FACT #14 Vision Training Therapy (VTT) VTT DOES WORK WONDERS to cure many vision disorders especially if it is a high-level program. Not all D-B Optometrists or traditional optometrists doing vision training therapy do high-level VTT. Some are less experienced with it, others lack in depth knowledge of vision development, processing, and perception so they choose not to do the complicated cases such as strabismus, amblyopia, vision disorders caused by head injuries, or LRVP. My VTT programs are high-leveled. In my, and many of the “giants” in our specialized field’s opinion, a high-level program has the doctor programming and directing the therapy session. I am in the therapy rooms the full hour of in-office VTT scheduled for once a week. In addition, high-level VTT should be done in what we call real space. A doctor who does only computerized VTT or most of his/her program with computerized techniques is not doing the best VTT, as it is known today. The highest level programs should involve both in-office and VTT procedures to be done at-home concurrently. The home procedures nurture, expand upon, hone, and integrate the processes of vision being worked upon in office, into and with other brain-mind-body systems. My programs incorporate a holistic, intersensory approach. In my VTT programs a parent (home VTT therapist) must be present the full hour in the VTT area while I work with the child. Adults in the program must also have a home therapist present if possible. Sometimes the “home therapist” interacts and assists the trainee on procedures at the office. This enables the “home therapist” to be more insightful and effective in the home based portion of the program. It also enables them to keep applying the vision principles learned in the program throughout the lives of all persons involved. The home therapist has to do the home based VTT procedures also. Over the years many of these therapists have told me that the home based program helped them in sports, safer driving, better thinking skills, reading longer without getting tired as they used to, etc. I have discovered over the years that I am unique by having a parent or other home trainer in the therapy area for the full time. I find it makes for faster and higher level visual gains because the trainer knows more about the program and really starts understanding how we are changing the vision system.
FACT #15 VTT is not “eye exercises The eye muscles are strong, often with no medical impairment of them or other structures of the eye. Even in cases of impaired eye muscles, etc. VTT helps the person to visually function better. VTT is a guided treatment program that enables one to undergo new or reorganize existing patterns of neural processing through professionally arranged vision activities. Various lenses, prisms, occluders, colored lenses, devices, and VTT instruments, are used while doing the activities, which set up unique conditions for the mind-brain-body to explore. The resulting neural stimulation and new thinking creates the enhanced neural processing resulting in better human potential and functioning. Remember again that we see with our brain/mind, not our eyes!
FACT #13 ADD and ADHD Most ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) sufferers have a vision problem that contributes to or primarily causes their ADD/ADHD behavior. Several of them also have allergies, developmental lags, diet, etc., contributing to their behavior. In my VISION assessment, as with LRVP cases, I often find they have inadequate eye tracking, eye coordination, focus dysfunctions, suppressions of vision, vision-perceptual-motor dysfunctions, and an inability to hold their eye alignment on an area of space for an adequate period of time. D-B Optometrists have known for years that where eye alignment goes, so does the mind and attention. If you cannot hold accurate eye alignment and sustained accurate fixation ability there is no way you can attend, sit still, and comprehend at normal levels! ALL THESE CASES SHOULD HAVE A D-B VISION EVALUATION AS PART OF THEIR DIAGNOSTIC WORK-UP. In my opinion, Ritalin and similar acting drugs are way over-prescribed too often to treat symptoms and not causes, in light of today’s knowledge.
FACT #12 Deviated or Lazy eye Any child or adult with a turned, deviated (strabismus), or lazy eye (amblyopia) should be evaluated by a D-B-Optometrist. High level vision training therapy is the best treatment program to eliminate, or greatly reduce these visual problems. Surgery alone is often the least desirable and effective therapy method to enable the brain to be able to reuse the two eyes together again as in normal binocular vision. Surgery treats the symptom (turned eye) but does not address the usual cause (a severe vision problem) in most cases of turned eyes. Vision Training Therapy should be tried first to straighten an eye. If after VTT the eye is still not as straight as desired, surgery can be performed for cosmetic purposes. This gives a better chance of the eyes holding straight longer due to the prior VTT developing better binocular neural patterns. Eyes which have had prior eye muscle surgery only, can at times achieve better alignment and binocular neural patterning with VTT, but the success rate is diminished due to neural binocular compensations, in many cases.
