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.

What Are Those Floaty Things IN Your Eye?

This four minute Ted-Ed Original provides an easy to understand summary of “floaters”. Floaters are experienced by almost everyone, especially as we get older. The vitreous is a gel which fills the back of our eyes and pushes against the retina keeping it in place. As we age, the vitreous shrinks and separates similar to curdled milk.  This is known as syneresis. While most floaters are benign, a sudden change in floaters, especially if they are associated with apparent flashes of light, may indicate a retinal tear or detachment and requires urgent care. Flashes are experienced as the vitreous pulls away from the retina. Any stimulation of the retina is experienced as light. The retina is part of the brain and, like the brain, cannot sense pain. If you experience a sudden change in floaters call your eye and vision care provider and explain what you are experiencing. They will schedule you appropriately. You should not go to an emergency center or walk-in. They are not staffed to evaluate this problem.

Sun and Glare Protection

Sun and glare protection are important for your comfort and safety. Now that most lenses are plastic, eyes and eyelids can be shielded from direct UV light even with clear lenses. Most plastic lenses naturally block UV light. Those that do not, can be treated with a clear coating (like sun block) to provide this protection. UV light contributes to our well-being but also contributes to the development of cataracts, macular degeneration, and cancers of the eyelids.

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Photochromic lenses (lenses that darken in the sun) are available in a number of different shades and colors. Many people like their convenience. They are activated by UV light. They darken quickly when you go outside and lighten when you come inside. They get the darkest in the winter and do not darken as much when it is warm. They do not reduce glare and they do not darken in your car because the windshield blocks UV light.


Polarized sunglasses, which are available in prescription and can be made in bifocals just like your clear glasses, reduce the amount of light reaching your eyes and also reduce glare. Since you must look where you are driving even if you are driving into the sun and the road is wet, polarized sunglasses increase your safety. Sunglasses are often more important in the winter, not only due to the snow on the ground, but also due to the low angle of sun in the sky.

Dusk is another difficult time to see. If you have been wearing your sunglasses, by taking them off at dusk everything will appear brighter due to the adaptation of your eyes behind the sunglasses and you will be able to see better.

Glare and glare recovery become more of a problem as we get older and the lenses inside our eyes become cloudy. This change, as it progresses, eventually becomes a cataract. The glare from the hazy lenses in our eyes is like driving into the sun with a dirty windshield. Polarized glasses reduce this significantly. If you are bothered by glare, please discuss this with your doctor or one of our opticians.