We all can benefit from more efficient vision.

 

Certain individuals will especially benefit from this type of care such as:

  • Those who use their near vision a great deal at work or school such as those that spend many hours every day on a computer, reading small print, examining small objects, ect.
  • Students who have been diagnosed as ‘learning disabled’
  • Athletes
  • Individuals who have suffered from brain injury or other head trauma
  • People who are myopic (nearsighted), hyperopic (farsighted), have astigmatism, and/or have presbyopia (similar to farsightedness that begins usually after the age of 40)
  • Anyone interested in improving their vision naturally

 

Will I have to do vision therapy forever?

No. Once your eye muscles and visual system have been reeducated, they remember their new skills and automatically use them all the time.

Can I wear glasses to avoid vision therapy?

Usually, no. This is not a seeing or eyesight problem, but an eye muscle problem –a problem controlling the eye muscles that usually can’t be helped by eyeglasses alone.

What is computer vision syndrome (CVS)?

It’s a condition recognized by the American Optometric Association that affects users of computer monitors and causes eye strain symptoms, such as blurred vision, dry or burning eyes, delayed focusing and headaches. It can arise from failure of the eye muscles to work properly.


Vision therapy –like a physical therapy for the Eyes and Brain

Vision Therapy is a highly effective non-surgical treatment for many common visual problems such as lazy eye (amblyopia), crossed eyes (strabismus), double vision, convergence insufficiency and many reading and learning disabilities. Many patients who have been told, “it’s too late” or “you’ll have to learn to live with it” have benefited from vision therapy. Eyes that are too tired to read after dinner, feeling sleepy when reading, reading too slowly and afraid to drive at night are just a few of the many reasons adults decide to improve their vision through vision therapy.

Feeling eyestrain and the need to do visual exercises is becoming more relevant these days with the dramatic onset of computer use, and overall close-up work required daily for students and professionals. Visual exercises help maintain healthy vision, reduce or eliminate the effects of eyestrain, and ultimately help to preserve eyesight. In the case of learning disabilities and attention problems, vision therapy is specifically directed toward resolving visual problems that interfere with reading, learning and educational instruction.

What is accommodation?

The ability of the eyes to focus clearly and sustain focus on objects of various distance.

What is convergence?

The aiming of the eyes inward toward an object.

What is fusion?

The process by which what is seen separately, by each eye, is integrated into a single perception.

What is stereopsis?

The learned ability to perceive relative depth– due to each eye having a different vantage point– commonly called 3D vision or depth perception.

 

Is Eye Strain from Binocular Vision Problems related to Learning Difficulties?

Often, yes. Children who tire easily from eye muscle problems have a greater workload when reading or using a computer. This additional load may make it harder for them to learn. Read more on our Vision and Learning page. 

 

What is vision therapy?

Vision Therapy it is a program of therapeutic activities designed for improving visual function including eye movement coordination, accommodation (eye focusing), binocular fusion (eye teaming) and visualization. It works on the eye-brain connections involved in visual coordination and visual processing and consists of a series of visual, and visual sensory-motor activities of progressive difficulty, performed several times a week until symptoms are resolved and a more efficient visual system is developed.

 

Who needs vision therapy?

People who have eye muscle problems that cause eye strain symptoms- such as blurred vision, headaches, fatigue, concentration difficulty- including computer vision syndrome and vision-related learning problems as well as people who want to get more done with less energy, less effort, and more efficiency.

Why does this happen?

Our eyes are not made to fixate on two-dimensional written pages or computer screens for hours at a time. Our eyes are more geared for distance vision activities, and the constant demand of near work puts stress on the eyes leading to a less than efficient visual system. 

How much time do I have to spend doing vision therapy?

That depends on how quickly your eye muscles and your visual system can learn the needed skills. A Vision Therapy treatment program can last anywhere from a few months to nearly a year depending on the severity of the vision problem as well as patient motivation and compliance. In most cases, significant benefits can be seen in a less than month. 


At Nebraska Visual Integration Center we dedicate all of our time in helping patients of all ages with visual issues that impact their lives. We are proud to offer Vision Therapy to the Omaha, Council Bluffs and surrounding metro areas. Please contact our office at (402) 502-0043 or email [email protected] with any questions or to see if an evaluation is necessary to determine if Vision Therapy can help you.

This article is adapted from Learning Magazine

Written By: Mitchell Scheiman, OD, FCOVD

Richard, a 12-year old in your 7th grade class, is a verbal child. From what you’ve seen early in the year, you expect him to be an above average student. But gradually, you realize that he is struggling just to maintain average grades. Looking at his past records, you see the same pattern: strong language and verbal skills, but marginal performance. As you try to figure out what could be wrong, you notice that Richard is easily distracted. He almost never completes in-class silent reading assignments and consequently does poorly on answering the follow up questions. On homework, if the task is creative writing, he does well. But if he has to read for understanding, he seems lost.Watching more closely, you also notice that Richard often rubs his eyes when he’s reading. Sometimes he complains that he has a headache or tired eyes.

