Neuro-Visual Training is an area of Optometry that concentrates on “Vision”, not “Sight”.
Vision is how the two eyes communicate with the brain. It answers questions of how you see, how you interpret space, your ability to visually process and much more. When the visual system is not functioning optimally it can impact every part of your life. It can impact something as simple as reading, but also something more complex such as your behaviors, your personality, your anxiety levels, and your ability to complete tasks with minimal effort. It can impact you with respect to your roles at school, work, home and your role in all of your relationships. Many patients are not aware that they have symptoms of a poorly functioning binocular visual system, they assume a good or bad visual system has only to do with what they see, not how they walk, how they function, how they feel, or how they behave. 60-80% of the brain is involved in visual processing. Neuro-visual training corrects the binocular visual system and allows patients to function based on their capabilities versus their struggles.
It is an area in Optometry that is most commonly referred to as Neuro-Visual Rehabilitation, Behavioural Optometry, or Vision Therapy. It has been practiced for at least 90 years.
Sight is what you see at 20 feet. It answers questions related to your need for corrective eyewear.
Assume someone has 20/40 SIGHT. If their VISION is not examined, it’s unknown if the patient is seeing 20/40 based on the eye chart depicted on the right or the one on the left.
If the brain tells the one eye to focus on something even 1 second before the other eye, the two eyes will give the brain two different pieces of information. This will result in what we call a binocular vision problem. A problem with the communication pathway to and from the brain to the eyes.
Neuro-Visual training is creating new and more efficient ways for the brain and eyes to communicate.
Many of these patients will struggle with one or all of the following symptoms: Headaches, troubles reading, difficulties with comprehension of what they read, poor handwriting, slow at copying things off the board, reversals of letters, or they may demonstrate behavioural problems such as moving around a lot, getting on and off their chairs, being more tactile, being clumsy, and having troubles with focusing or paying attention in class. Listed were the most common symptoms, however, there are many more a patient with a visually related learning problem may exhibit.
Some patients will do well in their academics and have very mild symptoms, and if questioned will deny feeling any of the above symptoms, but everything they do will take longer and require larger amounts of effort. Whether or not the patient has a learning difficulty versus a learning inefficiency, if there is evidence a binocular vision problem, it can be trained with Neuro-Visual training. With any sort of learning challenge, these patients are at times judged or in some cases have a distorted perception of their own capabilities. Neuro-Visual Training can have positive outcomes for these patients that experience difficulties with their inner self-confidence.
Many of the visual symptoms associated with these groups of patients can easily be masked by the behavioural symptoms related to the condition. For example lack of eye contact can be a symptom of Autism, but also a symptom of a poorly functioning binocular visual system. In certain cases once the visual system has been treated, patients can be re-assessed by their health care provider and the condition or the medications related to the condition are no longer valid. With increased amounts of independence these patients begin to have less emotional outbursts and less dependency on those they are closest to such as parents, siblings, or partners. These changes make the home life much easier for all parties involved. Prior to being tested for ADD/ADHD/Anxiety, it is always recommended to have a Neuro-Visual assessment and treat the visual system first, and in certain cases labels and medications can be avoided.
Neuro-Visual training can help patients with strabismus (eye turns), including those that have already had unsuccessful outcomes from surgery. Many patients require more than one surgery to correct the cosmetic eye turn, in certain cases the eye turn never fully resolves or if it does, tends to appear again later (some sooner than others) in life. For those cases that the eye turn does resolve, there is high probability that there is still a lack of binocularity and lack of depth perception. The problem in the majority of cases with surgical intervention is that you are treating the symptom, not the cause of the eye turn. In these particular cases it is a brain issue, not a muscle problem, and with Neuro-Visual Training the patient is trained to control the eyes and use them as a team versus independently.
The same is true about Amblyopia, it is a brain problem. Patching which has been used in the past as the first line of treatment rarely has long-term effects and typically does not work past a certain age. In the case of Neuro-Visual Training, patching is not used, binocularity is advocated, and there is NO age limit. Neuro-Visual Training can happen at any age.
Acquired brain injuries such as a concussion can have devastating effects on a patient, mentally, physically and emotionally. Some patients have symptoms that resolve within a month and have no long-term side effects, others continue to be symptomatic or begin to develop symptoms a few months or a few years after the original injury. The general population including most health care providers don’t realize that the most accurate way to diagnose a concussion is by assessing the visual system. 60-80% of the brain is involved in visual processing. As soon as u have an acquired brain injury the most common symptoms will be headaches, light sensitivity, nausea, being off balance, troubles focusing, seeing double and much more. Patients do not typically equate many of the symptoms to their visual system, however, they can all be managed with Neuro-Visual Training/Neuro-Visual Rehabilitation. The Neuro-Visual Training or Neuro-Visual Rehabilitation with these patients is quite in depth and all aspects of the patient are taken into consideration, their mental, physical and emotional health. These patients can be treated soon after the injury or years later. There is neuroplasticity, the brain can be trained at any age.
