One might think that Vision Therapy (VT) is a new treatment strategy. The truth is that VT actually has been available for some time. Surprisingly, it was initially an ophthalmological approach. During the early 1900s, ophthalmology withdrew from its practice of VT (called orthoptics at the time) and optometry began to utilize its practice, developing it into what it is today.
Optometric Vision Therapy (OVT) began with techniques designed to develop eye coordination, focus and the integration of tracking (eye movement) skills. Gross motor, fine motor and perceptual motor skills were added in the 1940s and ’50s. The addition of central and peripheral space integration was gradually adopted into the vision therapy programs of today.
Interwoven within the development of OVT programs was the development of a Behavioral Lens Prescription (BLP), which was originally developed during the late 1920s by A.M. Skeffington, the father of Behavioral Optometry. This lens prescription was designed to be what was called a “safe lens.” This was a lens that a patient felt comfortable with and eventually developed into a lens that was designed to support efficient, effective and effortless visual function. The premise of a BLP, as well as an OVT program, is that vision is a developed (learned) process and that a lag in development or an insult to development can be reversed.
Recognize that although muscle systems are typically targeted in both BLP and OVT, there is rarely anything wrong with muscle systems themselves contributing to functional eye muscle disorders. Rather, treatment strategies are directed towards reframing messages sent from the brain controlling the eye muscle systems.
Some have questioned whether or not a BLP or OVT alone can take the place of the other. In other words, can just a BLP or OVT alone be all that a child needs to remediate visual dysfunction?
In order for you, the reader, to answer this question we need to define what is meant here by remediation. What I mean by remediation is this: Remediation is the result of a treatment program in which visual dysfunction is resolved in a way that visual process functions as if the dysfunction never existed, without regression and without the need for future booster programs. Consider remediation as visual recovery without regression and with continued growth and development beyond simply improving visual skills.
Although most optometrists believe that remediation is theoretically possible, most believe that it is not practical. I believe that remediation is not only practical, but it is commonly experienced in my practice. Through remediation a child can not only achieve efficient, effective and effortless visual function, they additionally can achieve a much greater, an advanced, stage of development that positively affects their self image. I think the analogy of a computer can be easily used to get a better sense of how visual dysfunction can create instability in a child’s sense of self. Think of a computer riddled with viruses. You’ll never know when there is something going to go wrong or when you might lose all that you have. Think of pressing enter or send and nothing happens. No, now something does happen; the screen just goes blank. Rather than something going wrong with your computer, a child with visual dysfunction may ultimately believe that they are what’s not quite right. They can become unsure of what they see and unsure that what they are seeing might change. This is what I call the Failure Syndrome (FS) in my new book, How Behavioral Optometry Can Unlock Your Child’s Potential. Once a child enters the FS he/she begins a downward spiral, not being able to follow and understand words on a page and subsequently, not being able to believe in what he/she sees. This can translate into not believing in himself/herself. Children get frustrated and they get anxious and they even may feel demoralized by not being able to function like all the other kids. They get to a point where they just don’t believe in themselves and, consequently, their ability to perform. The perception defining who they are has been changed. The point being made is this: Remediation not only addresses visual performance, but it also addresses the effects of the FS. It helps children who doubt themselves and doubt who they are develop into children who trust who they are and what they are capable of achieving. These children need a solid foundation upon which a true sense of self is established and ultimately a platform upon which they can reach their true potential.
Now here is the question that needs to be answered. Can a BLP alone, or can a particular OVT/(neurological) technique alone reach a true level of remediation? Although it is rather a direct process to somewhat restore visual function capable of improved visual performance, it is quite a different story remediating to a level of enhanced self awareness and improved sense of self.
An OVT technique or a BLP alone may very well improve function, but to create an effortless system that remediates requires much more. An OVT technique or BLP alone will leave a child “half baked” at best. Some may even suggest that all that can be potentially achieved can be performed by simply wearing a pair of glasses. Let me be clear, this approach is false. To be clear, the extent of your child’s visual program and the broadness of its approach will determine the potential of their true success.
An OVT program in conjunction with a BLP is the treatment of choice for remediation of visual dysfunction and the subsequent enhancement of self. Each plays an essential and pivotal role in the remediation of visual dysfunction. Within this comprehensive program a BLP provides specific benefits. It substitutes for a child’s effort to coordinate and focus his/her eyes. It redistributes effort put into coordinating and keeping my eye focused on what I want to look at and putting that attention on what I want to know. A lens will additionally help to maintain improvements achieved throughout the program and finally, a lens will help to prevent regression once an OVT program has been discontinued. It will help a child to continue to develop and achieve his/her potential success.
An OVT program on the other hand serves to set the stage to reframe messages sent from a child’s brain. This reframed message constitutes the level of improvement in visual function achieved and ultimately can reach a level of greater sense of self. Only with a comprehensive program combining a BLP and an OVT program can this level of remediation be reached.
It is your choice as a parent or as a professional who supports a child’s visual development and welfare. What level of development do you want your child or patient to achieve? Don’t be fooled, children won’t reach their full potential without going through the practice, but once the practice is completed and remediation is reached, your child will develop the visual skills needed to achieve his or her full potential success. Yes, they will actually continue in life going from strength to strength, and success to success. The choice is yours.
Vision Therapist Dr. Warshowsky has three offices: One in Roslyn, N.Y., one in Ringwood, N.J., and one in Riverdale in the Bronx. His book can be purchased through any of his offices as well as from Amazon, Barnes and Noble, and Jessica Kingsley Publishers. You can also find out more about his practice and find the number to call to schedule an appointment by visiting his website at: http://pediatriceyecare-roslyn.com/contact-optometrist.html.
By Dr. Joel Warshowsky
