This document summarizes information on diagnosing and treating learning related vision problems. It discusses what optometrists should do to diagnose these issues, including conducting a comprehensive eye exam, visual efficiency exam, and vision information processing exam. It outlines the common tests that should be performed in each exam, such as visual acuity tests, oculomotor exams, stereopsis tests, and vergence and accommodative testing. It also discusses common binocular vision disorders like convergence insufficiency and accommodative disorders. Finally, it reviews research on the efficacy of optometric vision therapy and treatments for conditions like amblyopia and refractive errors.

1. Diagnosing and Treating Learning Related Vision Problems Dominick M. Maino, OD, MEd, FAAO, FCOVD-A Professor Illinois Eye Institute Illinois College of Optometry Private Practice Harwood Heights, Il.

2. Diagnosing and Treating Learning Related Vision Problems What do Doctors do (or should do) to diagnose LRVP? Where’s the research? What Therapy Procedures Should I Use? What’s New?

3. 3 BV Dx & Tx in the News!!

4. 4

5. 5

6. 6 3 D Movie Stars…Can’t See 3D!

7. 7 3-D TV and Movies Look to Attract Viewers But Not Everyone Can 'See' What All the Hype is About

8. 8 Healthbeat Report: The 3-D Dilemma

9. 9 3 D Classroom! …Studies have shown that the measurable educational benefits of presenting teaching materials in 3D are significant, generating a threefold improvement in comprehension and retention over the more traditional non - 3D style of presentation. And students respond well to the immersive and engaging qualities of the 3D effect … AOA/3D@Home www.3Dhealth.org

10. 10 Non-strabismic BV disorders Prevalence Prevalence of General Dysfunctions in Binocular Vision . Montés-Micó Robert. Annals of Ophthalmology, Volume 33, Number 3, September 2001 , pp. 205-208(4). (Spain) …in 1679 subjects aged 18 to 38 years. …. A high prevalence of binocular vision dysfunctions was found. … 56.2% presented symptoms of binocular dysfunctions, 61.4% with accommodation disorders and 38.6% vergence disorders. Accommodation insufficiency was most prevalent among those with symptoms (11.4%). …

11. 11 BV disorders Prevalence Pickwell's Binocular Vision Anomalies By Bruce J. W. Evans, David Pickwell Between 1 in 5 to 1 in 10 individuals have BV problems. 30-60 million people

12. 12 BV disorders Prevalence Prevalence and risk factors for common vision problems in children (in the UK) …for 7825 seven-year-old children. 2.3% had manifest strabismus, 3.6% had …amblyopia….

13. 13 Non-strabismic BV disorders Prevalence General binocular disorders: prevalence in a clinic population. Ophthalmic & Physiological Optics. 21(1):70-74, January 2001.Lara, Francisco 2; Cacho, Pilar 1; Garcia, Angel 1; Megias, Ramon 2 ….We examined 265 symptomatic patients …., 59 patients (22.3%) had some form of accommodative or binocular dysfunction …. The frequency of binocular dysfunctions was 12.9%, and 9.4% for accommodative anomalies. Convergence excess (4.5%) was more prevalent than convergence insufficiency (0.8%) and accommodative excess (6.4%) more prevalent than accommodative insufficiency (3%).

14. 14 BV disorders Prevalence: Additional Articles Prevalence of general binocular dysfunctions in a population of university students. 32.3% of the subjects showed general binocular dysfunctions

15. 15 BV disorders Prevalence: Additional Articles Stereoacuity levels and vision problems in children from 7 to 11 years …prevalence of defective stereoscopic vision was found to be between 2.1 and 3.2 per cent

16. 16 BV disorders Prevalence: Additional Articles Prevalence of amblyopia in ametropias in a clinical set-up …Out of 970 ametropic eye patients a total of 56 (5.97%) patients have amblyopia….

17. 17 Non-strabismic BV disorders Prevalence Convergence Insufficiency: 1.3% to 37% of the population; most report 3-5% Convergence Excess: ~6% Accommodative disorders: 3-5% AOA: Care of the Patient with Accommodative and Vergence Dysfunction http://www.aoa.org/documents/CPG-18.pdf

18. 18 What Does the Doctor Do to Diagnose Learning Related Vision Problems?