Neuro-Visual training is used by many athletes. It can enhance eye hand coordination skills. Amateur athletes use the training in attempt to further their careers and professional athletes use the Neuro-Visual training to enhance skills in specific areas of their game. Some US schools will ask if any Visual Training or Vision Therapy has been done, before considering a scholarship for an athlete.
Refractive error or Eye Focusing (Accommodation) Problem
Blinks/Rubs eyes during or after visual tasks
Frowns, scowls, or squints to see
Avoids close work
Fatigues easily during visual tasks
Slow when having to copying notes off the board
Holds near work very close
Complains of blurry vision while reading or writing
Comprehension is poor when reading or performing near tasks
Re-reads for comprehension
Eye Tracking (Ocular Motility) Problem
Skips or rereads words, letters, or lines
Mistakes words with similar beginnings or ending
Uses finger or marker when reading
Loses place often when reading
Repeatedly omits “small” words
Moves head excessively as reads across the page
Re-reads for comprehension
Eye Teaming (Binocularity) Problem
Complains of seeing double
Squints, covers or closes one eye
One eye turns in, out, up, or down on occasion
Tilts or turns head to one side
Trips and stumbles repeatedly, poor balance, clumsy
Poor eye-hand coordination
Nausea or motion sickness
Complains of letters or lines “floating,” “running together,” or “jumping around”
Re-reads for comprehension
Visual Information-Processing Problem (can be confused with behavioural problems)
Lack of eye contact
Short attentions span, distractible
Tends to be very tactile (touches everything around them)
Sensitive to sounds
Reluctant to answer or participate when in larger groups
May be defined as exhibiting “lazy” behaviour
Confuses similar words
Fails to recognize same word in next sentence or page
Difficulty completing tasks in allotted time
Poor printing or handwriting
Reverses letters, numbers or words
Poor recall of visually presented material
Moves around a lot, stands from chair, can’t sit still
Posture is unnatural
Neuro-Visual Training consists of a series of novel or unfamiliar activities/exercises that are related to the skill that requires training. This allows the brain to create new connections in order to function in a more efficient manner. The goal is to have the skill become automatized so that the patient can have visual, cognitive, auditory, and motor processing happening simultaneously. In addition to training exercises, patients are expected to use therapeutic lenses. This is similar to how a patient will wear a retainer prior to, and after braces. The retainer holds things in place, similarly, the therapeutic lenses provide visual comfort and visual space. Therapeutic lenses are labeled as such as they are prescribed differently from lenses that would be prescribed for sight.
The following are specific areas targeted for Visually related Learning Problems, but can also be used for any patient that has difficulties with respect to the specific skill involved:
To determine if Neuro-Visual Training can benefit you, book with any one of our Optometrists for a Comprehensive Eye Exam and please make your questions known. The Optometrist will then guide you towards the next steps.
If you are aware that you require a Neuro-Visual Assessment or are interested in Neuro-Visual Training, book directly with our Neuro-Visual Optometrist Dr. Kiran Ramesh for the Neuro-Visual Assessment. The Vision Care team will provide you with the appropriate questionnaires that are required to be completed prior to your assessment.
If you simply have questions, please e-mail us and the questions will be directed to our Neuro-Visual Training department and answered promptly.
(At least 6 are necessary)
|Often fails to give close attention to details or makes careless mistakes||𝕏||𝕏|
|Often has difficulty sustaining attention in tasks or play activities||𝕏||𝕏||𝕏|
|Often does not listen when spoke directly||𝕏||𝕏|
|Often does not follow through on instructions or fails to finish work||𝕏||𝕏||𝕏|
|Often has difficulty organizing tasks and activities||𝕏||𝕏||𝕏|
|Often avoids, dislikes or reluctant to engage in tasks requiring sustained mental effort||𝕏||𝕏||𝕏|
|Often loses things||𝕏||𝕏||𝕏|
|Often distracted by extraneous stimuli||𝕏||𝕏||𝕏|
|Often forgetful in daily activities||𝕏||𝕏|
|Hyperactivity and Impulsivity
( At least 6 are necessary)
|Often fidgets with hands or feet or squirms in seat||𝕏||𝕏||𝕏|
|Often has difficulty remaining seated when required to do so||𝕏||𝕏||𝕏|
|Often runs or climbs excessively||𝕏||𝕏|
|Often has difficulty in playing quietly||𝕏|
|Often “on the go”||𝕏||𝕏|
|Often talks excessively||𝕏||𝕏|
|Often blurts out answers to questions before they have been completed||𝕏||𝕏|
|Often has difficulty awaiting turn||𝕏||𝕏||𝕏|
|Often interrupts or intrudes on other||𝕏||𝕏||𝕏|
Comparative Symptoms of ADHD and of Vision Disorders
*DSM-IV: Diagnostic & Statistical Manual of Mental Disorders 4th Edition
*Table of Comparative Symptoms between ADHD and Binocular Vision Dysfunction
Helpful web resources: www.covd.org & www.childrensvision.com
Essilor Academy Canada was pleased to have our special guest, Dr. Kiran Ramesh, Neuro-Visual Optometrist speak about a very interesting topic on Neuro-Visual training (Vision Therapy).
