What We Offer
Comprehensive eye care that extends to children’s vision, vision-related-learning difficulties, brain injuries, binocular difficulties (strabismus, convergence insufficiency, etc) and contact lenses.
CHILDREN’S VISION AND VISION RELATED LEARNING DIFFICULTIES
Your child’s vision is as important as their physical health. Eye tests as early as from the age of 6 months should be done to detect any early signs of eye diseases, strabismus and whether your child needs glasses.
The next eye test should be done at 3 years and then again at 5 or 6 years, just before your child starts school.
Is your child visually ready for school?
Many challenges your child may experience in the classroom can be related to visual problems. Visual ability is one of the cornerstones of academic performance. Information obtained, as the first step in the learning process, is transferred through the visual system to the brain. The visual system of the child must therefore be able to determine the direction of movement, speed, distance, colour, form and space of objects.
These abilities are not inherited but can be learned, developed and changed if necessary. If both eyes operate together effectively learning becomes easy. Eye teaming problems cause vision problems which had to information processing and learning problems.
Your child needs more than clear sight (Snellen chart test) to be able to read, to gather, process and understand information, to solve complex learning problems and to keep his eyes on the ball in a game of sport or to balance himself while doing physical exercises, which makes vision a complex process. Other visual skills, as indicated below, are needed to reach these achievements:
Fixation: aiming the eyes or shifting rapidly from one object to another (reading from word to word on a line).
Tracking: following moving objects smoothly and accurately (catching a ball; keeping your place when the book or the reader moves).
Binocular Vision: seeing with both eyes and combining information received through each eye to make one mental picture. Using one eye and mentally shutting off the other is SUPPRESSION.
Convergence: turning the eyes toward each other to look at near objects (words at reading distance), and maintaining eye alignment comfortably and efficiently over time (attention span).
Stereopsis: determining relative distances between objects by looking at them from two different places (the two eyes) simultaneously.
Field of Vision: the area over which vision is possible, including motion, relative position of objects in space, contrast and movement sensitivity in side vision (reading from line to line without getting lost on the page).
Form Perception: organizing and recognizing visual sensations such as shapes, noticing likes and differences (the difference between was and saw, that and what, 21 and 12, e and o).
A behavioural optometrist can do the necessary tests (comprehensive eye examination, binocular examination and visual perceptual) to determine whether your child will be able to process information through his visual system and ensure that steps are taken in time to help your child to reach his/her full potential. Visual-related challenges can be corrected or be improved with the use of lenses for reading and other near work as well as vision training programmes.
Acquired Brain Injury can come in many forms. Below are some common diagnoses:
- Traumatic Brain Injury
- Mild Acquired Brain Injury
- Mild Closed Head Injury
- Post-Concussive Syndrome
- Cervical Trauma Syndrome
- Post Traumatic Vision Syndrome
- Cerebral Palsy
- Cerebral Vascular Accident
Essentially, Acquired Brain Injury is an insult to the brain. It can result from a blow to the head, stroke, or neurological dysfunction. This can produce a diminished or altered state of consciousness, and may result in impairment of cognitive abilities, sensory processing and/or physical function. Impairments may be mild or severe; most are amenable to rehabilitation. Specific effects can be:
- Disturbance of behavioural or emotional functioning
- Partial or total functional disability
- Physiological maladjustment
- Visual dysfunction
Hidden visual problems
Often, visual problems resulting from Acquired Brain Injury are overlooked during initial treatment of the injury. Frequently these problems are hidden and neglected, lengthening and impairing rehabilitation.
Vision is the most important source of sensory information. Consisting of a sophisticated complex of subsystems, the visual process involves the flow and processing of information to the brain. Because there is a close relationship between vision and the brain, Acquired Brain Injury can disrupt the visual process, interfering with the flow and processing of information, resulting in vision problems.
Symptoms indicating vision problem are:
- Blurred vision
- Sensitivity to light
- Reading difficulties; words appear to move
- Comprehension difficulty
- Attention and concentration difficulty
- Memory difficulty
- Double vision
- Aching eyes
- Headaches with visual tasks
- Loss of visual field
Optometry and rehabilitation
Very few in the health care professions, including head trauma rehabilitation centers, are adequately aware of visual problems resulting from Acquired Brain Injury and the visual-perceptual consequences. Unfortunately, this creates a gap in rehabilitative services, resulting in incomplete treatment and frustration for the patient, family and treatment team.
The vision care professional can play an important role in the rehabilitation effort. Through vision therapy and the proper use of lenses, a behavioural optometrist specifically trained to work with Acquired Brain Injury patients can help improve the flow and processing of information between the eyes and the brain.
Vision therapy can be very practical and effective. After evaluation, examination and consultation, the optometrist determines how a person processes information after an injury and where that person’s strengths and weaknesses lie. The optometrist then prescribes a treatment regimen incorporating lenses, prisms, low vision aides and specific activities designed to improve control of a person’s visual system and increase vision efficiency. This in turn can help support many other activities in daily living.
What is strabismus?
Strabismus, or crossed eyes, is a condition in which both eyes do not look at the same place at the same time. It occurs when an eye turns in, out, up or down.
Why does strabismus occur?
