A Process Approach to Treatment of Vision Dysfunctions

A Process Approach to Treatment of Vision Dysfunctions
Jeff Getzell, OD • Evanston, Illinois

ABSTRACT
This paper will present a process approach to the treatment of vision dysfunctions with the use of lenses and vision therapy. The process approach views vision dysfunctions as syndromes, potentially impacting cognition, posture, balance, movement, speech-auditory,emotions, and feelings. Performance lenses can be prescribed for most daily activities. A set of office vision therapy activities is performed in free or real space, most often slowly, relying on feedback to create change. This process requires the trainer to plant questions for the patient to consider rather than informing them of what they should be seeing. Diaphragmatic breathing, “hanging onto space, and good posture are fundamental ot each activity. Balance and movement are emphasized throughout the program.

Keywords: diaphragmatic breathing, dissociating glasses, hanging onto space, multifaceted activity

Introduction

Vision is a complex activity that interacts with various other processes. The intra-acting processes include eye movements and location skills (saccades), orientation, centering, identification, peripheral-central integration, visual memory, and visualization. The interacting processes include vision and cognition, posture, balance, movement, speech-auditory, vestibular, emotions, and feelings. Each process modifies or shapes another. The human brain carries out wide-ranging parallel processing, which can be impacted by contrary emotions and motivational influences.

Impact of Visual Dysfunctions

Visual dysfunctions rarely affect just a few skills; they generally impact the entire body. Inadequate centering, identification, or poor eye movement and location skills often signify more complex problems. Vision dysfunctions can affect cognition and communication, and may lead to various physical imbalances like:

  • Head tilts or turns
  • Shoulder, neck, and back tension
  • Leg weight imbalances
  • Locking knees
  • Heavy-footedness, toe walking, or difficulty standing in place

These dysfunctions may also cause shallow breathing, fidgetiness, fragmented behavior, tunneling, procrastination, frustration, and anxiety.

Performance Lenses in Vision Evaluation

In my vision evaluations, when new patients don’t require or wear compensating lenses, I often notice compromised cognition, posture, balance, movement, and speech-auditory patterns. Performance lenses can quickly impact these patterns. Types of performance lenses include:

  • Low plus lenses
  • Reduced plus for moderate to high hyperopia
  • Reduced or eliminated cylindrical power
  • Small amounts of prism (0.254 to 0.504 range)
  • Binasal occluders, tints, and spot or sector patches

The profoundness of performance lens evaluations is evident in the visible changes in most patients. These changes include better balance, walking with increased speed, taking bigger steps, lighter footedness, more accurate voice projection, and reduced fidgetiness.

Interactive Visual Therapy Techniques

During the therapy, I typically guide patients through exercises where the doctor or therapist and the patient maintain a 1-inch space between their hands. The patient’s job is to keep this space consistent as the therapist moves their hands. Slow and controlled movements (6-10 inches in each direction) are made, and the patient is asked to focus on breathing and synchronization of hand movements. If a hand moves slower or there’s a delay, it’s a signal that more attention is needed.

The Process Approach to Vision Care

A process approach to vision care acknowledges that patients experience real and perceived physical, physiological, perceptual, intellectual, and psychological stresses. Vision can deteriorate in response to acute or chronic stress, and patients should be educated about maintaining healthy vision through:

  • Visual hygiene
  • Avoiding being overly focused on small details
  • Maintaining awareness of the bigger picture

Key Components of the Process Approach

The process approach involves several key principles:

  1. Posture, Balance, and Movement – Establishing these as the foundation for creating a new space world throughout the program.
  2. Incorporation of HOS – Using head orientation strategies (HOS) in all activities.
  3. Diaphragmatic Breathing – Ensuring patients use diaphragmatic breathing during all activities.
  4. Feedback and Feedforward – Employing activities that provide immediate feedback and opportunities for feedforward learning.
  5. Visualization – Engaging the mind’s eye to enhance performance.
  6. Working in Free Space – Performing exercises as much as possible in real or free space.
  7. Use of Lenses and Prisms in Vision Therapy – Maximizing the impact of lenses and prisms during therapy.
  8. Critical Questions – Asking the following questions during each activity:
    • What do you see?
    • Does what you are seeing change?
    • Can you change how you are seeing?
    • What helped you in this activity?

    If a patient has performed an activity over multiple sessions, they are asked how their approach has changed over time.

  9. Feedback After Activities – After each activity, the patient walks around and reports on differences in how they perceive space, how their body moves, and how they feel.
  10. Slow and Deliberate Practice – Activities are conducted slowly to maximize the effectiveness of feedback.

Conclusion

In vision care, even small changes can lead to significant improvements in patients’ lives. A process approach considers the whole person, integrating posture, balance, movement, and the use of lenses and prisms to address and improve visual dysfunctions. By focusing on feedback and visualization, patients can experience profound shifts in their physical and perceptual abilities.

References

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  4. Getzell JH. The Power of Prescribing in Eighth Diopter Steps, Micro Prisms and Visualization. Great Lakes Optometric Congress, March 2012.
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  6. Loher JE, Migdow JA. Take a Deep Breath. Villard Books, 1986. https://amzn.to/2BKDYuG
  7. Francke AW. Introduction to Optometric Visual Training, 5th ed. Optometric Extension Program Foundation, Inc., 1988. http://bit.ly/2U3Q2yE

 

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