The Space Between

Today’s guest blogger is Dr. Robin Price. Dr. Price practices in Pleasant Grove, Utah.  He and his associate, Dr. Jarrod Davies, are the only Board Certified Fellows of COVD in Utah!  In fact, Dr. Price just completed a term on the Board of Directors of COVD.  He enjoys working with patients of all ages to help them overcome their visual problems but especially children with learning problems. 

A Google search for “The Space Between” brings up a song written by the Dave Matthews band. “The Space Between” I am referring to is a chapter in Fixing My Gaze: A Scientist’s Journey Into Seeing in Three Dimensions. In this book, Susan Barry, a neuroscientist and professor of neurobiology, describes how she went from perceiving space as rather flat and two-dimensional to developing the ability to see in 3-D.

“Space was very contracted and compacted. So if I looked at a tree, the leaves or the branches would appear to overlap one in front of another. But I didn’t actually see the pockets of space between the actual branches. So the world was actually smaller and more contracted before my vision changed.”

After working with a developmental optometrist in a program of office-based vision therapy, Dr. Barry developed stereopsis, or 3-D vision. A critical part of appreciating stereopsis is seeing the space between objects.  She describes seeing a snowfall for the first time in 3-D as follows:

One winter day, I was racing from the classroom to the deli for a quick lunch. After taking only a few steps from the classroom building, I stopped short. The snow was falling lazily around me in large, wet flakes. I could see the space between each flake, and all the flakes together produced a beautiful three-dimensional dance. In the past, the snow would have appeared to fall in a flat sheet in one plane slightly in front of me. I would have felt like I was looking in on the snowfall. But now, I felt myself within the snowfall, among the snowflakes. Lunch forgotten, I watched the snow fall for several minutes, and, as I watched, I was overcome with a deep sense of joy. A snowfall can be quite beautiful—especially when you see it for the first time.

You can listen to Dr. Barry describe her new visual experiences here:

http://bigthink.com/ideas/43690

Dr. Barry was recently profiled by the PBS program The Secret Life of Scientists & Engineers. You can watch her here:

http://www.pbs.org/wgbh/nova/secretlife/scientists/susan-barry/

I had the privilege of attending a seminar in Atlanta, Georgia a few years ago with Dr. Barry. As part of the seminar, I stood side by side with Dr. Barry as we were viewing the Spirangle vectogram projected onto a wall. We both had 3-D glasses on, but our experiences were very different. Dr. Barry was saying how certain letters were popping out from the wall and others were in a space behind the plane of the wall. I, however, could see some letters popping out slightly, but none appeared to be behind the wall to me. Dr. Barry could see the space between; I could not. I have always had “normal” vision, but Dr. Barry’s appreciation of depth was greater than mine. Since then I have worked to appreciate the space between objects, and my depth perception has improved.

Now, we recently returned from the annual meeting of the College of Optometrists in Vision Development (COVD). It was a wonderful gathering of developmental optometrists and vision therapists from all over the world. It was wonderful to be together with such a large group of dedicated professionals who understand the neurology of binocular vision and how to help patients like Susan Barry. But now we’ve returned home to our lives and practices, and often feel isolated in our science. It will be another year until we gather again. So my question is: How are you going to take advantage of the “space between” to promote developmental optometry and optometric vision therapy? Will you take the messages from the meeting back to your patients? Will you put in place the principles you learned to educate the public? Will you keep in touch with your colleagues from the College of Optometrists in Vision Development to continue learning throughout the year? Can you appreciate the “space between”?

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Amblyopia Therapy — It’s No Longer Just For Kids

Amblyopia therapy –” it’s no longer just for kids.”   These are the words used by Dr. Michael DePaolis in a recent editorial in Primary Care Optometry News.  He describes a big moment in optometry, a paradigm shift in patient care.  New research has made it very clear that neuroplasticity in the adult brain is alive and well, and the implications reach far beyond the treatment of amblyopia.  But let’s start with amblyopia.

