Vision therapy uses various techniques to actively train and improve visual skills. It aims to establish efficient binocular vision through tasks that target issues like amblyopia, strabismus, focusing, and eye coordination. Treatment involves procedures done at home and in the office using instruments like lenses, prisms, occlusion, and computer programs. Success depends on accurate diagnosis, a tailored approach for each patient, and their consistent participation in frequent sessions over time.

1. Vision Therapy

2. Also known as
 Behavioral optometry
 Vision training
 Visual therapy
 Eye training
 Orthoptic therapy

3. Introduction
• Establish efficient binocular vision
• Passive therapy:- remediation of strabismus is
attempted by such option as-
1.Lenses
2.Prisms
3.surgical reduction in the strabismic angle
Pt experiences change in visual stimulation,directed
at restoring normal visual functioning,with out any
conscious effort.

4. Contd..
• Active vision therapy:- it is design to improve
visual performance by involving the pt consciously
in a sequence of specific controlled visual tasks.
It accomplished by using wide variety of optical
instruments & methods.

5. Contd..
• When a specific instrument & methodology are
described then it is refer as - Vision therapy
techniques.which can be divided into multiple task
with individual goal.
• Each task is called –Procedure. The possible
procedure with in a training technique may
represent sequence steps to achieve a final goal.

6. What does vision therapy
improve?
 Depth perception
 Visual motor co-ordination
 Focusing skills
 Vision
 Binocular co-ordination

7. What does vision therapy
improve?
 Amblyopia
 Binocular fusion
 Convergence
 Stereopsis

8. Who can benefit from Vision
Therapy?
 All ages
 Nature varies with the condition
treated

9. Active vision therapy
• Vision training is active therapy requires
conscious participation by the pt.
• Biofeedback is an essential component of
all vision training activities.
• Important to select a suitable vision-
training procedure for each pt & not
prearranged any nonspecific program.

10. Successful vision training depends
on
1. An accurate diagnosis of pt visual problems.
2. A careful selection of visual procedures to best
remediate the problems.
3. A collection of visual procedures that will
facilitate the transfer of a learned visual skills
to the pt own visual world.

11. Misconception about vision
training
1. The goal of training is to improve the
strength of EOM.
2. Vision training is designed to eliminate
the need for lenses or surgical therapy.

12. Target characteristics
• Target content- provides the stimulus to
sensory fusion.
• Target position- provides the stimulus to
motor fusion.
• The stimulus to motor & sensory fusion
should be considered separately.
Motor fusion skills are difficult to improve
when there is a poor sensory fusion & vice
versa.

13. Target content
Target content parameters
1) Size
2) Detail
3) Location
4) Suppression checks
5) Fusion grades
6) Naturalness
7) Contrast
8) Brightness
9) Similarity
10) Color
11) Interest
12)Familiarity

14. Suggestion for successful
vision training
• Overall program should be simple but specific to
visual need to the pt.
• In first OVT-it is important to give a task that
initially can be performed correctly & easily.
• Therapy should be given on a level where success
is guaranteed.
• VTP should be prescribed incrementally.

15. Contd..
• Not to assign to many technique at one
time.
• Sufficient variety of technique must be
prescribe.
• 2-4 therapy technique per session.
• single technique is used then multiple
procedure & change of target should done.

16. Office vision training(OVT)
• Consist of three parts-
1. Pt’s activities from previous week
are reviewed.
2. OVT carried out,which is not
possible at home.
3. Changes in HVT program are
discussed & taught to the pt.

17. Home vision training(HVT)
• Integral part of total
treatment program.
• Frequent repetition produces
best results.
• If the pt is a child,parental
involvement or parent-
substitute is necessary.
• parent or substitute person
have to clearly understand his
or her role as a home therapist.

18. Suggestion for scheduling
vision training
• Total training time of 30-60 min per day in single
or multiple session.
• No. of daily session is depend upon the pt
age,attention span,time availability.
• Multiple daily session provides best results.
• For young children(3-7yrs)- 2-4 daily
session,each lasting10-20min.
• Infants & toddlers- 4-6daily session each lasting
3-10 min.

19. Contd..
• If HVT is well performed & good results
obtained, then OVT can be prescribed
once per week.
• For difficult children(those who are not
doing HVT properly)3 session per week
OVT is require.

20. Goal of treatment
• Alleviate the signs and symptoms
• Achieve desire visual outcomes
• Meet the patients need
• Improve patient’s quality of life
• To improve hand and eye co-ordination

21. Instruments used
• Lenses
• Prism
• Filters
• Occlusion
• Other appropriate material, modalities and
equipments

22. Visual skills developed by
VTP
• Tracking
• Fixation
• Focus
• Depth perception
• Peripheral vision
• Binocularity
• Distance and near vision
• visualization

23. Steps in VTP
• First step in VTP is comprehensive vision
examination
• Look at the functional visual examination
• Identify visual skill
• Set objectives
• Set activities
• Training
• Evaluation

24. Vision therapy
• Requires regular trips to optometrist
• Much of the training done at home
• Motivation required much from the parents and
family members

25. Vision therapy -examples
• Flippers
• Exercises given to the eye muscles
• Cases of anomalies of accommodation
• One side relaxes focus with plus lenses
• Other side stimulates focus with minus lenses
• Power ranges from +- 0.50to 2.50.