19. 19 Can We Measure Symptoms Test-retest reliability of the college of optometrists in vision development quality of life outcomes assessment.MAPLES W. C. , et al. The COVD Quality of Life Outcomes Assessment is a reliable tool to measure changes in symptoms on the basis of optometric intervention-specifically, vision therapy

20. 20 Can We Measure Symptoms Evaluating Changes in Quality of Life After Vision Therapy Using the COVD Quality of Life Outcomes Assessment Kelly M. Daugherty, OD, et. al. The COVD – QOL Questionnaire in a socially at-risk population of youthWillard B. Bleything, OD, MS, FAAO, FCOVD, Sandra L. Landis, OD, FCOVD

21. 21 Can We Measure Symptoms Validity of the convergence insufficiency symptom survey: a confirmatory study. Rouse M, Borsting E, Mitchell GL, et al. …The CISS continues to be a valid instrument for quantifying symptoms in 9 to <18-year-old children…

22. 22 Subjective Complaints of Patients with BV Disorders Blur Headache Aesthenopia Diplopia These complaints are usually associated with near work

23. 23 Subjective Complaints of Patients with BV Disorders Blur Headache Aesthenopia Diplopia These complaints are usually associated with near work

24. 24 Subjective Complaints of Patients with BV Disorders Blur Headache Aesthenopia Diplopia These complaints are usually associated with near work

25. 25 Subjective Complaints of Patients with BV Disorders Blur Headache Aesthenopia Diplopia These complaints are usually associated with near work

26. 26 Examination Sequence Comprehensive Eye/Vision Examination Visual Efficiency Examination Vision Information Processing Examination

27. 27 Examination Sequence Comprehensive Eye/Vision Examination History Visual Acuity Oculomotor/Entrance Tests Refraction Eye Health

28. 28 Examination Sequence Visual Efficiency Evaluation HX (Symptoms related to near work, school, sports, BV dysfucntions, etc.) VA Oculomotor System Sensory Fusion System Motor Fusion/Vergence System Accommodative System

29. 29 Visual Efficiency Examination

30. 30 Visual Efficiency Examination

31. 31 Examination Sequence Vision Information Processing Examination Laterality/Directionality Visual Information Processing Non-motor Visual Information Processing Motor Oculomotor Auditory Information Processing Misc.

32. 32 VIP

33. 33 VIP

34. 34 Master Problem List

35. 35 Master Problem List

36. 36 Visual Efficiency Examination: Basic Tests History Must be geared towards the child or adult with likely binocular vision dysfunction, learning related vision problems or work/recreational related functional vision anomalies.

37. 37 Visual Efficiency Examination: Basic Tests Visual acuity May find reduced acuity at near or complaints of blur at near (intermittent problems)

38. 38 Visual Efficiency Examination: Basic Tests Refraction Control Lens

39. 39 Visual Efficiency Examination: Basic Tests Oculomotor System Pursuits, Saccades Developmental Eye Movement Test DEM Visagraph/Readalyzer

40. 40 Visual Efficiency Examination: Basic Tests Developmental Eye Movement Test DEM J . TASSINARI Developmental Eye Movement Test: reliability and symptomatology . Journal of the American Optometric Association ,2005; Volume 76 , Issue 7 , Pages 387 - 399

41. 41 Visual Efficiency Examination: Basic Tests Cover test Distance and near Repeat during the exam to see if fatigue changes your result

42. 42 Visual Efficiency Examination: Basic Tests Nearpoint of convergence Repeat several times See what happens with fatique Red lens sensitive for CI A prospective study of different test targets for the near point of convergence Yi Pang, Helen Gabriel, Kelly A. Frantz and Faheemah Saeed

43. 43 Visual Efficiency Examination: Basic Tests Heterophoria In Phoropter Prism Bar Risley Prism/Madox Rod

44. 44 Other tests 2 Degree Fusion Suppression Worth 4 Dot

45. 45 Basic tests Stereopsis Look for reduced steropsis Less than 70 seconds of arc

46. 43 Basic tests Accommodative amplitude Either push-up, push away methods or minus lens method Minimum amplitude = 15 - (0.25) age So a 20 year old should have at least 10 diopters of accommodation The minus lens method exhibited the best repeatability... Repeatability intra-examiner and agreement in amplitude of accommodation measurements Antona B, Barra F, Barrio A, Gonzalez E, Sanchez I.