Dr. Dennis Levi explored the use of action video games to treat adults with amblyopia.  Why would playing action video games be an effective treatment of amblyopia?  “Action game play is extremely varied in its demands and rich in the set of visual experiences it offers.  Thus…. the very act of action game playing seems to train the brain to learn, on the fly, how to make the best use of the available information in the display, independent of the specifics of this display, allowing for the broad transfer of learning.”  Levi had 20 amblyopic adults play action video games with only their amblyopic eye.  All 20 subjects improved.  Levi speculates that video game playing is “arousing and rewarding.” Neurotransmitters such as acetylcholine and dopamine are released, and these neurotransmitters are associated with enhanced neuroplasticity.   Compliance is also enhanced, because action video games are more interesting and fun to play than many traditional vision therapy activities.

Now consider some incredible research by Dr. Elizabeth Quinlan.   Dr. Quinlan’s presentation at COVD’s annual meeting focused on the treatment of amblyopia, specifically on possible mechanisms to enhance neuroplasticity.  She has been recording the electrical response of the part of the brain associated with vision (aka the visual cortex) resulting from different types of visual stimulation.  In one series of experiments, she created amblyopic animals (in this case, amblyopic rats) by occluding one eye for an extended period of time.  The resulting pattern of visually evoked potentials from portions of the visual cortex was significantly altered in a pattern that reflected the lack of visual input from the occluded eye.  When the occlusion was ended and the animals had a chance to receive normal visual experience, this pattern of altered electrical activity in the brains of the rats did not improve.  In other words, there was no neurophysiological recovery when normal visual experience was restored.   That is, there was no neurophysiological recovery until she put these animals in the dark.  After placing these animals in total darkness for 3-10 days, and then providing a short period of “rat vision therapy,” these rats had a complete neurophysiological recovery.  The visual evoked responses from the visual cortex demonstrated a more balanced input from each eye.  The dark exposure enhanced the neuroplasticity of the visual cortex which is the basis for successful treatment of amblyopia.

Are we ready for another paradigm shift in the treatment of amblyopia?  Of course, this research was done with rats and involved recording electrical activity from electrodes placed into their visual cortex.  That is a very long way from clinical trials that might provide evidence of more effective treatment of amblyopia by enhancing neuroplasticity in the human brain after dark exposure.  But I cannot help but wonder …… can we provide a safe environment of total darkness for adult patients to enhance their neuroplasticity and then provide vision therapy programs that utilize action video games?  who will open the first Hotel Amblyopia?

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The Need (part 2)

Dr. Eric Borsting and colleagues are still investigating the diagnosis, treatment and consequences of convergence insufficiency.  The most current research from the Convergence Insufficiency Treatment Trial (CITT) which was presented at COVD’s annual meeting considers the behavioral and emotional problems associated with convergence insufficiency (CI).

Fifty-three children with symptomatic CI were enrolled in the study.  For each child, the parents completed the Child Behavior Checklist (CBCL) and the teachers completed the Connors 3 ADHD Index.  The children were then enrolled in office-based vision therapy programs, and 44 of them completed 16 weeks of treatment.  The parents and teachers then completed the surveys again.

When scores at baseline (pre-therapy) were compared to normative data, the children with CI had more symptoms on both surveys.  On the Connors 3 ADHD Index, the symptoms most frequently reported by teachers were inattentiveness, distractability and giving up easily.  On the CBCL, the symptoms most frequently reported by parents were somatic, such as headaches and eye discomfort.  Children with CI exhibited more symptoms and behaviors associated with ADHD than children with no visual problems.  Following vision therapy, the children showed significant improvement on both scales.  Treatment of convergence insufficiency resulted in a reduction in the behavioral and emotional problems reported by both parents and teachers.

