Top 5 Vision Therapy Tools 4/2/2020 1 TOP FIVE VISION THERAPY TOOLS Jennifer S. Simonson, OD, FCOVD Disclosure Statement: Consultant for g-Labs from 2013-2018 on development (no financial compensation) 2 LEARN WHEN TO STICK WITH THE OLD STANDBYS AND WHEN TO MOVE FORWARD WITH MODERN ALTERNATIVES iheartVT Simonson 1 Top 5 Vision Therapy Tools 4/2/2020 3 WORK MULTIPLE VISUAL SYSTEM PATHWAYS USING THE TOP 5 TOOLS OF TODAY SURVEY RESULTS 4 WHAT ARE THE TOP 5 VISION THERAPY TOOLS? A survey was sent to VTODs on Facebook (>2,600 members), Equipment distributors, and Vision Therapy course instructors iheartVT Simonson 2 Top 5 Vision Therapy Tools 4/2/2020 5 FACILITY ROCK FACILITY ROCK 6 ACCOMMODATIVE AND VERGENCE FACILITY ARE CRUCIAL IN TESTING AND THERAPY BECAUSE THEY MIRROR DAILY ACTIVITIES OF LOOKING FROM DISTANCE TO NEAR AND THE OPPOSITE. So much of our testing is static and smooth; Dr. Marc Taub facility activities are dynamic in nature. iheartVT Simonson 3 Top 5 Vision Therapy Tools 4/2/2020 7 Set includes: 6 cards Vergence Prism Patch Red/Green Reading Sheet Glasses FACILITY ROCK 8 ▸ Every exercise sheet includes 30 examples each of 2 acuity levels. 1) pre-school symbols 2) Landolt C’s (which test for recognition of direction) 3) Basic numbers (early school age) 4) 3 levels of words (school age) iheartVT Simonson 4 Top 5 Vision Therapy Tools 4/2/2020 9 FACILITY ROCK 10 THERAPY CAN BE ACCOMPLISHED: ▸monocularly ▸binocularly ▸under conditions of anti-suppression iheartVT Simonson 5 Top 5 Vision Therapy Tools 4/2/2020 11 Article by Dr. Marc Taub: http://optometrytimes.modernmedicine.com/optometrytimes/news/vision-therapy-10- more-tools-your-practice?page=0,2 BINOCULAR ACCOMMODATIVE12 ROCK “[THE PURPOSE OF BAR] IS TO GIVE YOU CONSTANT FEEDBACK AS TO WHETHER BOTH EYES ARE “TURNED ON” WHILE YOU ARE READING AND TO INCREASE THE SPEED OF YOUR ACCOMMODATIVE RESPONSE (FOCUSING MECHANISM) UNDER BINOCULAR CONDITIONS.” Optometric Extension Program (OEP) Description Reference: https://www.oepf.org/ iheartVT Simonson 6 Top 5 Vision Therapy Tools 4/2/2020 FACILITY ROCK 13 ▸ The Facility Test Set provides a broad set of tools to accurately diagnose and provide therapy for accommodative and vergence abnormalities. ▸ The set comes with +/- 2.00 D and 12 base out/3 base in flippers for use in testing or therapy EXPECTED LEVEL OF PERFORMANCE: 14 12 BO/3 BI GOALS ▸https://www.aaopt.org/detail /knowledge-base- article/vergence-facility- establishment-clinical- norms ▸NEAR: 15 cycles per minute ▸FAR: 12 cycles per minute iheartVT Simonson 7 Top 5 Vision Therapy Tools 4/2/2020 15 +/-2.00 FLIPPERS ▸ Monocular ▸ Age 8-12: 7 cpm ▸ Over 12: 11 cpm ▸ Binocular with suppression control ▸ Age 8-12: 5 cpm ▸ Over 12: 10 cpm ▸ http://www.optometrysm eeting.org/documents/h andouts/2015/2110.pdf TRANSPARENT TAPE AND A PAGE PROTECTOR 16 BUDGET VERSION ▸ 1/2 inch transparent tape in "red" and "green" colors (amazon) ▸ Page protector iheartVT Simonson 8 Top 5 Vision Therapy Tools 4/2/2020 17 1) +/-2.00 D 