Visual Efficiency Problems

Richard’s behavior is characteristic of a child with an undetected vision problem. And there are many Richards. Experts estimate that 10% to 15% of school-age children have vision prob­lems significant enough to inter­fere with academic performance. For children with learning prob­lems, the figures are as high as 30% to 60%. And many of these children have passed the annual school vision screening with flying colors.Do you have a student with an undetected vision problem? The charts on the next two pages may help you discover why a student you think should be doing fine is failing. If one of your students exhibits some of these symptoms, make sure he gets tested by a professional as soon as possible. Help that could dramatically improve his school performance is available.These kinds of sight problems interfere with a child’s ability to clearly and comfortably see and take in information for sustained periods of time. Many of these problems don’t surface until the upper elementary grades or junior high, when children are required to cover significantly more reading material. Visual efficiency problems include nearsightedness, farsightedness, astigmatism, and problems with focusing, tracking and eye teaming. Nearsightedness is the condition most commonly detected by the traditional school vision screening. But nearsighted children tend to be some of the best readers, and the traditional screening doesn’t necessarily identify any of the other problems.

Vision and Learning

Most people think that a child who has passed the annual school vision screening has “good vision” and can see the board and his textbooks clearly.Unfortunately, this is a serious misconception because the traditional school eye exam doesn’t test aspects of vision required for reading. And sadly, the perception that everything’s okay can mask significant learning-related vision problems.The key to understanding the relationship between vision and learning is realizing that vision is more than just being able to see the letters on the 20/20 line of a chart placed 20 feet away. Visual problems can be divided into two broad categories – visual efficiency and visual processing.

Nearsightedness (Myopia)

The inability to clearly see things in the distance

Symptoms:

  • Squints
  • Gets close to board

Farsightedness (Hyperopia)

The inability to clearly see closeup things

Symptoms:

  • Rubs eyes
  • Has watery eyes
  • Complains of blurred vision

Astigmatism

This condition causes blurred vision for distant and closeup things

Symptoms:

  • Complains of blurred vision
  • Holds book at close distance

Eye Teaming disorders (Binocular Vision)

A variety of conditions in which the eyes tend to drift inward, outward, or upward

Symptoms:

  • Has intermittent double vision
  • Closes or covers one eye
  • Says letters or words appear to move
  • Loses place
  • Is inattentive
  • Rubs eyes
  • Has watery eyes
  • Has poor reading comprehension

Eye Focusing disorders (Accommodation)

The inability to contract or relax the eye focusing muscles to allow for clear, stable vision

Symptoms:

  • Has blurred vision when looking from board to book or book to board
  • Holds things very close
  • Has headaches when reading
  • Is tired at the end of the day
  • Is inattentive
  • Rubs eyes
  • Has watery eyes
  • Complains of blurred vision
  • Has poor reading comprehension

Eye Tracking disorders (Saccadic Dysfunction)

Inadequate ability to scan along a line of print and move the eyes from one point in space to another

Symptoms:

  • Moves head excessively when reading
  • Loses place frequently
  • Skips lines when reading
  • Uses finger to keep place
  • Has poor reading comprehension
  • Has short attention span

Visual Processing Problems

These problems have to do with the child making sense of incoming visual information. They include difficulty with laterality, directionality, visual form perception, visual memory, and visual motor integration.In contrast to visual efficiency disorders, many of which surface in the middle grades, visual processing problems tend to sabotage learning for children in the early grades even kindergartners. Children with visual processing problems may be difficult to teach because they fail to understand and grasp basic concepts and ideas.

Visual Issues Impact Learning

Directionality and Laterality Problems

Poor development right/left awareness

Symptoms:

  • Has trouble learning right and left
  • May read either left to right or right to left
  • Reverses letters and words
  • Has trouble writing and remembering letters and numbers

Faulty Visual Form Perception

The inability to discriminate among different shapes

Symptoms:

  • Confuses likenesses and minor differences
  • Mistakes words with similar beginnings
  • Can’t recognize the same word repeated on a page
  • Can’t recognize letters or even simple forms
  • Can’t distinguish the main idea from insignificant details
  • Has trouble learning the alphabet recognizing math facts, and learning basic math concepts of size, magnitude, and position

Faulty Visual Memory

Inability to remember what is seen

Symptoms:

  • Has trouble visualizing what is read
  • Has poor comprehension skills
  • Has trouble learning new material
  • Is a poor speller
  • Has poor recall of visually presented material
  • Has trouble with tasks that require more than one step
  • Has trouble with math concepts
  • Has trouble with  sight vocabulary

Faulty Visual Motor Integration

The inability to process and reproduce visual images by writing or drawing

Symptoms:

  • Has sloppy writing and drawing skills
  • Can’t space letters or stay on lines
  • Has poor copying skills
  • Erases excessively
  • Can respond orally but not in writing
  • Seems to know material but does poorly on tests