47. 47 Basic tests Accommodative facility Perform monocularly and binocularly with suppression control (+/-2.00) ~10 cycles per minute is diagnostic For children with reading problems: Binocular accommodative facility values were significantly lower (p < 0.05) in the poor readers (4.9 cpm +/- 3.1) than controls (6.3 cpm +/- 2.9) Accommodative function in school children with reading difficulties. Palomo-Alvarez C, Puell MC.

48. 48 Basic tests NRA Negative Relative Accommodation PRA Positive Relative Accommodation

49. 49 Basic tests Vergences Use either prism bars or Risley prisms Sheard’s criteria Need twice your phoria in reserve Example: a 10 pd exophore at near needs 20 pd BO reserves

50. 50 Other Tests Dynamic Retinoscopy Monocular Estimation Method Expected Values: +0.50 to +0.75 D

51. 51 Other Tests Fixation Disparity Testing Wesson Card Bernell Fixation Disparity (Associated Phoria) Disparometer

52. 52 Other Tests Fixation Disparity Testing Wesson Card Bernell Fixation Disparity (Associated Phoria) Disparometer

53. 53 Other Tests Fixation Disparity Testing Wesson Card Bernell Fixation Disparity (Associated Phoria) Disparometer

54. 54 Other Tests

55. 55

56. 56

57. 57 Common BV Syndromes Convergence Insufficiency Most common syndrome Symptoms: aesthenopia, headaches, blur, diplopia, loss of concentration associated with near work often occur near the end of the day

58. 58 Convergence Insufficiency Signs: An exodeviation at near Can even be an intermittent exotropia at near Receded NPC value NPC larger than 10 cm Reduced BO vergences at near Often fail to meet Sheard’s criterion

59. 59 Convergence Excess Symptoms: Diplopia, headaches, aesthenopia almost always near related Signs: Esophoria at near Use detailed accommodative target or you may miss the esophoria Vergences BI vergences at near may not compensate

60. 60 Convergence Excess Signs Dynamic Retinoscopy May be the most significant test Typically a high lag of accommodation Lag may be +1.00 to +2.00 DS at 40 cm Lags greater than +2.50 D at 40 cm should suggest uncorrected hyperopia

61. 61 Binocular Vision Dysfunction Symptoms: aesthenopia, headaches, blurred vision (Binocular Vision/Visual Discomfort Dx) Associated with reading or near work Signs: Phorias: Normal at distance and near Reduced BI and BO vergences at distance and/or near

62. 62 Accommodative Disorders Symptoms: blur, headache, aesthenopia, fatigue when reading, difficulty changing focus from one distance to another

63. 63 Accommodative Disorders Signs Accommodative Insufficiency: Reduced amplitude of accommodation Minimum Accommodation: 15 - (0.25) (age) Accommodative Infacility Failure of monocular facility testing Expected value: 11 cpm

64. 64 Other BV Disorders Divergence Excess Prevalence of ~0.5 to 4% Exophoria greater at distance than near Frequently first discovered in grade school Divergence Insufficiency Very rare! Esophoria greater at distance than near Be careful to rule out lateral rectus palsy!

65. 65 Strabismus & Amblyopia 3-6% of the population Tx appropriate at all ages May do out of office VT and achieve success!

66. 66 Exotropia CI, Intermittent XT @ near DE, Intermittent XT @ distance

67. 67 Accommodative Esotropia First seen in 2-4 year olds Uncorrected hyperopia High ACA

68. 68 Accommodative Esotropia From: http://www.strabismus.org/esotropia_eye_turns_in.html

69. 69 Diplopia & Head Turns/Tilts Paresis or paralysis? Duane’s Retraction Syndrome

70. 70 Amblyopia Pathological until proven otherwise Infants/Toddlers Young Children Busy Adults

71. 71 Amblyopia Pathological until proven otherwise Infants/Toddlers Young Children Busy Adults Anisometropia Bilateral Refractive Error Strabismus (Constant) No disease present

72. 72 Efficacy of Optometric Vision Therapy Efficacy of vision therapy as assessed by the COVD quality of life checklist. Maples WC, Bither M. The COVD-QOL can be used to measure changes in symptoms, and to objectively demonstrate quality of life changes that are achieved through optometric vision therapy.

