DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/vision-therapy/❤❤ Dear viewers Check Out my other piece of works at___ https://healthkura.com Vision Training/ Vision Therapy (Active/ Passive Vision Therapy)/ Sports Vision/ Computer Vision Syndrome Contents: -Vision Training Overview Misconception Tips for success Office Vision Training Home Vision Training Conditions treated by vision training Sports Vision Training Computer Vision Syndrome Controversy Summary Summary • Vision training is active therapy as it requires conscious participation by the pt. • The achievement of the final goal occurs slowly and progressively • VT is not a substitute to lenses or surgical therapy, it is an additional treatment • Variety of BSV related conditions can be treated with VT • The underlying neuropsychophysiological mechanisms affected by VT are still under intense investigation • VT is the most controversial subject in eyecare profession

1. Vision Training
Bikash Sapkota
B. Optometry
BPKLCOS, IOM
Nepal

2. Contents
• Vision Training
oOverview
oMisconception
oTips for success
• Office Vision Training
• Home Vision Training
• Conditions treated by vision training
• Sports Vision Training
• Controversy
• Summary

3. Vision Therapy
• Also called vision training, orthoptics, eye training, and eye
exercises
• Clinical approach for correcting the effects of eye movement
disorders, nonstrabismic binocular dysfunctions,
accommodative disorders, strabismus, amblyopia,
nystagmus, and certain visual perceptual (information
processing) disorders
• Entails a variety of non-surgical therapeutic procedures
designed to modify different aspects of visual function

4. Vision Therapy
• The “specific controlled visual tasks” are accomplished by
using a wide variety of instruments and methods
• Specific instruments and methodology are described as
“vision-training techniques”
• Includes multiple subskills or procedures
• Subskills represent sequential steps
• Pt’s visual dysfunction determines “the sequential plan”

5. Passive Therapy
Pt. experiences a change in visual stimulation without any
conscious effort
Active Therapy
Designed to improve visual performance by the pt.’s conscious
involvement in a sequence of a specific, controlled visual task
that provide feedback

6. Vision Training
• Vision training is active therapy as it requires conscious
participation by the pt.
• It asks the pt. to use mental effort ( Giles 1947) to learn a
specific visual response when performing a specific procedure
• Some method of identifying correct from incorrect responses
(Biofeedback) should be incorporated into each training
procedure (Forrest 1981; Letourneau 1976)

7. Vision Training
• Pt. is taught to obtain a correct response and then to repeat
it until the response goes from a conscious effort to an
unconscious reflexive level (Giles 1947)
• When a reflexive response is achieved, improved visual
performance will transfer to other noncontrolled visual tasks
(Consweet and Crane 1973)
• And ultimately will change the underlying visual processing
mechanisms (Liu et al. 1979, North and Hensen 1982)

8. Vision Training
• The integrity of the sensory and motor systems underlies the
final results of any mode of treatment
• VT attempts to reach the sensory and motor potentials by
involving the active efforts of the pt. to maximize visual
performance during each procedure
• The selection of suitable VT procedures for each pt. is
essential and should not be a prearranged nonspecific
program

9. Vision Training
• Successful vision training depends on three important
elements:
1. An accurate diagnosis of the pt.’s 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 the learned visual skills to the pt.’s own visual
world

10. Vision Training
• The achievement of the final goal occurs progressively,
as correct responses from controlled tasks are
transferred to noncontrolled tasks
• The underlying neuropsychophysiological mechanisms
affected by vision training are still under intense
investigation,
- and it is hoped that they will be clarified in future studies

11. Misconceptions about Vision Training
1. VT Improves the strength of the EOM
 Change the neurophysiological vergence-control
mechanism (Schor 1983) through repetition of specific
visual stimulation
2. VT eliminates the need for lenses or surgical therapy
 VT is not a substitute
 VT is an additional treatment

12. Overview of vision training
• Most procedures use separate targets for each eye
• Separation is accomplished by:
- Septum
- Mirrors
- Anaglyphic and vectographic systems
- Chiastopic/ orthopic techniques

13. Overview of vision training
• Polaroid or anaglyph reduce sensory stimulation by acting
as partial filters
- but they provide the advantage of apparently open
environment or open-space viewing (Vodnoy 1972)
• Septum and mirror allow viewing of targets without filters
- but introduce an artificial split field and often stimulate
proximal convergence

