As I am nearing the end of my residency year, I have realized that there is hardly ever a vision therapy evaluation where the patient has had one simple diagnosis. Dr. Barry Tannen, my residency supervisor, and I often joke that my one and only simple vision therapy patient came a few weeks into my residency and that I will probably not have another by the time I finish.
With all jokes aside, I believe that doctors often do want things in black and white: a straightforward diagnosis with a straightforward solution. However, when you are dealing with children with learning issues, acquired brain injury patients and post-concussion patients, this is just never the case. As health care providers with the knowledge and expertise in the visual system, we must act as advocates and a liaison to our patient’s that their ability to gather, process and integrate visual information may be what stands in their way to success.
This is why it is crucial to integrate visual processing testing into your vision therapy evaluation. This piece of the puzzle will help you better understand your patient, their visual system and how they are functioning.
Here are few tests that I suggest to add into your work-up:
This is most commonly tested through the PTS program, which looks at both simultaneous visual memory (tachistoscope testing) and sequential visual memory (visual span). This component of visual processing is important to obtain the maximal visual information in the shortest time possible for optimal academic and athletic performance. The ability to retain this information over an adequate period of time is essential for proficiency in reading comprehension and spelling.
Visual Motor Integration:
If you have a child who has poor handwriting or avoids sports at all cost, it is important to test for visual-motor integration issues. Typically, visual information is taken in and then integrated with other systems in order to generate a motor response. This skill is essential in spelling, copying from the board, and athletic abilities. The easiest and most reliable test of visual-motor integration skills is the Beery Test of Visual Motor Integration.
Other Visual Perceptual Difficulties:
A visual perceptual disorder results in the inability to adequately interpret, process and organize presented visual information. A delay here may cause difficulties with reading, writing and/or math. Using the Test of Visual Perception (TVPS), you are able to screen for many types of visual perceptual skills such as visual discrimination, visual closure, visual memory and form constancy.
Possible Reading Disability:
This is an important distinction, and one that is too often overlooked, to make before you began a course of vision therapy. We screen every one of our vision therapy patients with a phonetic skills test (WIAT-II), a test of silent reading fluency (TOWSRF) and if indicated the dyslexia determination test (DDT). It should be clear to the parents that we are not making the official diagnosis of a reading disability, but we can make the appropriate recommendations when necessary.
At the end of day, the person sitting in your chair wants answers for the etiology of their symptoms. Young or old that patient is someone who trusts your expertise and believes you are giving them a full examination. By evaluating their visually system as a whole, your therapy will be able to address all of their visual issues and in turn, give them a complete vision therapy experience.
And if you do come across a patient with a just convergence insufficiency, remember to enjoy the simple things in life 🙂