73. 73 Efficacy of Optometric Vision Therapy Ciuffreda KJ. The scientific basis for and efficacy of optometric vision therapy in non-strabismic accommodative and vergence disorders. Optometry. 2002;73(12):735-62

74. 74 Efficacy of Optometric Vision Therapy Scheimann M et al. A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. Optom Vis Sci. 2005 Jul;82(7):583-95. …vision therapy/orthoptics was the only treatment that produced clinically significant improvements in the near point of convergence and positive fusional vergence.

75. 75 Efficacy of Optometric Vision Therapy A Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children Mitchell Scheiman, OD, FCOVD, CITT Study Chair Office Based Vergence/Accommodation Therapy was significantly more effectivethan Home Based Pencil Pushups, Home Based Computer Vergence/ Accommodation Therapy with PP+, and Office Based Placebo Therapy in improving both the symptoms and clinical signs associated with symptomatic CI in children

76. 76 Treatment for BV Disorders Evidence Based Medicine Cotter S et al. Treatment of strabismic amblyopia with refractive correction. Am J Ophthalmol. 2007 Jun;143(6):1060-3. These results support the suggestion …that strabismic amblyopia can improve and even resolve with spectacle correction alone.

77. 77 Treatment for BV Disorders Scheimann M et al. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol. 2005 Apr;123(4):437-47. Amblyopiaimproveswith optical correction alone in about one fourth of patients aged 7 to 17 years, although most patients who are initially treated with optical correction alone will require additional treatment for amblyopia. For patients aged 7 to 12 years, prescribing 2 to 6 hours per day of patching with near visual activities and atropine can improve visual acuity even if the amblyopia has been previously treated. For patients 13 to 17 years, prescribing patching 2 to 6 hours per day with near visual activities may improve visual acuity when amblyopia has not been previously treated

78. 78 Refractive Error Myopia: Can Its Progression Be Controlled? Yi Pang, PhD, OD, Dominick M. Maino, OD, MEd, FAAO GuomingZhang, MD, PhD, Fan Lu, MD, OD …. muscarinic receptor antagonists, including atropine and pirenzepine. Bifocal and progressive lenses can be effective in the control of myopia and have greater effectiveness for subjects with nearpointesophoria and a high lag of accommodation.

79. 79 Refractive Error Two-year multicenter, randomized, double-masked, placebo-controlled, parallel safety and efficacy study of 2% pirenzepine ophthalmic gel in children with myopia. R. Michael Siatkowski MD, Susan A. Cotter OD, MS . Et al. Pirenzepine ophthalmic gel 2% was effective compared with placebo in slowing the progression of myopia over a 2-year treatment period and demonstrated a clinically acceptable safety profile. ( J AAPOS 2008;12:332-339)

80. 80 New Amblyopia Treatments? Thompson B, Mansouri B, Koski L, Hess RF.Brain plasticity in the adult: modulation of function in amblyopia with rTMS. Curr Biol. 2008 Jul 2;18(14):1067-71. Watch for studies on “Perceptual Learning”!

81. 81 Li RW, Ngo C, Nguyen J, Levi DM (2011) Video-Game Play Induces Plasticity in the Visual System of Adults with Amblyopia. PLoS Biol 9(8): e1001135. doi:10.1371/journal.pbio.1001135 …..video-game play may provide important principles for treating amblyopia, and perhaps other cortical dysfunctions.

82. 82 Learning Related Vision Problems All vision problems affect learning, usually as a secondary contributing factor. New research suggests that the Magnocellular pathway may show a direct vision link.