There is a delicate muscle and nerve system that controls the position of the eyes. We have six muscles attached to a vast network of nerves that control their movements. Any disruption to those muscles and/or nerves that control them can result in strabismus.
Strabismus can also occur when the brain develops drastically different perceptions of visual space in each eye. A person’s perception of visual space is developed beginning at birth. Each eye should perceive visual space at the same time in order to work together as a ‘team’. When the two eyes develop very different perceptions of visual space, strabismus can occur.
Classification of strabismus
- Infantile Strabismus is strabismus that developed in the first year of life
- Acquired Strabismus develops after the first year of life. Acquired strabismus can be the result of an injury in the brain: blunt force trauma to the head, an aneurysm, a brain tumor and strokes are all examples of brain injuries that can cause strabismus.
Different types of strabismus:
- Esotropia: When one or both eyes turn in
- Exotropia: When one or both eyes turn out
- Hypertropia: When one eye turns up
- Hypotropia: When one eye turns down
Strabismus can occur constantly or intermittently and can involve one, both or alternating eyes.
Strabismus that only occurs some of the time is a condition referred to as intermittent strabismus. For example, the eyes may be lined up most of the time and only turn when fatigued; such as after extended periods of near work or when a person is sick, tired or stressed.
What happens when the two eyes don’t work together?
Strabismus primarily occurs because the two eyes cannot work together. Our eyes generally work as a team, fixing on an object and sending two slightly different signals to the brain. The brain then combines those signals and produces a 3D image. This creates depth perception.
If the two eyes don’t work together, the brain can’t combine these signals to form a single 3D image. The result is two misaligned images, which is double vision. It’s like watching a 3D movie without a set of 3D glasses. Combining the images effectively is something that must be learned after birth.
When double vision occurs, the brain sends new signals to the eyes to change alignment in order to get the image together. Some people have constant double vision, while others learn to suppress the information from the one eye so that they won’t have double vision.
Symptoms of strabismus:
The symptoms of strabismus seem fairly obvious: a person who has one or both eyes turned in, out, up or down.
However, there are also less obvious symptoms than an obvious eye turn. People who have strabismus may experience a number of different symptoms such as:
- Eye-strain and headaches or fatigue from near work.
- Trouble keeping their place when reading.
- Difficulty remembering what was read.
- Poor depth perception and even double vision all or part of the time.
If the eyes are misaligned, the brain will receive two different images, and confusion will result. In order to solve this confusion, the brain can ignore (suppress) the image from the turned eye. The advantage of suppression is that it may alleviate headaches, eye-strain or fatigue when doing near work. However, suppression can have serious consequences like reduced depth perception or the development of strabismic amblyopia in the eye being suppressed.
A person with strabismus may also simply avoid activities that may be difficult because of their condition.
Treatment of strabismus
Strabismus can be treated with surgery or vision therapy.
Surgeries for strabismus manipulate the muscles which control the alignment of the eyes in order to make the eye(s) appear straighter. However, surgery does nothing to address poor visual skills. Vision therapy, on the other hand, uses a series of vision activities to improve these visual skills. We strongly recommend to first do vision therapy before considering surgery.
What is convergence insufficiency?
Convergence insufficiency is a problem with eye ‘teaming’. Both eyes should point in the same spot and perceive visual space equally in order to work together as a team and provide efficient vision. If you have convergence insufficiency, your eyes will be aligned most of the time, but there may be periods when they aren’t. Your eyes may drift outward when you’re reading or doing close work, which can result in double vision.
What causes convergence insufficiency?
Convergence insufficiency is caused by a poorly developed perception of personal visual space. Good perception of personal visual space is when the things you see and their actual position are one and the same.
What are the symptoms of convergence insufficiency?
You may experience the following symptoms when doing any type of close work, including working on a computer and reading. The more work you do and the more fatigued you are, the more pronounced the symptoms will become.
- Blurred vision
- Double vision
- Inability to concentrate
- Short attention span
- Frequent loss of place when reading
- Squinting, rubbing, closing or covering an eye
- Sleepiness during the activity
- Trouble remembering what was read
- Words that appear to move, jump, swim or float
- Problems with motion sickness and/or vertigo
Convergence insufficiency can range from mild eye strain to strain so severe that you don’t want to look at an object up close. Severe cases can experience double vision.
How do you treat convergence insufficiency?
After we’ve diagnosed the severity of your convergence insufficiency, and whether or not other vision problems are involved, we then determine if a lens prescription can help.
A problem with visual space perception means that where you see things and where they actually are doesn’t match. These lenses are meant to help improve the mismatch between where you view the object and where it actually is.
Vision therapy includes a series of activities designed to help improve the patient’s perception of visual space.
What is convergence excess?
With convergence insufficiency, the eye tends to drift out. With convergence excess, the eyes tend to point at a spot closer than where the target actually is. For example, if a book is held at 40 cm away from the reader, the eyes may be pointing to a spot only 35 cm away. Like convergence insufficiency, this condition results from a poorly developed perception of personal visual space. People with convergence excess have just developed their perception of that space in a different way than someone with convergence insufficiency.
Note that you can have 20/20 eyesight and still have convergence insufficiency or excess. Tests such as the Snellen Eye Chart and other screenings generally don’t test for eye teaming and space perception, which can reveal convergence insufficiency or excess.