Here’s the take-home message:  if your child has been diagnosed with ADHD or exhibits many of the behaviors associated with ADHD, your child needs a comprehensive vision examination.  If vision deficits are revealed, then vision therapy might be the most appropriate treatment option.  This study is another contribution to evidence documenting the power of vision therapy in the treatment of learning-related vision problems.

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The Splash – From Ripples to Waves

Check out this video highlighting a child that has been helped with vision therapy.  In the feature story, the child says he went from C’s and D’s to A’s and B’s in a matter of months.  To me it is another great example of how these developmental life altering vision problems can impact school performance and beyond.

This child’s developmental optometrist is Dr. Carol Scott.  She is the reason I am a developmental optometrist today.  During my first year of optometry school, Dr. Scott came and lectured about children she was working with.  She talked with passion about how so many of these smart, intelligent children were struggling in school due to treatable vision problems.  She talked about the profound impact treating these vision problems had on these children – in many instances, completely altering the trajectory of their lives.  Unfortunately, in our society,  if you cannot read well and therefore cannot perform well in school, so many doors quickly close to your future.  I knew during that lecture that this was the part of my profession I wanted to practice for the rest of my life.

In thinking about that moment, it is amazing how Dr. Carol’s seemingly small act of lecturing to a group of first year optometry students had such a profound impact on my life.  Before attending her lecture, I had considered vision therapy to be one of the last things I wanted to do in my future practice.  Now as a developmental optometrist I see the lives of children change everyday.

And so it is with vision therapy.  The way we will reach the many people who can benefit from developmental optometry  will be the accumulation of many little ripples.  The ever-growing number of lives affected and the ever-mounting body of evidence supporting vision therapy are becoming the waves that will bring our brand of optometry to the mainland.

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Dr. Don Getz — Strabismus and Amblyopia

Developmental optometry has lost another giant.  Dr. Donald Getz has died.  His dear friend and colleague, Dr. Robert Sanet had this to say:  “Don loved many things…. he  especially loved COVD, where he served as President and Master of Ceremonies at the Awards Banquet, and he loved mentoring optometry students.  Don and Lynn opened their home, and Don freely gave enormous amounts of his time and energy to hundreds and hundreds of students who visited him over the years.  Don was a great clinician and a tireless champion of behavioral optometry.  The impact of his generosity, friendship, and knowledge will be carried on through the lives of the patients whose lives were enriched because of his clinical expertise, and through the amazing optometric knowledge he shared with us.”

Dr. Getz received the Skeffington Award in 1988.  I happily re-read his monograph on Strabismus and Amblyopia, which was first published in 1974 by the Optometric Extension Program.  In the acknowledgements, he recognizes his vision therapist, Lora McGraw.  “She did not have the disadvantage of an optometric education, and, consequently, did not know that certain things were impossible.”  Dr. Getz and Lora McGraw were always pushing the envelope and thinking outside the box.

A strabismus is a condition in which the eyes are not aligned. One eye may be turned in (esotropia), out (exotropia), up (hypertropia) or down (hypotropia) relative to the fixating eye.  When the eyes are not aligned, this can cause patients to see double.  Even worse, overlapping images will cause 2 different objects to appear superimposed on the same location in space.   Brains find this “visual confusion” intolerable.  In fact, brains will go to great lengths to avoid double vision and visual confusion.  Having a strabismus will often cause a series of adaptations to avoid double vision, and perhaps permit the visual system to make the most of a bad situation. These adaptations include amblyopia (reduction in visual acuity and other visual functions), suppression (turning off the visual input from the turned eye), eccentric fixation (using an off- center point on the retina to denote straight ahead) and even anomalous correspondence (remapping the processing of spatial coordinates when both eyes are attempting to work together).  It is these adaptations that often make the treatment of a strabismus a difficult task.  These adaptations must be eliminated if a patient is going to learn how to straighten their eyes and keep them straight.

