Building Blocks: Vision Therapy for Young Children
Optometric Extension Program Foundation (OEPF) https://www.oepf.org/calendar/building-blocks-vision-therapy-young-children-2021-08-22
This is a 12-hour course spread over two subsequent Sundays 8-22 and 8-29
Course begins at 8 am Pacific, 9 am Mountain, 10 am Central, 11 am Eastern
with Dr. Jennifer Simonson
Learn about age-appropriate vision therapy procedures for preschool-aged patients from 3-6 years old. Discover procedures to build tracking, focusing, and binocular skills. Train on visually-guided gross motor coordination, fine motor skills, and visual information processing appropriate to the patient’s age and development. This course will cover optometric vision therapy for amblyopia and strabismus to decrease suppression and improve eye alignment and sensory fusion. Learn how to modify therapy techniques for young children and how to successfully sequence vision training.
Jennifer S. Simonson, OD, FCOVD is the clinical director of the Boulder Valley Vision Therapy Center in Boulder, CO. She achieved Fellowship in the College of Optometrists in Vision Development (COVD) in 2006. Dr. Simonson was the recipient of the 2007 Colorado Young Optometrist of the Year Award. She is currently serving as the vice-chair of the International Examination and Certification Board (IECB) and is the Speaker Chair of the Colorado Vision Training Conference. Her primary interests in practice include pediatric vision care, vision therapy, sports therapy, and vision rehabilitation. Dr. Simonson is the author of several picture books for children about vision therapy.
OEPF Staff Contact Ms. Line Vreven
Event Type Over the Internet or Online
Children are often not aware that they are experiencing vision challenges since they don’t have a point of reference for optimal functional vision. This makes regular comprehensive eye exams important for children as they approach and advance through classroom learning.
Misdiagnosis of visual challenges is also common, and these visual issues can look similar to the following ADHD symptoms:
- Reading issues
- Poor attention span in school
- Frequent mistakes
- Difficulty doing and completing schoolwork
The best way to determine if these academic challenges are due to visual issues is to see an optometrist who will assess how well the child’s eyes work together. Additionally, some individuals who have ADHD also have vision issues that can compound the ADHD symptoms when not addressed. This makes seeing an eye doctor important to fully understand if vision therapy can assist in alleviating some of the symptoms.
Symptoms that may indicate a need for vision therapy:
- Skips words or lines when reading
- Rubs eyes when reading or doing near work
- Closes one eye with reading or near work
- Holds reading material close to face or tilts head or paper
- Sits close to the TV
- Headaches from reading or homework
- Good word reader, but poor reading comprehension
- Poor handwriting
- Blurred vision when transitioning from far to near vision
- Homework takes a long time or is highly frustrating
- Short attention span for schoolwork or reading
Colorado’s doctors of optometry recommend a comprehensive eye exam if a child is experiencing one or more of these symptoms. Early identification and intervention are key in preventing impact on school performance and student confidence. Vision therapy can also help avoid or improve outcomes of surgical intervention. If you think your child may need vision therapy, call us today!
Course Learning Objectives:
- Understand the impact of TBI on patients’ neurological and visual performance.
- Diagnose visual deficits related to TBI utilizing optometric testing including: oculomotor, eye alignment, accommodation, pupil function, contrast sensitivity, depth perception, and peripheral vision assessments.
- Develop management strategies for TBI-related vision disorders including the use of lenses, filters, prism, partial occlusion, and vision therapy rehabilitation.
- Know when to refer a TBI patient to other physicians and rehabilitation therapists.
- Educate patients on optometrist’s role in the prevention of further injury.
- Provide recommendations for appropriate accommodations to improve work and academic performance.
TBI Visual Evaluation and Management Outline:
- TBI is an acute brain injury resulting from mechanical energy to the head from external physical forces.
- TBI incidence in the US: 1.7 – 4 million (CDC, Journal of Neurology)
- falls (35%)
- motor vehicle-related injuries (17%)
- strikes or blows to the head from or against an object (17%), such as in sports injuries
- Neurology of the visual pathway
- diffuse axonal injury (DAI) has emerged as one of the most common and important pathological features of traumatic brain injury (TBI)
- diffuse axonal injury does not show up on scans.