Treatment

A full evaluation by a professional who has the expertise to test for both visual efficiency and visual processing disorders is the only way to detect some vision problems. When one of these hidden problems does exist, treatment involving eyeglasses, vision therapy, or both can correct it. Glasses are generally effective for nearsightedness, farsighted­ness, and astigmatism. They can also correct some types of focus­ing and eye teaming disorders. In fact, 85% to 90% of people with vision problems are treated with glasses. However, the other 10% to 15% require vision therapy. This therapeutic approach involves a series of treatments that includes using special instruments and activities under close supervision.The education and clinical training of optometrists stresses both eye health and eye function. This makes them uniquely qualified to detect and treat vision problems that interfere with school performance.To find an optometrist qualified to treat learning-related vision problems, visit the College of Optometrists in Vision Development (COVD) at www.covd.org. COVD can provide a list of its fellows in any area of the United States.It is important to understand that optometrists don’t specifically treat reading or learning problems. But along with extra help or tutoring from parents and teachers, an optometrist can correct the vision problems that may be blocking the possibility of learning.


Nebraska Visual Integration Center is a Vision Therapy office in Omaha, Nebraska that specializes in the diagnosis and treatment of visual efficiency (visual skills) and visual processing issues that impact school and learning. If you think you or your child may have a hidden visual issue impacting learning, please contact our office at (402) 502-0043 or email at [email protected] We enjoy seeing lives change by taking care of visual issues that block learning and we would love to help you.

WHAT IS A BRAIN INJURY?

An Acquired Brain Injury is an insult to the brain. It can result from trauma to the head, stroke, or neurological dysfunction. This may produce a diminished or altered state of consciousness and may result in impairment in cognitive abilities, sensory processing and/or physical function. Impairments may be mild or severe; most are amenable to rehabilitation. A concussion is medically defined as a mild form of brain injury, but often times the symptoms and issues are not so mild. A concussion will typically not be detected by standard brain scans, but that does not mean there was no damage or disruption to brain functioning.

CONCUSSION AND VISION

HIDDEN VISUAL PROBLEMS

Visual problems resulting from concussion and more severe brain injury are often overlooked during initial treatment of the injury. Frequently these problems are hidden and neglected, lengthening rehabilitation and impairing full recovery. Vision is one of the most important sources of sensory information, consisting of a sophisticated complex of subsystems involving the flow and processing of information to the brain. Because there is a close relationship between vision and the brain, a concussion will often disrupt the visual process, interfering with the acquisition and processing of information, and resulting is a brain-based vision problem. These problems go beyond normal eyesight and impact many life skills.

Symptoms indicating a neurological vision problem following concussion are:

Blurred vision
Double vision
Tired, achy eye
Headaches with visual tasks
Loss of visual field/peripheral vision
Difficulty with balance, vertigo, car sickness
Sensitivity to light, photophobia
Reading difficulties; words appear to move
Poor comprehension
Attention and concentration difficulty
Difficulty with memory

Good visual skills are necessary for efficient information processing. When there is a deficiency in processing visual information, one may “try harder,” thus straining without even knowing it as the effort is subconscious. If the visual system is inefficient, every task can seem difficult, using more energy than required.

Visual skills affected by Concussion and Brain Injury include:

Tracking: the ability of the eye to move smoothly across a printed page or while following a moving object.

Fixation: quickly and accurately locating and inspecting a series of stationary objects, such as words while reading.

Focus change: looking quickly from far too near and back without blur or delay.

Depth perception: judging distance of objects – how far or near they are relative to self.

Peripheral vision: monitoring and interpreting what is happening in the surrounding field of vision.

Binocularity: using both eyes together as a team – smoothly, equally and accurately- allowing for appropriate distance spatial estimates and depth.

Sustained attention: keeping focused on a particular activity while interference, such as noise, may be present.

Visualization: accurately picturing images in the “mind’s eye,” and storing them for future recall in cognitive processing.

Near vision acuity: clearly seeing, inspecting, identifying and understanding objects viewed within arm’s length.

Distance acuity: clearly seeing, inspecting, identifying and understanding objects viewed at a distance.

Visual perception: gathering appropriate information from what is seen allowing for accurate understanding and meaning

OPTOMETRY AND CONCUSSION REHABILITATION

Few in the health care professions, including head trauma rehabilitation centers, are adequately aware of visual problems resulting from Concussion and Acquired Brain Injury and the visual-perception consequences. Unfortunately, this creates a gap in rehabilitative services, resulting in incomplete treatment and frustration for the patient, as well as the family and treatment team. The vision care professional can play an incredibly important role in the rehabilitation effort. Through vision rehabilitation therapy, an optometrist specifically trained to work with concussion and brain injury patients can help improve the acquisition and processing of information between the eyes and the brain. Vision therapy can be very practical and effective. After examination and consultation, the optometrist determines how a person processes information after an injury and where that person’s strengths and weaknesses lie. The optometrist then prescribes a treatment regimen of vision therapy incorporating lenses, prisms, and specific activities designed to improve control of a person’s visual system and increase visual efficiency. This in turn can help support many other activities in daily living and allow for optimal rehabilitation.

