Catalan Association of Optometry and Vision Therapy

Treatments

The vision is a set of skills to identify, interpret and understand what we see. The eyes need more than 17 different functions to read efficiently. More than 35 brain areas are involved in whole or in part in the process of vision.

The development of these visual skills is progressive from birth. Much can be evaluated by a visual inspection to detect specific problems or symptoms, such as:

• Learning problems, strabismus, amblyopia (lazy eye), head trauma, problems focusing, visual perception problems.

• Symptoms such as headache, red or watery eyes, dizziness, low speed or reading comprehension, needing to move the head to read, little ability to remember what has been seen, not having 3D vision, reversing numbers or letters, not keeping the line straight when typing, poor handwriting, diplopic (double vision)...

All these symptoms and problems, among others, can be avoided, reduced or eliminated with good vision therapy treatment. For an effective result the method must be customized and monitored by an optometrist specialized in vision therapy.
Treatments

1. Ophthalmic lenses and prisms
In ophthalmic optics lenses are used to compensate for refractive errors. The refractive blur caused by an excess or a lack of power of the eye.

Refractive errors

Myopia: offset by negative lenses
Hyperopia: offset by positive lenses
Astigmatism: offset by toric lenses
Presbyopia is offset by positive lenses or multifocal lenses

The power of the lenses can be

Positive: compensate for hyperopia and presbyopia. They help to relax the focusing and help decrease the effort of convergence.
Negative: compensate for myopia. Stimulate focusing and convergence.

Depending on the power of the lenses, can be classified as

Monofocal: a single power (allowing the focus to a distance).
Bifocal, two potencies (allowing the focus to two distances).
Multifocal or progressive: more than two powers (allowing the focus to "all" distances).

A prism is a lens that if you look through it you observe an apparent displacement of the object that is fixed. The prisms may have a compensatory purpose or behavioral use (twin prisms, postural).

Compensating prisms are used

• When the person has difficulty in aligning the visual axis which will cause headaches, dizziness, diplopic (double vision).
• In strabismus, to compensate for the deviation of the strabismic eye or to provide a stimulus for a change in binocular vision.

Postural prisms are used to modify the perception of space resulting in a change in eye and body posture of the person.

Within this group are the yoked prisms. They are prescribed with equal power and base in both eyes. Used to treat binocular vision problems, incipient myopia in cases of brain injury and brain trauma (helping to change body posture and gait).

 
2. Contact lenses
Contact lenses are corrective or cosmetic lenses placed in the eye, particularly on the tear film that lubricates the cornea. These lenses are medical devices and must fulfill all requirements.

Contact lenses can compensate myopia, hyperopia , astigmatism and presbyopia.

In addition to aesthetics they have other advantages:

• It is the most convenient option for people who play sports.
• Improve peripheral vision.
• Not changing the size of the image, so they improve the binocularity in patients who have a different prescription in both eyes (anisometropia)
• Allow to have good visual acuity in patients with irregularities in cornea and do not improve with the prescription of glasses (keratoconus, post-refractive surgery, ...)

 
3. Orthokeratology
Orthokeratology is a clinical procedure that aims to reduce myopia using contact lenses. Lenses are specially designed to make a molding of the cornea while the patient is sleeping. This way when you get up in the morning it is like a visual acuity when wearing your glasses or conventional contact lenses.

Indications for ortho-k

• To 6 diopters myopia and astigmatism to 3 diopters.
• Evolutionary myopia in adolescents and young adults.
• People with sports or activities incompatible with the use of eyeglasses or conventional contact lenses.
• People who have professional reasons for the requirement of good visual acuity without correction.
• Patients who are unwilling or unable to undergo laser surgery for myopia.

The Orthokeratology is a procedure under development in the search for new designs that will also treat hyperopia and presbyopia.

 
4. Primitive or primary reflexes
The primitive reflexes are innate reflexes of the Central Nervous System (CNS) that enable humans to develop from birth. Some of these reflexes are: breathing, suction, grip, etc.

Should be integrated between 6-12 months giving way to the postural reflexes.
These are automatic responses that if kept beyond the stage that corresponds is evidence of developmental immaturity of the central nervous system.

These active reflexes each time are stimulated, cause an involuntary reaction preventing normal operation of the CNS.

If these reflexes are not integrated, they can cause movement disorders, inability to maintain a comfortable position for some time, constant movement, clumsiness, exaggerated responses to environmental stimuli, frequent tiredness, behavioral problems arising from their motor restlessness, lack of poor attention and visuo-motor integration.

Why do we evaluate them? We need to know the motor development and integration with other sensory systems, to determine whether this relationship interferes with proper development.

Common primitive reflexes:

- Moro.
Is connected to R. Tonic Labyrinthine, both are vestibular reflexes. Effects: Hypersensitivity sensory overreaction, insecurity, mood swings, poor pupillary reaction, oculomotor and perceptual problems, motion sickness, poor balance and coordination.