- Effects of TBI on the visual system
- Areas of potential injury (pathways and lobes)
- Types of TBI
- Visual field defects and spatial inattention
- Post-traumatic vision syndrome
- Common symptoms
- Headache (30 – 90%)
- Light sensitivity
- Blurred vision
- Visual motion sensitivity
- Sound (especially background noise) sensitivity
- Mood alteration
- Memory issues
- These intracellular responses are NOT directly correlated to severity of TBI
- Some people with mTBI can have more microtubule damage and post inflammatory damage than people who recovered from more severe TBI
- Diagnosis of TBI-related visual deficits (~90% of people with TBI have vision problem)
- Common symptoms
- TBI incidence in the US: 1.7 – 4 million (CDC, Journal of Neurology)
Expected Recovery Timeline
- Balance Recovery <7 days
- Symptom Scores 5-14 days
- Cognitive Recovery 7-21 days
- Oculomotor Recovery 21-28 days
Key questions to ask post-injury (Goodrich et al, 2013)
- What changes have you experienced in your vision?
- Are you light sensitive, in- or outdoors?
- Do you experience double vision?
- Have you noticed a change in your peripheral vision?
- Do you have blurred vision at distance or near?
- Has there been a change in reading?
- Do you lose place while reading?
- How long can you read before you need to take and break or stop?
- Do you experience Headaches?
- Do you have trouble remembering what you’ve read?
Emergent Visual Conditions
- Flashes of light
- Floaters in field of view
- Restricted field of vision
- “Curtains” billowing into field of view
Urgent Visual Conditions
- Inability to completely close eyes
- Difficulty moving or turning eyes
- Pain with movement of the eyes
- Pain in or around eyes
- Wandering eye
- Double vision
Vision Rehabilitation Conditions
- Blurred vision for distance viewing / Blurred vision for near viewing
- Slow shift of focus from near to far to near
- Difficulty copying or taking notes
- Pulling or tugging sensation around eyes / Discomfort while reading/ Eyes get tired while reading / Headaches while reading
- Unable to sustain near work or reading for periods of time / General fatigue while work/reading
- Covering, closing one eye
- Loss of place while reading / Easily distracted when reading / Difficulty remembering what has been read
- Decreased attention span / Reduced concentration ability
Post-concussion Vision Evaluation:
Pediatric post-concussion Check-list (CDC) Concussion Checklist Kids
Visual acuity, refractive status, oculomotility, accommodation, binocularity
Northeastern State University College of Optometry’s Oculomotor Test
VOMS: Vestibular/Ocular-Motor Screening VOMSExam
Visual field, visual neglect, egocentric localization (midline shift) BESSmanual
Visual Perceptual testing: Visual Figure-ground, Visual Closure, Visual Reaction Time, Visual Memory
TBI Prevention, Education, and Outreach
Patient population: Athletes, Parents of children, Recreational activity participants
- Awareness, Risk assessment
- King-Devick Test
- Pre-season training protocols
- Vision screenings
- Sports training
- Optometric Treatment and Vision Rehabilitation
- General health considerations: Nutrition, Exercise, vitamin info sheet for best brain healing and function
- Multidisciplinary, team approach: Patients may be seeing multiple practitioners, When to refer
- Small refractive errors often make a large difference
- Tinted lenses (Blue, grey; light and dark tints)
- Treating diplopia with lenses: low plus, prism, occlusion
- Field loss: Prism to increase field awareness
- Yoked prism
- Reduction in screen time and near work often necessary
- Changing color spectrum and brightness
- Classroom and work accommodations: Classroom Accommodations Letter detailed
- Vision therapy designed for patient’s diagnosis and goals
- Are there any activities that you wish you could do?
- What are your visual needs to return to school, your sport or work?
- What are your recovery goals?
Visual-vestibular therapy often required
Specialized therapy for visual inattention and other visual processing deficits
General Reading References:
- Review of Optometry, “Save a Life, Neuro-Optometry Primer: The Brain” by Mario Gutierrez, OD, FAAO. https://www.reviewofoptometry.com/CMSDocuments/2009/9/Neuro-Optom-Supp_RO-09.02.09.pdf
- Vision Therapy for Post-Concussion Vision Disorders. Gallaway, M, et al. Optometry & Vision Science: Jan 2017 – Vol 94 – Issue 1 – p. 68-73 .