14. Tips for Successful Vison Training
Program
• Prescribe incrementally
• Adapted to the individual patient
• Progress at the patient’s own rate
• Maintain the patient’s interest
• Use 2-4 therapy techniques or procedures per week

15. Office Vision Training (OVT)
Each OVT session usually consists of 3 parts
• First, pt.’s activities from the previous week are reviewed, in
order to assess performance and progress
• Pt. is asked to demonstrate to the therapist how he/ she did
the technique
• In this way, the therapist can ascertain whether the training
was performed correctly and as prescribed

16. Office Vision Training (OVT)
• Second, the OVT is carried out, emphasizing techniques
and procedures that cannot be done at home
• The OVT will enhance pt.’s performance on the
techniques that will be prescribed for home vision
training (HVT)

17. Office Vision Training (OVT)
• Third, changes in the HVT program are discussed, and any
new techniques to be prescribed for HVT are taught
• Be ensure that pt. is capable of adequately performing the
assigned procedures before leaving the office
• Both verbal and written instructions should be given to pt.
(and to the parent, if the pt. is a child)

18. Home Vision Training (HVT)
• HVT is an integral part of the total treatment program for
many pts.
• When properly controlled and administered, HVT
significantly contributes to the success of the overall vision
training program
• As an adjunct to OVT, it provides the continuity that is
absent in an active therapy program managed entirely in
the office

19. Home Vision Training (HVT)
• Parental involvement is necessary for HVT if the pt. is a child
• HVT is rarely successful when the parent is not emotionally or
intellectually capable of administering the prescribed
procedure
• HVT failures are more often due to a parent’s inability to deal
with the family dynamics and stress created during active
therapy than due to the inadequacies of the prescribed at-
home training techniques (Shiva 1971)

20. Advantages of HVT
• Provides regular practice periods, which are necessary for
correct responses to eventually become reflexive in nature
• Enables pts. to make progress on their own
• Results in a reduction in the frequency and total number of
office visits
• Maintains the pt.’s interest

21. Educational Principles Underlying
Vision Training (Spivey 1970)
• Better accomplished in an active rather than a passive
manner
• Individualized process that occurs at different rates and in
different ways for different pts.
• Accomplished more easily when it is meaningful and
relevant to the pt.
• Goals should be realistic and achievable so that the pt.
does not become discouraged

22. Educational Principles Underlying
Vision Training
• Best accomplished when the pt. is provided with feedback
so that he/she can monitor his/her own performance
- This feedback should be positive and rewarding,
not negative or punishing
• Facilitated in the presence of pleasant surroundings and
good interpersonal relationships

23. Suggestions for Scheduling Vision
Training
• Daily therapy for a short time is preferable to weekly therapy
for longer time periods
• Total training time of 30 to 60 mins performed in one or
multiple sessions per day is prescribed
• No. of daily sessions is dependent upon the pt.’s age, attention
span, and time availability
• Although multiple daily sessions provide the best results,
compliance may be best when one daily session is prescribed

24. Suggestions for Scheduling Vision
Training
• For young children (3 to 7 yrs old), 2 to 4 daily sessions, each
lasting 10 to 20 mins, are spread over the day
• Infants and toddlers are prescribed 4 to 6 daily sessions,
each lasting 3 to 10 mins
• When HVT is possible and good results are anticipated, OVT
can be prescribed on a once-per-week basis
• When HVT cannot be performed, a minimal schedule of 2 to
3 times per week of OVT is recommended

25. Suggestions for Training Patients of
Different Ages
• Techniques that require strict visual attention and a steady
body posture should be alternated with gamelike activities
• Short break when a child is losing interest or motivation
• Competitive games and a reward system can be used to
increase motivation, concentration, and compliance

26. • Young children require short period of training, with
frequent changes in activity or targets
• Attractive and interesting target help to hold the child’s
interest
- Bright colors
- Moving objects
- Musical accompaniment
- Flashing lights
Suggestions for Training Patients of
Different Ages

27. Role of Behavior Modification in
Vision Training
• Important component of VT program for children (Feldman
1981; Granger and Letourneau 1977; Groffman 1969; Punnett
and Steinhauer 1984)
• Take care to reward children for “looking carefully” and for
“hard work” not for providing the correct answer
• Avoid saying “good” after a child responds or a procedure is
completed, because it implies that the responses were
correct

28. Role of Behavior Modification in
Vision Training
• Saying “good looking” instead leaves the emphasis on
good behavior rather than the child’s responses
• Always ask open-ended questions such as, “How many
do you see?” rather than, “Do you see one?”