- Tonic Labyrinthine Reflex.
Hypotonic or hypertonic, walk hunched or tiptoe, disorganization, poor balance, does not like sports, car sickness, prevents crawling, oculomotor dysfunction and binocular, spatial problems, orientation and distance calculation , poor sense of time, fail with sequential task.

- Asymmetrical Tonic Neck Reflex.
Poor eye coordination, difficulty crossing the midline, ill-defined handedness, writing problems and poor expression of ideas on paper, focusing , binocular, visual perception problems and hand-eye coordination.

- Symmetrical Tonic Neck.
Inability to maintain a sitting posture, poor hand-eye coordination and slow when copying, problems of focusing from far to near, poor coordination when swimming.

- Spinal Reflex-Galant.
Nocturnal enuresis, rotation of the hips when walking, difficulty sitting, concern.

- Grasp reflex.
Manual difficulties, inappropriate grip, sucking reflex activated when writing, lexical difficulties in speaking, understanding and attention problems.

Having located the active primitive reflexes, preparing a Rhythmic Movement Therapy (MRT) to assimilate and automate these reflexes as it should have occurred in natural evolutionary development.

 
5. Visual Therapy
Visual therapy, visual training or visual rehabilitation is an optometric treatment, fully individualized, which aims to enhance and correct the problems of the visual system: focus, coordination of visual axes, lazy eye, strabismus or learning problems related to vision.

The optometrist prepares a personalized program of exercises to develop and maximize visual skills and integrating these with the other senses. Through repetition of these exercises the increased demand is achieved automatically of the visual system, i.e., creating new neural connections.

The visual therapy is effective for patients of all ages. You need to spend time, perseverance and effort needed to achieve the desired improvement. In the case of children also requires the collaboration of parents.

A visual therapy program consists of:

• In office therapy: usually works 1 time per week in sessions of 45- 60 min. with a series of specific exercises.

•Therapy at home: working every day for about 20 min. approx. The duration of a program of visual therapy can vary from 20 to 40 sessions depending on the problem and the objectives to be achieved. Throughout the program evaluations will be conducted to assess patient outcomes.

Visual therapy improves:

• focusing
• eye movement
• binocularity
• perception
• mathematical thinking
• visuo-motor integration
• laterality
• directionality

 
6. Hearing treatment
This treatment stimulates the central auditory processing (ability of our brain to recognize and interpret the sound stimuli). Auditory perception involves hearing, listening and interpreting.

Therefore, therapy is neuro-aural hearing quality, not quantity (deafness), so that the auditory information correctly reaches the brain.

Tomatis, Berard and Senna are different treatments of auditory stimulation.

Indications:

• Problems with language and speech
• Difficulty listening and remembering verbal information
• Hyperactivity
• Attention Deficit
• Dyslexia
• Learning difficulties
• Problems with concentration
• Memory problems
• Difficulties reading and writing
• Difficulties in reading comprehension
• School performance inferior to intellectual capacities
• Confusion in some sounds and words
• Difficulty pronouncing words correctly
• Difficulty following sequential orders
• Slow responses
• Hearing uncomfortably or painfully

Common symptoms:

• Otitis
• Covering ears
• Getting nervous in public places with a lot of noise
• Talks too high or screams
• Likes loud music, turn up the volume on the TV
• You have to repeat things several times
• Problems of attention in class
• Confuses phoneme, whether spoken, read or written
• Drain operated
• Delay in the emergence of language

 
7. Syntonic
Syntonic treatment, also known as optometric phototherapy, has been used successfully for 70 years in the field of optometry.

Is a treatment that uses the application of light through a colored filter with a specific frequency. The light enters the eye, not only helps us to see, but also comes as electrical impulses to the occipital cortex or visual cortex and follows other paths in the brain. Acts on the hypothalamus and regulates the nervous system from there, sympathetic and parasympathetic, pituitary, and also connects to the epiphysis. For this reason, the light has access to the whole organism and regulates and balances hormonal secretions of the pituitary-dependent, as the nervous system and synchronicity with our biological rhythms of nature (epiphysis).

The goal is to improve visual problems balancing the autonomic nervous system (sympathetic and parasympathetic).
Exposure to certain colors are known to vary the behavior, mood and physiological functions.

It is proven that a large number of children with learning problems have reduced the sensitivity of their peripheral vision, decreasing functional visual field. Light therapy is effective in expanding the field and in improving visual skills.

Indications:

• Focus Problems
• Convergence Problems
• Strabismus
• Amblyopia (lazy eye)
• Eye discomfort and headaches
• Photophobia (sensitivity to light)
• Reduced field of view: extended peripheral vision
• Learning disabilities (reading and writing)
• Attention Deficit
• Stress reduction
• Visual disturbances in emotional disorders: States of humor, anxiety
• Visual problems associated with brain trauma
• Degenerative disorders of the visual system
• Eye diseases.
• Improved physical and mental performance
• Improved the quantity and quality of sleep
• Increased ability to concentrate

Treatment:

Syntonic can be applied as primary treatment or accompanied by other therapies.
The treatment consists of 20 sessions lasting 10 minutes each. The frequency of the sessions is performed 3 to 5 times in a week.