- A Review of the Current Practice in Diagnosis and Management of Visual Complaints Associated with Concussion and Post concussion Syndrome. Heinmiller, L and Gunton, K. Curr Opin Ophthalmol 2016; 27(5): 407-412.
- Current and Emerging Rehabilitation for Concussion: A Review of the Evidence. Broglio, S, et al. Clin Sports Med 2015 April; 34 (2): 213-231.
- Concurrent Vision Dysfunctions in Convergence Insufficiency with Traumatic Brain Injury. Alvarez, T, et al. Optom Vis Sci. 2012 December: 89 (12)
- Mucha A, Collins MW, Elbin RJ, Furman JM, Troutman-Enseki C, DeWolf RM, Marchetti G, Kontos AP. A brief vestibular and ocular motor screening (VOMS) assessment to evaluate preliminary concussion: Preliminary findings. Am J Sports Med; in press.Form Sources: https://www.bamc.org/media/1393/voms-exam.pdfhttps://www.physiotherapyalberta.ca/files/vomstool.pdfVOMS Instruction Sethttps://www.youtube.com/watch?v=PJLv5zdmEns
- Anzalone AJ, Blueitt D, Case T, McGuffin T, Pollard K, Garrison JC, Jones MT, Pavur R, Turner S, Oliver JM. A positive Vestibular/Ocular Motor Screening (VOMS) is associated with increased recovery time after sports-related concussion in youth and adolescent athletes. AJSM 2017;45(2)474-479
- Yorke AM, Smith L, Babcock M, Alsalaheen B. Validity and reliability of the Vestibular/Ocular Motor Screening and associations with common concussion screening tools. Sports Health. 2017;9(2): 174-180.
- The King-Devick Test: https://kingdevicktest.com/
- NSUCO-Oculomotor-Test Instruction SetNorms for Oculomotor Skills: Pursuits and Saccades: https://www.oepf.org/sites/default/files/journals/jbo-volume-3-issue-6/3-6%20Maples.pdf
- PERIPHERAL VISION
- PERCEPTION: VISUAL/VESTIBULAR
- BINOCULAR (Sensory Fusion/Motor Alignment)
- Neuro-optometric Rehabilitation Association: https://noravisionrehab.com/
- Vision Training can decrease concussions: http://healthnews.uc.edu/news/?%2F26057%2F
- Collins M, Kontos A, Okonkwo D. et al. Statements of Agreement from the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion .Neurosurgery. Dec 2016;79(6):912-929.
- Katz BJ, Digre KB. Diagnosis, pathophysiology, and treatment of photophobia. Surv Ophth. 2016;61:466-477
Here are some helpful resources to learn more about vision development:
- The infantSEE program is a national public health service where a doctor of optometry (OD) performs a no-cost vision assessment of babies between ages of 6-12 months of age. The infantSEE program has great information for parents on their website: infantsee.org
- The American Optometric Association (AOA) has guidelines for testing and treatment of our little pediatric patients. Do you know the first eye examination should take place between ages 6-12 months and the second at age 3? The AOA Parents Center is packed with information. To learn about vision from birth to age 24 months, visit AOA Infant Vision.
- To learn more about preschool vision development, visit AOA Preschool Vision
- Dr. Lynn Hellerstein, a personal friend and colleague blogged about her granddaughter Edina’s Visual development at each age and stage. This great series includes videos, milestones, and observations. Learn more here: https://www.lynnhellerstein.com/category/vision-development-through-edinas-eyes/
- All about Vision is a helpful website for families to learn more about children’s vision: https://www.allaboutvision.com/parents/infants.htm
I also highly recommend the following book for parents:
Active Baby, Healthy Brain: 135 Fun Exercises and Activities to Maximize Your Child’s Brain Development from Birth Through Age 5 by Margaret Sassé
What does a baby see?
