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The doctors and therapists at the Wichita Vision Development Center welcome you to our therapy clinic! You'll see some of our patients at work learning how to develop fully functional visual systems which will last them a lifetime!

Note: While every practice that provides vision therapy may be a little different based upon their size and philosophy of clinical care, this page will allow you to gather a general overview of some of the different types of treatment your child might receive during therapy. For help in locating a vision therapy practice in your area, contact the College of Optometrists in Vision Development, www.covd.org.

Before a child begins treatment, a full diagnostic workup is completed to determine low areas in a child's visual information processing. Normed- referenced tests check his visual perception skills, writing speed and precision, eye-hand and eye-body coordination, tracking, and visual reading efficiency. Combined with the information the doctor gathers during the clinical exam, these tests help us make decisions about treatment.

The Brock String is a simple tool which gives the child a great deal of visual feedback. It teaches the patient how to aim his eyes together correctly for varying distances in space and allows him to experience the difference between convergent and divergent eye aims. It also allows the child to determine if he is shutting off an eye, or suppressing, and tells him where his eyes are aimed and how far off his eye aim may be. This is usually one of the first techniques the child is taught and is often assigned as home therapy.

Computers are an important part of vision therapy treatment. Orthoptic software can create a wide range of visual stimuli and affords the variability to individualize techniques to meet each child's specific needs. The child can work on programs which train eye movements, eye coordination, stereo vision, and antisuppression techniques. Therapy always begins at a level where the patient can succeed and gradually increases the visual demands to stretch his range and skill.

This patient is working on a diagnostic and training machine called a cheiroscope. It's used to assess binocular stability and alignment and to detect the presence and extent of suppression. Suppression occurs when the patient's brain shuts off an eye by blocking its visual input when the child loses the ability to control his eye aim or alignment. Suppression is an adaptive neurological response to protect oneself from double vision. Training on the cheiroscope gives the child important feedback that he is suppressing and allows him an opportunity to gain the binocular control necessary to correct his eye aim and eliminate suppression.

Here a therapist works with a child on a fusional technique called an aperture rule. The patient is asked to look through a window in a slide at a series of targets placed at the end of the instrument. Each eye sees a different part of the target, and the child learns to fuse the two images coming in from his left and right eyes into a single picture. The therapist's role is to coach the child on ways to adjust his visual system to achieve the goal of clear, single vision.

The amblyoscope is a machine which trains a child to use his/her eyes together. The goal of the instrument is to help the child achieve binocular fusion, or normal two-eyed single vision with depth perception. As the child progresses in skill, the doctor or therapist increases the fusional demands to stretch and normalize the patient's ability to efficiently use his/her two eyes together. This machine also allows a child to know when he/she is suppressing an eye; visual awareness is the first step in successful training.

Children with unstable visual systems often learn a neurological adaptation called suppression, in which their brains block the visual input coming in from one eye. Children unconsciously learn to suppress at very young ages to keep from seeing double. Suppression is never normal and is always a sign of an unstable visual system. Vision therapy trains the eyes to work together but to do so both eyes have to be "on." Here a therapist works with a child using special red-green lenses and a target with red-green letters. One eye can only see the red letters, and the other the green. If the visual system shuts off an eye, the child won't be able to see all of the letters. Antisuppression activities such as these make the child aware of when she is suppressing and allow her to gain control and learn to leave both eyes on simultaneously. This is especially important for children with wandering eyes, crossed eyes, and lazy eyes.

Lenses and prisms are always important in visual training. They modify the patient's world and allow him to the opportunity to create an appropriate visual response. Here a child is working on a focusing technique called accommodative rock. The "flippers" hold two different sets of lenses. One is a pair of plus lenses; the other are minus. By rapidly alternating between the two sets of lenses, the patient is forced to relax or increase focusing accommodation in order to clearly see the print, thus gaining greater facility and control over his focusing system. Patients always begin with lower powered lenses and gradually increase the strength at which they can successfully complete the task.

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This child is working on another focusing technique called "mental minus" that teaches him to control how much he's focusing. Focusing problems cause children to see blurry print, especially when they read small print for long periods or have to make a lot of focusing shifts between the board and their desks.
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This patient is working with special polarized slides called Vectograms. These slides allow a child to work with a variety of targets to train central or peripheral vision, flat fusion or stereo fusion, and convergent or divergent eye positions. The targets also help to control suppression, or the patient's tendency to shut off an eye when his visual system is stressed. Vectograms allow the doctor or therapist to control a wide variety of visual stimuli presented to the child while he is still operating in the natural seeing environment of free space.

Children with conditions called convergence insufficiency and exotropia have difficulty turning their eyes inward at close ranges. As a result, they often struggle in school because they simply can't maintain the inward eye aim required for reading and most closeup activities. These children have to be taught to converge their eyes. Here a therapist is helping a young patient experience the "tug" she should feel on both sides of her nose bridge as muscles located there contract and pull her eyes inward. Kinesthetic awareness is an important first step in teaching the child to control her eye coordination.

The saccadic fixator is an instrument which trains eye movements, tracking, visual memory, peripheral awareness, and visual motor integration. It allows the children to set goals for themselves as they continually strive to improve their last performance. Besides children with oculomotor dysfunctions, this machine is particularly good for young athletes; it improves their eye-hand-body coordination and response time. Overall, it's an excellent trainer for visual stamina and efficiency.

The rotator is a tracking instrument used to increased a child's ability to control where she's moving her eyes. The child is asked to place golf tees in a rotating pegboard. As the child's skill improves, the speed at which the pegboard is rotating is gradually increased. This procedure is usually done while the patient is wearing a patch over one eye. Strong monocular ("one-eyed") skills must be gained before a child can achieve good binocular, two-eyed skills.

The walking rotator integrates the child's eye movements with his or her body movements. The child is asked to find letters or pictures on the turning wheel as he walks on a raised rail. This activity not only helps tracking skills, but it also improves visual motor integration skills. Our visual systems are continually sending information to our bodies to help control movement, balance, coordination, and define where we are located in space. Children who have poor control over their visual systems often have poor control over their body coordination. These children appear awkward and clumsy, do poorly in sports, and may find it difficult to learn to ride a bike. Fine motor skills are also affected. Poor handwriting is a common problem of children with poor eye-hand coordination.

These are samples of some of the many techniques and procedures used by children in our therapy room to help remediate their poor visual skills. Therapy sessions are always individualized to meet the child's specific visual needs. Patients' improvements are regularly evaluated to monitor their progress, and their therapy program modified as they reach each treatment goal. In addition to in-office treatment where children learn control over their visual systems, our patients are also asked to do home therapy each day to reinforce their new skills and ensure the changes become permanent.

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