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Accommodative Dysfunction

Our eyes have a focusing system which automatically adjusts in order to see clearly at different distances. Our eyes rapidly change focus when we look far away, up close, and back again. If there is a problem with the flexibility of our focusing system, that visual disorder is called an accommodative dysfunction.


Normally, children have a large amount of focusing capacity. However, some children do not have the ability to sustain focus for long periods of time while reading, or they may be unable to quickly change the focus of their eyes from distance to near.


Accommodative dysfunctions can cause:

  • Blurred vision at distance or near

  • Eye strain

  • Headaches

  • Difficulty reading and concentrating

  • Avoidance of near work

  • Difficulty copying from the board to paper


Amblyopia is a neuro-developmental disorder of binocular vision commonly known as a “lazy eye” and is defined as reduced vision in one eye compared to the other. There are forms of amblyopia that involve both eyes, though this is less common. Amblyopia is an active process due to suppression, or the brain actively ignoring the information coming from one eye. In addition to poor visual acuity, people with amblyopia are more prone to have difficulties with depth perception, eye movements related to reading, and visual decision-making in driving. According to the National Institute of Health, amblyopia is the most common cause of visual impairment among children.


Amblyopia is treatable at any age. Recent research has shown that a binocular approach to treating amblyopia is an effective alternative to the previously used approach of patching. Less reliance on patching can help avoid unnecessary emotional stress on a child or the family.


Symptoms include:

  • Reduced eyesight in one eye

  • Lack of depth perception

  • Delays in visual information processing

  • Delays in visual-motor coordination


Treatment may include:

  • Eyeglasses or contact lenses (proper lenses can help reduce stress so that the under-used eye can start to work more efficiently)

  • Binocular vision development with 3D videos and gaming

  • Perceptual learning and visual processing development

  • Development of the accommodative (focusing) system

  • Eye-hand coordination training

Convergence Insufficiency

Convergence Insufficiency (CI) is a common binocular vision disorder in which the eyes do not work well together at near. Difficulty with convergence can cause frustrations with reading and near-centered tasks, including computers and tablets, due to poorly developed eye-teaming skills. Convergence skills are learned during our early years, and Convergence Insufficiency is a common problem with the development of these skills. The research shows that office-based vision therapy is the most effective treatment of Convergence Insufficiency.


Common symptoms may include one or all of the following:

  • Eyestrain (especially with or after reading)

  • Headaches

  • Blurred vision

  • Double vision

  • Inability to concentrate

  • Short attention span

  • Frequent loss of place

  • Squinting, rubbing, closing, or covering an eye

  • Sleepiness during the activity

  • Trouble remembering what was read

  • Words appear to move, jump, swim, or float

  • Problems with motion sickness and/or vertigo

Oculomotor Dysfunction

Oculomotor dysfunction (OMD, also known as Ocular Motility dysfunction) is characterized by a deficiency in one or more of the following visual skills: fixation, saccadic eye movements, and pursuit eye movements. Dysfunction of this nature prevents efficient reading skills and can also limit or reduce reading comprehension.


Symptoms include:

  • Loss of place and/or omission of words when reading

  • Difficulty visually tracking and/or following objects

  • Poor academic performance

  • Reduced efficiency and productivity

  • Poor attention span/easy distractibility

  • Muscular incoordination

  • Vertigo

  • Motion Sickness

  • Difficulty separating head/body and eye movements

  • Difficulty sustaining adequate pursuit or saccadic eye movement under cognitive demands

  • Inability to follow targets in proper sequence

  • Need for tactile/kinesthetic reinforcement while performing ocular motor activities

  • Increased time required to perform tasks dependent upon saccadic eye movements

Post-Trauma Vision Syndrome

Following a neurological event such as a traumatic brain injury, concussion, cerebrovascular accident, multiple sclerosis, cerebral palsy, etc., it has been noted by clinicians that persons frequently will report visual problems such as seeing objects appearing to move, which are known to be stationary; seeing words in print run together; and experiencing intermittent blurring.


More interesting symptoms are sometimes reported, such as attempting to walk on a floor that appears tilted and having significant difficulties with balance and spatial orientation when in crowded moving environments.


The visual process is part of a sensorimotor feedback loop, which includes kinesthetic, proprioceptive and vestibular processes. Insults to the cortex produced by an acquired brain injury or stroke cause stress or interference in the central and autonomic nervous systems. As a result, a brain-injured person may experience double vision, binocular dysfunction, or concentration difficulties. In the past, these symptoms were diagnosed as individual eye problems or muscle imbalances.  We now know that these eye problems and other reported difficulties that result from a brain injury often occur because of interference in the visual process. This, in turn, will cause sensorimotor spatial disorganization. The resulting binocular problems are characteristic of Post Trauma Vision Syndrome.


The Post Trauma Vision Syndrome is a disruption of the visual process, causing eye problems like difficulty with accommodative function, binocular fusion, and fixation ability. MRI findings are usually negative in post-trauma vision syndrome. The injuries suffered are most often diffuse and are caused by shearing and stretching of the brain fibers, as well as the neurotoxic cascade induced by the injury.