83. 83 Learning Related Vision Problems Repeatability of the VMI Supplemental Developmental Test of Visual PerceptionMarjean Taylor Kulp, OD, MS, FAAO and Michael J. Earley, OD, PhD, FAAO Visual perceptual ability has been found to be related to academic achievement. Therefore, the screening of perceptual skills in children should provide valuable information. … The VMI Supplemental Developmental Test of Visual Perception (VP) test 1) has been shown to be related to academic performance, 2) has an objective scoring system and 3) can be administered and scored quickly and easily. Therefore, the VP test may have the potential to be used as a stand-alone screening test of motor-reduced visual perception. However, its repeatability as a stand-alone screening test has not been evaluated. No consistent learning effect appeared to be present upon retest. It give repeatable results.

84. 84 Learning Related Vision Problems Subitizing and Visual Counting in Children with Problems in Acquiring Basic Arithmetic SkillsBurkhart Fischer, Dipl. Phys., Christine Gebhardt, Dipl. Phys., and Klaus Hartnegg, Dipl. Phys. We concluded that the deficit in a basic visual capacity may contribute to the problems encountered by children with anomalies in acquiring basic arithmetic skills. Fischer B, Gebhardt C, Hartnegg K. Subitizing and Visual Counting in Children with Problems in Acquiring Basic Arithmetic Skills. Optom Vis Dev 2008:39(1):24-29.

85. 85 Learning Related Vision Problems Effects of Daily Practice on Subitizing, Visual Counting, and Basic Arithmetic SkillsBurkhart Fischer, Dipl. Phys., Christine Gebhardt, Dipl. Phys., and Klaus Hartnegg, Dipl. Phys. Since the result of the second study of this paper shows a transfer from improvements in subitizing to improvements of basic arithmetic skills one may conclude that the basic visual capacity of subitizing and visual number counting contributes to the problem encountered by children with dyscalculia. Fischer B,Gebhardt C, Hartnegg K. Subitizing and Visual Counting in Children with Problems in Acquiring Basic Arithmetic Skills. Optom Vis Dev 2008:39(1):24-29.

86. 86 Learning Related Vision Problems Solan H et al. M-cell deficit and reading disability: a preliminary study of the effects of temporal vision-processing therapy. Optometry. 2004 Oct;75(10):640-50. This research supports the value of rendering temporal vision therapy to children identified as moderately reading disabled (RD). The diagnostic procedures and the dynamic therapeutic techniques discussed in this article have not been previously used for the specific purpose of ameliorating an M-cell deficit. Improved temporal visual-processing skills and enhanced visual motion discrimination appear to have a salutary effect on magnocellular processing and reading comprehension in RD children with M-cell deficits.

87. 87 Learning Related Vision Problems Solan H et al. Is there a common linkage among reading comprehension, visual attention, and magnocellular processing? J Learn Disabil. 2007 May-Jun;40(3):270-8. Solan H et al. Role of visual attention in cognitive control of oculomotor readiness in students with reading disabilities. Learn Disabil. 2001 Mar-Apr;34(2):107-18. Eye movement therapy improved eye movements and also resulted in significant gains in reading comprehension.

88. 88 Learning Related Vision Problems The Effects of HTS Vision Therapy Conducted in a School Setting on Reading Skills in Third and Fourth Grade Students David Goss, O.D., Ph.D., FAAO, FCOVD-A, et. al.A Study of the Effectiveness of Cognitive Skill Therapy Delivered in a Video Game Format Don Helms, O.D., and Sara M. Sawtelle, Ph.D. Training Direction-Discrimination Sensitivity Remediates a Wide Spectrum of Reading Skills Teri Lawton, Ph.D. Optom Vis Dev. 2007;38(1)

89. 89 Learning Related Vision Problems Vision, Visual-Information Processing, and Academic Performance Among Seventh-Grade Schoolchildren: A More Significant Relationship Than We Thought? Sarina Goldstand, Kenneth C. Koslowe and Shula ParushAmerican Journal of Occupational Therapy July/August 2005 vol. 59 no. 4 377-389 Effect of attention therapy on reading comprehension. Solan HA, Shelley-Tremblay J, Ficarra A, Silverman M, Larson S. J Learn Disabil. 2003 Nov-Dec;36(6):556-63.