Click the link below to view the webinar:
Before beginning my therapy at Vision Care Centre, I frequently struggled with my vision. As a university student, reading and taking notes in lectures were a significant struggle and using my glasses caused great distress. Headaches and motion sickness were very common with and without the use of my glasses. On a routine check-up with Dr. Ramesh, I communicated my concerns and was quickly enrolled in the neuro-visual training program. My wonderful neuro-visual trainer, Kelley would provide me with comprehensive tasks that would both challenge and help me develop understanding and control of my vision. I no longer use my glasses, suffer from headaches or motion sickness and have great confidence in my vision.
We want to thank you very much for all your hard work that went into Alicia's Neuro-Visual Therapy. It has opened Alicia's ability to do so much more both personally and in school, and what means most to us as her parent, we see how confident Alicia is in herself and in her school work. She was always falling down a lot and she always had her head tilted to one side. Now she is focused to get her tasks done on time and the best part, correctly...
I would like to thank you and Cristina for working with my son over the past year. They have not only trained his eyes but they provided him with a sense of confidence in his abilities. When we first came for our check up it was only mentioned on the side that his reading was regressing...We knew it had to do with some of his Chronic Lyme Treatment and we did not want things to get worse... We will be forever grateful that our son will not be another statistic of "lost kids" in the school system being medicated to manage behavioral issues which would have undoubtedly arisen the worse his eyes got.
Before eye therapy school was hard and not fun. School is now easy and I look forward to go to school every day. Eye therapy has helped me be more focused. Eye therapy has taught me how to read, write and learn in a different and better way. Thank you for all your help.
I thought overall it was a very fun and difficult experience, the people I worked with are very nice and patient people and around me that’s tough so I would like to thank you a lot it helped so much and you will hear about my achievements. Thank you.
The staff at Vision Care Centre has been amazing while Nicholas has been undergoing his vision therapy. They have been incredibly patient while Nicholas was having some difficult weeks. Over the course of therapy, his focus in school has improved, his headaches have lessened and he has started scoring goals in Hockey again. We feel good and are happy with the whole experience.
The 36 week eye therapy program that Hannah has completed has been a very positive experience. The main benefits have been to teach her how to focus her eyes on a specific task and to have her eyes work effectively with the rest of her body. This has improved her reading, effectiveness and focus at school and her hand eye coordination...
Dear Dr. Ramesh, I am writing to thank you for your persistence and dedication to my daughter. I am so thankful for encountering such an amazing doctor who truly cares about her patients. Back in 2015 when I brought my daughter in for the first time, I was hysterical and scared...
When I started the program, I had trouble focusing and sitting and doing my work. Since I started the 36 week program, this has changed. I focused on getting better grades than I did in grade 2 (now in grade 3). I have got A’s in all subjects this year. Now I can sit and do my work, I am able to focus and I am not always looking around the room at other things. I used to need a ruler to read, now I don’t and I can read better and faster than I used to. I am doing great and have learned a lot through this experience.
Before I started Vision Therapy I would get very bad headaches while taking notes in class or studying. Because of the headaches, I wouldn't be able to study very efficiently for as long as I needed...
Before eye therapy I could not write and did not see words properly. Sometimes the words floated around my paper. After eye therapy reading is easier. I can read in a group and follow along. It is also easier to read the board at school. Eye therapy has really helped me and now I know my b's and d's !! Thankyou
Dr Ramesh, I cannot thank you you enough for giving both my girls the opportunity to do eye therapy. It has been wonderful to see them go from struggling to self confident. I thank you so much for what you have done for the girls. Sincerely
Prior to starting therapy Madison had difficulties with spatial awareness, balance, reading (re-reading), low peer interactions at school and difficulty concentrating at home and at school when doing tasks. Madison had many difficulties...