Vision Therapy: Types for TBI Recovery

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Vision therapy is one of the most overlooked therapies for patients in general, but for those with TBIs, its potential role and the process by which it is conducted is crucial to their recovery. 

Vision therapy is proven science, with over 260 published articles ensuring its effectiveness (Optometrists Network, 2020). It works to act as a “gym” for the brain, helping the brain regain and retrain its eye-brain functionality, connections, and speed (Optometrists Network, 2020). It is a fully customizable and personalizable treatment designed to improve and strengthen one’s visual skills and visual system in general, focusing on functionalities such as eye-tracking, focusing, convergence, eye-hand coordination, visual processing speed, and much more (Optometrists Network, 2020). This is especially important because, after the brain, our eyes are the second most complex part of the body, so checking on it after a traumatic brain injury can make all the difference to a TBI patient, especially since it is estimated that up to 90% of people with TBIs experience some form of oculomotor dysfunction and effects on the eyes are often overlooked after one sustains a TBI (Complete Eye Care, 2020; Optometrist Network, 2020).

Vision Therapy includes treatment for issues such as:

  • Convergence Insufficiency, or a binocular vision condition that affects the near vision and eye muscle coordination. The eyes struggle to focus on close tasks and can cause eyestrain, headaches, blurred or double vision, motion sickness, etc.
  • Amblyopia (lazy eye), or a condition where one cannot achieve normal visual acuity due to a disconnect in the visual pathway between the eye and the brain. 
  • Strabismus (crossed-eyes), or the result of two eyes being unable to align and focus together on a singular object properly. It can be constant, intermittent, affecting one eye, or alternating and affecting a different eye each time.
  • Diplopia, or double vision
  • Eye teaming and tracking problems
  • Accommodative dysfunction, or focusing difficulties
  • Asthenopia, or eye fatigue/strain
  • Depth perception and 3D vision difficulties
  • Hand-eye or eye-foot coordination difficulties, or the inability to accurately coordinate when reaching or walking
  • Visual perception and processing issues: inability to recognize faces, words, or shapes
Other issues and exam types

And other issues such as binocular vision difficulties (uncoordinated eye movements), spatial disorientation (difficulty organizing visually presented material), ocular motor dysfunction (inaccurate pursuit or saccadic eye movements), visual distortion (objects appear to more or distorted in shape), and more that are specifically present in TBI patients (Optometrists Network, 2020). Vision therapy evaluation for TBI patients can include, but not be limited to, comprehensive vision exam, higher cerebral function assessment of visual information, extended visual field evaluation, and electrodiagnostic testing (Complete Eye Care, 2020).

How does vision therapy work?

Our brains are full of neuroplasticity, which is the neural brain cells’ capacity to change in response to internal/natural or external factors (Shaffer, 2016). The neuroplasticity (or change) within our brains allows for flexibility and remains dynamic throughout our lifetime, and is crucial to maintaining optimal visual health (Optometrist Network, 2020). Vision therapy consists of personalized exercises using lenses, prisms, filters, occluders (an object that partially or entirely blocks light going into one eye), and more – all aiming to re-develop visual skills and processing information skills within the optical system to improve overall vision (Optometrists Network, 2020). Computer-based therapies and other advanced technology are recent non-traditional ways of conducting vision therapy.

Here are three distinct ways that one can receive vision therapy: 

  1. In-Person: In-person vision therapy is the most commonly prescribed way of treatment by both optometrists and ophthalmologists and the most extensively studied type of vision therapy (Aletaha et al., 2018). It consists of 45+ minute appointments and a series of exercises typically done weekly over several months or more, depending on the severity of the visual impairment, eye health, and patient compliance (American Association for Pediatric Ophthalmology & Strabismus, 2016; Exceptional Vision, 2020). This is primarily performed in an optometric office with close monitoring and follow-up appointments that ensure noticeable improvements and positive changes are made to the patient’s visual functionality (Exceptional Vision, 2020). The doctor will determine how many visits are needed to improve functionality based on progress, and patients may be assigned specific home exercises with equipment (Concussion Alliance, 2020). In-office sessions are the best because they provide a controlled environment in which any adjustments can be made as needed, and the therapist can precisely and closely monitor and track progress (Visual Learning Center, 2020).

