When a Vision Related Learning Problem is not Convergence Insufficiency

Reading trouble.

It seems that when Vision Therapy is mentioned then the following condition seems to be automatically mentioned and that is Convergence Insufficiency (CI).  CI  is that binocular condition in which the two eyes have difficulty maintaining near demanded tasks. This condition may result in double vision, asthenopia, and headaches.  No wonder it would cause reading issues as well as learning related problems. But, you don’t have to have this visual condition to have a visually related learning problem.

General visual skills dysfunction can be comprised of inadequate teaming skills, inadequate eye movement skills, focusing (Accommodative) problems or visual processing skills.

Teaming skills can be inadequate. This means that the skills may not provide the desired ranges necessary  for free and easy binocular movement of the eyes. The eyes seem to fatigue easily, asthenopia or discomfort sets in, headaches may or may not occur, or the individual just has no desire to read for any length of time.

Eye movement skills may be inadequate.  Simple observation may reveal inadequate fixation or scanning skills.  Evaluation may include but is not limited  to Fixation tests such as the modified King-Devic test.  A timed test of displayed single digit numbers in an array called out by the patient.

Focusing problems may be exhibited by what the optometrist refers to as Accommodative Infacility.  AI is an inability to change focus rapidly from near to far and then far to near.  Usually the child is slow at copying information from the board. This exhibits a delay in focus slowing down the child as he waits to receive the distance information and then responds with the near activity which is in most cases writing the information down.

Visual Processing skills can be measured in a variety of ways;

1) Visual Memory

2) Visual Motor Integration Skills-Speed and Accuracy


4) Letter Reversals

Visual Memory can be tested in many ways but so much information is gathered when the memory test is presented as a set of symbols that must be memorized and reproduced on paper. Visual Motor Integration-SA is an evaluation that requires the gathering of information (eyes), the processing of the information (visual brain) and then the integration or the use of this processed information. Visualization is tested by manipulating shapes in the mind.  It is an important skill especially when incorporated with reading.  In order to retain the written word it must be visualized.  Letter Reversals is a controversial area, but has been related to higher orders of vision in respect to visual processing. Due to the complexity and controversy of the subject, Letter Reversals will be discussed in detail at a later date.

Teaming, focusing, and fixation skills along with visual processing skills may be at the core of most learning related problems.

Dr. Dan



Mothers- this one is for you!

Happy (belated) Mother’s day!

To all the moms out there, we know how hard you work. We see it every day in our office. We see mothers who come in and are doing everything in their power to see that their children are happy and healthy. We love it!

We know it’s a bit late, but we want to express our thanks and gratitude to all the mothers out there. This blog has been created to help many people, yet we know the vast majority of our readers are indeed concerned mothers. Those of you with children in vision therapy and those who are beginning to research the field, you’re on the right track!

We appreciate the schlepping back and forth between school and vision therapy, the hours spent assisting with homework and often dealing with your child’s frustration. It is our goal to help you find the answers and get the breakthrough you’re looking for in your child’s learning. We know it will pay off.  Without you and your dedication we wouldn’t be able to help get your child on track. We wanted to take this time to thank you for everything that you do.


So mothers, this one is for you. Happy Mother’s Day!


Keep an eye out for upcoming post on the “why’s” of vision therapy as Dr. Weinberg will be discussing the links between vision and learning.


What is Vision Therapy?

What is Vision Therapy?

The definition is very complex and after reviewing the Wikipedia information that fictitious Brittany’s mother may have perused she must have become even more confused by vision therapy. A better definition comes from the organization that certifies both doctors and therapists in the art and science of developmental optometry. The College of Optometrists in Vision Development is the world leader in this area.

The definition offered by COVD.

“Optometric Vision Therapy is:

A progressive program of vision procedures

  • Performed under doctor supervision
  • Individualized to fit the visual needs of each patient
  • Generally conducted in-office, in once or twice weekly sessions of 30 minutes to an hour
  • Occasionally supplemented with procedures done at home between office visits

Depending on the case, the procedures are prescribed to:

  • Help patients develop or improve fundamental visual skills and abilities
  • Improve visual comfort, ease, and efficiency
  • Change how a patient processes or interprets visual information

Optometric Vision Therapy Is Not Just Eye Exercises

Unlike other forms of exercise, the goal of Optometric Vision Therapy is not to strengthen eye muscles. Your eye muscles are already incredibly strong. Optometric Vision Therapy should not be confused with any self-directed program of eye exercises which is or has been marketed to the public. Optometric vision therapy is supported by ongoing evidence-based scientific research. Here you can read the latest research published on optometric vision therapy.”

However, this definition just does not tell us what vision therapy encompasses.

The Optometrist Network offers an alternative definition.

The definition offered by Optometrist Network.

“Vision Therapy is an individualized, supervised, treatment program designed to correct visual-motor and/or perceptual-cognitive deficiencies. Vision Therapy sessions include procedures designed to enhance the brain’s ability to control:

  • eye alignment,
  • eye tracking and eye teaming,
  • eye focusing abilities,
  • eye movements, and/or visual processing.

Visual-motor skills and endurance are developed through the use of specialized computer and optical devices, including therapeutic lenses, prisms, and filters. During the final stages of therapy, the patient’s newly acquired visual skills are reinforced and made automatic through repetition and by integration with motor and cognitive skills.

