Have you ever heard of vision therapy? Not the eye muscle-building type, but the professionally administered vision therapy that actually makes changes in the brain? The individualized progressive treatment that uses optical devices such as prisms, filters, and lights, and integrates motor and cognitive skills? You’ve never heard of it? Then read on.

More than 50 percent of the brain’s neurons are connected to vision, yet few health care professionals, including those at trauma centers, are aware of the subtle but significant visual problems that often accompany brain injuries, concussions, or strokes. Even an age-related decline in vision can cost a senior his or her independence. But the benefits of vision therapy aren’t limited to the damaged or aged brain. Children who are doing poorly in school, or have behavioral problems, may also benefit from it.

Let’s look at damaged brains first. “Eighty-five percent of concussions are considered mild, and look normal on CT imaging,” says Debbie Luk, team optometrist for the Calgary Flames and member of the medical team at the Benson Concussion Institute, where she works with Olympic athletes. “That’s why most of them are missed. People don’t realize vision is such a big part of the brain and most people have a problem after concussion.”

For this reason, Luk performs eye-tracking tests with professional hockey players and establishes baseline times for eye tracking. “When they’ve been hit, they’re taken off the ice and we redo the test. If the test takes four seconds longer than the baseline, we know there’s a serious problem,” she said.

So, even when the emergency room doctor deems a concussion to be mild, getting assessed by an optometrist with advanced training, specifically in vision therapy, is prudent.

Brain injury (including from strokes) can prevent the brain’s ability to process information accurately. Common treatments, such as rest or antidepressives, are often ineffective. But using computerized and optical instruments such as prisms, colored lights, lenses, string devices, therapeutic games, and other devices, vision therapists can (over a period of two to six months) create remedial programs that are individually tailored to the needs of the patient’s brain, and which are progressive in nature. These therapies are proven, by research and imaging, to be highly effective for athletes, children, or geriatrics who have suffered some kind of assault to the brain.

“Damaged axons don’t show up in one area of the brain in a diagnostic image because they may be damaged throughout the brain,” said Dr. Rick Thompson, a Brampton, Ontario, optometrist and vision therapist. “There’s no relationship between the severity of the injury and the severity of the symptoms.”

A large number of people with brain injuries or concussions are unable to identify, or articulate, the problems they’re having. For instance, after having several concussions, I didn’t realize that words and lines of text were vibrating, making reading an exhausting undertaking for me. It wasn’t until after I‘d gone through vision therapy that the words and lines became still and I could read easily again. Then I realized the jarring textual movement I’d been battling.

Children can have unrecognized difficulties too, and they sometimes manifest as behavioral issues or poor academic performance.

“After a concussion, a child might say the letters on the eye chart, but if asked to read a book for, say 15 or 20 minutes, it might be overwhelming,” Luk said. “They might lose their place when reading, or have double vision, or a headache.”

Our eyes are meant to work together. They look at the same point, and should follow that moving point together, but if they don’t, or if there is a problem with depth perception (directly related to sports performance), visual memory, balance, difficulty seeing clearly up close or at a distance, or low-contrast issues are present (more on low contrast coming up), then safety and quality of life can become major issues.

“If the binocular vision is out of whack, with vision therapy you can re-learn how to track,” says Thompson. “Peripheral vision can also be lost with concussions, but regained through vision therapy.” And recent studies have shown that low-contrast issues, which can render a flight of stairs life-threatening to a senior, can also be improved.

Optometrist and vision therapist Dr. Greg Thompson (yes, the son of Rick, in a four-generation family of optometrists), said: “We’ve done quite a few stroke and peripheral vision loss cases. They can’t judge where the curb or stairs are.” The inability to determine where one stair ends and the next begins has caused countless numbers of falls and hospitalizations, but vision therapy helps patients determine the sharp edges of stairs by changing brain structure and increasing white matter at the visual processing center of the brain. These changes are actually visible on functional MRIs.

Greg Thompson hears the same plea repeated from many of his patients: Can I get my driver’s license back?

“People are desperate and grasp at anything to be able to drive again. They'll self-diagnose and come in desperate for treatment,” he said. Nerves need to fire together, and with some injuries or assaults on the brain, some circuits shut down so the brain can focus on other tasks.

“As we age, the brain prunes parts that aren’t needed,” he said. “Neuroplasticity is behind the effectiveness of vision therapy. It allows things to keep getting better.”

So how is it possible that your emergency room doctor doesn’t know about vision therapy and its benefits?

“We’re the only profession that is trained to diagnose and treat these conditions,” said Dr. Mitchell Scheiman, dean of research at Salus University. “The visual assessment the school nurse does on a chart is totally irrelevant.” A good vision test is much more than the wall chart we’re all familiar with.

“Twenty or 30 years ago, it was reasonable to think vision therapy didn’t work, but this is no longer the case,” Scheiman said.

“We’ve done the highest level of research, and much of it. We’ve done so much evidence-based research nobody can say vision therapy doesn’t work. We’re actually making changes in the brain that are visible on before-and-after (f)MRIs.”

However, Scheiman notes that vision therapy itself won’t improve reading or learning directly. It’s similar to how medications for ADHD work. Such medications allow the patient to concentrate, and through that, learn better. Vision therapy allows people’s brains to “see” better, hence they have the opportunity to perform better, whether catching a ball, passing a driver’s test, descending a flight of stairs, or any number of other activities.

For those considering vision therapy, look for an optometrist in your area who specializes in the practice. Some offer vision therapy via Zoom sessions.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00007-4/fulltext

https://www.neurovisualperformance.ca/education/research-papers/

https://journals.lww.com/optvissci/Abstract/2003/12000/Validity_and_Reliability_of_the_Revised.14.aspx