WHAT IS NEURO-OPTOMETRY

Neuro-optometry is based on the core principle that vision is a learned process and can be rehabilitated at any age following concussion or brain injury. Eye doctors working with concussion and brain injury patients have advanced education in the use of lenses, prisms, and vision therapy to enhance a patient’s visual capabilities, reduce visual stress, prevent and rehabilitate vision problems. As a member of the rehabilitative team, neuro-optometrists have extensive experience treating the vision problems stemming from concussion and brain injury.


Nebraska Visual Integration Center is a specialty vision care office in Omaha that provides vision therapy / rehabilitation to patients following concussion and brain injury. Our eye doctors have extensive training in providing the best rehabilitative vision therapy to patients of all ages. Dr. Gates serves as the Director of Vision Rehabilitation at Madonna Rehabilitation Hospitals and is a rehabilitative optometric consultant to various other brain injury rehabilitation centers in the Omaha and Lincoln area.

If you or a loved one has suffered a Concussion or Brain Injury and may have undiagnosed neurological vision problems, please contact our office at (402) 502-0043 or email [email protected] so we can provide the necessary information to begin the steps to vision rehabilitation recovery.

How proper visual hygiene can help

While many Individuals feel that most vision disorders are either hereditary or naturally occurring, there is substantial evidence that many non-pathological (disease) vision disorders are related to how we use our eyes and the ergonomics (posture) we use in school and work. Commonly known conditions such as nearsightedness and astigmatism often develop from excessive near work and poor posture while reading or working at a desk. Other less known functional vision disorders including eye focusing (accommodation), eye teaming (fusion) and eye tracking (saccades)  are also considered a breakdown in visual efficiency skills from prolonged visual stress and poor posture. While some visual conditions have obvious visual symptoms such as blurred or double vision, many symptoms of visual or binocular breakdown can also create behaviors that normally might not be associated with a vision problem.

 Just because an individual has 20/20 eyesight and a current glasses prescription is no guarantee that all critical visual skills are intact and functioning efficiently.

Other behaviors and signs that visual dysfunction may exist include:

  • Developed or acquired reading disorder
  • Headaches (tension or migraine)
  • Symptoms resembling ADD or ADHD
  • Chronic muscle tension in the neck or upper back
  • Motion, or carsickness
  • Psychiatric conditions (such as depression)
  • Behavior problems in academic study
  • Avoidance of prolong near work activities (such as reading, games or hobbies)

Things you can do for your Visual Hygiene

Many of the previously mentioned vision disorders can have multiple causes in some may stem from other systemic problems. Much like the daily routine of dental hygiene, we can also practice visual hygiene to help reduce the incidence and severity of many visual conditions that affect our health and lifestyle goals. The following recommendations have been shown to be very helpful in developing good visual hygiene into reduction in many of the visual and behavioral adaptations mentioned above.

Posture- Sit up straight to reduce muscle tension (stress) in the back, neck and shoulders. Do not read while lying on your back or stomach, or while resting the head on one hand with the elbow on the desk. Keep both eyes and equal distance from the desk or reading material, also your torso and hips parallel to the desk surface. The feet should be resting on the floor or on a support. The elbow should rest on the writing surface and the arm should remain parallel to the sides of the paper. The chair must provide proper support, allow for balanced posture and equal weight on both buttocks (no leaning to one side), and should be adjustable in seat height/back alignment.

Working Service- A sloped work surface that is tilted between 20 and 25 degrees from the horizontal reduces tension and stress on the head, neck, shoulders and eyes. Inexpensive slant boards are available for this purpose.

Working (Harmon) Eye to Desk Distance- The optimal distance for visual efficiency varies from person to person. The distance is measured from the center of the middle knuckle to the elbow, and all reading and desk activity should be done at this distance or slightly further. Prolonged nearwork conducted closer than this distance is a major cause of visual that defects and functional vision breakdown.

Lighting- Balanced and adequate lighting on the desk material and in the room is crucial. Reduced lighting and glare in the room has an effect of decreasing peripheral vision sensitivity.

Penmanship and Pencil Grip- The pencil/pen should be held no closer than 3/4 inch from the tip. The fingers and knuckles should not become white/red when writing. Ergonomically correct pencil grips are available for students in early grades. Writing should involve mainly finger and wrist movement with a little  in the room is crucial.

Stress Relieving Lenses- The lenses that are prescribed for distance use can often create neuromuscular stress when use for reading or desk work. Specific low powered reading lenses can be prescribed in single vision or bifocal form, depending on visual status or lifestyle needs. Individuals who use such lenses often report less headaches, neck or back tension, and increased reading efficiency. This need for such lenses can be determined by a development optometry specializing in vision therapy.

Visual Breaks- Practice “The 20/20/20 rule“. While studying and reading, periodically look up and away an object at least 20 feet away, at least every 20 minutes, for at least 20 seconds. It is also recommended to get up and walk around for at least five minutes every hour. Relaxation of body muscles has a carryover effect on visual relaxation.