Now that we have established a working definition for Vision Therapy its important to note who benefits from Vision Therapy.

Who Benefits from Vision Therapy?

Typically children and adults with visual challenges, such as:

Learning-related Vision Problems have benefited from these services.

  • Vision Therapy can help those individuals who lack the necessary visual skills for effective reading, writing, and learning (i.e., eye movement and focusing skills, convergence, eye-hand activity, visual memory skills, and other related visual processing issues.).

Poor Binocular (2-eyed) Coordination

  • Vision Therapy helps individuals develop normal coordination and teamwork of the two eyes (binocular vision). When the two eyes fail to work together as an effective team, performance in many areas can suffer (reading, sports, depth perception, eye contact, etc.).

Convergence Insufficiency (common near vision disorder)

  • Recent scientific research — funded by the National Eye Institute and conducted at Mayo Clinic — has proven that in-office Vision Therapy is the best treatment for Convergence Insufficiency.

Amblyopia (lazy eye), Diplopia (double vision), and Strabismus (cross-eyed, wandering eye, eye turns, etc.)

  • Vision Therapy programs offer much higher cure rates for turned eyes and/or lazy eye when compared to eye surgery, glasses, and/or patching, without therapy. The earlier the patient receives Vision Therapy the better, however, our office successfully treats patients well past 21 years of age.
  • Recent scientific research has disproven the long held belief that children with lazy eye, or amblyopia, can’t be helped after age 7.

Stress-related Visual Problems – Blurred Vision, Visual Stress from Reading and Computers, Eye Strain Headaches, and/or Vision-induced Stomachaches or Motion Sickness

  • 21st century life demands more from our vision than ever before. Many children and adults constantly use their near vision at school, work and home. Environmental stresses on the visual system (including excessive computer use or close work) can induce blurred vision, eyestrain, headaches, etc.

Visual Rehabilitation for Special Needs – Traumatic Brain Injury (TBI), Stroke, Birth Injury, Brain Damage, Head Injury, Whiplash, Cerebral Palsy, MS, etc.

  • Vision can be compromised as a result of neurological disorders or trauma to the nervous system. Vision Therapy can effectively treat the visual consequences of brain trauma (including double vision).

Sports Vision Improvement

  • Strong visual skills are critical to sports success. Not much happens in sports until your eyes instruct your hands and body as to what to do! We can measure and successfully improve eye-hand coordination, visual reaction time, peripheral vision, eye focusing, eye tracking and teaming, visualization skills, and more.”

To summarize, the definition for vision therapy is at best complex and complicated. Vision and Vision Processing is involved  from Amblyopia to Sports Vision and everything in between.

Dr. Dan

Answering the ultimate question: What is Vision Therapy?

Working for a developmental optometrist it is inevitable that you will be asked the question,”what is vision therapy?” As an optometric technician it is our obligation to answer this daunting question. We all know the answer to the question, but for some reason there is a disconnect when explaining vision therapy to patients. Allow me to paint a familiar picture for you:

Our (fictitious) patient “Brittany” is referred by a local eye doctor. Brittany’s mother is so distraught she can’t keep it together in the office. She’s running a thousand errands that day, has three kids with her and now she’s been told her daughter is in need of vision therapy. Mom sends her three children to the play room and slides here iPhone out of her purse. She contemplates the term vision therapy but has no Idea what that means. She thinks to herself, “Google is my only friend.” Mom now studies what Google has told her, looks it over a few times to get a grasp of the concept and then peers over her phone to look at the optometric tech who is vigorously typing away at the computer.

“May I help you?” the tech asks sensing the question coming.

“Yes” the mother replies hesitantly. “The doctor told me Brittany needs some sort of therapy. What is that, is it like some sort of physical therapy?”

Their eyes meet and each seems just as puzzled as the other. The mother’s question is met with a low sigh as the optometric tech bites her lip while she conjures up the best response to the question. The tech musters up the courage to respond and replies with hesitation “yeah, it kind of is….but…there umm…there’s a lot of….well…no, not really”. After carefully rethinking her mumbled response the optometric tech comes back with a simple reply “it’s like exercising the eyes!”

Well, you can imagine what mom thought of that response. I have been in this situation before as an optometric technician, and believe me the problem has nothing to do with the competence of either party. Vision therapy is hugely complex and is not only difficult to comprehend but is equally daunting to explain. That is why I have asked Dr. Weinberg O.D. FCOVD to explain what vision therapy is for us. Keep a look out for Dr. Weinberg’s response in “what is vision part 2”.


In the mean time here are some helpful links:

Advanced Vision of Louisville


Welcome to ThinkVision

Hello blogosphere, welcome to the official blog of Advanced Vision of Louisville! Through this blog we intend to share our appreciation for the art and science of visual rehabilitation and learning. The two are interwoven tighter than any known fabric and we would like to show you how. ThinkVision will feature interviews with developmental optometrist Dr. Daniel Weinberg O.D. FCOVD, insight from the vision therapists at Advanced Vision of Louisville, patient testimonials and much more! Future posts are already in the works so stay tuned.


“The more that you read, the more things you will know. The more that you learn, the more places you’ll go.”

-Dr. Seuss, I Can Read With My Eyes Shut.