2) LOOSE LENS TRAINING (-4, -5, -6 ETC.) 3) TRIAL LENS SORTING LENS TRAINING 18 1) 12 BASE-OUT/3 BASE-IN 2) LOOSE PRISM TRAINING 3) YOKED PRISM GOGGLES PRISM TRAINING iheartVT Simonson 9 Top 5 Vision Therapy Tools 4/2/2020 19 VECTOGRAMS (VECTOGRAPHS AND ANAGLYPHS) VECTOGRAMS 20 3D IMAGES 1.Polaroid Vectograms and Vectographs 2.Red/Green Anaglyphs (TranaglyphsTM, Emergent) 3.Red/Cyan and Red/Blue (iPad or Computer) 4.Phantograms iheartVT Simonson 10 Top 5 Vision Therapy Tools 4/2/2020 VECTOGRAMS 21 FUSIONAL RANGE BUILDING 1.Convergence 2.Divergence RECORDING PERFORMANCE 22 FUSIONAL RANGE AND RECOVERY ▸ Range of clear vision ▸ Range of single vision ▸ Typically recorded as: ▸ BLUR / BREAK / RECOVERY ▸ Consider “point of effort or discomfort” ▸ And “recovery of comfort” or “recovery of clarity” iheartVT Simonson 11 Top 5 Vision Therapy Tools 4/2/2020 VECTOGRAMS 23 VISUAL PERCEPTION OF SIZE AND DISTANCE 1.Float (spatial localization) 2.Stereopsis (awareness of small differences in depth perception) VECTOGRAMS 24 VISUAL PERCEPTION OF SIZE AND DISTANCE 3. Types of Targets: ▸Contour (off-set line disparity) ▸Random Dot Stereopsis (local and global) iheartVT Simonson 12 Top 5 Vision Therapy Tools 4/2/2020 25 STEREOSCOPE TRAINING WOLFF STEREOSCOPE 26 BREWSTER TYPE ▸ These stereoscopes use Plus lenses – creating a focal demand equal to distance viewing (no accommodation) ▸ The lenses contain Base-Out Prism. This overlaps the target images so that no convergence is needed to fuse the images (no vergence) iheartVT Simonson 13 Top 5 Vision Therapy Tools 4/2/2020 KEYSTONE 27 28 BERNELLOSCOPE iheartVT Simonson 14 Top 5 Vision Therapy Tools 4/2/2020 G-LABS 29 ‣ iPad Stereoscope 30 iheartVT Simonson 15 Top 5 Vision Therapy Tools 4/2/2020 31 32 iheartVT Simonson 16 Top 5 Vision Therapy Tools 4/2/2020 33 34 iheartVT Simonson 17 Top 5 Vision Therapy Tools 4/2/2020 STEREOSCOPE FOR IPAD 35 SENSORY FUSION DEVELOPMENT ▸Luster ▸Level 1: Simultaneous Perception ▸Level 2: Flat Fusion ▸Level 3: Stereopsis 36 iheartVT Simonson 18 Top 5 Vision Therapy Tools 4/2/2020 37 38 iheartVT Simonson 19 Top 5 Vision Therapy Tools 4/2/2020 39 40 iheartVT Simonson 20 Top 5 Vision Therapy Tools 4/2/2020 41 42 iheartVT Simonson 21 Top 5 Vision Therapy Tools 4/2/2020 STEREOSCOPE FOR IPAD 43 VISUAL PROJECTION AND PHORIA POSITION ▸Van Orden Star (VO Star) ▸Cheiroscopic Tracing 44 iheartVT Simonson 22 Top 5 Vision Therapy Tools 4/2/2020 45 STEREOSCOPE FOR IPAD 46 CHEIROSCOPIC TRACING Picture Tracing Record Images iheartVT Simonson 23 Top 5 Vision Therapy Tools 4/2/2020 STEREOSCOPE FOR IPAD 47 TIPS FOR CHEIROSCOPIC TRACING EXERCISES ▸ Add a central fixation dot ▸ Add a peripheral fusion lock STEREOSCOPE FOR IPAD 48 TIPS FOR CHEIROSCOPIC TRACING EXERCISES ▸ Color in the shapes (vs. tracing) ▸ Can the patient see the image and the stylus at the same time? iheartVT Simonson 24 Top 5 Vision Therapy Tools 4/2/2020 STEREOSCOPE FOR IPAD 49 EYE ALIGNMENT AND FUSIONAL VERGENCE RANGES ▸Convergence ▸Divergence ▸Virtual