90. 90 Learning Related Vision Problems A randomized prospective masked and matched comparative study of orthoptic treatment versus conventional reading tutoring treatment for reading disabilities in 62 children. Atzmon D, Nemet P, et al. Binocular Vision & Eye Muscle Surgery Quarterly, 8(2):p. 91-106, 1993.

91. 91 Orthoptic treatment, to increase convergence amplitudes to 60 D, is as effective as conventional in-school reading tutoring treatment of reading disabilities. An advantage of orthoptic treatment was that subjective reading and asthenopic symptoms (excessive tearing, itching, burning, visual fatigue, and headache) virtually disappeared after orthoptics. We recommend orthoptic treatment as: 1) an effective alternate primary treatment; 2) adjunctive treatment for those who do not respond well to standard treatment; and 3) as primary treatment in any case with asthenopic symptoms of /or convergence inadequacy.

92. 92 Optometric Vision Therapy are NOT! Eye Exercisers!

93. 93 Vision Therapy is…..! Brain Therapy Neuro-therapy Neuro-plasticity Therapy

94. 94 Treatment for BV Disorders Treatment modalities Lenses Prisms Vision therapy Traditional therapy Computer therapy

95. 95 Lenses as Treatment Best Rx (clarity, comfort, function)

96. 96 Lenses as Treatment Best Rx (clarity, comfort, function) Accommodative disorders Can prescribe reading only Rx or an add Exodeviations Overminusing (DE) Not usually a first choice! Give add

97. 97 Bifocals for Kids Bifocal Seg Height Infants/Toddlers Pre-schoolers Bi-sect pupil

98. 98 Bifocals for Kids Bifocal Seg Height 3-5 Years Bottom 1/3 of Pupil

99. 99 Bifocals for Kids Bifocal Seg Height > 5yrs Bottom of Pupil

100. 100 Bifocals for Myopia Progression Gwiazda JE, Hyman L, Norton TT, Hussein ME, Marsh-Tootle W, Manny R, Wang Y, Everett D; COMET Grouup. Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children.Invest Ophthalmol Vis Sci. 2004 Jul;45(7):2143-51. ….Children with large lags of accommodation and near esophoria …are prescribed …bifocals to improve visual performance. Results of this study suggest that such children, if myopic, may have an additional benefit of slowed progression of myopia…..

101. 101 Polycarbonate Lenses You Must Rx.... Polycarbonate lenses For All Children !

102. 102 Prism as Treatment Can be used with CI, CE, DI, DE, Vertical Deviations Prescribe the least amount of prism needed Determine the associated phoria with a Wesson Card or Bernell Box Fresnel Prism trial, then Rx

103. 103 Optometric Vision Therapy as Treatment The approach of choice for CI, Fusional Vergence Dysfunctions, accommodative disorders, and Amblyopia High chance of success with these disorders Results are typically long lasting Often can treat these disorders using primarily home VT with in-office check-ups

104. 104 Vision Therapy as Treatment Traditional therapy Hand-eye, Vergence and Accommodative procedures Computer Therapy Can attack hand-eye, vergence, accommodative and oculomotor problems (Vision information processing anomalies?)

106. Implement occlusion therapy

107. Active vision therapy

108. Monitor

110. 107 Atropine Pediatric Eye Disease Investigator Group. The course of moderate amblyopia (20/100) treated with atropine in children: experience of the amblyopia treatment study.Am J Ophthalmol. 2003 Oct;136(4):630-9.

111. 108 Atropine Repka MX, Cotter SA, Beck RW, Kraker RT, Birch EE, Everett DF, Hertle RW, Holmes JM, Quinn GE, Sala NA, Scheiman MM, Stager DR Sr, Wallace DK; A randomized trial of atropine regimens for treatment of moderate amblyopia in children.Ophthalmology. 2004 Nov;111(11):2076-85.

112. 109 Atropine Weekend atropine provides an improvement in VA of a magnitude similar to that of the improvement provided by daily atropine in treating moderate amblyopia in children 3 to 7 years old.

