Vision Therapy is Messy

In his book Messy: How to be Creative and Resilient in a Tidy-Minded World, Tim Harford provides examples of how extreme organization and structure, reduced diversity, and oversimplification makes things easier but constrain and compromise outcomes.

Vision is complex and each person’s combinations of problems and circumstances is unique. Vision doesn’t function in isolation. It is represented in more areas of the brain than any other sense. It is involved in almost everything we do. How we see the world is an integral part of who we are. It follows that enhancing essential visual functions;

-eye alignment and movement,


-object perception, spatial perception, and guidance of movement

is messy and complex and that it is naïve to think that therapy is not influenced by the patient’s mindset, age, conflicts, and prior experiences.

All of this must be taken into consideration to treat patients. Computerized programs cannot do this but they can be useful to stimulate attention and motivation. It also requires more than a list of techniques. Doctors and therapists need to be ready and able to modify plans to match the patient’s current visual abilities. Optometric vision therapy is provided by doctors and therapists with specialty qualifications. Certified doctors are Fellows in the College of Optometrists in Vision Development (FCOVD). Certified therapists earn the title, Certified Optometric Vision Therapists (COVT). The College of Optometrists in Vision Development is the certifying body for this specialty.

Relationships between providers, patients, and their families are integral to the success of all healthcare, especially incremental care. Atul Gawande wrote about one of thirteen centers for treating patients with cystic fibrosis in the US in his book Better. One center had much better outcomes than all of the others even though the centers all followed the same protocol. The difference was that the director in one center got to know his patients personally. The better understanding and communication that resulted from these personal relationships fostered improved compliance. Atul Gawande also addresses this in his article on The Heroism of Incremental Care.

Therapy is an interplay between treatment and assessment as the patient progresses. The doctor and therapist continue to learn about patients from the way each patient responds. Dwight D. Eisenhower stated in reference to war that “Plans are useless, but planning is indispensable.” This also applies to other complex, messy situations.

Vision therapy is not easy and can be frustrating. Plasticity in Sensory Systems makes therapy possible. While neuroplasticity declines with age, it continues throughout life. Motivation can recruit surprising amounts of plasticity.  The Power of Habit balances our ability to change. Habit enables us to function without consciously thinking through everything we do, which is not possible, but it can also cause us to err when conditions change. Therapy develops new visual habits.  Focused rehearsal under a variety of circumstances facilitates supplanting existing habits with new skills and makes them more automatic than the dysfunctional patterns that they are replacing.

Optometric vision therapy takes advantage of neuroplasticity and the messiness in our visual system to make change possible. Therapy creates new visual patterns to be more efficient, more comfortable, and less taxing. Patients must achieve this for themselves, but appropriate feedback at the right time can be powerful, which is why doctors and therapists are indispensable in this process. Daniel Coyne provides example which demonstrate this in The Talent Code as does Norman Doidge in The Brain that Changes Itself. Humans are endowed with amazing abilities to learn and to adapt.

Amblyopia and Neuroplasticity

Neuroplasticity – our brain’s ability to develop throughout our lifetime – is now understood, but neuroscientists did not accept neuroplasticity in the human brain until it was confirmed 50 years ago by David Hubel and Thorstein Wiesel through their research on the visual cortex of the brain. Over the last 50 years, research on neuroplasticity has continued to focus on vision.

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Amblyopia’s New Kids On The Block

The VisionHelp Blog

ReismanOur story begins in 2011 with Anna Reisman, M.D., an associate professor of medicine at Yale.  Writing a review of a book for Slate Magazine, Dr. Reisman opened her commentary with a very personal anecdote about her son.  “When my son was a toddler, an ophthalmologist diagnosed him with a form of amblyopia (lazy eye) and recommended an eye patch to improve his overall vision. But, he added, he couldn’t promise that my son would ever have normal depth perception. I felt like I’d been kicked in the gut. I threw a few search terms into Google, came upon an offbeat treatment for eye disorders called vision therapy, and soon found a local practitioner, a middle-aged Chinese-American woman with short hair and half-moon glasses whose messy office was filled with eye charts and board games and had tennis balls hanging from the ceiling and who promptly engaged my…

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Answers to Beautiful Questions

The VisionHelp Blog

The answer to the question we just posed is that the still predominant approach to amblyopia treatment, involving patching the better eye, needs to be brought up to date.  Research is coming out so rapidly that even our previous pass at this can be updated.  Don’t get us wrong – we’re not ready to say that quality time patching is never indicated.  We’re saying that in many types of amblyopia, particularly refractive amblyopia in the absence of strabismus, or when there is already reasonably good binocular capacity, that there are a bunch of “fun with a purpose” activities now available that can build on if not bypass occlusion.  Here are some examples of fun activities, and bear in mind that as much as we’re not fans of calling amblyopia “lazy eye”, that’s still the way these programs are publicly listed.

“Lazy Eye Tetris”


“Lazy Eye Bubble Shooter”

Lazy Eye Bubble

“Lazy Eye…

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Isn’t it about time we end “Lazy Eye”?

The VisionHelp Blog

girl-eye-exam_resizedAmblyopia is the most common form of unilateral vision loss affecting over 10 million individuals in the US alone. It a disease of the visual system that impacts the lives of 2-4% of the world’s population yet occurs in the absence or removal of ocular pathology.  Amblyopia  is a serious visual problem that has been recognized for centuries as the inability to see in one eye compared to the other, even with corrective lenses.

However , there is an overwhelming amount of research evidence that shows amblyopia  impacts a person in more than visual acuity (eye sight) alone. The amblyopic individual has poor depth perception,  dysfunction in micro-eye movements affecting reading fluency, visual perception and processing ability causing poor judgments, deficiencies in eye hand and general coordination leading to errors in visually directed motor behaviors.

Modern neuroscience has provided us with the complete understanding for the cause of Amblyopia too…

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The Re-Launching of Christopher Walter

The VisionHelp Blog

C1Christopher’s parents began noticing his left eye turning in during the Fall of 2012, a few months after he had turned three.  They took him to a pediatric ophthalmologist who diagnosed accommodative esotropia.  The prescription in his glasses was R eye +4.75 and L eye +5.75.  But even with the glasses on his left eye continued to turn inward resulting in amblyopia, and his father pointed out that Christopher had become more cautious after obtaining the glasses.  From December 2012 through December 2013 his parents patched Christopher’s right eye to improve the eyesight in his left eye, according to a patching schedule devised by his doctor.

Concerns were developing in school, particuarly about midline crossing and fine motor skills, which led to an occupational therapy evaluation.


His OT evaluation noted that Christopher was having difficulty consistent with binocular integration problems.  Through a friend whose daughter came to our practice, Christopher’s parents brought him…

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