In his book, Strabismus and Amblyopia, Dr. Getz explains the importance of tackling these adaptations and then offers many different activities that can be incorporated into a vision therapy program.  He places great emphasis on the monocular phase of treatment. If monocular skills are not developed and equalized, binocular therapy will be very difficult;   or stated another way, if monocular skills are developed and equalized, binocular therapy will be much easier.

In addition to amblyopia, strabismic eyes have poor spatial localization skills.  The brain has learned to interpret straight ahead while the eye is actually turned.  This process of locating where objects are, and how far away they are, must be relearned, under monocular conditions.  If equal spatial localization exists under monocular conditions, it is almost impossible for the patient to have eccdentric fixation; and if equal spatial localization exists under binocular conditions, it is almost impossible for the patient to have anomalous correspondence.

I have prescribed many of the activities listed in his book as part of a treatment program for amblyopia, but re-reading his book has forced me to reconsider what I am attempting to accomplish.  Dr. Getz has reminded me not to overemphasize the visual acuity of the amblyopic eye.  Instead, attempt to improve and EQUALIZE the performance of each eye during these activities.  The visual acuity will improve along with the improvements in spatial localization and performance.  Even if visual acuity is never equalized, the patient may be capable of binocular function.  Equalizing the behavior and performance of each eye separately should not be overlooked or rushed in the therapy program for a strabismic patient.  The patient will now be ready to match the 2 “ocular circuits” and proceed to the binocular phase of therapy with greater likelihood of success.

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The Science: Performance-Related Symptoms

Convergence insufficiency (CI) is a common visual disorder that is characterized by great difficulty maintaining binocular eye alignment when looking at something close up (such as a book or a writing assignment).  This landmark study, funded by the National Eye Institute, provides strong evidence that office-based vision therapy is the most effective treatment for CI.  Treatment success can and should be measured 2 ways: objectively (looking at changes in measurements used in the diagnosis of CI) and subjectively (looking at changes in symptomology associated with CI).

The Convergence Insufficiency Symptom Survey (CISS) was developed to quantify the frequency and severity of symptoms reported by patients with CI.  The 15 symptoms on the CISS can be divided into 2 categories: performance- related and eye-related.  There are 6 performance-related symptoms evaluating visual efficiency when reading and/or performing near work:

• Loss of place
• Loss of concentration
• Having to re-read
• Reading slowly
• Trouble remembering what you read
• Getting sleepy when reading

The 9 eye-related symptoms include blur, headaches, double vision, tired, sore, uncomfortable eyes, words that move and jump, and pulling sensations around the eyes.

This study evaluated the symptomology of children with Convergence Insufficiency before and after optometric vision therapy.   Before vision therapy, the six most frequently reported symptoms were the six performance -related items. Fifty percent of all the children in the study responded “fairly often or always” when asked if they lose their place when reading.  Similarly, 45% of the children reported loss of concentration and having to re-read; 40% read slowly; 38% have trouble remembering what they read; and 37% get sleepy when they read.

Children with parent-reported ADHD (attention-deficit hyperactivity disorder) had significantly higher symptom scores on the CISS and the higher score was almost entirely attributed to an increase in the frequency and severity of these performance-related symptoms.

The good news is that ALL the children who responded to treatment reported a decrease in ALL their symptoms.  And while this study did not look at academic performance, the authors do note this relationship when they state: “the treatment of symptomatic CI may have a positive impact on reading performance and attention.”

What is the take home message?  If your child has a convergence insufficiency, it is important to consider both eye-related and performance-related symptoms.  Your child may not be complaining of blurred or double vision, but they still might have performance-related symptoms.  Loss of place, re-reading, poor reading comprehension, slow reading, sleepiness, poor concentration….. am I describing your child’s symptoms?  Have you considered a vision problem as a possible explanation?

Read more about convergence insufficiency here.

Reading more about vision and ADHD here.

