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
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
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 firstname.lastname@example.org. Thanks!
Resources for: A New Neurofunctional Approach to the Treatment of Amblyopia and Strabismus
When a link or .pdf to the article was available, it was attached. If not, a more detailed reference was listed.
- Birnbaum MH , Koslowe K , Sanet R American Journal of Optometry and Physiological Optics [01 May 1977, 54(5):269-275]
- Occlusion for amblyopia: A comprehensive survey of outcome: F Hiscox, N Strong, J R Thompson, C Minshull & G Woodruff in Eye volume 6, pages300–304 (1992)
- Elbow splinting as a method to increase patching compliance in amblyopia therapy
- Why is compliance with occlusion therapy for amblyopia so hard? A qualitative study: https://www.ncbi.nlm.nih.gov/pubmed/16531452
- Patching may be strengthening rather than reducing the binocular imbalance that characterize amblyopia: Binocular Plasticity in Adults
- Under-correction of hyperopia reduces risk of becoming strabismic: https://www.ncbi.nlm.nih.gov/pubmed/8776448
- Refractive error change and vision improvement: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175780
- Awan, M & Proudlock, Frank & Grosvenor, D & Choudhuri, I & Sarvanananthan, N & Gottlob, Irene. (2009). An audit of the outcome of amblyopia treatment: A retrospective analysis of 322 children. The British journal of ophthalmology. 94. 1007-11. 10.1136/bjo.2008.154674.
- https://www.cell.com/trends/neurosciences/fulltext/S0166-2236(00)01967-6 Environmental complexity stimulates visual cortex neurogenesis.
- Duffy, F. H., Snodgrass, S. R.: Bicuculline reversal of deprivation amblyopia in the cat. Nature 260, 256-257 (1976).
- https://www.nyas.org/events/2007/plasticity-of-sensory-systems/ “Alleviating neural inhibition in adulthood with drugs or training paradigms may unmask the full capacity for lifelong learning”
- Birch-Amblyopia-and-Binocular-Vision “Unless the binocular dysfunction is treated, abnormal binocular vision may result in residual amblyopia, and may trigger recurrence of amblyopia”
- Binocular Vision in Amblyopia: Hess Binocular Vision in amblyopia
- User’s Guide to the Brain: Dr. John Ratey
- Franz and Sherman: Amblyopia-Therapy-Rationale-for-Refractive-Correction-Occlusion-VT
- Greenwald: Brock A Binocular Approach to Amblyopia Therapy brock_-_a_binoc_approach_to_amblyopia-therapy-Greenwald
- “The anatomical changes that we find in the eye muscles are minimal and only in rare instances are they of any importance in the total picture” https://visionhelp.wordpress.com/2012/04/04/a-ruede-re-awakening/
- ELISSS Study: Early vs. Late Infantile Strabismus Surgery Study. Note: At age six, 13.5% of the early vs. 3.9% of the late group recognized the Titmus Housefly; 3.0% of the early and 3.9% of the late group had stereopsis beyond Titmus Housefly. https://www.ncbi.nlm.nih.gov/pubmed/16361188
- Reoperation rates were between 60% and 80% for children first operated around age 1 and approximately 25% for children operated around age 4: https://www.ncbi.nlm.nih.gov/pubmed/20843185
- “It has not been possible to resolve the controversies regarding type of surgery, non-surgical intervention, and the optimal timing” The Cocharan Collaboration https://www.ncbi.nlm.nih.gov/pubmed/15674970
- Strabismus Surgery and its complications: https://www.springer.com/us/book/9783540327042
- The_Prevalence_of_Reoperation_and_Relate d Risk Infantile Esotropia: As can be seen in the decision tree, the most appropriate age for the first operation is 37 months, if a minimum number of operations and achieving gross stereopsis inpatients older than 5 years old is desired.
- Pilar Vegara: Crossed and Lazy Eyes (I was unable to find this on Amazon Books) It is currently available here – https://www.oepf.org/product/643
Title: A New Neurofunctional Approach to the Treatment of Amblyopia and Strabismus
Registration Link: https://www.regonline.com/registration/checkin.aspx?eventId=2563295
This 2-day course will provide attendees with an understanding of amblyopia and strabismus including eccentric fixation and anomalous correspondence and effective evaluation techniques to determine the prognosis in amblyopia, exotropia and esotropia. The course will provide an overview of myths and misconceptions regarding amblyopia and strabismus and review scientific studies on the underlying cause of amblyopia and strabismus and treatment options including patching, surgery and optometric vision therapy. This course will conclude with easy-to-follow, sequential and effective vision therapy treatment procedures for amblyopia, exotropia, and esotropia.
