Most people don’t associate attention, learning, slow processing speed or difficult behaviors and emotions with vision. They should, however, because the brain is responsible for the way we collect, organize and interpret the material we are presented with. And our eyes are the organ that brings information into the brain. When visual disturbances go undetected or untreated, a range of difficulties can develop – including developmental delays, reading and comprehension issues, double vision, fatigue and headaches. Many of these symptoms are often associated with learning disabilities, ADHD, autistic behaviors and social and emotional concerns such as anxiety disorders.
Most vision professionals examine the eyes to determine if the patient is seeing clearly or if corrective lenses are warranted. They also look for any abnormalities in eye health. However, a subgroup of optometrists, known as behavioral or developmental optometrists investigate the role of vision and visual processing in the symptoms mentioned above. The American Optometric Association considers vision therapy to be an essential and integral part of the practice of optometry, and is a necessary and growing aspect of diagnosing and managing vision disorders.
The Exam
Besides a comprehensive exam which examines vision and eye health, a specialized visual-perceptual analysis is conducted. These tests explore in full specific eye movements, as well as adequacies and inadequacies in sustaining visual attention. Typically conducted over 60 to 90 minutes, this testing is suitable for patients with reading problems, hyperactivity and trouble focusing, headaches, fatigue, trouble with physical coordination and balance (which many times includes motion sickness and vertigo), postural insecurities and head tilts, as well as nervousness and anxiety disorders. If a visual dysfunction is detected, the first goal is to compare one’s habitual reactions and performance with that of corrective, or therapeutic lenses.
The Kaplan Nonverbal Battery, can also be used which allows experts to examine patients with neurodevelopmental disabilities, including autism, cerebral palsy, Down syndrome, amongst others who may be non-verbal or have limited language. It is also ideal for patients whose processing issues prevent them from being able to express their thoughts clearly to others. This battery is the outgrowth of decades of testing “untestable” patients and is built on the approach of observing your patient and allowing them to teach you how to help them.
What is Visual Therapy?
While corrective lenses and prisms are powerful tools, they are just one aspect of treating the individual. To achieve maximum benefit, a visual therapy program may be recommended for some patients. This involves far more than just “fixing the eyes.” Visual therapy procedures often incorporate movement, breathing, sensory-integration and emotions, while consistently addressing how the individual feels, not just what they see.
Selecting the appropriate care for each patient and presenting them with developmental exercises and treatment through new visual stimulation is a transformative process. With a team approach involving doctor-therapist-parents and children, an increasing number of individuals recover from their impairments and lead more successful, productive and happier lives.
Who Benefits?
Even within the “normal” population, vision deficits are surprisingly common. Some individuals can relate to mild reading (or re-reading), comprehension or writing issues, while others may sense a buildup of visual stress when focusing, driving, or even socializing with peers, family members or colleagues. The College of Optometrists in Visual Development (COVD) recently reported one in 10 children in the US – over 5 million in all – have a vision problem significant enough to impact their ability to learn in school.
Also included within this “normal” population are adults who may suffer from headaches, migraines, motion sickness or vertigo. This is not to imply that everyone in the general population is in need of visual therapy, however, those who benefit are usually those whose impairments are interfering with their everyday life.
For individuals with binocular dysfunctions, learning disabilities, developmental delays, autism and other neurodevelopmental conditions the rate of visual problems is sizably higher. Left untreated, visual deficits impair the abilities of affected individuals. This impacts their sense of body in space, the world around them, processing speed, as well as the ability to integrate visual stimulus with input from other sensory systems – all of which are crucial skills to function physically, academically and emotionally.
Often incorporating ambient lenses with a visual management program typically results in rapid generalization of new and higher ordered skills, and leads to great automaticity of gains in performance and behavior.
Executive Director of the Center for Visual Management, Barbara Kotsamanidis- Burg, MSE, and Larah Alami, OD, FAAO can be reached at 631-1070 or thecenterforvisualmanagement.com.
Common Characteristics of Visually Related Disorder in Developmental Delays
- Lack of eye contact or attention to environment
- Unable to imitate adult facial expressions
- Limited eye movements when tracking a toy
- Strabismus, or a noticeable eye turning in or out
- Squints or rubs eyes
- Delays reaching milestones, such as sitting up, standing, crawling or walking • Fearful of objects or body in motion (i.e. walking without holding onto walls or the caregiver)
- Unsteady when taking steps past 18 months
- Abnormal posture, such as a head tilt or torticollis
- Toe-walking
- Peripheral “side” viewing
- Self-stimulatory or repetitive behaviors • Hesitant to reach for or catch objects
- Avoids interaction with other adults or children
- Less interested in playing with toys.
Common Characteristics of Visually Related Disorders in School Age Children
- Poor visual attention or easily distracted • Double or blurry vision
- Loss of place when reading, re-reads frequently and has low reading comprehension
- Preference for auditory input, such as listening, rather than reading
- Trouble focusing with noise in the background
- Drowsiness in class
- Sits too closely to books or television • Difficulty with eye-hand coordination tasks (such as bike-riding, writing or catching a ball)
- Poor chalkboard to desk copying • Quickly fatigues
- Sensitivity to light
- Trouble with eye contact
- Preference for side viewing, or “peripheral viewing”
- Falls or tumbles frequently
- Balance and posture difficulties, including but not limited to head tilts, body shifts or toe-walking • Has emotional outbursts.