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The Splash – Persistent Parents

Our guest blogger this month, Carrie Hall,  is one of the very talented vision therapists at my practice. She brings a unique perspective to the blog since she works with patients every week often times for many months.  Because of this,  she often gets to know the patients and their families on a very personal level and truly gets to know the struggles, trials, and triumphs patients go through.  At the conclusion of COVD’s National Vision and Learning month, I think her perspective into one of our patients is a perfect addition to what has been a great highlight of many inspiring vision therapy success stories.

As a vision therapist, I often see a theme among the parents that I encounter. Though they are of various ages, personalities, beliefs and styles, they often share one certain characteristic that sets them apart as vision therapy parents. They are incredibly persistent. They have been told many times in their lives that their children may not be capable of certain things. Perhaps by a doctor intending to give them a realistic expectation of the future, or perhaps by a teacher who is frustrated by a lack of success in their child. Whatever the source, I encounter parent after parent who has been informed that their child will not be capable of a certain level of ability, be it athletic,  academic, or just general life skill development.

Lynn was one such parent. Her daughter Shelby was simply not blooming in school like her older sister had. Reading was inexplicably difficult for this 8 year-old. Always a fight, often involving tears, Shelby simply would not take to reading. Lynn was baffled. Shelby was obviously bright and determined, a spunky and enthusiastic girl. It just didn’t add up. The pieces did not fit. Her eye doctors confirmed that Shelby’s vision was fine. She had 20/20 acuity, so the only reason why she shouldn’t be learning to read was if she simply wasn’t as smart as Lynn thought.
Perhaps some parents are more inclined to take the words of professionals at face value than others. Perhaps some parents simply refuse to be satisfied with an underwhelming determination of their children’s potential. Whatever is the mitigating factor, Lynn could not and would not be satisfied with this evaluation of her daughter. She persisted in her search. When she eventually found Washington Vision Therapy Center whose symptom checklist of vision-related learning problems read like a specific description of Shelby’s struggles, Lynn knew she had found her answer. When confronted with the financial strain that therapy would mean for her family, her persistence did not waiver. She would make whatever sacrifices were necessary: she would ensure her daughter’s chances for success in school and life no matter what.
Maybe persistence is a genetic trait as well. I certainly saw the same attributes in little Shelby that her mother demonstrated. Months after beginning therapy, after countless lifesaver cards and hart charts, Shelby was burnt out with it all. Who can blame her though? When the goal of all the work is just to get better at doing homework, it hardly seems a fair thing to ask of a girl of 8 who would rather be playing outside than getting better at reading any day of the week.
But like I said, maybe persistence is a genetic trait. Or perhaps it’s more nurture than nature. Whatever the case, Shelby persevered. Not only did she make it through therapy, she did great at it. She learned to be able to coordinate the use her two eyes like the best of them by the time it was all said and done. She and her mother developed a balanced working relationship in regards to this specific area in order to attack vision therapy head-on and accomplish every last bit of what Dr. Winters wanted to see from her clinically. Neither one of them would quit. Lynn pushed Shelby, and Shelby pushed right back in order to finish well. That little girl was the definition of persistence.
It’s the characteristic that marks out the parents, and the patients as well, for success. They are all up against diagnoses and school evaluations that make the future look bleak. They have been told repeatedly that they can’t, that they won’t. But they refuse to listen. Little fighters, they are, coming in and out of our offices defying the odds stacked up against them.
The other day, Shelby came up to her mother after doing some reading and said, “You know Mom, I think I like this reading thing.”  She is now at grade level in reading.  That is the payoff for any persistent mother.  Lynn has continue to fight to get Shelby’s story of hard work and persistence out to the public and she is now being featured on COVD for National Children’s Vision and Learning month.
http://www.cisionwire.com/college-of-optometrists-in-vision-development/r/mom-of-struggling-reader-finds-help-and-speaks-out-for-college-of-optometrists-in-vision-development,c9283372
Imagine that. A homeshooling mom from Yakima, Washington who believed her child’s struggles with reading were more than a resistant attitude or just that her daughter wasn’t smart enough. Persistence is a powerful thing.