113. 110 Occlusion Therapy

114. 111 Amblyopia Therapy What do we know about amblyopia? More than decreased VA Visual-Spatial affects Accommodation Hand-eye Stereopsis

115. 112 Active Vision Therapy Hand-eye Oculomotor Accommodation Have child “Do Stuff” Interact with environment

116. 113 Roberts CJ, Adams GG.Contact lenses in the management of high anisometropic amblyopia. EYE. 2004;18(1):109-10 High anisometropic amblyopia is challenging to treat. …contact lenses improved visual acuity in myopic anisometropia of up to 9 diopters.

117. 114 Vision Therapy as Treatment Phases of Therapy Monocular (HE, OM, ACC) Biocular (HE, OM, ACC, Anti-suppression) Binocular (Vergence, Acc) Integration/Stabilization Do it all at the same time!

118. 115 Vision Therapy as Treatment Phases of Therapy Monocular (HE, OM, ACC) Biocular (HE, OM, ACC, Anti-suppression) Binocular (Vergence, Acc) Integration/Stabilization Do it all at the same time!

119. 116 Vision Therapy as Treatment Phases of Therapy Monocular (HE, OM, ACC) Biocular (HE, OM, ACC, Anti-suppression) Binocular (Vergence, Acc) Integration/Stabilization Do it all at the same time!

120. 117 Vision Therapy as Treatment Phases of Therapy Monocular (HE, OM, ACC) Biocular (HE, OM, ACC, Anti-suppression) Binocular (Vergence, Acc) Integration/Stabilization Do it all at the same time!

121. 118 Vision Therapy as Treatment Phases of Therapy Monocular (HE, OM, ACC) Biocular (HE, OM, ACC, Anti-suppression) Binocular (Vergence, Acc) Integration/Stabilization Do it all at the same time!

122. 119 Traditional Therapy Procedures Hand-Eye Procedures mazes dot to dot cutting coloring filling in O’s Bunt Ball

123. 120 Traditional Therapy Procedures Vergence procedures Brock String Lifesaver card BI and BO Anaglyph Series (BC920, others) Accommodative Procedures Minus lens dips Flippers Hart Chart

124. 121 Vergence Procedures Brock String Brock String Simple Inexpensive Easy Effective

125. 122 Vergence Procedures Life Saver Cards BO and BI Good fusion Anti-suppression Inexpensive Effective

126. 123 Vergence Procedures Eccentric Circles Aperture Rule Fusion Cards Random dot targets BC 920, BC 50 Anaglyph series Aperture Rule

127. 124 Vergence Procedures Vectograms Aperture Rule “Flying W” Stereoscopes Vectograms

128. 125 Accommodative Procedures Rock Card Flippers Anti-suppression

129. 126 Accommodative Procedures Hart Chart the old standby

130. 127 Vision Therapy Videos http://www.youtube.com/watch?v=HtzEHSie-90

131. 128 Vision Therapy Videos http://www.youtube.com/watch?v=fX8mqtgdzgs

132. 129 Vision Therapy Videos http://www.youtube.com/watch?v=RTy3o8DwON8

133. 130 Vision Therapy Videos http://www.youtube.com/watch?v=Ui3KTZOdzbo http://www.youtube.com/watch?v=wcVX684r3xQ

134. 131 Computer Vision Therapy Can attack vergence, accommodative, and oculomotor problems Most programs are set up to record patient’s performance each session Removes the problem of compliance! Different products on the market Home Therapy System Computer Aided Vision Therapy

135. 132 Computer Vision Therapy Computer based vision therapy program Patient can use at home, work, wherever they have access to computer Trains eye movements, vergences, accommodation, and perceptual skills

136. 133 Why use Computer Aided VT? “Patients who cannot make a time commitment Patient compliance problems Insurance or Third Party Problems It’s Fun!

