V I S I O N . T H E R A P Y
The vision therapy staff have worked wonders with my 9 year old son over the past 5 months. His reading and spatial awareness skills have improved tremendously, as has his overall confidence. The entire team at Keith Holland are a pleasure to work with. Thank you all!

What is Behavioural Optometry?

Whereas conventional optometry concentrates on correcting visual errors (often concentrating just on refractive error or sight defects alone) and checking on eye health, the behavioural optometrist goes well beyond this to consider how vision has developed, whether there are problems with the developmental process, and how this is impacting on what is being asked of the system – and what may be asked of it in the future.

As over 80% of our learning comes through vision, an inefficient visual system can play a big part in how we learn and acquire information at school, at play and in the workplace.

Typically, the behavioural optometrist will want to understand the developmental processes, and health of the individual during early childhood, linking this with information on movement development as well as intellectual development. Only with this information can the behavioural optometrist make sense of what is happening currently and see whether there are things that can be done to enhance visual processing.

Having developed an understanding of the visual processes in an individual, the behavioural optometrist can go on to formulate strategies to help that individual use their vision more efficiently which may involve using glasses, changing learning strategies and working through a vision therapy programme to enhance visual processes. These are all evidence based strategies with proven success, and can transform how an individual not only learns – but how they feel about learning as well.

What is Vision Therapy?

Vision therapy is the name given to the activities used by a behavioural optometrist to enhance and improve vision processes. This is different to ‘orthoptics’ which uses an exercise programme to strengthen the eye muscle systems and literally straighten the eyes. Vision involves over

two- thirds of the brain and links very closely with all the sensory systems. Often these links have not developed well, or are inefficient, and it is through the development of these links that vision therapy makes an individual visually more efficient.

A ‘VT’ programme will involve working on how the eyes team together, how they focus on objects, and how they move in space – but in addition will work on the links between these systems with the balance and listening systems and the way we interpret visual information (visual perception). Following a VT programme, an individual should be more efficient and faster at processing visual information, and should do this with far greater ease, free of the symptoms of strain and discomfort, and better able to think. Often they will find they are better at problem solving, maths and spelling, and able to work for longer with less effort.

Every individual is just that – individual, and no two subjects will have the same problems or needs, and so a VT programme needs to be tailored to the needs of that person, and monitored and modified as they develop. This requires professional and specialised input, coupled with an understanding of the demands on that person both now, and in the future, to ensure they work efficiently and well. Activities are structured to be enjoyable, but can be demanding and will require some discipline – and will need to be worked on every day if real success is to be achieved!

We offer 2 types of Vision Therapy programmes:-

In Practice – We see the individual in the practice on a weekly basis, as well as providing additional home training tasks for the days in between. Typically an ‘In Practice’ programme lasts for 4 months. Without a doubt this is the most effective programme we offer, as we have the expertise and the experience to keep the programme spot on for the subject, but also have one of the largest and most comprehensively equipped Vision Therapy training centres in Europe.

Distance Learning – Here, the emphasis is on working at home. We see the individual once every 4 weeks, and during that visit both monitor what work has already been done, and provide new activities for the next 4 weeks, training the individual and their parent in what needs to be done at home. This programme is most popular with parents who have to travel a long way to the practice, and for whom weekly visits are impossible. Our distance programme typically needs around 15 minutes training each day at home to give the maximum benefit.

How does vision affect learning?

Vision is the dominant sense, and provides over 80% of the information we receive about the world around us. Most of our memories are of visual information, and our ability to visualise is crucial to thinking. Anything which interferes with this will affect how we learn, and may also cause a range of symptoms including strain and fatigue. With children this will often affect their desire to learn – particularly through close work, and will affect the development of their reading and writing. Some difficulties can affect balance and coordination, whilst others can leave a child exhausted by even short periods of study.

However it is the more subtle difficulties that can affect performance without causing symptoms that can be hardest to recognise. These can affect a child’s success in an apparently unexplainable way, leading not only to underachievement, but a sense of failure.

Below is a very brief guide to some of the issues affecting vision. It is a complex area, and no two individuals will have just the same pattern of difficulty – or have the same requirements. It is only after a comprehensive visual investigation that we can understand just what makes an individual ‘tick’, and what can be done to help.

Refractive Error – The most basic eyesight requirement is a clear retinal image, unaffected by excessive long or short sight. Often this is the only visual skill to have been assessed in routine sight checks.

Poor Convergence – the way the eyes team together and work as a pair. This is the commonest area of difficulty, and accounts for over half the symptoms associated with reading difficulties.

Poor Focusing – the way the eyes adjust to see something clearly up close. Reduced focus in adults is expected in the forties, but in children is usually ignored or not even suspected.

Poor Scanning or Tracking – the way the eyes move around the visual world to access and take in information. Problems here cause place- keeping difficulties as we read, and may affect spatial localisation as well as making us less aware of our surroundings.

Spatial Awareness – Our eyes provide a ‘Space map’ of the world around us, and the accuracy and completeness of this ‘map’ determines how well we react with our surroundings. The better our spatial awareness, the better our interactions with the world.