29. Conditions Treated by Vision
Training
 Strabismic and non-strabismic binocular dysfunctions
 Ambylopia
 Accommodative dysfunctions
 Ocular motor dysfunctions
 Visual motor disorders
 Visual perceptual (visual information processing) disorders

30. Accommodative Therapy
• Directed towards improving accommodative amplitude,
facility, sustaining ability, reducing response time
• Accommodative demand is altered by the use of plus or
minus lenses or change in fixation distances
• Done monocularly and binocularly

31. Accommodative Therapy
Traditional Therapy
 Hart Chart
 Lens flippers
 Loose minus lens rock
 Split pupil rock
 Brockstring Exercise
Computer Vision Therapy

32. Hart Chart Rock Exercise
• Consists of two cardboard charts each with a block of 100
(10 rows of 10 letters each) black letters printed on white
background
• Larger HC is used for distance fixation, smaller HC for near
fixation
• Uses change in fixation distances
• Can increase AA, facility or both
- HC push up for AA training
- Altering fixation as facility therapy
Fig: Hart chart for accommodative rock

33. Lens Flippers
• Plus/minus lenses to produce rapid changes in the
accommodative demand
• Choose lens flippers of equal dioptric powers(+/-0.50D to
2.00 DS)
• Flippers held directly in front of pt.’s eyes at the spectacle
plane
• Begin with minus lenses, then plus side, make the letters
clear within 1-2 secs without fatigue and discomfort

34. Binocular Accommodative Facility
• A red/green bar reader and red/green glasses are used
along with age-appropriate reading material with about
20/30 size
• The bar reader is placed on top of the reading material
• Flip lenses are held before the pt.'s eyes, and is instructed to
clear the print
• The pt. reads one line of print, and the flip lenses are flipped
to the other side
• Can also be performed using any fusional vergence therapy
procedure such as vectograms, tranaglyphs, the Aperture
Rule
Fig: Binocular accommodative
facility using a bar reader
Fig: Aperture Rule used for binocular
accommodative facility

35. Loose Minus Lens Rock
• Loose minus lens, interposed directly in front of open eye to
read the print
• If letters become blur, try to make it clear
• As soon as letters are clear, interpose minus lens and make
letters clear within 1-2 seconds without fatigue and
discomfort
• Start from -0.50 D
Fig: Loose lens rock procedure

36. Split Pupil Rock
• Loose minus lens held below the open eye and slowly moved
upwards so that the top edge of lens bisects the pupil with
monocular diplopia of target
• Images are separated vertically, top image appear larger
than bottom
• See the top image and make it clear, shift gaze to bottom
image and again make it clear within 1-2 seconds

37. Computer Vision Therapy
• Can improve vergence, accommodative, and oculomotor
problems
• Most programs are set up to record pt.’s performance each
session
oRemoves the problem of compliance
• Different products on the market
oHome Therapy System
oComputer Aided Vision Therapy
oPsychological Software Services

38. Computer Vision Therapy
• Pts. can use at home, work, wherever they have access to
computer
• Trains eye movements, vergences, accommodation, and
perceptual skills
• A study showed an improvement on tests of cognitive
skills with computer vision therapy1
1- A study of the effectiveness of cognitive therapy delivered in a video
game format. Helms D, Sawtelle SM. Optom Vis Dev 2007

39. Fusional Vergence Therapy
• Anaglyphs, Polaroids, and liquid Crystal Filters
Variable Tranaglyphs
Variable Vectograms
Nonvariable Tranaglyphs
Computerized Binocular Vision Therapy Procedures
• Lenses, Prisms, and Mirrors
Flip Prism or Loose Prism
• Septa and Apertures
Aperture Rule
Modified Remy Separator

40. • Paper, Pencil, and Miscellaneous Tasks
Eccentric Circles
Free Space Fusion Cards
Lifesaver Cards
• Stereoscopes
Brewster Stereoscopes
Cheiroscope
Wheatstone Stereoscope
• Voluntary Convergence Procedures
Brock String
Barrel Card/3-Dot Card
Fusional Vergence Therapy
Objectives of fusional vergence procedures
 Increase the amplitude of negative fusional vergence (NFV)
and positive fusional vergence (PFV)
 Decrease the latency of the fusional vergence response
 lncrease the velocity of the fusional vergence response

