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

2. 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

3. Housekeeping I have no financial interests in any of the products I may mention during this presentation. If you have questions please email me…. areddell@FamilyEyeCareCenterLV.com

4. 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

5. What is it?

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

7. Oculomotor Dysfunction What if your eyes jumped around like this?

8. 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

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

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

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

12. Binocular Vision Dysfunction

13. 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

14. 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

15. 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

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

17. Accommodative Dysfunction

18. 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)

19. 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

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

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

22. Autism Spectrum Disorders Imbalance of sensory information Use of Yoked Prism Lenses Toe walking Eye contact http://www.youtube.com/watch?v=OOS8q04kN-4 http://www.youtube.com/watch?v=f-9N-mRRbMc

23. 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

24. Questions areddell@FamilyEyeCareCenterLV.com