TV Viewing-  Do not sit closer than 6-7 feet from the TV screen. Adequate room light is crucial because watching TV in a dim or dark room reduces peripheral vision sensitivity. Excessive TV viewing reduces total body muscular development, which has a carryover effect on visual neuromuscular development. Video game use should be limited to no longer than 20 minutes sessions.

Reading While in Motion- Reading while in motion requires substantially more effort and creates additional visual stress then reading while stationary. Peripheral vision movement needs to be suppressed in addition to vision disturbance from the rest of the system in the ears. Reading while in motion should be limited.

Computer Use- In addition to the previous suggestions (such as posture, taking breaks, lighting and working distance), the position of the terminal monitor is very crucial. The monitor should be placed as low as possible in relation to the head (eyes) position.  When the monitor is too high, the eyes have a reduced ability to converge in the eyes tend open more causing more drying of the ocular tissues. In the case of bifocal wears, high monitors cause users to excessively raise their heads, causing more tension and stress in the neck and upper back.


Our Vision Therapy office in Omaha specializes in testing, diagnosing and treating functional visual issues. If you have any questions about Vision Therapy and how it may impact your/or your child’s life, please call our office at 402.502.0043 or email us at [email protected].

 

Attention Problems:

Are They Due to Vision, ADHD, or Both?

At Nebraska Visual Integration Center, many of the children and adults we see in Vision Therapy suffer from attention problems.

It is very important to understand that if your child enjoys being read to, will sit and listen for long periods of time, but demonstrates attention problems when reading or doing homework, there is an excellent chance that your child’s attention problem is caused by an inability to use his eyes. There is no “biochemical imbalance” which allows children to be attentive when information comes in though the ears, but distracts children when information come in through the eyes. It is not uncommon for problems with visual abilities to masquerade as ADHD.

Similarly, if a child can pay attention for math, but not pay attention for reading, there is no “biochemical imbalance,” which occurs when the child looks at numbers, that then disappears when the child looks at words. In math, excluding story problems, there is less visual information to cope with. The child looks at individual numbers and copies them one at a time. In reading, the letters are crowded together so visual problems can more easily cause the letters to run together. Children who can pay attention for math but lose attention for reading frequently have a visual problem masquerading as an attention problem.

However, if when you read to your child, his attention is better although still a problem, then a number of causes–along with vision–could be contributing to the attention problem. For instance, your child might not understand the words, or there could be some other problem affecting attention. Whatever the reason for your child’s struggle with attention or behavior, untreated vision problems will only increase frustration, trigger behavior problems, and make things worse.

Visual Abilities for Success in School, Sports & Life

At Nebraska Visual Integration Center, our Vision Therapy allows an individual to train and improve these visual abilities:

1. 20/20 Eyesight

This is the best known visual ability. If you have 20/20 eyesight, all it means is that at twenty feet, you can see the same letters that people with normal eyes can see at twenty feet. Unfortunately, 20/20 eyesight–with or without new glasses– does not mean that during reading, computer, or desk work you can see clearly for more than a few minutes. Having 20/20, does not mean you can “sustain focus,” enjoy reading, have depth perception and localization skills to drive at night, or that you are free from vision-caused headaches and general fatigue. All 20/20 eyesight guarantees is that you can see clearly long enough to call out the small letters on a dotor’s eye chart. In addition to “20/20 eyesight” we have to consider other visual abilities often ignored during routine eye exams.

2. Eye Teaming

Using the two eyes together as a team is the second visual ability. We have fourteen eye muscles. The brain must coordinate these muscles perfectly if we are to see comfortably and efficiently. If this coordination is reduced as in Convergence Insufficiency, eyesight can be clear at times, but blurred or double at other times. When eye teaming is inaccurate seeing is inaccurate. Eye teaming is a direct measure of how vision affects our attention and this lack of efficient eye control can cause a child to be mislabeled as having ADHD. The effort to prevent such blurred or double vision can cause premature fatigue, or loss of attention and comprehension during reading, desk or computer work. Certain types of eye muscle coordination problems can reduce depth perception for driving and sports. In more severe cases, poor eye muscle coordination can cause crossed eyes (Strabismus) or lazy eye (Amblyopia).

3. Eye Tracking

Accurate eye tracking allows a person to quickly and precisely move their eyes across a line of print to look at the symbols (numbers, letters or words) and process the written text for meaning. During reading, poor eye tracking causes loss of place, confusing one word with another, careless errors, and problems breaking words down into their parts. A common adaptation of poor eye tracking is the use of a finger as a guide when reading. This may help serve as a crutch for eye tracking, but will slow down fluency and restrict peripheral vision of upcoming words reducing anticipation of the text. Appropriate eye tracking also allows us to accurately move our eyes when tracking a ball in a variety of sports.