41. Anaglyphs, Polaroids, and Liquid Crystal
Filters
Variable Tranaglyph
Fig: Peripheral tranaglyph targets
Fig: Peripheral tranaglyph target. Moving the
green slide to the left and the red slide to the
right creates a convergence-type demand

42. Fig: Variable vectograms Fig: Vortex vectogram Fig: Baseball vectogram.
Fig: Central tranaglyph targets Fig: Non variable Tranaglyph

43. Office Based Computer Vision Therapy
Computer Orthoptics VTS4 Liquid Crystal System
Fig. A: Child working with the Computer Orthoptics Random Dot Stereopsis program.
B: Patient's view of the Computer Orthoptics Random Dot Stereopsis target.

44. Lenses, Prisms and Mirrors:
Flip Prism or Loose Prism
• The objective is to supplement other fusional vergence therapy
techniques such as such as tranaglyphs, vectograms, the
Aperture Rule, and Eccentric or Free Space Circles
• For example, if a pt. is working with a Quoit vectogram doing
convergence therapy and finds the task very easy, additional BO
prism could be used to increase the level of difficulty of the task
• Alternatively, BI prism could be used to decrease the difficulty
of the task

45. Septa and Apertures
Aperture Rule
A: Single Aperture- the visual axes cross at a distance closer than the viewed targets, creating a
chiastopic or BO fusion demand
B: Double Aperture- the visual axes cross at a distance farther away than the viewed targets,
creating an orthopic or BI fusion demand

46. Aperture Rule
• Fusion occurs through chiastopic (base-out) or orthopic
(base-in) fusion
• Consists of a rulerlike apparatus, two plastic slides-one with a
single aperture and the other with a double aperture and 12
cards with varying disparities, ranging from 2.5 to 30 Δ
Fig: Location of the plane of accommodation and convergence
during convergence therapy using the Aperture Rule.

47. Fig: Aperture Rule for convergence therapy
Fig. A: Right-eye view of Aperture Rule card
B: Left-eye view of Aperture Rule card
C: View of Aperture Rule card with both eyes

48. Paper, Pencil and Miscellaneous Tasks
Eccentric circles, Free Space Fusion Cards A
and Lifesaver Cards
Fig: Eccentric Circles setup for convergence
therapy, illustrating planes of accommodation
and vergence
Fig. A: Pt.’s perception of Eccentric Circles setup
with the "As" during chiastopic fusion.The outer
rings appear to be floating closer.
B: Pt.'s perception of Eccentric Circles setup
with the "As" during orthopic fusion. The inner
rings appear to be floating closer.
Appearance When Fusing Base-Out
Appearance When Fusing Base-In

49. Lifesaver Cards and Free Space Fusion Cards B
Fig: Lifesaver and
Free Space Fusion Cards B
Fig: New Lifesaver Cards

50. Modified Remy Separator
• It is used for divergence therapy
• Useful for home therapy
• If the pt. experiences any difficulty, plus lenses are helpful
to get started
• Discontinue this technique when the pt. can achieve fusion
with a divergence demand of about 15 base-in
Fig: Modified Remy separator
using a septum and Lifesaver card

51. Stereoscopes
Brewster Stereoscope
• Designed to separate the fields of the two eyes using a
septum
• Optical system consists of + 5.00 D spheres
• Optical centers are usually separated by 95 mm, which
induces BO prism because the separation is wider than the
average pt.'s IPD
• Stereoscope targets can be placed at varying distances
• Can be used to vary both the accommodative demand and
convergence demand
Fig: Bernell-0-Scope. Fig: Sample stereograms. A: Base-out
Bioptograms. B: Keystone cards AN 9 and
AN 77.

52. Accommodative Demand
• Because the power of the stereoscope lenses is known and
the distance of the target from the lens plane is known, one
can easily calculate the accommodative demand, using the
following formula:
A= (l/TD)- P
Where, A= accommodation (D)
TD = distance between target and lens plane (m)
P = power of stereoscope lenses (D)

53. Examples
• You are working with a stereoscope with +5.00 D lenses and a 95
mm lens separation. If you place the stereoscopic card at 20 cm,
what is the accommodative demand?
Answer
A= (l/TD)- P A = (l/0.2) - 5 A=5-5=0
- At a working distance of 20 cm, there is no accommodative demand.
This is the distance setting for this particular stereoscope.
• If the target is now moved to a working distance of 13 cm, what is
the accommodative demand?
Answer
A= (l/TD)- P A = (1/0.13) - 5 = 7.6 - 5 = 2.6 D
- At a working distance of 13 cm, the accommodative demand is
about 2.6 D.