Dates: October 11-13, 2019
Location: Barclay Lodge, YMCA of the Rockies, Estes Park, Colorado
This event is held next to Rocky Mountain National Park. The closest airport is Denver International Airport. I recommend renting a car for the 2 hr(ish) drive. Fastest route takes the E-470 Toll Road. If you have more time, take Pena to 36 and visit Pearl Street in Boulder, CO for lunch on your way up. There are also several restaurants in the City of Estes Park, Colorado. Even more time? visit the National Park for a hike or scenic drive. Our event starts with dinner at 5 pm at the Barclay lodge. YMCA of the Rockies
50th Annual Colorado Vision Training Conference
ROBERT B. SANET, O.D., F.C.O.V.D.
Dr. Robert B. Sanet graduated with honors from the Southern California College of Optometry. He has served as President of the College of Optometrists in Vision Development, Chair of the A.O.A. Sports Vision Section, Board of Directors of the Neuro-Optometric Rehabilitation Association, International Clinical Director of the Special Olympics Opening Eyes Program, Staff Optometrist San Diego Rehabilitation Institute at Alvarado Hospital, Consultant to the Centro de Optometria International in Madrid, Consultant to the Domus Nova Hospital in Ravenna and Adjunct Associate Professor at the Southern California College of Optometry.
Dr. Sanet has worked with amateur and professional athletes including the USA Men’s and Women’s Olympic Volleyball teams, San Diego Chargers, San Diego Padres, and LPGA Golf Professionals.
Dr. Sanet is the developer of the Sanet Vision Integrator, an automated state of the art touch-screen biofeedback Vision Therapy instrument that is beneficial for the rehabilitation of numerous types of visual problem and the enhancement of visual performance.
Dr. Sanet’s numerous awards include the San Diego County Optometrist of the Year, COVD G.N. German Award for Excellence in Children’s Vision Care, NORA Founders Award, COVD President’s Award, OEP Ralph Barstow International Award, Guiseppe Rico Award (Italy) for Excellence in Clinical Practice, International Optometrist of the Year- SIODEC (Spain), International Optometrist of the Year (Mexico), the OEP Armand Bastein International Award (OEP). Dr. Sanet was named as a Distinguished Practitioner in the multidisciplinary National Academies of Practice. He is one of only 100 Optometrists in the USA to have received this award.
Special event in 2019: Learn about the vision of Birds of Prey with Dr. Jennifer Redmond
A room in the Barclay Reunion lodge or the Wind River Lodge (through the registration site) is $300 for the weekend (either 2 double beds or a double bed and bunk bed set). You can also make your own arrangements off-site if you prefer to stay in a hotel instead of a rustic lodge. Catered meals & entertainment plan is $100 for the weekend per person. Registration: Vision therapist $325, Optometrist is $395. Lecture will be in the Wind River lodge this year. Meals and entertainment will be in the Barclay lodge (our normal cabin).
The Oregon COVD Study Group
See in 3D: Stereopsis
Everything you need to know about sensory and motor FUSION
Jen Simonson, OD, FCOVD
Boulder Valley Vision Therapy
Registration form: Oregon-study-group-invite
Location: The Hampton Inn, 730 SW Columbia Street, Bend, OR 97702. Phone (541) 385-5045.
Friday August 9th 1pm-5pm
Saturday August 10th 8am-noon, 1 pm-5 pm
Sunday August 11th 8am – 10 am, 10 am – noon Vivid Vision Training
Building Blocks for Vision Development
Join us Sunday February 24, 2019 at Western University College of Optometry
At this year’s practicum, Dr. Simonson will share some of her most coveted pearls and strategies for young patients with special needs/developmentally delayed and physical handicaps. She will review normal versus delayed visual development from general motor concepts to development of visual perception and motor output for reproduction. You will gain insight into a systematic approach to vision therapy procedures for these young cases.