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Questions and Answers with Our Vision Therapist Doctor

How did you first become interested in vision development and therapy?

While at the Southern College of Optometry I learned about the different visual skills and began to understand that vision is more than just the ability to see something clearly. There I had the opportunity to learn from Dr. Glen Steele, an ongoing leader in the area of pediatric vision development.

The interest-only grew while on externship at the s.a. NOEL Center. I had the privilege to learn from one of the pioneers and educators in the field, Dr. John Streff. The more I learned the more passionate I became in wanting to provide this type of care.

What is a common misconception regarding vision?

Many people think that if you can see clearly, your vision is automatically fine. This is not true at all. This misconception contributes to the belief that if you can pass a vision screening, any problems you may be having with performance must not be vision-related.

How would you describe the difference between seeing clearly and vision?

This most basic way I like to think of it is – Sight is the ability to see something clearly, Vision is the ability to interpret and understand what is seen.

Here is a classic example: Look at this picture, what is it?

Renshaw cow

It is an actual photograph of a familiar subject. Can you see it?

You may not initially be able to “see” the subject in the photo. Once you see what it is, it is almost impossible to not see it. Your ability to see clearly (sight) did not change, but your ability to get meaning from what is seen (vision) did. You just experienced the difference between sight and vision.

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cow 2

It is a photograph of a cow

Are there any underlying principles of vision that are important to understand?

A main principle is vision guides motor.
Vision is both sensory and motor, but vision motor is prime.

“Vision is the boss, it should lead; if not, it interferes. Vision leads, the body follows.” (Dr. John Streff)

Another is vision is developed.
Visual problems arise from interferences in, or inadequate development. As such, vision is trainable. (Dr. Robert Kraskin)

What are some of the more recent thoughts regarding lazy eye (Amblyopia) and patching?

Amblyopia is recognized as being a binocular (two-eyed) problem, that appears as a monocular (one-eye) issue. Binocular vision therapy is becoming the preferred treatment option.

To get lasting improvement to vision, you must improve the underlying binocular vision problem. Long term patching interferes with binocular vision and often has only short-term gains in clarity.

Besides improving overall visual skills, binocular vision therapy has the added benefit of minimal to no patching and no age limit.

What are the current thoughts on treating crossed eyes (Strabismus)?

Most cases of crossed eyes are from a difficulty in development. It is a lack of learning good binocular vision. The goal is to train binocular vision, which takes place in the brain.

What are some things to consider before undergoing eye muscle surgery?

It is important to realize that surgical success is based on the eyes appearing straighter, not on improved functional performance. Vision therapy focuses on the underlying binocular issue and the frequent functional visual difficulties present.

Following strabismus surgery, it is not uncommon to need additional surgery. Vison therapy can often resolve difficulties with strabismus and without the risks associated with surgery.

Larger deviations in strabismus may require a combination of surgery and therapy. By starting with vision therapy, you may avoid the need for surgery. If surgery is ultimately needed, you will have prepared the patient for a possible better outcome. This can be further reinforced with therapy following surgery and help reduce the need for additional surgeries.

What are some situations where the effect of poor visual skills is often overlooked?

Vision as an underlying performance issue is often not a consideration. This is often due to the misconception that if you can see clearly, your vision is good.

A list of common situations where visual performance is often lacking include, learning difficulties, attention deficit, autistic spectrum and acquired brain injury. A developmental visual evaluation in these populations is highly recommended. When problems are identified they can make great improvements through lenses, prisms and/or vision therapy.