54. Convergence Demand
• C = (P X LS)- (TS/TD)
where
C = vergence demand in prism diopters
P = power of stereoscope lenses
LS = separation of optical centers of stereoscope lenses (cm)
TD = distance of stereogram from stereoscope lenses (m)
TS = separation of corresponding points of the stereogram (cm)

55. Examples
• You are working with a stereoscope with +5.00 D lenses and a
95 mm lens separation. What is the vergence demand for a 60
mm target set at 20 cm?
Answer
C = (P X LS)- (TS!ID) C = (5 X 9.5) - (6.0/0.2) = 47.5- 30 = 17.5 BO
• If you use the same stereoscope as in above example and the
same card, now set at a working distance of l3 cm, what is the
vergence demand?
Answer
C = (P X LS)- (TS!ID) C = 47.5 - (6.0/0.13) = 47.5 - 46.0 = 1.5 BO

56. Cheiroscope
Fig: Keystone Correct-Eye Scope setup
for cheiroscopic tracing.
Fig: Cheiroscopic tracing forms
Fig: Illustration of drifting during cheiroscopic tracing.

57. Wheatstone Stereoscope
Fig: Variable Prismatic Stereoscope
Fig: Patient working with Variable Prismatic
Stereoscope

58. Voluntary Convergence Procedures
Brock String
 Employs the principle of physiological diplopia
Objectives
- Develop the kinesthetic awareness of converging
and diverging
- Develop the ability to voluntarily converge
- Normalize the near point of convergence

59. Procedures
1. Recognition of physiological diplopia
2. Jumps, two brads at near, and introduction of fixation
accuracy
3. Jumps, three beads at near
4. Jumps, far to near
5. Jumps, three beads (near, intermediate, far)
6. Push-ups and push-aways
7. Bug on a string

60. Fig. A: Patient working with Brock string.
B: Patient's perception when looking at the near, or
C: far bead when using the Brock string.

61. Barrel Card/ 3-dot Card
Fig: Patient working with Barrel Card Fig: Patient working with Albee 3-Dot Card

62. • Vergence therapy resulted in some improvement in both
objective findings and symptoms for some subjects. (The
effectiveness of pencil pushups treatment for convergence insufficiency: a
pilot study. Gallaway M et al, Optom Vis Sci 2002 Apr)
• Office-based vergence accommodative therapy is an effective
treatment for children with symptomatic convergence
insufficiency. (Randomized clinical trial of treatments for
symptomatic convergence insufficiency in children. Convergence
Insufficiency Treatment Trial Study Group, Arch Ophthalmol. 2008 Oct)

63. Antisuppression Procedures
• Cheiroscope
• Bar Reader
• TV Trainer
• Red/Green Glasses and Penlight
• Vertical Prism Dissociation
• Mirror Superimposition
• Computer Home Therapy Procedures Home Therapy
System
• Computer Aided Vision Therapy: Computer Vergences
Program-Random Dot Stereo grams

64. TV Trainer
• Sheet of plastic with one side all green and the other side all
red
• Attached to the TV, and the pt. wear red/green glasses
• Eye behind the red filter sees through the red side of the TV
trainer, while eye behind the green filter sees through the
green side
• If one eye suppression-one side of the TV trainer will turn
black
Fig. A: TV trainer. B: TV trainer positioned on TV

65. • Pt. holds a small mirror at a 45-degree
angle in front of one eye and views a
target through the mirror
• With the other eye, views another
target
• Pt. must try to superimpose one image
on top of the other
Mirror Superimposition
Fig: First-degree targets used with
mirror superimposition
Fig: Second-degree target used with
mirror superimposition

66. Vision Training for Amblyopia
• Pleoptics
• Near activities
• Active stimulation therapy using CAM vision
stimulator
• Syntonic phototherapy
• Role of perceptual learning
• Binocular stimulation
• Software-based active treatments
• Exposure to dark

67. Ocular Motility Procedures
• Loose Prism jumps
• Hart Chart: Saccadic Therapy
• Letter and Symbol Tracking
• Visual Tracing
• Rotator Type Instruments
• Flashlight Tag
• Computer Software/Advanced Technology Procedures
• Afterimage Technique