26. FLIPPERS

27. EXERCISES WITH FLIPPER
•

28. PEN PUSH UP
• For convergence anomalies
• Focus on the tip of the pen
• Bring the tip of the pen till it becomes
double
• Move a bit so the tip becomes single
• Repeat for at least five to seven minutes

29. PENCIL PUSH UP
• Build vergence facility,stamina and to train
accommodative skills
• NPC should be within arm’s length
• Duration ten minutes daily
• Goal to train smooth vergence and to achieve NPC
of 8-10 cm
• Given also for cases of divergence
excess,exotropia and exophoria

30. PENCIL PUSH UP

31. •

32. •

33. BROCK STRING AND BEADS
• Breaking suppression and establishing
physiological diplopia
• Also for fusional divergence
• Patient sequentially fixates each of the three
beads placed along the string at the prescribed
distance
• The distance between the beads are increased as
the training proceeds

34. • Vergence training in various fields is done
by asking the patient to posture his head
in various position

35. • Goal
• To assist in the development of gross or
voluntary convergence
• To train and to monitor the accuracy of
binocular fixation
• To improve the quality of sensory fusion
• To train the flexibility of vergence

36. •

37. TRACING
• Antisuppression exercise
• To trace over the outline of the projected image
• Both the picture outline and the pen or pencil
should be visible at the same time
• Goal is to percieve both the target viewed

38. • By the fixating eye and tracing by the
suppressing eye simultaneously
• When simultaneous perception of the
target is achieved the patient is then
asked to close and open his eyes five to
ten minutes.

39. FAST POINTING
• Fixation training for ambylopic patient
with eccentric fixation
• Can be used in conjunction with other
therapy such as hadinger brushes
• GOAL- to promote central fixation

40. Procedure
• Occlude nonamblyopic eye
• Pointer in the dominant hand
• Quickly move the pointer in the direction
of the fixation target without looking at
the hand
• To touch the fixation with the tip of the
pointer

41. • Target can be any reading material and the
goal to point the center of the letter ‘o’
• Smaller targets used with the
improvement of the patients performance

42. MENTAL EFFORT
• Important role in active vision therapy program
• Psychomotor phenomenon is used with other
vision therapy procedures
• Mental effort is used enhance performance
• Concept of mental effort is an integral part of al
therapy procedures

43. Examples
• Divergence
• Instruct to imagine a particular object eg an
aircraft or rocket approaching a tower
• To steadily fixate a precise detail of the distant
object
• If the mental effort is effective the target will
appear to approach each other

44. • Convergence
• Mental effort is used to facilitate relatively
convergent position in exodeviation
• Patient directed to imagine a person approaching
on an escalator from below or a bug flying toward
the nose
• Mental effort is used to achieve convergence

45. • Patient asked to walk
on
strip
• Help to improve eye
and
body coordination

46. •

47. COMPUTER AS VISION AS A THERAPY
Child can work on various programs to train
1. eye movements
2. eye coordination
3. Stereovision
4. antisuppression

48. • Computerised investigation and Home Training
System
• Improve children's' and adults' eye muscle co-
ordination.
• Programme trains you in new visual habits
• Improving visual performance and achieving much
more effective comfortable vision, with less tiredness
and headaches.

49. CHEIROSCOPE
• Asses binocularity and alignment
• Detect and to give antisuppresion exercises

50. SACCADIC FIXATOR
• Instrument to train saccadic eye
movement,tracking,visual memory and
peripheral awareness

51. ROTATOR
• An instrument used to increased a child's visual
efficiency and stamina.
• Used primarily to improve eye movements,
• the child is asked to place golf tees in a rotating
pegboard.
• As the child's skill improves, the speed at which the
pegboard is rotating is gradually increased.
• This procedure is usually done while the patient is
wearing a patch over one eye.

53. PRISM THERAPY
• Exercises given with the prism to improve
convergence
• Prism bar or amblyoscope can also be used

54. •

55. Success stories
 Achievements in school
 Improved reading
 Success in sports

56. Summary
 Vision is a complex process
 An individual with good visual acuity
can still have a vision problem
 Optometric vision therapy is an
effective treatment of many vision
problems

57. Summary
• It is a gradual improvement process.
• It requires active involvement by the pt &
therapist during the treatment program.
• It provides a method of sequentially improving
sub skills so that each pt potential may be
reached.
• The final criteria of success in strabismus-the
establishment of efficient binocular vision.

58. Websites referred
 www.children-special-
needs.org
 www.vision 3d.com
 www.optometrist.org
 www.visiontherapy.org