Basic Vision Rehabilitation/Therapy Principles & Techniques Ashley S. Reddell, OD, FCOVD HOACLS 2015

About Me From Haysville, KS Graduated from KU…..Rock Chalk! Worked as a vision therapist during undergrad Graduated from Southern College of Optometry Completed pediatric residency at SCO Joined a private practice in Leavenworth in 2010 Now have 3 locations, 5 ODs, and ~28 staff

Housekeeping I have no financial interests in any of the products I may mention during this presentation. If you have questions please me….

Background Information on Vision Vision is the dominant sense Prism Demo 80% of what we learn comes through the visual system What happens if we have a faulty system? Garbage In  Garbage Out The Myth of 20/20

What is it?

Visual Skills Eye Tracking (Oculomotor) Oculomotor Dysfunction Eye Teaming (Binocularity) Convergence disorders Divergence disorders Strabismus Eye Focusing (Accommodation) Accommodative Spasm Accommodative Insufficiency

Oculomotor Dysfunction What if your eyes jumped around like this?

Oculomotor Skills Pursuit Eye Movement The ability to smoothly follow a moving target i.e. Following a ball or a pendulum Saccadic Eye Movement The ability to move eyes accurately and efficiently between two stationary objects i.e. Words on a page Link to gross motor skills

Symptoms of OMD Loses place while reading Skips words, skips lines while reading Difficulty copying from the chalkboard Uses finger or straightedge to read

Diagnosis of OMD NSUCO Tracking test Developmental Eye Movement Test (DEM) Visagraph Gross motor evaluation Vision & Learning Symptoms Survey

Treatment of OMD Eye Control Near-Far Hart Chart Hart Chart Saccades 4 Corner Saccades

Binocular Vision Dysfunction

Binocular Vision The ability to point both eyes together at the same place and same time Necessary for 3D vision, good depth perception Poor with strabismus or amblyopia Convergence Refers to binocularity at near Divergence Refers to binocularity at distance

Symptoms of Binocular Vision Dysfunction Sees double when reading Words move/float on the page Closes/covers one eye when reading Avoids work involving reading or prolonged close- up activities Falls asleep when reading Poor depth perception

Diagnosis of Binocular Vision Dysfunction Stereo Vision Testing Cover Test Near Point of Convergence Vergences in the phoropter Worth-4-Dot Vision & Learning Screening Survey

Treatment of Binocular Vision Dysfunction Marsden Ball Games Brock String 3D computer programs Yoked prism activities

Accommodative Dysfunction

Accommodation The ability to change focus without blur at any distance EXP: Looking from the chalkboard to their deskwork EXP: Looking from traffic to the dashboard Becoming more and more common with prolonged near vision tasks (i.e. computer/iPad/phone use)

Symptoms of Accommodative Dysfunction Reports intermittent blur while reading Headaches while reading Must squint or blink when looking up from book May complain of blurred vision but still see 20/20 or pass the school screening Eyes feel tired, dry

Diagnosis of Accommodative Dysfunction Refraction Accommodative amplitudes Accommodative facility Vision & Learning Screening Survey

Treatment of Accommodative Dysfunction Near-Far Hart Chart Accommodative Flippers Mental Minus Minus Lens Sorting

Autism Spectrum Disorders Imbalance of sensory information Use of Yoked Prism Lenses Toe walking Eye contact

Traumatic Brain Injury Baseline concussion testing is an EYE MOVEMENT TEST!!! Many post-concussion symptoms are visual Blurred and/or Double Vision No longer able to compensate for small prescription Focusing Dysfunctions Unable to change focus from distance to near and back Visual Field (peripheral vision) Loss Vision Fluctuations Light Sensitivity Balance Issues

Questions