68. Loose prism jump
• While the pt. views a target monocularly, a prism is placed
before the fixating eye
• Prism displaces the image of the fixation object off the fovea
and a saccade will be necessary to regain foveal fixation
• Must be able to quickly and accurately regain fixation
• Important goal is to be sensitive to very small amounts of
prism

69. Hart Chart: Saccadic Therapy
• Place the Hart chart about 5 to 10 ft from the pt.
• Occlude the pt.'s left eye with an eye patch
• Instruct pt. to call out the first letter in column 1 and then the
first letter in column 10,
- the second letter from the top in column 1 and the second
letter from the top in column 10 and so on

70. Letter and Symbol Tracking
• Occlude pt.'s one eye
• Tell the patient to begin at the upper right and scan from left
to right to find the first letter "a"
• Ask the patient to then find the very first "b," cross it out,
and continue through the entire paragraph
• The goal is to complete this task as quickly as possible
Fig: Symbol tracking workbook
ABC DE FGH tJKLM N OPQRSTUVWXYZ
a bcdefghijklmnopqrstuvwxyz
lin chako evi nomd zeby thipg nare.
Zuth pirm nuroc dif stok. Nileg myt
lolf. Tixs nom reus zab tuin lugah.
Marb sewt rotsir puje. Yonak nesud
voz alee. Xart chod bugm turh sref
tree gen foru. Vab reps tique kowj.
Dagh meulb fwer ilg side. Ubc they
bouf yed neoph vaik. Wolen kig peab
nod tenc xerb. Rait rebey fal zibt
Min. Sec .
Fig: Letter tracking workbook

71. Visual Tracing
• Contains tracing tasks that gradually increase in level of
difficulty from the beginning to the end of the book
• Occlude one of the pt.'s eyes and ask the pt. to place the
pen on the letter "A" and to trace along the line until the
end of the line
• As the pt.'s accuracy and speed improve, the next level of
difficulty can be added
Fig: Visual tracing workbook

72. Rotator-Type Instruments
• Occlude pt.’s one eye
• Instruct the pt. to place a golf tee into a hole in the pegboard
• The holes on the innermost part of the rotating pegboard are
the easiest to work with, and the outer holes are the most
difficult
• To combine saccadic eye movements with pursuit eye
movements, a pattern can be drawn to follow on a wall
directly behind the rotating pegboard
Fig: Rotating pegboard (concentric circles are
different colors: red, yellow, and blue)
Fig: Automatic rotator

73. Afterimages
• Any photographic flash device with narrow slit can be used
to create afterimages
• Occlude pt.’s one eye
• Instruct pt. to fixate at the center of the vertical slit on the
flash unit
• Activate the flash unit and, after the flash, ask the pt. to blink
rapidly or flicker the lights in the room
• Can enhance any ocular motor technique such as Hart chart
saccadic technique and the automatic rotating device

74. Computer Software/ Advanced
Technology Procedures
• Computer Orthoptics Liquid Crystal Automated Vision
Therapy (VTS4)11
• Computer Perceptual Therapy (CPT)b
• Sanet Vision Integrator (SVI)
• Neurovision Rehabilitator (NVR)
• The Perceptual Visual Tracking Program (PVT)
Fig: Sanet Vision Integrator-Saccadic
procedure
Fig: Sanet Vision Integrator-Pursuit
procedure

75. Therapy for Heterophoria
Exercises for Esophoria
1. Divergence exercises with prisms
• Prisms of increasing strength are placed base-in before one
eye while he/she is fixating an object at a distance
• Loose prisms, a prism bar or rotating (Risley) prisms may
be used: prism bar is preferred
• Performed for a few mins. at each
weekly visit

76. 2. Divergence Exercise on Synoptophore
• Performed on synoptophore using stereopsis slides, because
they provide the strongest stimulus to fusion
• After fusing 2 pictures, pt. is trained to maintain a single
vision (by relaxing convergence) while the instrument tubes
are diverged
• Should be performed for about 5 mins.
at each weekly visit

77. 3. Physiologic Diplopia Exercises using
Stereograms in the Crossed Position
• While pt. is fixating a distance object, the stereogram card is
held about 25 cm in front of eyes
• Pt. will perceive 4 pictures (due to crossed physiological
diplopia)
• He/ she is trained to adjust its position until the 2 central
pictures are fused and pt. perceives 3 pictures
• Pt. is trained to maintain the joined pictures and to see it
clearly
• Pt. can practice at home for few
mins. several times a day