I have straightened a number of deviated eyes without surgery, and raised the eye sight and vision abilities of a number of amblyopic eyes through Vision Training Therapy techniques. In some cases, patients were told by many eye doctors that nothing else could be done except additional eye surgery in deviated eye cases and those with amblyopia were told not to expect better vision in the amblyopic eye! Neural studies now show that there is no “critical period” in vision development in many amblyopia cases that precludes sight and vision improvement at a later date with proper VTT methods. Many of the doctors are not keeping up with this current knowledge and as previously stated, often tell their amblyopic patients, “Nothing else can be done to improve the sight in that eye.” Usually the only attempt to raise the sight of the amblyopic eye was to patch the good eye for a period of time! Compared to today’s knowledge this is a very low-level form of therapy for amblyopia (lazy eye), with limited results in many cases.
FACT #11 Basic vision screenings. Most school and pediatrician's so-called vision screenings are often basic “sight” screenings that often cannot detect many vision imbalances affecting learning potential.
FACT #10 D-B-Optometrists are the most highly trained and skilled eye care providers to diagnose and remediate LRVP. We have standard optometric training but have gone on to specialize in a more expansive, holistic, knowledge of the process and development of vision. The degree to which we acquire vision influences our total development, use of intelligence and many of our behavioral patterns. This is where the behavioral part of our title comes from. The developmental part comes from our knowledge of the sequence of development of the human vision system from birth through adulthood and our knowledge of guiding and directing vision to it’s fullest potential. D-B Optometrists utilize traditional and expanded holistic methods to determine the best spectacle prescriptions and treatment methods; including contact lens fittings and treatment of certain eye diseases. Most of us also specialize in Vision Training Therapy (VTT) as previously discussed.
FACT #9 Learning or Reading difficulties Any child or adult with learning and/or reading difficulties should see a D-B optometrist to rule out a learning related vision problem (LRVP). They should do this even if their family eye doctor tells them it is unnecessary because the doctor's exam revealed “20/20 and healthy eyes.” Most of the children I’ve worked with and diagnosed as LRVP had 20/20 without glasses and healthy eyes! Many of their family eye care providers missed detecting the vision problem that was affecting their learning potential.
FACT #8 LASIK or other similar procedures.After LASIK or other similar procedures, the patient will often still benefit from prescription eye glasses. As previously addressed, these lenses can provide more comfortable, efficient vision while doing near visual activities. They also help the vision system to keep from regressing back into nearsightedness, astigmatism, etc., as time elapses. This reduces the need for future “enhancements.” Remember-LASIK and similar procedures only address the refractive status of the vision system at the time of the procedure.
The human vision system often does not stay static, it can keep changing as it is stressed and used over time. Studies show that prolonged vision stress, especially within near distances, often can induce increases in near sightedness and a breakdown of many vision skills. Some of these skills that become unbalanced are eye tracking and coordination, focus ability, and accurate sustained eye-pointing skills. Properly determined prescription eyeglasses for the near distance tasks one engages in can help guard against these vision stress induced vision imbalances, even if the person sees “20/20” without glasses. There are many stress factors - external, internal, and mental, that a caringeye-visiondoctor can discuss with you. After the healing process of LASIK and other procedures, there can be a little “left over refractive error” that needs to be compensated for to see clearly for driving and other distance seeing tasks. Again glasses may be prescribed for this if needed.
FACT #7 Prescription computer glasses. Most people using computers, whether they are nearsighted, farsighted, or neither and they have “20/20” and healthy eyes, would benefit from prescription computer glasses. The prescription is specifically determined to allow the vision system to operate easier and more balanced when using computers.
