Vision Training/ Vision Therapy (Active/ Passive Vision Therapy)/ Sports Vision/ Computer Vision Syndrome

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  • Vision Training

    Bikash Sapkota

    B. Optometry



  • Contents Vision Training



    oTips for success

    Office Vision Training

    Home Vision Training

    Conditions treated by vision training

    Sports Vision Training



  • 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

  • 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

    Pts visual dysfunction determines the sequential plan

  • 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

  • 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)

  • 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)

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • Tips for Successful Vison Training Program

    Prescribe incrementally

    Adapted to the individual patient

    Progress at the patients own rate

    Maintain the patients interest

    Use 2-4 therapy techniques or procedures per week

  • 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

  • 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)

  • 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)

  • 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

  • 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 parents 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)

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • Young children require short period of training, with frequent changes in activity or targets

    Attractive and interesting target help to hold the childs interest

    - Bright colors

    - Moving objects

    - Musical accompaniment

    - Flashing lights

    Suggestions for Training Patients of Different Ages

  • 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