Symptoms include:

  • Double vision

  • Headaches

  • Blurred vision

  • Dizziness or nausea

  • Light sensitivity

  • Attention or concentration difficulties

  • Staring behavior (low blink rate)

  • Spatial disorientation

  • Losing place when reading

  • Can’t find the beginning of the next line when reading

  • Comprehension problems when reading

  • Visual memory problems

  • Pulls away from objects when they are brought close to them

  • Exotropia or high exophoria

  • Accommodative insufficiency

  • Convergence insufficiency

  • Poor fixations and pursuits

  • Unstable peripheral vision

  • Associated neuromotor difficulties with balance, coordination and posture

  • Perceived movement of stationary objects

Sports Vision

Sports vision training works on improving the visual abilities of an athlete that are necessary to excel in their sport. These visual skills include:

  • Dynamic Visual Acuity: Seeing moving objects clearly.

  • Eye Tracking: the ability to "keep your eye on the ball.”

  • Eye Focusing: the ability to change focus from one object to another quickly and clearly.

  • Peripheral Awareness: being aware of surroundings.

  • Depth Perception: the ability to quickly and accurately judge the distance and speed of objects.

  • Eye-Hand or Eye-Body Coordination: the ability to use our eyes to effectively direct the movements of our hands/body.


Sports vision training activities are done on a sport-specific basis with a custom-tailored program for each sport and athlete. A program for a tennis player will emphasize eye-hand coordination and dynamic visual acuity, whereas a program for a golfer will concentrate on visual alignment and depth perception to see the breaks in the green.

Our office has partnered with Pirates Baseball to offer sports vision training to their athletes. A variety of training tools and activities are utilized to enhance visual skills, including tracking, vergence and depth perception, peripheral awareness, and eye-hand coordination for improved performance on the field. Visit to learn more.


Strabismus, or "crossed eyes", is the inability to properly team and align both eyes together. This results in an eye that will appear to wander out of alignment, which in turn has a significant impact on an individual's functional vision. One eye may appear to turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia). The eye turn may occur constantly or only intermittently. Eye-turning may change from one eye to the other, and may only appear when a person is tired or has done a lot of reading. Strabismus may cause double vision. To avoid seeing double, vision in one eye may be ignored resulting in a "lazy eye" (amblyopia).

One approach to try to correct strabismus is eye muscle surgery, which may result in the cosmetic realignment of the eyes after one or multiple operations. While these surgeries aim to make the eyes appear realigned, the brain has not learned how to properly team the eyes so that they work together. As a result, the brain will continue to suppress the visual input from one eye, therefore, the individual will still experience poor depth perception.

Crossed eyes most often develop in infants and young children, although it can occur in adults. This may also be caused by:

  • Inadequate development of eye coordination in childhood

  • Excessive farsightedness (hyperopia) or differences between the vision in each eye

  • Head trauma, stroke, or other general health problems


Our treatment approach for addressing strabismus allows patients with this condition to achieve binocular vision, including the ability to perceive depth.


We often incorporate Syntonic light therapy during our treatment process. This is a branch of ocular science that utilizes specific light frequencies applied through the eyes. Syntonic light therapy can help improve treatment outcomes and often shorten duration of treatment.

Vision & Learning

Vision is our dominant sense and our primary source for gathering information in learning. Therefore, vision problems can have a profound effect on how we learn. Many children who experience academic difficulty may have a visual dysfunction in addition to their primary reading or learning dysfunction.

  • "25% of students in grades K-6 have visual problems that are serious enough to impede learning.” - American Public Health Association

  • "When vision problems go undetected, children almost invariably have trouble reading and doing their schoolwork. They often display fatigue, fidgeting, and frustrations in the classroom—traits that can lead to a misdiagnosis of dyslexia or other learning disabilities.” - American Optometric Association

  • "It is estimated that 80% of children with a learning disability have an undiagnosed vision problem.” - Vision Council of America

  • "A three-year study of 540 children found that those children who had visual perceptual and eye movement difficulties did poorly on standardized tests.” - Dr. Lynn Hellerstein, FAAO, FCOVD, Developmental Optometrist and Past President of COVD.


Unfortunately, parents and educators often assume that if a child passes a school vision screening, then there is no vision problem. However, school vision screenings often only test for visual acuity. In reality, the vision skills needed for successful reading and learning are much more complex. A child who can see 20/20 can still have a vision problem.

Vision is a complex process that involves over 20 visual abilities and more than 65% of all the pathways to the brain. One in four children has an undiagnosed vision problem which can interfere with learning and lead to academic and/or behavioral problems. However, it is important to know that these children frequently do not report symptoms because they think everyone sees the same way they do.

Often a child with a vision-based learning problem has excellent verbal skills, causing parents and educators to think the child must be lazy, have ADD/ADHD, or is learning disabled. The possible misdiagnosis can be due to similar symptoms, but the causes are not the same. Vision therapy can help teach a child how to control their visual system with more efficiency to become successful in their reading and learning abilities.

Treatment includes development of the following:

• Visual perceptual skills
• Oculomotor skills for improved quality of eye movements during reading
• Accommodative system for improved "focusing" skills
• Binocular vision skills for improved eye teaming
• Visual imagery for greater reading comprehension and recall

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