Symptoms of refractive errors vary per individual and may include: – headache – fatigue – eye strain – squinting – blurred or distorted images, up close and/or in the distance
My colleague Sarah Lane, OD, FCOVD has some great videos on helping your child’s sensory (sight, touch, balance, pressure, hearing) and motor (movement of the body) systems development here:
- Dr. Jen Simonson, April 2020
Top Five Vision Therapy Tools
Understand how to utilize traditional therapy procedures and when to move forward with modern alternatives. 1 hour – English – ODs, VTs, Optometry students
Course Handout Top Five Vision Therapy Tools iHeartVT 2020
Products from this course:
- Virtual Reality
- MFBF Game
- Facility Rock
Virtual Reality Platforms
Vivid Vision: https://www.seevividly.com/
Optics Trainer VR: https://www.opticstrainer.com/
Monocular Fixation in a Binocular Field (MFBF)
MFBF Game: https://www.bernell.com/product/MFBFMG/398
Sherman Cards: https://www.bernell.com/product/KEY4102/Games
Carl’s Cards: https://www.bernell.com/product/RGCC/398
Franzblau Cards: https://www.bernell.com/product/FZKIT/398
*Lens flipper set: Optego (Canada)
Home Therapy Flipper Set (each flipper sold individually)
Flipper A +0.75/-1.50 -2.50/+1.25
Flipper B +1.75/-3.50 -4.00/+2.00
Flipper C +2.25/-4.50 -5.00/+2.50
Headline Stereoscope Cards:
Vectograms and Vectographs (Polarized glasses):
Vectographs produced by Vision Assessment Corporation (note – these manuals are great and indicate the stereopsis demand of each 3-D target)
Anaglyphs (Colored Glasses)
Red/Green Emergent VT Anaglyphs:
Red/Cyan Opto iPad app: http://gerull-labs.com/red-cyan
Red/Blue Home Therapy System (HTS): https://visiontherapysolutions.net/hts-inet/
Red/Blue Vision Builder: http://www.visionbuilder.no/
Facility Rock Test Set: https://www.good-lite.com/Details.cfm?ProdID=940&category=0&Secondary=0
Flipper Sets from Good-Lite: https://www.good-lite.com/flippers.pdf
Prism Flippers: https://www.bernell.com/category/Prism_Flippers
**If you have similar products in other countries and you would like me to add links, just send the information to email@example.com. Thanks!
When: Sunday, February 23, 2020 from 9:00 AM to 12:00 PM (MST)
Where: Hellerstein & Brenner Vision Center, P.C.7400 East Orchard RoadSuite 175-SGreenwood Village, CO 80111
Topic: Testing and Treatment of Vertical Deviations
Presentors: Dr. Jennifer Simonson of Boulder Valley Vision Therapy and Dr. Lynn Hellerstein of Hellerstein & Brenner Vision Center, P.C.
Course Description: Dr. Simonson and Dr. Hellerstein will share clinical pearls in treating vertical diplopia. This course will discuss eye alignment, prism prescribing, and recommended vision therapy techniques to decrease symptoms of double vision. The goal is of this course will be to utilize compensatory and therapeutic strategies to improve fusion skills for patients with vertical strabismus and diplopia. During this workshop, attendees will complete hands-on training on clinical testing for vertical misalignment. Stations will include Maddox rod, Modified Thorington, laser-assisted Hess Lancaster, and other clinical techniques to measure the amplitude of misalignment and fusional ability. This training will help vision therapists understand the direction and amplitude of strabismus. Attendees will also experience induced vertical misalignment and determine optimal prism perscription based on findings. In addition, vision training concepts and procedures will be performed to increase the accuracy, stability, and concomitancy of eye alignment. Learn new techniques and appropriate procedure modifications.
Course is APPROVED for 3 hours of Colorado State licensure CE credit through COA.
Thank you for coming! Additional Resources here:
- Vectograph Information: https://www.visionassessment.com/polarized-variable-vectographs
- Variable Prism Maddox Rod: https://www.good-lite.com/cw3/Assets/documents/120004%20Instructions-web1.pdf
- Keystone Eccentric Circles: https://www.bernell.com/product/KEY411/Free_Space
- Fresnel Prism: https://www.fresnel-prism.com/
Course Notes: SECO 2020 Board Review Simonson
Course Links and Resources:
1) Clinical Practice Guidelines from the American Optometric Association:
*Several other topics are available on the AOA website.
2) Binocular Vision Topics
3) Entopic Phenomenon:
4) Color Vision Testing:
https://ekjo.org/ViewImage.php?Type=F&aid=532955&id=F2&afn=65_KJO_29_6_359&fn=kjo-29-359-g002_0065KJO (Korean Journal of Ophthalmology)