4. Eye Focusing

Eye focusing, also known as accommodation, is a visual skill that allows us to have clear focus when looking at targets up close, as well as when shifting focus from close to far. Close to far focus is necessary when looking from the board back to desk notes in class. Eye focusing strongly overlaps with eye teaming and plays a large role in maintaining attention during visual tasks. If eye focusing is poorly controlled, it can increase the time it takes to copy notes and make it extremely difficult to maintain concentration and attention on sustained up-close tasks.

5. Eye-Hand Coordination

The visual information taken in through our eyes helps to guide our hands with fine motor or “little” coordination and gross motor or “big” coordination. We need “little” coordination to copy sentences and keep words equally spaced and on the line. We need “big” coordination to throw or catch a ball or to guide a steering wheel. The “big” type of eye-hand coordination is also very much linked with balance and general coordination.

6. Visual Perception

“Visual Perception” is the ability to organize visual images and ideas and to understand what is seen by the eyes. It’s useful to help understand how things are alike and different and how the pieces fit together to make up the whole. At one extreme we have the artist who can  look at a scene and “see” the relationships between the shapes and colors well enough to reproduce them with paint on canvas. On the other extreme we have the child who cannot tell the difference between a “b” and a “d” or  “was” and “saw”. Visual perception problems can make it difficult to recognize words, complete puzzles, align columns in math or–for adults– read a roadmap.

7. Visualization

Visualization, or Visual Imagery can be explained as, “seeing with the mind’s eye.” If visualization is good, a child or adult can “see” words in the mind to spell them. They can “see” the story when they are reading. They can picture their goal in their minds and they have the ability to picture the consequences of their actions. Visualization allows us to learn from the past and plan for the future. All reluctant readers should be tested for these important visual abilities.

The Solution

At Nebraska Visual Integration Center, we work with children and adults in Vision Therapy whose attention problems are caused by vision. If a child who has vision problem affecting attention in school is never diagnosed, chances are they will not outgrow it, but rather simply become an adult with a vision problem affecting attention in the workplace and life. Vision therapy treats the vision problems that interfere and prevent an individual from functioning at the highest level which can impact learning, attention, and behavior. Some patients may have vision problems that mimic learning disabilities and may be misdiagnosed and this is where specialized vision testing is necessary and very important. Other patients may have co-existing vision problems and learning disabilities where the visual issues should still be addressed.

 

Our Vision Therapy office in Omaha specializes in testing, diagnosing and treating these visual issues. If you have any questions about Vision Therapy and how it may impact your/or your child’s life, please call our office at 402.502.0043 or email us at [email protected].

 

 

How Accurate are Vision Screenings?

If you have a child in school they have probably had a vision screening. These are generally performed by a pediatrician, or a nurse if done at school. It’s important to note that these are rarely performed by a vision specialist or optometrist.  A vision screening is usually part of a school general physical. This is an opportunity to note any physical issues and may lead to a referral to an eye doctor, although they do not offer a diagnosis or treatment plan.

The Good and Bad of School Vision Screenings

The American Optometric Association says:

  1. Schools screenings provide <4% of the vision tests needed to help a child see.
  2. Miss up to 75% of children with vision problems.
  3. Of the children found to have eye problems through screening, 61% never visit the eye doctor.

School vision screenings are limited, but are typically able to detect issues such as myopia (nearsightedness) and amblyopia (lazy eye). Amblyopia is a visual issue that requires an optometrist with specialty training. Vision screenings often fall short diagnosing visual issues that have an impact on learning, reading and classroom performance. Issues like hyperopia (farsightedness), binocular vision (eye teaming) disorders, eye tracking and eye focusing can have a significant impact on visual functioning for learning.

What to do after a Vision Screening

Your child has had a vision screening so what now?

If your child has failed any portion of the vision screening, it’s necessary for them to see an optometrist or other eye care specialist. If there is suspicion of a visual issue impacting learning, your child may likely need to see an optometrist who specializes in vision therapy and binocular vision. Optometrists who specialize in treating visual issues that affect learning are called developmental or functional optometrists.

What does a Developmental Optometrist Do?

A developmental optometrist specializes in vision therapy. Vision therapy has been scientifically proven to treat and remediate a number of learning-related vision issues. COVD is a website dedicated to the advancement of vision therapy and the prevention, enhancement, and rehabilitation of functional visual issues.

Below you’ll find the full article on vision screenings and how they are insufficient in detecting a number of significant visual issues.

HPI American Optometric Association Issue Brief: “Vision Screen: Should Be Called “Amblyopia Screening” 

Vision is More than 20/20

Vision therapy, or vision rehabilitation, is a program of therapeutic activities that works on the eye-brain connections involved in visual coordination and visual processing. Vision therapy, is not eye exercises, nor is it designed to strengthen your eye muscles since they are generally very strong on their own. By influencing how the eyes and brain work together, vision therapy develops, rehabilitates, and enhances deficient visual skills to improve visual comfort, ease, and efficiency, and change how a person processes and interprets visual information.