For nearsighted persons, this prescription is of reduced nearsighted power rather than their standard full nearsighted prescription glasses. These glasses often allow more comfortable vision and less myopia progression as stated above. If a person has “20/20” without glasses, their computer and near visual task glasses are in a low powered, farsighted prescription form. Many of my patients have told me that their previous “eye” doctors never discussed these options with them! (Facts #6, #7, and the near lenses for young, non bifocal age patients in #8.)
I’ve often seen rapid increases in nearsightedness, a break down in some vision skills such as eye tracking, and focus ability, develop due to computer use, especially if the person is wearing their full nearsighted prescription in either spectacles or contact lenses. If the person has adequate vision skill development, sets up the computer station like they learn in my 1 ¼ to 1 ½ hour vision exam, and wears the appropriate computer prescription, this rarely happens in my patient population.
FACT #6 Full strength prescriptions. We D-B Optometrists, and even some traditional optometrists, know that if you wear your full nearsighted correction glasses indoors, or for prolonged near visual tasks such as computer work, reading, writing, etc , your nearsightedness can often increase higher and faster. For years, I have told my patients this and many have benefited from a reduced nearsighted prescription for these near tasks. The more they wear them in and around their homes in place of their standard full strength prescription glasses, the better their chances of reducing their nearsightedness or stabilizing it at their current level. I also suggest a pair of glasses to be worn with the full strength nearsighted prescription contact lenses to reduce their effective overall nearsighted power when doing near visual tasks for the same reasons. The result is more visual comfort and vision efficiency while doing these tasks especially at intermediate and near distances.
In a surprising number of my patients who do this, I find in the following year, a reduction in their overall nearsightedness or at least a stabilization of it!
FACT #5 Upselling eye glasses or contacts. In a number of cases, these discount exams and even non-discount short eye exams are not where the eye doctor makes his/her money. The temptation may be there to hope a person needs glasses or contact lenses where most of the doctor's profit lies. Often the average is a 200-300% markup on a pair of glasses, which I’ve always felt is an unfair price. But remember, they can charge what they want.
For years and even now, my prices for the exact same frames and lenses have been significantly less than most other optometrists and optical stores in the area. Also my materials charge for contact lenses is often lower than mail order companies like 1-800-Contacts, etc.
Your Eye Doctor Just Said Your Eyes are Healthy and you have "20 / 20" vision. Is that enough?
FACT #4 Discount eye exams. In my opinion there are too many traditional optometrists (mostly non D-B optometrists) emphasizing discount “eye” exams with a short duration of a half-hour or less. Too often I feel their main emphasis is to determine a prescription for glasses or contact lenses to enable a person to see clearly at a distance or if a person needs “reading” glasses for near visual tasks. These exams do include checks for glaucoma and eye diseases, but are often too short and often not geared to detect a true vision problem as we D-B optometrists define it.
FACT #3 Undetected vision problems. Many children and adults who have reading and/or learning difficulties often have an undetected vision problem affecting their learning potential that is missed by most standard optometric “eye” exams and most always totally missed by current ophthalmological “eye” exams.
FACT #2 VISION is learned and can be trained and enhanced. D-B Optometrists provide these services through programs called Vision Training Therapy (VTT). Not all optometrists who do VTT are D-B Optometrists. D-B-O is a specialty area of practice within optometry.
FACT #1 VISION is understanding what we see. It is the deriving of meaning and the directing of action from sight input. This is why “20/20” eye sight is not enough information to determine one’s vision. We see with our brain and mind, not our eyes! The eyes are only a tool we use to gather light from the external environment. What we do with that information determines one’s vision. Vision is the personal structuring, organizing, and interpretation of visual space.
Iam writing a unique, honest,non-profitmotivated no holds barred, information fact sheet on vision care, as I know it. I have had this on my mind for years, but I did not want to upset others in my, and related fields of eye-vision care. Many HMOs and insurance companies are often pressuring many doctors to alter their exam and treatment programs; some in ways the doctor knows is not what he/she would do for themselves or their loved ones. These outside influences can see “cost” care, not the best “health”care, as the bottom line. This, along with the tactics of some commercial optical centers and even fellow optometrists, has pushed me past the threshold point.