137. 134 How do you incorporate Computer Aided Vision Therapy in your program? Diagnose the patient!!! Assign a therapy protocol Computer aided VT in the office Schedule follow-up appointments Evaluate the patient’s progress/Follow-up

138. 135 Computer Aided VT Resources Computer Orthoptics HTS (Home Therapy System) http://www.homevisiontherapy.com/

139. 136 Computer Aided VT Resources

140. 137 Computer Aided VT Resources

141. 138 Computer Aided VT Resources

142. 139 Computer Aided VT Resources

143. 140 Computer Aided VT Resources Computerized Aided Vision Therapy Gary Vogel, OD, FAAO http://www.cavt.net/software.html Available from Bernell 800-348-2225 http://www.bernell.com/

144. 141 Computerized Aided Vision Therapy Module 1 Track and Read Visual attention/fixation test Visual reaction time test Short term visual memory test Eye tracking test

145. 142 Computerized Aided Vision Therapy Module 2: Visual Therapy Visual information processing skills Left-right warm-ups Directional reactions Directional questions Random targets Directional grids Tachistoscopic arrows Satellite commando game

146. 143 Computerized Aided Vision Therapy Module 2: Visual Therapy Visual Skills Therapy Tic-Tac-Toe rotations Spatial Sequencing Spatial Patters BPDQ Grids Circles, Boxes, Triangles Geo Boards Rotating patterns

147. 144 Computerized Aided Vision Therapy Module 2: Visual Therapy Therapy Procedures Visual attention/fixation Tracking with Numbers Span of recognition Random eye movements Short term visual memory Large angle eye movements

148. 145 Computerized Aided Vision Therapy Module 2: Visual Therapy Visual Figure Ground Skills Target counting Character searching Letter locator Dot to dot Shapes Hidden patterns

149. 146 Computerized Aided Vision Therapy Module 2: Visual Therapy Visual Closure Skills Therapy Circles & boxes Lines & rectangles Closing on center Closing patterns Letters/numbers dot to dot Closing words Tracking with sequences/words Verbal saccades Tracking with stories

150. 147 Computerized Aided Vision Therapy Module 3: Computer Vergences Jump vergences (single/double targets) Smooth vergences Pursuit vergences Life saver drills Anti-suppression games

151. 148 Vision Builder

152. 149 Brainware Safari http://www.brainwareforyou.com/

153. 150 Brainware Safari Helms D, Sawtelle SM. A study of the effectiveness of cognitive therapy delivered in a video game format. Optom Vis Dev 2007;38(1):19-26. Students in the study group showed an average of 4 years and 3 months improvement on tests of cognitive skills, compared to 4 months improvement for the control group and showed an average of 1 year and 11 months improvement on tests of achievement compared to 1 month for the control group. http://www.brainwareforyou.com/

154. 151 Conclusions Easy to incorporate VT for BV disorders into your activities Monitor the output to check for compliance and tricks! Remember that the key is in diagnosing patients and follow-up

155. 152 VT Equipment Use the tools discussed You do not need a whole room of VT “stuff”

156. 153 WWW Sites for BV/VT Gemstonevision.Org

157. 154 BV Organizations COVD http://www.covd.org/ OEP http://www.oepf.org// 949-250-8070 AAO BV Sectionhttp://www.aaopt.org/section/bv/index.asp 301-984-1441

158. 155 BV Organizations PAVE/Parents Active for Vision Education http://www.pavevision.org/ Neuro-Optometric Rehabilitation Association http://www.nora.cc/

159. 156 Patient WWW Sites 3 D Pictures http://www.vision3d.com/optical/ index.shtml#stereogram How Does Binocular Vision Work? http://www.vision3d.com/stereo.html

160. 157 Patient WWW Sites http://www.children-special-needs.org/vision_therapy/what_is_vision_therapy.html

161. 158 Position Statement on VT AOA, AAO, COVD many others: Position Statement on Optometric Vision Therapy “The American Optometric Association affirms its long standing position that optometric vision therapy is effective in the treatment of physiological, neuromuscular and perceptual dysfunctions of the vision system……..”

162. 159 My Private Office

163. 160 MainosMemos, Facebook, LinkedIn, ICO

164. 161

165. 162 Social/ProfessionalConnections

166. Questions? Contact: Dominick M. Maino, OD, MEd, FAAO, FCOVD-A Professor, Pediatric/Binocular Vision Service Illinois Eye Institute/Illinois College of Optometry 3241 S. Michigan Ave. Chicago, Il. 60610 312-949-7280 voice 312-949-7668 fax Private Practice 708-867-7838 dmaino@ico.eduMainosMemos.blogspot.com www.nw.optometry.net www.ico.edu