  2. Hybrid: The hybrid model of vision therapy includes in-person and telehealth or at home encounters. In a 1999 randomized controlled study of 60 adult patients aged over 40 years with convergence insufficiency (CI), it was found that patients who received in-office vision therapy and supplemental home therapy had a 61.9% success rate (Aletaha et al., 2018). This was only found in those patients with CI, so the success rate of hybrid vision therapy may be different for other visual issues and in this current time. Patients come into the office for vision work and are given exercises to work on at home. Hybrid models can call for eye-strain, discomfort, irritability, nausea, and worsening or regression of symptoms if patients conduct them at home and not under their health provider’s watch. Still, there is always the ability to correct how the at-home sessions are done the next time the patient comes into the office (Visual Learning Center, 2020). Hybrid models of vision therapy are the subsequent best therapy after in-person. 
  3. Virtual: Virtual vision therapy consists of completely at-home therapy sessions meant to replicate in-office sessions, but with virtual functionalities. In a 1999 research study of 60 adult patients aged over 40 years with convergence insufficiency, it was found that home-based vision therapy was only successful in about 10.5% of patients (Aletaha et al., 2018). This may have changed as new technologies have been developed, but further research needs to be conducted on virtual vision therapy’s efficacy. Virtual sessions are conducted now through secure video conferencing platforms such as Zoom, where doctors work one-on-one with patients and possibly caregivers (Eagle Eye Vision Therapy, 2020). Visual repair activities are conducted through screen-sharing so that the doctor may directly watch a patient’s eye movements, in turn evaluating them. Patients may also be given tools that a doctor can help them set up within their home step by step (Eagle Eye Vision Therapy, 2020). Another way that one can receive virtual vision therapy is through a mobile app called Binovi, in which patients are connected with their doctors on reinforcement activities, can send messages directly to their doctor, and feature crucial elements such as a timer, metronome, and progress tracker (Eagle Eye Vision Therapy, 2020). 

IS VISION THERAPY A DYI THERAPY? 

A subset of virtual vision therapy utilized by some TBI patients is through Youtube vision therapy videos.

Some TBI survivors have found videos on YouTube which look like or claim to offer vision therapy, but neuro-optometry specialist Dr. Katie Davis warns that this is not the case. While these videos may seem informative, they fail to produce the benefits a professional evaluation can produce.

TBI patients must utilize the in-office type of vision therapy, if possible, to offer the best oversight of care and provide individualized treatment for an often individualized condition/range of symptoms. At Power of Patients, we believe that no two brain injuries are alike, and neither are two vision therapy treatments for TBI patients. So, where does this leave us? This leaves many patients wondering how to get involved with professional, at-home vision therapy. For these individuals, the first step is a virtual intake process.

How can Power of Patients help?

Power of Patients is conducting a three-part webinar series on Vision Therapy with two neuro-optometrists. Next week, on November 18th, we will be airing a live vision therapy session with Dr. Yamam Almouradi, a neuro-optometrist, and her assessment of a TBI survivor Brian Gurry. Register here to join us as we show you what vision therapy can do for you and your TBI recovery. 

If you haven’t joined our dashboard to track your brain injury triggers and symptoms, what are you waiting for? Almost 200 users are currently benefiting from our free platform, wherein they have access to past webinars, including the vision therapy ones. Sign up today at powerofpatients.com, and let us advocate for you.

 

References: 

Aletaha, M., Daneshvar, F., Mosallaei, M., Bagheri, A., & Khalili, M. R. (2018). Comparison of Three Vision Therapy Approaches for Convergence Insufficiency. Journal of ophthalmic & vision research, 13(3), 307–314. https://doi.org/10.4103/jovr.jovr_99_17

American Association for Pediatric Ophthalmology & Strabismus. (2016). Vision Therapy. Retrieved November 11, 2020, from https://aapos.org/glossary/vision-therapy

Complete Eye Care (2020). Vision and Traumatic Brain Injury. Retrieved November 11, 2020, from https://www.completeeyecare.net/eye-care-services/vision-therapy-faq/vision-and-traumatic-brain-injury/

Concussion Alliance. (2020).  Vision therapy for concussions. Retrieved November 11, 2020, from https://www.concussionalliance.org/vision-therapy

Eagle Eye Vision Therapy. (2020, April 06). Virtual Vision Therapy. Retrieved November 11, 2020, from https://www.eagleeyevisiontherapy.com/vision-therapy/virtual-vision-therapy/

Exceptional Vision. (2020). How Does Vision Therapy Work? Retrieved November 11, 2020, from https://www.exceptionalvision.com/vision-therapy-optometrist/

Optometrists Network. (2020, October 06). What Is Vision Therapy? Retrieved November 11, 2020, from https://www.optometrists.org/vision-therapy/what-is-vision-therapy//

Shaffer J. (2016). Neuroplasticity and Clinical Practice: Building Brain Power for Health. Frontiers in psychology, 7, 1118. https://doi.org/10.3389/fpsyg.2016.01118

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