Adventures of the Vision Aware Therapist

Many of my patients come from our local pediatric neurologist, a few pediatricians and neuropsychologists, and a few optometrists that have diagnosed a vision problem (usually convergence insufficiency). All of these patients, like yours, have functional problems. Recognizing the role vision is playing in their functional difficulties helps to shape treatment plans and improve outcomes.

The following are some cases that demonstrate just why therapists need to have a better understanding of vision.

Case #1

DB is a 6 year old male who was referred for sensory issues as well as feeding sensitivities. His initial evaluation is completed by one of the sensory occupational therapists, but because of scheduling problems, he is transferred to the Vision Aware OT to start treatment while a spot opens in one of the other OT’s schedules. He is also in SOS feeding group to address his feeding difficulties.

On the first visit, the Vision Aware therapist notices that one eye is dilated. Mom explains that he eye is dilated daily with atropine for treatment of his refractive amblyopia. Mom explains they have been using the atropine for several months and do not have an eye doc visit for additional two months. After consulting with a few doctors, the Vision Aware therapist recommends the mom get a sooner eye doc appointment resulting in the atropine being stopped as the acuity was good in the amblyopic eye and a fresh prescription for his glasses.

With his new glasses and no dilation, behavior improves rapidly, as does confidence as he beings to explore novel gross motor activities like swinging. His tolerance and improvement in fine motor tasks also improves. Sensory behaviors are reduced as well as an increase in the number of foods he eats and is trying.


Case #2

AR is 5 years old and has had recent neuropsychology visit. He was referred by neuropsych because the doctor was unable to make clear diagnosis but did see a consistent difficulty with visual tasks.

The Vision Aware therapists asks when AR’s last eye exam was with motor reporting “His pediatrician said he didn’t need glasses” following his vision screen. The Visoin Aware therapist recommends a complete eye exam where it is discovered that AR has latent hyperopia and requires glasses to help him see up close.

With glasses in place, AR is able to tolerate fine motor tasks but has some behavioral issues. A sensory screen and NICHQ Vanderbilt questionnaire are completed with the sensory profile showing no clear pattern but he Vanderbilt revealed scores a consistent with ADHD and Oppositional Defiance Disorder.

Mom question? “Why didn’t the neurpsych test reveal this?” The Vision Aware therapist responds “Because he could not see the testing.


Case #3

A 16 year old female is referred by neurology following long lasting complaints following a concussion suffered 8 months ago. She continues to complain of headaches and dizziness.

The Vision Aware therapist assess ocular motor skills and finds reduced near point of convergence, accommodative spasm and saccade inaccuracies. The Vision aware therapist applies binasal occlusion, then begins treatment for near vision focusing. With a month, the patient reports no dizziness and headaches, She return to the volleyball court in 2 months and resumes school and her sport.


Look for new stories that demonstrate how understanding vision will help you get better results for your patients.