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Building a House With Dr. Amorita Treganza

Amorita Treganza as “Miss Lemon Grove”

Dr. Amorita Treganza received the Skeffington Award  in 1986 .  She was another GIANT in developmental optometry.  She was instrumental in the birth of COVD as the national (and now international) organization of developmental optometry.  In fact she served as COVD’s first president, in 1971.   When I typed her name into Google, I was delighted to find this story about the celebration in Lemon Gove, CA, honoring her life and legacy , 100 years after her birth.  Dr. Treganza continues to be  an inspiration and role model for women pursuing optometry, especially those of us specializing in developmental vision.  Dr. Treganza is the co-author of Optometric Evaluation of Children with Academic Dysfunction, published by the Optometric Extension Program, from 1977-78. 

In her case presentation to parents, Dr. Treganza would often begin by separating the vision problem and the reading problem.  She would use the analogy of building a house.

Vision is the foundation.  Vision provides the platform, the stability and the strong beginning on which the remainder of the house will be built.  Reading is the structure of the house; the framing, walls, ceiling and finishing work.  The visual dysfunction affects reading efficiency.  It eliminates or puts crack in that foundation that is supposed to provide stability and strength.  Learning to read and reading to learn are both more difficult.  Attempts to teach that child to read may add a few boards to the walls of the house, but what might we expect if the foundation is unstable and weak?  The pieces won’t fit together and won’t function properly.  At best it will be disorganized, and at worst, it will be unusable!  In order to treat the academic dysfunction, it is necessary to start at the beginning, by rebuilding the foundation.  This can be accomplished with optometric vision therapy.  Then, it is possible to address the reading problem with the appropriate educational intervention.  The framing, walls, ceiling and finishing touches can be built.  Just as building a house requires a team effort (contractor, plumber, electrician, carpenter, etc) so does treatment of the academic dysfunction.  Optometrists, parents and educators must work together.

–August is National Children’s Vision and Learning Month–

So let’s build some houses, from the ground up.   If your child has academic problems, please schedule a vision examination today! 

Find a developmental optometrist in your area.

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Parents speak out about their children’s struggle with undetected vision problems

August is National Children’s Vision and Learning Month! This marks an important time of the year for public awareness of a critically important set of visual problems that can have serious impact on a child’s ability to apply him or herself in reading or other classroom activities in learning.  Parents are stepping up to tell their stories, like the one below by Kathleen Hayford who posted her child’s story on Pinterest.

“Our son struggled in school starting in second grade, once reading was required. He was frustrated, anxious, complained of frequent dizziness and headaches and was withdrawn socially. Over the years, he was diagnosed with various disorders, including ADD, Processing Disorders, Sensory Integration Dysfunction, anxiety, OCD. He had Occupational Therapy, Psycho Therapy, medication, and EEGs. Every year his vision was tested and he was 20/20. Clarity was fine.”

“Davis would scream out, ‘I’m stupid!’ more times than I’d like to remember,” Hayford continues. “He thought so little of himself.  Constantly frustrated, he developed anxiety that interfered with every aspect of his young life. It was heartbreaking for us as parents knowing he was a remarkable and intelligent boy, trying everything we could think of to help him, and not finding the appropriate help.

“Based on a tutor’s suspicion he had Dyslexia, Davis was referred to a Developmental Optometrist who tested and diagnosed him with Convergence Insufficiency, an eye tracking problem, and accommodation disorders to compensate. Basically, he had suffered with double vision because his eyes did not track together.”

After completing optometric vision therapy, Hayford shares, “He’s a new boy!!! He’s off the variety of medications he was on and is now an A/B student with increased confidence, less anxiety, and has better relationships. He is happier and has hope for his future. I wish we could have spared him the years of struggling and pain.”