78. 4. Exercise using diploscope
5. Exercise using Remy separator
6. Reading bar exercise

79. Exercises for Exophoria
• The aim is to improve the fusional convergence (relative
position convergence)
1. Convergence exercise with prisms
• Similar to that described for esophoria, except that in it, prisms
are placed base-out in front of the eyes
• Watch the pt.’s eyes to make certain that he/ she is converging
and has not diverged and suppressed

80. 2. Convergence exercise using synoptophore
• Performed as described for esophoria, except that in it, the
instrument arms are slowly converged, beginning at an angle
at which pt. can fuse the picture
3. Physiologic diplopia exercise using stereogram
in the uncrossed position
4. Convergence exercise using diploscope

81. Vision Therapy after Acquired Brain
Injury
• A number of investigators have described treatment of binocular
vision, accommodative, and eye movement problems associated with
ABI using vision therapy (Brahm KD 2009, Ciuffreda kJ 2008, and others)
• Vision therapy is an excellent option when the pt. has adequate
cognitive, memory, and attention skills
• Recent studies concluded that the majority of participants who
completed the study experienced meaningful improvements in signs
and symptoms
(Conrad JS et al Optom Vis Sci. 2017 Jan)
(Gallaway M et al 2017 Jan)

82. Sports Vision Training
• Works on improving the visual abilities of an athlete that are
most necessary for excellence in their sport
• The visual skills necessary for peak athletic performance in
many sports are:
 Dynamic visual acuity
 Focusing skills (Accommodation)
 Tracking
 Saccadic eye movement
 Fixation
 Binocularity
 Depth perception

83. Sports Vision Training
 Visual recognition and reaction time
 Visual concentration
 Peripheral awareness
 Central-peripheral integration
 Eye-hand-body coordination
 Visual memory
 Visualization
• Specific Sports VT program is assigned for specific type of
sports. E.g peripheral vision enhancement training for team
sports
Good peripheral vision is needed to keep
an eye on other players during team sports

84. • In a study, the claim that sports vision training can enhance
visual skills and the level of sporting performance was
investigated
• There was no evidence for VT improving either visual or
motor performance
(Joanne et al, Efficacy of Sports Vision Training Programs, Optom and
vis science 1997 )
• Another study suggested that certain visual abilities,e.g. the
peripheral perception or the choice reaction time are
trainable and can be improved by means of an appropriate
VT. An automatic improvement of othervisual abilities could
not be verified
(Sebastian et al, The impact of a sports VT Program in youth field
hockey players, J of Sports sci and med 2012)

85. Controversy
• The U.K. College of Optometrists noted the “Continued
absence of rigorous scientific evidence to support
behavioral management approaches” in the second college
of Optometrists report {Judith Warner (10 March 2010). “Concocting a
Cure for Kids With Issues”.}

86. Controversy
• In 2009 The American Academy of Pediatrics reviewed 35 years
of the literature in support of vision therapy and issued a stern
warning about the seductions of treatments: “Ineffective,
controversial methods of treatment such as vision therapy may
give parents and teachers a false sense of security that a child’s
learning difficulties are being addressed, may waste family
and/or school resources and may delay proper instruction or
remediation.” {Judith Warner (10 March 2010). “Concocting a Cure for
Kids With Issues”.}

87. Controversy
• The website by the American Association for Pediatric
Ophthalmology and Strabismus states: “Behavioral vision
therapy is considered to be scientifically unproven” and “There
is no evidence that vision therapy delays the progression or
leads to correction of myopia.” (“Vision Therapy — AAPOS”.
Aapos.org. Retrieved 2013-02-15.)
• Some physicians are skeptical about the efficacy of “vision
therapy” stating that it lacks data and is mostly anecdotal (Jo
Seltzer (30 Nov 2010). “Ophthalmologists express skepticism about vision
therapy”. St. Louis Beacon.)

88. Summary
• Vision training is active therapy as it requires conscious
participation by the pt.
• The achievement of the final goal occurs slowly and
progressively
• VT is not a substitute to lenses or surgical therapy, it is an
additional treatment
• Variety of BSV related conditions can be treated with VT
• The underlying neuropsychophysiological mechanisms affected
by VT are still under intense investigation
• VT is the most controversial subject in eyecare profession

89. References