Brock String ▸Smooth vergences ▸Step vergences 50 PHANTOGRAMS iheartVT Simonson 25 Top 5 Vision Therapy Tools 4/2/2020 51 MFBF GAME MONOCULAR FIXATION IN BINOCULAR FIELD MATCHING GAME MFBF 52 ACCORDING TO DR. MARC TAUB: ▸ “This activity uses the concept of monocular fixation in a binocular field, or bi-ocular, as some refer to it. ▸ This means that both eyes consensually react to the stimulus, but only one eye at a time actually sees the given stimulus. ▸ This is an intermediate step in accommodative techniques between monocular and binocular therapies.” iheartVT Simonson 26 Top 5 Vision Therapy Tools 4/2/2020 MFBF 53 INSTRUCTIONS: ▸ Put on red/green glasses ▸ Place the tiles on top of their match MFBF 54 ANAGLYPHIC THERAPY: ▸Using colored filters to provide different information to the right and left eye. ▸Red/Green Glasses ▸White tiles with red ink are viewed by the eye behind the green lens. ▸Red acetate with black ink is viewed by the eye behind the red lens. iheartVT Simonson 27 Top 5 Vision Therapy Tools 4/2/2020 MFBF LOADING 55 ‣ This activity can be made more challenging with the addition of plus and minus lenses on opposite eyes stimulating the control and accuracy of accommodation. I recommend changing the plus and minus lenses half way through the exercise. MFBF 56 DICHOPTIC THERAPY ▸1) Stimulation of the amblyopic eye ▸vs. penalization of the sound eye ▸2) Elimination of inter-ocular suppression iheartVT Simonson 28 Top 5 Vision Therapy Tools 4/2/2020 HOW TO MODIFY VISION THERAPY ACTIVITIES TO BE MFBF: 57 MFBF ▸ Perceptive, Carl’s or Sherman Cards: ▸ Sort out one color set. ▸ Acetate or plastic report cover: ▸ Place over material so that only one eye can see the detail ▸ Colored pencil or ink ▸ Only one eye can see the detail 58 iheartVT Simonson 29 Top 5 Vision Therapy Tools 4/2/2020 59 VIRTUAL REALITY 60 1. VIVID VISION 2. OPTICS TRAINER VR 3. HOME VR VIRTUAL REALITY iheartVT Simonson 30 Top 5 Vision Therapy Tools 4/2/2020 VIRTUAL REALITY 61 SETTINGS 1.Target size 2.Target speed 3.Contrast 4.Blur 5.Brightness 62 iheartVT Simonson 31 Top 5 Vision Therapy Tools 4/2/2020 63 64 iheartVT Simonson 32 Top 5 Vision Therapy Tools 4/2/2020 VIRTUAL REALITY VISION TRAINING 65 OPTICS TRAINER VR ▸ 8 games designed to make visual and sensory training fun and immersive. Our VR training objectives include: ▸ Depth Perception ▸ Eye Hand Coordination ▸ Multiple Object Tracking ▸ Reaction Time ▸ Peripheral Vision ▸ Visual Memory ▸ Contrast Sensitivity 66 iheartVT Simonson 33 Top 5 Vision Therapy Tools 4/2/2020 67 1.VIRTUAL REALITY 2.MFBF GAME 3.STEREOSCOPE 4.VECTOGRAMS 5.FACILITY ROCK 68 1.Dichoptic therapy (different stimulus to each eye) 2.Lenses (accommodation training) 3.Prism (vergence training) 4.Sensory fusion (stereopsis and spatial localization) 5.Visual perception: Discrimination, memory, and identification iheartVT Simonson 34 Top 5 Vision Therapy Tools 4/2/2020 69 Jennifer S. Simonson, OD, FCOVD E-mail: [email protected] www.bouldervt.com iheartVT Simonson 35.