The following truths and facts are of my own opinion. They are derived from 30+ years of practicing Developmental-Behavioral Optometry (D-B-O) in this area. Many are supported by clinical studies within our profession, other professional fields, and hands-on clinical experience.
I HOPE YOU TAKE THE TIME TO READ THIS – IT WILL BE WORTH YOUR TIME!
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Facts About Vision
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Holistic Developmental, Behavioral Optometrist
Dr. Alan Sikes
IN CONCLUSION, a report from an eye doctor that your eyes are “20/20 and healthy” does not mean much in today's near-centered visual task environment and tells you almost nothing about your vision functioning. It is important, of course, to see clearly at a distance and near and to have healthy eyes. Most standard “eye” exams are often too short, lack the extra tests, and extended history questions to pick up many vision problems or a LRVP.
Most traditional, general optometrists, and almost all ophthalmologists lack the training and in-depth knowledge to diagnose and treat many of the complex vision disorders I’ve discussed at the level D-B Optometrists can. Watch out for bargain “eye exams.” They may mainly be checking for a prescription for glasses that often are sold at an average 200%-300% markup price, which I personally feel is excessive. From what you've learned, do you really think it is best for your vision system for you to wear your full prescribed nearsighted glasses for prolonged close tasks such as reading, writing, and computer work?
After LASIK and other procedures to eliminate your current “refractive error,” you would benefit from a spectacle prescription for more comfortable, efficient near vision functioning. After LASIK and other refractive techniques healing takes place, some “residual refractive error” is left at times, which may need “glasses” for compensation. Vision is learned and can be guided and enhanced through our holistic VTT programs. You learned that VTT is the best treatment plan for amblyopia, most crossed or deviated eyes, vision disorders from closed head injuries, and children with LRVP. ADD and ADHD individuals should be evaluated by a D-B-O as part of their diagnostic work-up, not just put on Ritalin or similar drugs to treat the symptoms and not the causes. All the “symptoms” that “diagnosis” ADD and ADHD can also be caused by the vision system being out of balance.
Many of these persons have undetected vision dysfunction contributing to their attention disorder. D-B Optometrists emphasize prevention and remediation of nearsightedness, astigmatism, and vision dysfunctioning, especially in children since their vision systems are still developing and more malleable. Even adults can obtain many of the same preventive and remediation benefits. Overall, if you have vision symptoms that other eye doctors cannot remediate, try D-B Optometry. We have specific training and knowledge in vision development, enhancement, perception, and vision processing to the extent that no other eye care provider has, and often are more holistic in our methodologies. Many optometrists choose not to go into the specialty area of D-B-O for different reasons.
Some of these may be due to it’s complexity, time to learn and keep up with, the doctor’s rightful interest to practice in other areas of eye-vision care, possibly a lack of interest in practicing with a more holistic, expanded concept of vision, and for some, unfortunately, because they think its concepts lack validity! For the last group I wonder if they still think chiropractic lacks validity as the medical profession stated for so many years! Even now a number of traditional optometrists won’t refer their patients to a D-B-O for needed care because their history questions and eye exam procedures may not detect vision problems as discussed in this paper. For some it may be out of fear of “losing a patient” once that person discovers the level of vision care D-B-O provides. I personally send the patient back to the referring doctor after I’ve completed their needed D-B-O treatment. Even during my treatment, if the patient needs different optical devices, I will send them back to the referring doctor to have the prescription filled. This is standard practice in D-B-O. Many ophthalmologists also won’t refer to us because they are often “so in the dark” and biased against non medical, holistic, vision treatment plans which their professional literature doesn’t contain. The real tragedy of course are those persons who may need D-B-O services as the best treatment plan, but are not aware of it. Remember, not all eye-vision care providers areas described. I’m just giving you information to help you develop better knowledge for your vision needs. In my opinion, if your eye doctor sees the need for D-B-O treatment, and doesn’t do it themselves, they should refer you out. If they do, I feel you have a concerned, caring doctor who is keeping up with the latest knowledge in a non biased, non profit motivated way. He/she is looking out for your best vision welfare. Keep with them! Feel free to call or schedule