The general population, and many eye care professionals alike, commonly use the word “vision” interchangeably with “sight” or “eyesight”. But vision is much more than sight alone. Sight is the ability of an organism to resolve radiant light energy. Vision is the interpretation and processing of this radiant light energy to form actions – thoughts and movements. The sense of hearing provides a simple analogy – as sight is to hearing what vision is to listening. Sight implies a passivity while vision is an active process.

Visual dysfunction beyond problems with eyesight is common in our modern society for a variety of reasons. Whether the problem stems from poor development, stress, disease, injury, or age, it is important for an individual with visual problems to have them addressed before it impacts their self-esteem, performance, and overall well-being.

We specialize in optometric vision therapy and we are proud to serve the greater Washington, DC metropolitan area here in McLean, Virginia. Prospective and new patients often inquire us about optometric vision therapy. Here are answers to a few Frequently Asked Questions that may be helpful.

Q: What is optometric vision therapy?

In-office optometric vision therapy (VT) is an evidence-based system for training individuals with visual impairments and problems through non-surgical procedures and activities under the supervision of an optometrist. VT aims to train or re-train the learned aspects of vision through the concept of brain adaptability and plasticity. Orthoptics, which literally means “straightening of the eyes”, dates back to the 1850’s. However, optometric vision therapy is much more than the limited muscle work of orthoptics and also includes the enhancement and rehabilitation of the eye-brain connections involved in vision.

Q: How does vision therapy work?

People who have vision problems may not even know of their problems because they have never known anything different from their own experience. Every individual is unique and learns to see in their unique way, right or wrong. Because vision takes place in the brain, VT works by improving the processing of information in the brain. For change to occur, individuals are placed into environments where they are made aware of their visual problems and then guided toward more effective solutions to these problems. Visual skills develop like any other skill so they can be improved and optimized like any other skill. Skill development and learning takes time so repetition is vital to replace old schemes with new ones.

Q: What type of equipment is used in vision therapy?

Effective vision therapy can be done with minimal equipment. VT equipment vary from ordinary everyday items to sophisticated computer-assisted instruments and machinery. One of our most effective tools is in fact a simple string – the Brock string! Equipment usually consists of optical lenses, prisms, and filters, red-green and polarized glasses, 3-D tranaglyphs and vectograms, telebinoculars, balance boards, chalkboards, and various electronic targets.

Q: Balance boards and chalkboards? So why are people drawing on the chalkboard or walking on a rail during VT? What does that have to do with the eyes and improving vision?

Vision is a process that involves the entire body and all of its senses since vision guides and directs the movement of our bodies in space. The visual system does not just passively receive information but invokes action. An effective and dynamic VT program will consist of more than just working with the eyeballs and should include getting the entire body involved as vision guides the action of the body. The integration of the visual system with the body and all its senses is vital for long-lasting change.

Q: Why did my child’s pediatrician refer us to an ophthalmologist and why do both of these medical professionals state that optometric vision therapy does not work?

VT is a well-established field in the profession of optometry as its concepts were a foundation of early optometric education. Unfortunately, many medical professionals propagate misinformation about VT and tell their patients that it does not work. The simple answer to these questions is based on education and economics. Generally, medical professionals are under-informed in the areas of convergence, accommodation, visual processing, and vision therapy. They are trained to diagnose, manage, and treat disease using their preferred tools – pharmaceutical agents and surgery. Many do an excellent job at what they are trained to do. A few of them are objective and understand their limitations and make the appropriate referrals. On the economics side, non-surgical treatment is obviously not as rewarding for surgeons in the U.S. as most major medical insurance companies cover eye muscle surgery but do not provide coverage for vision therapy.

Unlike physical therapists and orthopedic surgeons, the majority of optometrists and their ophthalmologist counterparts have not learned how to work together to provide the public with objective and optimal eye and vision care.

Q: My daughter’s eyes occasionally wander and point in opposing directions. The ophthalmologist called this condition strabismus and recommended surgery to cut her eye muscles to align them. Surgery seems rather invasive. Are there alternative and less risky treatments?

Yes! This is a main area of disagreement between the two eye care professions. The ophthalmologist likely blamed the misalignment on overly weak and/or strong eye musculature so naturally their preferred treatment is to shorten and/or lengthen these muscles by surgical means. Developmental optometrists place the responsibility of integrating the two eyes on brain processing which has little to do with muscle strength. In fact, the eye muscles are already incredibly strong and strabismus is rarely caused by weak eye muscles. This can easily be demonstrated by covering one eye at a time and asking your daughter to look around in all directions. You will see that each eye can move in all directions with relative ease when it is the only eye viewing the world. Only with both eyes open will you see an eye turn away from the other. Would each eye be able to gaze in all directions by itself if the muscles pulling and pushing it were truly “weak”? Vision occurs in the brain. Treatment for strabismus aims to break down the maladapted processing and replace it with better and more efficient processing.

Q: Too late, the Eye MD already performed surgery on my daughter. But now he wants to do another one because her eyes are still not straight. What should I do now? Is it too late to try optometric vision therapy?

Because ophthalmologists do not fully consider the brain’s role in eye alignment, they disregard the role of sensory fusion to maintain eye alignment. Sensory fusion is the glue that holds the two eyes together for a lifetime of binocular vision. This brain process is what allows binocular beings to perceive space in three dimensions, or 3-D. People with strabismus are essentially one-eyed individuals because they have learned to suppress information from one eye to avoid double vision. They do not see in 3-D. Just because their eyes are now straighter does not mean that they have spontaneously learned to use both of them together as a team. Sure, some do learn on their own but many will need assistance to learn this skill. The assistance of a trained professional helps guide this learning. Muscles that have been cut diminishes the overall prognosis but the brain can and will adapt. It is never too late to try VT.