Before understanding what vision therapy is and how vision plays a role in a person’s life, it’s necessary to know the difference between eyesight and vision. Eyesight is the ability to see a set of letters clearly on a chart at a distance of 20 feet. A common misconception is that 20/20 eyesight means you have perfect vision. Vision is more than seeing clearly; it is a complex combination of learned skills, including eye movement coordination, binocular fusion (eye teaming), accommodation (eye focus) and visual perception. It’s been stated that nearly 80% of what we are required to learn and process in school comes in through the visual system. When visual skills are well developed, a person can sustain attention, read and write without careless errors, give meaning to what they see and rely less on movement to stay alert. These visual skills & visual perceptual abilities require specialty vision testing to determine if they are interfering with abilities in learning. 

Functional Vision Issues & ADHD, Dyslexia

Vision therapy treats the vision problems that interfere and prevent a person from functioning at the highest level which can impact learning, attention, and behavior. Children may have functional vision problems that mimic learning disabilities such as ADHD and may be misdiagnosed. This is where in-depth vision testing is important and necessary before any diagnosis is made or medication prescribed. Other patients may have co-existing vision problems and learning disabilities where the visual issues still need to be addressed.

Does Vision Therapy Work?

In a word, yes. Vision therapy is a well established field within the optometric profession with research studies that parallel other therapies such as occupational and physical therapy. There are, however, some websites or professions that attempt to misrepresent Vision therapy and it is important to look to organizations that provide objective information on the topic. The list of scientific research on the support of vision therapy is well known.

Be Cautious of Surgical Recommendations or Outdated Treatments

Too often, unnecessary eye surgical interventions, or outdated eye treatments such as patching or drops to penalize the “better eye” may be recommended when the issue is not the eyes, but rather how the brain controls the eyes. The brain must be taught how to use the eyes.

Where Can I Find More Information About Vision Therapy?

There are a number of great organizations that support and advocate for the scientific efficacy of Vision Therapy.

  • COVD   College of Optometrists in Vision Development
  • OEP      Optometric Extension Program
  • NORA   Neuro-Optometric Rehabilitation Association
  • AOA      American Optometry Association

An optometrist with the credentials, FCOVD, after their name indicates they have advanced speciality certification as a board-certified Fellow in vision development & rehabilitative optometry. Because these visual issues are often not detected on routine eye exams or vision screens, they can easily be missed and go undiagnosed. Appropriate near-point and functional vision testing by an optometrist specializing in Vision therapy is necessary.

Please contact our office at (402) 502-0043 or email [email protected] to learn more about vision therapy and how it can improve your life.

Vision is more than seeing clearly! It’s the ability to obtain meaning and understanding from what we see with our eyes. Vision is a complex combination of learned skills including eye movement coordination, binocular fusion (eye teaming), accommodation (eye focus), and visual form perception.

Visual Skills for the Classroom, Learning & Life

Eye Tracking – the ability to keep the eyes on target when looking from one object to another, moving the eyes along printed page, or following a moving object like a thrown ball.

 

Eye Teaming – the ability to coordinate and use both eyes together for spatial orientation and to be able to judge distances and see depth (3D Vision).

 

Eye Focusing – the ability to quickly and accurately maintain clear vision when looking from the board to the desk and back. Eye focusing allows you to easily maintain clear vision over the time like when reading a book or writing a report.

 

Eye-Hand Coordination – the ability to use visual information to monitor and direct the hands when drawing a picture or trying to hit a ball.

 

Visual Perception the ability to organize visual images and ideas and to understand what is s

 

een by the eyes.

 

Please feel free to contact us at (402) 502-0043 with any questions. 

Individuals and families come to us seeking professional help with vision therapy, but may find medical insurance will not readily help cover the out of pocket costs.  

Often a gap exception, or network deficiency exception, may be applied for.  This will allow for payments to be applied towards in-network deductibles, but not every insurance company makes this possible. 

We understand the commitment required of Vision Therapy, but we are also aware of the truly life-changing impact Vision Therapy can have on children and adults of all ages. Our goal is to ensure insurance or any financial reason is not the barrier preventing you / your child from receiving the necessary life-changing care.

It’s important to understand the unwillingness of your insurance company to pay for services does not reduce the need for obtaining treatment. While Vision Therapy is not inexpensive, it can be seen as an investment in yourself or your child’s future.


If you find yourself stuck between much needed care and the potential cost, these creative suggestions to cover out of pocket expenses are for you.

Vision Therapy costs estimate around $2,000 – $6,000 for all evaluations, therapy, progress examinations, and follow-up post-therapy visits. 

1.Finance through Care Credit

Care Credit is a reputable company that can help you finance Vision Therapy costs and is offered on a 6-month financing plan here at Nebraska Visual Integration Center.  Care Credit provides you with a revolving line of credit with deferred interest plans that you can use for Vision Therapy treatment. Many families take advantage of the benefits of Care Credit for orthodontics (braces) as insurance often deems braces as an elective procedure similar to Vision Therapy. 

Affordable monthly payment plans can get your costs below $200 a month.

2. Take out a home equity loan or home equity line of credit

Provided you have equity to tap, home equity loans or lines of credit are a great source of money.  They have low interest rates and inexpensive closing costs, and because you’d use the loan to pay for the entire treatment up-front, you’d also receive a 10% discount.

