Exercise for eyes? Up, down, in, out, base in, base out. Your eyes have muscles, and those muscles need to be kept in tiptop shape to keep you seeing well.
As optometry students, there are a variety of specialty pathways we can delve into. Exploring these pathways helps us develop skills to enhance the vision of our future patients above and beyond routine comprehensive eye care. In my own career, I have looked into fields such as low vision and contact lenses, among several others. These all have marked importance in the field of optometry, but the one that really sparked my fuse was vision therapy.
It excited me to think how exercises for the eye could make such a noticeable difference in a patient’s ability to not only see better in everyday life, but also to read, interact socially, and even play sports better. I realized I did not know that much about vision therapy, and I wanted to learn more.
I decided to talk to my optometrist friend from my hometown, Jenna Goepfert-Walters, O.D., to ask her a few questions and learn more about the subject. Dr. Goepfert-Walters thoroughly enjoys practicing vision therapy in Hershey, Pa., and loves seeing the smiles on her patients’ faces when they notice their improving sight. She even allowed me to do some vision therapy sessions with her to help me learn the basics.
Hoping to pique interest in vision therapy in my fellow students, I interviewed Dr. Goepfert-Walters about vision therapy.
Can you break down vision therapy for me? What is it and what does it entail?
Vision therapy can be broken down into four main areas – ocular motility, accommodation, binocularity, and visual processing/perception. Within these areas, optometrists can also work on peripheral awareness, which falls into two categories: binocularity and visual perception and improving visual acuity (for patients with amblyopia, with and without strabismus).
Ocular motility can be broken down into two main areas: quick & fast (saccades) and smooth (pursuits/versions). They both need to be accurate because we use saccades to read and pursuits to follow a moving object.
Accommodation and binocularity are HUGE categories, but I’ll just break it down into two main areas of focus: expanding ranges and flexibility.
Here’s an example I use with young patients (up to college age) and their parents to show how all of these areas are used at the same time: copying from the blackboard/Powerpoint in the classroom.
Children and teenagers have to read the words (ocular motor) on the blackboard (eyes have to diverge – turn eyes outward and relax accommodation), remember what they read (visual processing/perceptual), then look up close and copy it into their own notes (ocular tracking, convergence – turn eyes inward, stimulate accommodation, and perception – recalling what they just read on the blackboard).
Why is vision therapy important?
I like to tell patients vision therapy is similar to physical therapy but for the eyes. However, unlike physical therapy where (I think) the goal is to strengthen the muscles, in vision therapy you are teaching the patient and his/her brain to gain better control and coordination of his/her eyes and to be aware of what the eyes are doing – usually eye muscles are already very strong! A lot of people in the general population think of “good” vision as being able to see 20/20 in each eye – I tell them that there are two eyes, and how they work together as a team is necessary for great vision!
How does vision therapy help patients?
If someone is having double vision, blurry vision, skipping lines/words etc., vision therapy can really make a difference in a patient’s quality of life. VT can also be used to help patients with amblyopia, strabismus, and even those who have vision problems from the result of a brain injury – which can vary from a concussion to a stroke where patients may have peripheral vision loss. Sometimes VT is used to help stabilize a strabismus patient’s degree of eye turn before surgery, and then after the strabismus surgery we can work with the patient to develop better binocularity.
How did you get interested in vision therapy?
My sister went to vision therapy when she was younger, so I knew about vision therapy, but my interest in VT really started when we started to learn about binocular vision at PCO. I thought it was fascinating how much binocularity can contribute to how well someone sees. As a second- and thirdyear optometry student, I became more aware of the questions to ask patients during an exam.
If someone is having double vision, blurry vision, skipping lines/words etc., vision therapy can really make a difference in a patient’s quality of life.
If the patient’s symptoms did not seem to make total sense with the refraction and eye health findings, I knew to start looking at the binocularity. As a second-year student, I may not have known exactly what was wrong with a patient from a binocular standpoint, but at least I knew that a more extensive binocular workup was warranted. My passion for vision therapy started when I was an extern at Dr. Carl Gruning’s and Dr. Randy Schulman’s practice in Connecticut. I loved working with the two of them and the vision therapists there were extremely knowledgeable.
My recommendation to all optometry students is to spend a couple of hours observing vision therapy, either in a private practice or at your school’s clinic. You’ll gain a better understanding of what VT entails and therefore you’ll become better equipped at identifying the patients who may benefit from a VT program.
As you can see, vision therapy is a rewarding field for both clinician and patient. I hope I have influenced some students to look more into this field so that optometry can expand its scope of practice to accommodate an even larger patient base.