WHAT IS OPTOMETRIC VISION THERAPY? — The College of Optometrists of Vision Development

Optometric vision therapy is an individualized treatment program designed to improve visual function and performance. It is an approved treatment modality for disorders including, but not limited to:

* Ocular motility dysfunction/eye movement disorders

* Vergence dysfunction/inefficiency in using both eyes together

* Strabismus/misalignment of the eyes

* Amblyopia/lazy eye

* Accommodative disorders/focusing problems

* Visual information processing disorders

* Visual sensory and motor integration

* Visual rehabilitation after traumatic brain injury or stroke all of which result in inefficient visual information processing.

Most people who visit an optometrist know that any eye health problems will be detected and managed and that glasses or contact lenses will be prescribed if indicated. That picture is incomplete because there are visual conditions that are best managed by optometric vision therapy. This therapy enables an individual to learn more efficient ways to perform visually. It is an art and science of vision care that complements the prescription of eye glasses, contact lenses and the treatment of eye disease.

Optometric vision therapy, also referred to as visual training or orthoptics (CPT 92065), is an established, medically necessary therapy when prescribed by an optometrist. Optometric vision therapy can improve visual function much like physical therapy can improve general motor function. Clinical tests with associated normative values are administered by an optometrist to determine the presence of visual deficiencies. If optometric vision therapy is indicated, the optometrist recommends a specific treatment plan.

Optometric vision therapy typically invokes a programmed combination of office treatment and home therapy. Lenses. prisms. optical devices, and specially adapted computers are some of the devices through which one learns to use vision more effectively. The specific materials are less important than the feedback provided to the patient to enable change. Visual skills need to be developed until they become automatic and are subconsciously integrated with the other skills. The extent of success is also linked to patient compliance.

The benefits of optometric vision therapy, which include improved visual information processing and the ability to sustain visual function over time, are as applicable to the child in the classroom as they are to the adult using a computer or reading a book. Without efficient visual skills the act of reading can be frustrating. Some of the common symptoms relieved through vision therapy include eye strain, visually induced headaches, inability to concentrate when doing visual tasks, and errors such as loss of place or reversals. More often, individuals have no recognized symptoms due to their avoidance of visually demanding tasks or an adaptation that decreases their performance. Optometric vision therapy also facilitates appropriate visual development, and serves as a component of the multi-disciplinary effort following stroke or head injury.

Members of the College of Optometrists in Vision Development (COVD) have post-graduate education in the diagnosis and management of conditions for which optometric vision therapy is an appropriate treatment. Fellows of the College are certified in providing this vision care. For further information, contact COVD or consult with your COVD optometrist.

Dedicated to the Enhancement of Vision

Permission to reprint the contents of this C.O.V.D. White Paper granted to Visual Edge, Inc ® – 4/15/09 by:

College of Optometrists in Vision Development (COVD)
215 West Garfield Road, Suite 200
Aurora, OH 44202
(330) 995-0718, (888) 995-0719, FAX (330) 995-0719

ATTENTION DEFICITS
A Developmental Approach

Attention Deficit Hyperactivity Disorder or ADHD is being diagnosed with increasing frequency in both children and adults. Many of these individuals were previously labeled hyperactive or minimally brain damaged. It is estimated that over one million people presently have this disorder.

The fourth edition of the Diagnostic and Statistical (Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, classifies three types of Attention Deficit/Hyperactivity Disorders: predominantly inattentive, predominantly hyperactive, and combined. Six of nine symptoms of inattention, and six of nine of hyperactivity and impulsivity are necessary for diagnosis.

In each case, the symptoms must be present for at least six months to a degree that is maladaptive and inconsistent with developmental level. In addition, some symptoms must be present prior to age seven, and in two or more settings (e.g. at school, work and home). There must be clear evidence of clinically significant impairment in social academic or occupational functioning, and the impairment cannot be caused by other disorders such as anxiety, psychosis or a pervasive developmental disorder.