A home equity loan or line of credit is generally tax-deductible, which puts more money back in your pocket.

3. Reach out to churches, friends and family

Patients often reach out to their community for help. You’ll be surprised how receptive people will be when they understand the cause.  Don’t be afraid to reach out.

4. Appeal to community groups

Besides churches, friends and families, you may also consider reaching out to local groups like the Lion’s Club and Rotary Club. The Lion’s Clubs are big supporters of vision care, and they may be willing to extend some help financially.

5. Get a credit card with zero percent APR introductory rates

You may be able to find a credit card that will offer you a six-month, 0% introductory rate.   Pay back the loan aggressively, and you could finance Vision Therapy without paying any interest.

6. Use your Flex Spending or Health-Savings Account

This is another very popular approach. Vision Therapy at Nebraska Visual Integration Center fully qualifies as an approved use of Flex Spending or HSA. Based on your tax bracket, this is a way to save significantly on your costs by spending the money on a pre-tax basis.


Our goal is to ensure every patient who requires Vision Therapy is able to find to way to begin receiving the needed care.


Please contact our Omaha Vision Therapy office (402) 502-0043 or email: [email protected] with any questions and we’d love to help.

Primitive Motor Reflexes and their Role in Vision Development

Most people are familiar with retained motor reflexes, they just may not know it. They can be witnessed when: a baby’s head is turned to one side and the arm and leg on that side turn out and the baby assumes a ‘fencer’ pose; or if a baby, when startled by a loud sound, extends his head back and spreads arms out; or if you touch a baby’s palm, a reflexive gripping of your finger will occur.

Doctors often assess the development of a child based on the progression and integration of these reflexes.

Primitive reflexes are involuntary movement patterns directed by the brainstem, meaning they are not under conscious control. They emerge in-utero and during the early months of life play an essential role in infant survival and development.

These reflexes have a limited life span and lay the foundation for more precise movement. For ideal development, they should become integrated during the first year of life to allow for more complex movement patterns controlled by higher levels of the brain.

What if these Reflexes are retained (stay around too long) or re-emerge after a brain injury?

The persistence of these reflexes can indicate poor neurological development and immaturity within the nervous system. They can interfere and prevent the development of succeeding postural reflexes.

Postural reflexes are necessary to support control of balance, posture and movement. Because eye movements are often considered the most precise and neurologically demanding motor skills initiated by the brain, when earlier movement patterns do not develop appropriately, visual skills tend to be poorly controlled and integrated.

The brain possesses a finite amount of energy, and when we are required to compensate for retained reflexes, this takes a toll on the brain and nervous system, and limits the amount of remaining energy available for other necessary cognitive action.

One of the possible underlying causes of academic and/or visual problems may be the retention or inadequate integration of one or more of the primitive reflexes.

Why Test for Retained Primitive Reflexes during a Vision Evaluation?

Integrating primitive reflexes can help patients progress faster during their Vision Therapy program because the visual skills are built on a more secure neurologic foundation. If the brain has better control over the large movements of the body, this frees up mental resources that can be dedicated for learning and thinking, much of which depends on visual skills and visual information processing. Depending on the individual, Dr. Gates works closely with occupational therapists providing collaborative care.


Below you’ll find a brief overview of symptoms of retained primitive reflexes:

Moro Reflex:

poor eye movement control; visual-perceptual problems; difficulty ignoring irrelevant visual material; difficulty with black print on white paper; motion sickness; poor balance and coordination (commonly during ball games); physical timidity; dislike of change/surprises; poor auditory discrimination; hyperactivity; mood swings; tense muscle tone

Asymmetrical Tonic Neck Reflex:

poor balance with head movement to either side; poor smooth tracking eye movements (especially when crossing the midline); mixed laterality (uses right/left hands interchangeably); poor handwriting; difficulty shifting focus from near to far; difficulty keeping place when copying from the board; difficulty catching and throwing a ball; hard to tell right from left

Symmetrical Tonic Neck Reflex

poor eye-hand coordination; difficulty adjusting binocular vision from distance to near; poor posture; tendency to slump when when sitting (especially at desk/table); ‘W’ position when sitting on the floor; poor depth perception; poor balance

Spinal Galant Reflex

bedwetting; fidgety and wiggly (especially when seated); poor short-term memory; poor concentration; hip rotation to one side when walking; ADHD characteristics

Tonic Labyrinthine Reflex

eye movement, visual-perceptual, spatial awareness problems; poor posture; toe walking; vestibular related problems —poor balance, car/motion sickness; dislike of sporting activities, running; poor sequencing skills; poor sense of time


Nebraska Visual Integration Center is one of the only vision clinics in the region to combine Vision Therapy with primitive reflex integration to treat the whole person.

After all, vision is a brain-based process and requires interaction with many other neurological systems to be efficient. It only makes sense to treat the entire brain as there is no way to isolate vision from other brain-based actions.