Perception – All of the above skills provide inputs that give us information. Perception is about what we do with that information, and how we make sense of the myriad of sensory stimuli we receive at any moment in time. Attention, speed of action and concentration are all products of perception, and problems with any of these will impact on our learning.

What are the signs of a problem?

Please use the checklist below to see if we can be of help, but remember that these will not necessarily identify everyone we can help. If you are in any doubt, please contact us to see if we can assist. Many individuals develop excellent strategies to cope and to avoid overt pain or discomfort. These strategies can include unusual postures, distraction techniques – and simple downright avoidance! Children especially have limited experience of what others are seeing or perceiving – to them how they see is how everyone sees. They will not think to say that something is hard, assuming it is like that for everyone, so because a child does not mention a problem does not mean they don’t have one!

Some common signs of difficulty include:

  • Often loses place when reading
  • Misses out words or re- reads the same word
  • Needs to use a finger or marker to keep their place
  • Quickly becomes tired when reading
  • Experiences transient blurred or double vision during close work
  • Complains of words “moving about”, “shimmering”, or “dancing” when reading
  • Has difficulty copying from board down on to paper
  • Complains of headache (usually around the temples or eyes) after close work
  • Has poor concentration for close work
  • Short and often decreasing working distance
  • Continuous reading is inaccurate, yet they can read single words quite easily
  • Has difficulty “taking in” what they are reading, and have to read something several times for meaning
  • Poor coordination at near, typically shown as bumping into, or knocking things over, yet may be good at sports. This might have been identified as ‘dyspraxia’, but may simply be a vision problem.
  • Reluctance to play with jigsaws and similar puzzles.
  • Difficulty with spatial concepts in maths
  • Irregular and untidy handwriting
  • Travel sickness
  • A strongly phonetic pattern to spelling

If you have any queries or doubts about whether your child would benefit from a visual assessment then please contact the practice and we will gladly help.

Who and how can we help?

A behavioural vision assessment can benefit almost anyone, but some groups in particular can gain enormous benefit from our help. These include children and adults with any of the following patterns of difficulty:

  • Dyslexia
  • Reading difficulties
  • Dyspraxia
  • Coordination problems
  • Autism
  • Attention difficulties – including ADD
  • Brain Injury – especially following brain trauma
  • Neuro- developmental delay

We do not pretend in anyway to ‘cure’ any of the above conditions. However it is well recognised that visual problems are usually a significant factor in all of the above conditions. Treating these issues can greatly reduce the impact of the condition on general living and learning.

A S S E S S M E N T
What is involved during an Assessment?

We offer several forms of assessment dependent on the age of the subject, and the nature of the difficulties.

Reading and learning difficulties in school-age children

Here we normally offer a two hour assessment that looks at all the key visual and developmental aspects of learning and may include investigations of primitive reflexes, motor coordination, and auditory processing as well, if relevant to the individual. A shorter assessment is offered for young children, where concentration is an issue.

Adults & Students

May not require such a full range of testing, and we normally see them for an hour, but if the problems are complex, a two hour visit may still be necessary. Adults with brain injury will normally be seen for two hours.

About the Assessment

Typically the assessment will be preceded by completion of a detailed questionnaire that allows us to plan what we will need to do during the day. It is important that this is completed fully and returned ahead of the appointment if we are to give the best care possible. On the day we will usually start by talking through points raised in the questionnaire, both to give us a fuller picture, and to help put you at ease. We will then normally run through a set sequence of visual efficiency tests to obtain the basic data on how well the visual system is functioning. This is fairly structured but ensures the data we need is obtained in a consistent manner and is thus comparable on repeat testing.

Once we have the key data we will then tailor the exam to each individuals needs varying the tests used dependent on the problems and information obtained earlier. The examination is demanding, but fun, and most children greatly enjoy the experience. We have stops for refreshments and rest, and try to make the whole visit as pleasant as possible. Rarely do we need to use any eye drops with children and there is not normally any pain or discomfort involved. At the end of the assessment we will feed back to you what we have discovered, and outline our suggestions for help.

Once we have completed the assessment, the subject is likely to be very tired, and we normally schedule a break so that you can get some fresh air and have a meal. During this time we are able to plan in detail any training that will be needed and when you return to the practice one of our team of therapists will go through the training programme with you and ensure you are comfortable with what we are recommending. Should spectacles be needed these will be chosen at this point, and then normally produced in our in- house laboratory to exacting standards.

After you leave our commitment does not end. We will produce a detailed, but easily readable report for you, to summarise what we have found and this will be posted or e- mailed to you a week or two later.  We will also keep in touch with your progress on any exercises given, and are always just a call away for support.

After an assessment we will offer several treatment options, and the follow- up on these will differ according to what we are doing. As a rough guide, patients on in- office programmes will be seen by the therapy team weekly for around four months, and will then be seen by an optometrist to review what we have achieved.

Patients on ‘home programmes’ will normally come back every four weeks for a VT session, and will see an optometrist for review around six months later. But our aim is to do what is best for YOUR needs, and these programmes can be modified and tailored to your particular needs. With patients in over 60 countries we have become adept at ‘fitting in’ around your needs!

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