child and at the exam they are not sure which eye they had to occlude, it is most probably that the occluding therapy was successful. Occluding is needed when one eye deviates from the ideal axis in regard to the other eye. The most common eye deviations are when one eye is inclined towards the nose – nasally (ESO deviation) or outwards – temporally (EXO deviation). The less common deviation is vertical, however, it is more symptomatic. 

The deviations are categorized in the intensity of the deviation or measured in the angle or prism dioptres. The visual system is so advanced that also in the cases when the two eyes are not aligned ideally the picture on the retina and therefore in the visual cortex is perceived as one.  The problem occurs when one eye is declined in such extent that the pictures projected of the two eyes on both retinas are not merging and are not perceived as one when double vision kicks in. When the image on the retina is projected on the corresponding points on the retinae, the vision is then comfortable and single with the presence of stereopsis (depth perception). If the angle of declination is too big, then the single image is not possible. In this case, the visual system neglects the image that is declined in regard to the other to perceive only one single image.

So is there no problem anymore? When suppressing one eye, what is the most common result in the development stage of the vision (e.g. between 3 and 8 years of age), the deviations are very difficult to recognize. Small deviations are normal and acceptable.

We know a few ways how to recognize bigger deviations on our own. With the test Cover-Uncover, we might find out some deviations. The procedure is as follows:

  • Find an occlude in the shape of a small racket (e.g. Wooden spoon)
  • The test person is focused on an object more than 6 meters away (e.g. Door handle)
  • Start the test by covering one eye (with occluder) and precisely observe the un-occluded eye if there is any deviation
  • Proceed with covering the second eye and again precisely observe for any deviations
  • Repeat these steps a few times to be certain
  • If there is no deviation, the test is negative, so no obvious error or anomaly
  • If the eye is declined nasally – inwards then we get EXO deviation, in case of declination temporally – outwards then we get ESO deviation
  • The same test can be done at near also, for the target get something small (e.g. Pencil top)

In case of uncertainty or bigger declinations, we suggest you visit an eye care specialist for further and more thorough testing.

Top 5 steps for successful vision therapy

Vision therapy is nowadays regarded as one of the most successful methods of treatment for several vision system dysfunctions, such as lazy eye/amblyopia, accommodation issues, and others.

However, performing vision therapy can be tricky and it can quickly derail the enthusiasm for performing daily or weekly tasks by the young patients. We must take notice of several details and address them in a comprehensive manner.

  1. Determining Patient’s Level

Before we can start with vision therapy we must first understand what is the level at which the patient’s vision is currently performing. A comprehensive eye exam is, therefore, a prerequisite; however, it is not enough. We must both understand where he or she is at, as well as what is the range in which it can still perform well.

  1. Patient’s Frustration Level

If you ever played video games, you know what we are talking about. You finally start getting a grasp on what you have to do when the difficulty level jumps and you start having difficulties progressing. People like to have a feeling of progress and accomplishment, and this desire is especially present with today’s children who are used to instant gratification. For successful vision therapy we must constantly try to push the lazy eye a little bit further every time, but never to the point where a person is just not able to perform anymore and starts feeling frustration, which is in the end counter-productive and may cause patient to stop performing vision therapy altogether.

  1. Use of Positive Reinforcement

When patient is performing their therapy, we must stimulate them further with positive reinforcement. Sometimes an encouragement and a compliment can work magic, while other times we must bribe them with small tokens or rewards. We will talk more about how you can stimulate children to perform their daily therapies in the weeks to come, since this is one of the main elements of gamified methods of vision therapy, such as AmblyoPlay.

  1. Effective Training Level

After we have established the positive reinforcement and the correct level at which therapies are performed, we must find the correct level at which we can continuously enhance the performance through difficulty of the treatment. It is a sweet spot between the patient’s level and their frustration level. Given that therapy is working, one should expect that both levels would increase.

  1. Let Them Understand

This one might as well be put under number one since it is absolutely essential. Patients should be aware of what they should expect. Patients and eye care specialists should establish clear goals (what patient can expect if they perform as instructed) and strategies (how these goals will be achieved) of vision therapy. Only this way patients will clearly know why they have to put themselves through intense daily therapies.

Based on these steps it is clear that one of the possibilities for successful vision therapy could be methods using game mechanics. Game mechanics (or gamification) use precisely these steps: they provide instant rewards for progress, the difficulty is constantly adapted to the current level and it increases constantly (but not linearly to sustain a feeling of improvement for a longer period while avoiding the frustration of hitting difficulty ‘wall’). AmblyoPlay has sprung out as a potential solution precisely because doctors and eye care specialists mentioned lack of motivation for home-based exercises as one of the main issues with lazy eye / amblyopia treatment.

Do you have any other steps you would include in this whole process? What are the issues you face? Let us now at info@amblyoplay.com!