Even though it is generally assumed that people diagnosed as having ADHD evidence a common set of characteristics emanating from a common etiology, little agreement is found among researchers regarding these symptoms. Some symptoms seen in children diagnosed as having attention deficits include:

• Making careless mistakes in schoolwork
• Difficulty sustaining attention to tasks
• Not listening to what is being said
• Difficulty organizing tasks and activities
• Losing and misplacing belongings
• Fidgeting and squirming in seat
• Talking excessively
• Interrupting or intruding on others
• Difficulty playing quietly

These symptoms are also seen in both children and adults with learning-related visual problems, sensory integration dysfunction as well as with undiagnosed allergies or sensitivities to something they eat, drink or breathe. The chart that follows illustrates this graphically.

Physicians often recommend that ADHD be treated symptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they may mask the problems rather than get to their underlying causes.

In addition, many common drugs for ADD, which have the same Class 2 classification as cocaine and morphine, can have some negative side effects that relate to appetite, sleep and growth. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine rather than boost his self-esteem.

A sensible, multi-disciplinary, developmental approach treats underlying causes rather than the symptoms which are secondary.

TREATMENT OF ALLERGIES to pollen, molds, dust, foods and/or chemicals by eliminating or neutralizing them has also been shown to alleviate the identical symptoms, and without side effects.

VISION THERAPY improves skills that allow a person to pay attention. These skill areas include visual tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.

OCCUPATIONAL THERAPY for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, understanding movement, body position and touch. This allows them to pay more attention to the higher level senses of hearing and vision.

The public needs to understand that some behavioral optometrists, physicians, educators, mental health professionals, occupational therapists and allergists are all addressing the same symptoms and behaviors. The difference is that medication, special education and counseling can mask these symptoms and behaviors, while vision therapy, occupational therapy and the treatment of allergies may alleviate the underlying causes and thus eliminate the symptoms long-term.

When making a choice about treatment for attention deficits:

• Consult a behavioral optometrist for a developmental vision evaluation
• Have a child evaluated by an occupational therapist with expertise in sensory processing problems
• Consult an allergist regarding possible reactions to foods or airborne particles

References:

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-lV), 1994.

Ayres, A. Jean, Sensory Integration and the Child, Western Psychological Services, 1979.

Crook, William G., Solving the Puzzle of Your Hard-to-Raise Child, Professional Books, 1987.

Gesell, Arnold, and Ilg., Frances L., Infant and Child of the Culture of Today, Harper) 1943.

Goodman, Gay, Poillion, M. J., The Journal of Special Education, “ADD: Acronym for Any Dysfunction or Difficulty,” Vol 26, No. 1, l992, pp. 37-56.

Kavner, Richard S., Your Child `s Vision, Simon and Schuster, 1985.

Rapp, Doris J., Is This Your Child?, Morrow, 1991.

Schmidt, M.A., Smith, L.H., Sehnert, K.W., Beyond Antibiotics: Healthier Options for Families, North Atlantic Rooks, 1994.

Smith, Lendon, Foods for Healthy Kids, Berkeley Books, 1981.

FOR RESOURCES IN YOUR AREA

Vision Therapy

Optometric Extension Program Foundation, Inc. (OEP Foundation)
1921 E. Carnegie Ave., Ste. 3-L
Santa Ana, CA 92705-5510
(949) 250-8070

College of Optometrists in Vision Development (COVD)
215 West Garfield Road, Suite 200
Aurora, OH 44202
(330) 995-0718, (888) 995-0719, FAX (330) 995-0719

Occupational Therapy

Sensory Integration International
1602 Cabrillo Avenue
Torrance, CA 90501
(310) 320-9986

American Occupational Therapy Association, Inc.
4720 Montgomery Lane
P.O. Box 31220
Bethesda, MD 20824-1220
(301) 652-2682

Developmental Delay Registry
6701 Fairfax Road
Chevy Chase, MD 20815
(301) 652-2263

International Health Foundation, Inc.
P.O. Box 3494
Jackson, TN 38303
(901) 427-8100

Pamphlet Copyright © 1994, OEP Foundation, Inc.

A nonprofit foundation for education and research in Vision

Permission to reprint the contents of this brochure granted to Visual Edge, Inc. ® – 04/15/09
by: the Optometric Extension Program Foundation, Inc