As schools are reopening and online classes start to commence, kids are getting back into the school routine. For some, this maybe a very difficult time, especially if they have trouble focusing, reading or writing. As kids struggle through school, parents struggle to find out what is wrong and how they can help fix it. Vision Therapy has proven to be life changing for its patients. We interviewed Dr. Kiran Ramesh who specializes in Vision Therapy to tell us what it is, how it works, how it helps and if you should consider adding vision therapy to your practice.
What is vision therapy (VT)?
First it is important to understand the difference between sight and vision.
SIGHT is what you actually see.
VISION is how you process what you see; is it clear, do you see things double, how long it takes you to change your focus, are your eyes moving properly, your spacial awareness, how you move, how you sit, how you feel, and how you behave is all vision. It is how the brain & the eyes communicate and process material.
Vision therapy is helping you process your visual world efficiently. VT is working with filters, lenses, and different training aids to help your vision.
Who is vision therapy used for?
VT is used for helping with learning related visual problems such as reading, writing, comprehension and dyslexia. It is also used to rehabilitate patients that have suffered a post traumatic brain injury/concussion.
Vision therapy is also the best avenue to support patients with strabismus, where the eyes are turned or do not align properly. It can also support athletes with eye hand coordination.
Is there a specific age VT is practiced on or more effective with?
There is no specific age, as you can get injured at any time and at any age.
I know places who have patients as young as 4 months old all the way up to 90 years old. Reading and writing difficulties is mainly in children, but personally I have worked with a lot of high school and university students. Symptoms can be as simple as a headache, but when you ask more targeted questions you come to find out that they need vision therapy to help correct their sight, not glasses.
How does vision therapy help?
It changes the patient’s life. I went through it myself and that is why I am a big advocate. It literally transforms a person’s life – it adds confidence, behavioural changes, they are efficient, more aware of what they are doing and how they are doing it. I have had people who were told they could never work again, but after vision therapy they are working. I have people come off anxiety medication after vision therapy who understand themselves better and have been able to modify how they interpret the world. There are so many different avenues. Academically, I know that we are going to help make the changes, what is more important to me is that what changes in their behavior. I can see how they walk, how they smile, their confidence levels rise, these behavioral changes for me are key.
How effective is vision therapy?
There is in office training that we provide and then there is home training. When patients do both, especially keep up with their home training, VT is more effective and the patients will notice changes faster. It really depends on how much effort the patient puts in. I have never seen someone with no changes.
How long has vision therapy been around for?
About100 years, but optometrist and patients alike don’t know what it is and don’t understand how it works. Optometrists think it is very complicated, they are not taught how to do binocular vision exams efficiently in school or how to understand vision therapy, which can be very confusing. It was the same for me when I graduated. When I learned about vision therapy, I went back to take courses and got trained. I became a board member of Vision Therapy Canada and began to travel across Canada speaking to optometrists and teaching them quick and effective ways they can screen or prescribe glasses differently. Every optometrist can use these tips without having to go back to school.
Do you find people are more open to this holistic approach?
We are finding patients are very open to vision therapy and its holistic approach. Definitely parents are are looking for new options as there are so many kids who have been misdiagnosed with ADHD for example when it is an actual vision problem. Parents are more open, and rather than having their children psychologically tested, they want to find out what the root of the problem is. Especially, when there is a disconnect. If a child has ADHD for example, why are they only medicated during school and not at other times. Could it be because it is a focusing problem, a problem with their visual system. A true disease would require medication all the time. Also, I am noticing parents are coming in knowing something is wrong, that they feel they can’t explain. When I demonstrate what it feels to be their child they finally understand and feel they have an answer. It is such a turning point for them seeing their kid go through the training and how it has literally changes their child’s life and their own.
What does the process entail?
Each patient is very different. There are standard exercise based on the issues the patient is experiencing, but these are tailored on a case by case basis. It all depends on the patients’ problems, what direction we need to go in and where the emphasis is going to be placed.