a visit at my office to discuss any of these “facts” or any unsolved vision difficulties you may have. My holistic vision exams, which everyone, especially children should have yearly, take approximately 1½ hours! We discuss and show each patient ways to help slow down, stop, or prevent becoming nearsighted, astigmatic etc. We discuss nutrition, posture, and go over many visual hygiene methods one can practice to increasevision functioning or to begin to alleviate or prevent vision dysfunction. Before coming to see me, many patients were never shown the best visual way to hold a book while reading to help ensure high level binocular (two eyed) functioning. They also were never shown or told by their eye doctor that they should not be writing on a flat surface! Failure to do these tasks properly can help lead to the development or increase of nearsightedness, astigmatism, or binocular vision problems. I fit many types of contact lenses and do pre and post operative LASIK vision exams. Yes, as discussed, I also do general exams like most eye-vision doctors, when a person needs to see better. Of course, these are more comprehensive and holistic than many other “eye” exams. Being a D-B-O, I’m strongly opposed to monovision (one eye set to see clearly at distance, and the other eye to see near tasks) in contact lens fits, after LASIK or in other forms. It goes against our core knowledge of the value of high level binocular functioning for the best human functioning through VISION. I also suspect that it may affect total health and cognitive functioning of the person over time. If you are currently in a monovision mode, I hope your eye-vision care provider at least discussed the benefits of you wearing glasses for distance driving, sports, etc, to enable each eye to set up more equal seeing. This can increase your binocular potential for better depth perception, visual reaction time, decision making etc. It may even lessen your chance of being in an automobile or other type of accident! I also feel that the doctor should discuss the benefits of prescription glasses for reading and other close visual tasks for the monovision person. These enable each eye to focus and coordinate together at near task distances. This enables the brain to integrate binocular processing which studies show is best for intelligence development and functioning. Besides regular VTT, I offer VTT programs for sports enhancement, developmental vision programs for young children and vision enhancement programs for older children and adults. These enhancement programs can also be for those who have no current learning or vision difficulties. Some enrolled are GT students or adults and children who just want to be all they can visually. This enables them to strengthen their vision abilities so they can keep up and not be held back by a breakdown of vision functioning under prolonged extensive visual task stress that they demand in their activities, schooling, or jobs. This is similar to a parent enrolling their child in a dance class for enrichment. Parents are getting wise to the fact that vision can be developed and enhanced with professional high-level optometric VTT programs. They understand that this can give their child the “edge” in sports, schooling, future vocations, and many other areas of life. I also give in-services at my office for teachers, doctors, school nurses, psychologists, or anyone else who wants to know about our D-B Optometric vision, concepts. At these in-services, I provide the materials and show them how they can conduct a much better vision screening of persons with which they work. This screening is better than most school and pediatric “eye” screenings for detecting a LRVP and other vision dysfunctions. If you have a child or you are an adult with reading or learning difficulties, our office has a great video tape entitled 20/20 Is Not Enough for you to borrow for the asking. We also have available books for purchase such as, How to Develop Your Child's Intelligence and Smart In Everything But School by G.N. Getman, O.D., D.O.S. who many consider to be the “father” of Developmental Optometry. As Dr. Getman would say, “Vision and intelligence are one in the same, as one’s vision abilities increases, so does their intelligence.” Every parent should read these books! You would gain more knowledge about vision processing and development and its effects on determining one's use of intelligence, than most eye doctors know! I know this is a powerful statement but it is true. I am not knocking traditional optometry or ophthalmology. Each eye care provider rightfully chooses those areas of interest they wish to practice. Currently they also have the choice of what to charge for their services, glasses, contacts, etc. This is unless they belong to an HMO, entered into specific visual contracts, or are affected by socialized medicine’s creep etc.
My purpose is to give you information, so you can choose wisely for your particular vision needs. Remember, there are few bargains in health care and parachutes, and there is a difference between “eye” care and vision care.
I COMMEND YOU FOR READING THESE FACTS!