A common theme within these parents stories of their children who have struggled, is a relatively common condition known as Convergence Insufficiency (CI). There are many reasons why obstacles block public awareness for this condition that affects over 20 million.  One reason could be its unusual name…Convergence Insufficiency. What is Convergence Insufficiency?  Take a look at this video produced by vision advocacy group, The VisionHelp and see if you have a better insight. Then please let us know your thoughts with a comment. We would especially like to hear from parents. Please speak out if you have a child who has struggled. Let’s all help make the 2012 August National Children’s Vision and Learning Month an event that will truly help more children struggle less due to an undetected vision problem…like Convergence Insufficiency!

 

Dan L. Fortenbacher, O.D., FCOVD

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The OK Plateau

Today’s guest blogger is Dr. Robert Fox.  Dr. Fox graduated from SUNY-State College of Optometry in 1985, after which he completed a residency in Rehabilitative Optometry at the Northport VA Medical Center.  He is in private practice in Schenectady, NY, and also consults on brain injury related vision problems at the Sunnyview Rehabilitation Hospital in Schenectady.  When not busy at his practice Dr. Fox likes to snowboard, play hockey, and golf.

The parents of our vision therapy patients are consistently amazed by progress in leaps and bounds made by their children in academics, sports, and many other areas.  We know the importance of the visual process in learning, motor performance, memory, and action.  Even knowing this, why do we often see gains often far and above that expected in the short time the child is with us at a pace with far exceeds the rate of gains made in other therapies such as occupational and speech therapies?  The answer to this may be the way we deal with the “OK Plateau.”

I just finished reading Joshua Foer’s book, “Moonwalking with Einstein:  the Art and Science of Remembering Everything.”  The book chronicles Foer’s year-long journey from a journalist covering the United States memory championship, to actually competing on the stage at this same competition.  He reviews the history of memory aids and mnemonics from the ancient Greeks to modern times.  He introduces us to brain injured patients who have lost the ability to remember anything anymore, and to savants such as the man who inspired Dustin Hoffman’s character in Rain Man.

Two aspects of this book made me reflect on what we, as developmental optometrists, do in vision therapy.  The first is the use of visualization.  Foer learns how our brains are incredibly good at remembering places and pictures, as opposed to abstract concepts.  Those skilled in instantly forming pictures in their head to which new concepts and ideas can be linked are much better at remembering things.  The ancient Greeks would take a visual walk through their homes, linking images to each room, to remember concepts for their speeches.  As developmental optometrists, we know how important it is to use parquetry blocks, visual mazes, and tachistoscopes in our vision therapy programs.  Visualization is considered by many the highest form of visual processing.

The second concept in Foer’s book is less obvious, but much more relevant to our success in vision therapy.  It is the “OK Plateau.”  In many activities we all reach a level where we seem to do well, but no longer improve.  Two examples are driving and typing.  After a couple of years of driving we settle into our levels of driving and don’t really improve much, despite continuing to drive regularly.  In typing, we start out awkwardly, but reach a certain speed and seem to stop improving.  This plateau is the time when we switch from learning mode to a more automatic, subconscious level of performance.  Foer learns that only by intentionally pushing yourself beyond your comfort zone and being willing to make mistakes can you reach a higher level of performance.

In this same manner, we use VT to push our patients into areas of learning and performance they did not think they could have success at.  Just when they think they have mastered a procedure, we go and make it harder with metronomes, balance boards, prisms, and other loading techniques.  We teach our patients that a plateau is just a temporary stop on a journey to higher levels of performance, thinking, and learning.  They realize that they can control the outcome of a variety of situations, be it in the classroom, the sports field, or life in general.  As a result our patients become more successful in and out of the therapy room and are grateful for the skills with which we have provided them.

“Moonwalking with Einstein” certainly made me think about how we attend to and remember things.  I plan on teaching some of my therapy patients memory techniques to show them that everyone has the capacity to remember large amounts of information.  I will strive to teach them that using what they learn in vision therapy can help them be successful in life.

Read more blog posts from Dr. Fox here.

Read more about motivating therapy patients here.

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