How long before you see results?
Depends on how well patients are doing with their home training, a lot of people see changes within 8-16 weeks.
How long do patients need to continue with the VT?
There is no set timeline, the length of treatment depends on what the patient struggles with and how complex the problem is. We are making neurological changes, creating new pathways in the brain. Once I feel the patient is done or has “graduated”, I usually do a follow up after one month and after 6 months. Even a year later patients are performing better than when they first left us. The whole goal of vision therapy is to make permanent changes.
When should an optometrist recommend vision therapy to their patients?
First optometrists need to know if their patient is symptomatic. If a patient is not symptomatic despite exhibiting binocular dysfunctions, they are not going to want the help. If they are symptomatic, next is knowing how to screen them for vision therapy. If lenses alone are not going to make a difference, then a referral for vision therapy should be the next step for your patient.
Are prescription glasses recommended in conjunction with vision therapy to help aid the progress?
Yes, usually prescription glasses are used in conjunction with vision therapy in the form of therapeutic or neuro-functional lenses. These types of lenses help in terms of comfort or as a temporary solution to help the brain build the connection. Lenses may remain as a support system.
Do you recommend offices incorporate vision therapy into their practices?
I don’t think its practical for every office to add vision therapy inside their practice for various reasons from limited space and interest in this niche market. It is important to be passionate about what you do.
However, I think it is extremely important for every office and every optometrist to understand how to properly screen, prescribe and refer to a vision therapy specialist, or to any other niche they may not specialize in. Our goal as Optometrists is to be able to provide the best patient care and take care of our patients needs through our own clinics or those of our colleagues. In terms of vision therapy speak to the Optometrist that does vision therapy in your local area ask them to discuss with you what to look for, how to prescribe lenses efficiently, and when to refer out.
Practice management for non-VT practices who do not have VT in their office, but want to learn how to prescribe for lenses, or screen better for VT can email me directly at firstname.lastname@example.org. I have a lecture I can do virtually for doctors.
If offices wanted to incorporate Vision therapy into their practices, where do you recommend, they start?
There are different courses you can take to gain greater knowledge and how to get started with practice management. I recommend courses to learn about all the depths of Vision Therapy as a good starting point. Below are some useful links:
Vision Therapy Integration (VTI) is a practice management course that is available to help clinics get VT full incorporated into their offices. Please email me directly for more information or refer to visiontherapycanada.com.
For VT specialist in your area, please refer to VISION THERAPY CANADA find a doc:
Find A Doc
About Dr. Kiran Ramesh: Owner & Neuro-Visual Optometrist
Dr. Ramesh lives her life based on four main values, love, connection, inspiration, and empowerment. She connects with patients to better understand their goals, connects with industry leaders to better support her goals, and inspires and empowers her team to achieve their full potential inside and outside of work. She also travels across Canada to lecture, inspire, and empower colleagues to better understand the role Neuro-visual training plays in Optometry, and the importance of inspiring and empowering your team. In every area of her life her judgement and her actions are solely based on her heart.
During school, Dr. Ramesh struggled with paying attention, focusing, and headaches, until she discovered neuro-visual training. This changed her life and the lives of all her patients. She was trained by world-renowned speakers in Vision Therapy and now close friends, Drs. Robert Sanet, Robin Lewis, and Stefan Collier. She supports and trains patients that struggle with reading, learning, and those that have suffered a concussion.
Dr. Ramesh is the proud recipient of 2019 Canada Best Eye Care Practice of the Year. She completed her Doctor of Optometry at the University of Waterloo in 2004. She served on the board of directors for VTC (Vision Therapy Canada), is an associate member of COVD (College of Optometrists in Vision Development), a clinical associate of the Optometric Extension Program, and is a member of the OAO (Ontario Association of Optometrists). She has 2 beautiful daughters and a husband that always makes her smile.