In the twentieth century, more than ever before, large numbers of people have been traumatized by eyestrain. Eyestrain is often overlooked as a causative factor for many learning problems, autistic behaviors, and even emotional difficulties. Even though a conventional eye examination may result in a report of 20/20 acuity, a significant vision problem could still exist that needs to be resolved. Parents often leave the office of a traditional ophthalmologist or optometrist wondering why — if their child sees so well — does he or she perform so poorly?
The word “see” has two meanings: to have the power of sight and, also, to grasp the meaning of something — to understand. It’s an appropriate double-meaning, because we learn to understand our environment primarily through sight. Each animal favors a particular way of interacting with the environment. In humans, it’s vision. Vision affects how we move, feel, and think. It’s been estimated that 80% of our impressions come through the eyes. If our visual perception is significantly flawed (such as viewing space on two planes rather than the three that are critical for proper depth perception), our understanding of the environment can be impaired. Visual perception is the process of receiving, integrating, decoding, and interpreting visual stimuli. The antithesis of a healthy visual system is one in which the individual can see, in the traditional sense, yet experiences difficulty locating, examining, and identifying dominant visual cues. Problems with integrating or combining stimuli may also be present. Testing an individual with dysfunctional vision using conventional techniques addresses only the central process, without regard to visual organization, orientation, or selective attention to space. Symptoms of eyestrain may include fatigue, blurring of vision, headaches, and vertigo.
These symptoms can impede reading, because erratic eye movements can cause loss of place, lack of eye coordination, and reversals of words. In addition, eye-movement dysfunction may result in a halo (diplopia) around letters and the reduction of linear space, requiring an individual to reread for meaning. Frequently, we respond to the stress of these symptoms with avoidance behavior. This can mask or disguise the visual problem, so that outward signs of discomfort are not readily recognizable. As the environmental demands of school, work, and recreation increase, poor performance in the visually impaired individual becomes more obvious. This performance has a hierarchy of levels: Level 1: Problems with reading; difficulty with physical activity and sports; some types of social problems. Level 2: Problems with visual organization and depth perception. May manifest as difficulty with night vision, or sometimes as a panic disorder. Level 3: Weakness in visual organization and visual orientation. In some cases, dysfunction may contribute to autistic behavior, and even impact conditions such as schizophrenia and bipolar disorder. The relationship between visual perceptual dysfunction and psychiatric dysfunction was the subject of a control study at New York Medical College in Valhalla.1 Results supported a causative relationship. Treatment The role of visual management in rehabilitation is to promote conditions that will significantly improve performance. This requires a combination of traditional and novel approaches for diagnosis and treatment. The method of visual management I employ requires both lenses and training procedures.
The appropriate lenses may be time-honored focal lenses or unique ambient lenses (yoked prisms). Ambient lenses affect spatial organization and orientation. This author has pioneered the use of ambient lenses as prescription wear since 1972.2 Ambient lenses have proven effective in clinical research studies for symptoms of perceptual compensation.3 The training procedures used in conjunction with lenses are tailored to meet the individual’s specific needs. It is essential to recognize that we have perceptual strengths and weaknesses, with varying preferences for self-orientation or spatial organization. The results of the integrated approach I use, which I call “visual management,” were described by a thirty-eight-year old patient with a history of bipolar disorder that had required frequent hospitalizations. His perceptual disorder was treated through the use of ambient lenses and a supervised program of visual rehabilitation over a period of six months. His improved perceptual skills had a positive impact on his emotional difficulties. This man asked if I was aware of how my approach to visual training differed from other vision therapy techniques. Without waiting for a response, he volunteered that at the age of fourteen he had undertaken a traditional visual training program, with little or no change. After participation in my program, he felt considerably more in control of himself, became gainfully employed, and has not been hospitalized since treatment. His interpretation of what had happened was, “They forced my attention, whereas you allowed it to happen.” Forced attention reduces productivity; relaxed attention maximizes it. The primary difference between traditional techniques and my method of visual strategies is that the former initiates with focal tasks, whereas my program initiates with ambient stimulation before moving to focal tasks. This allows the individual to reach a higher level of organization and orientation.4 For integrated vision to occur, the procedures must synthesize how we see, move, feel, and think, rather than just what we see.
One such procedure is “luster.” Luster is the ability to fuse the visual fields and perceive a surface as white, shades of pink, or celery green while wearing a red lens over one eye and a green lens over the other. When combined with movement awareness, it becomes a biofeedback technique for the patient that can produce a feeling of relaxation and well-being. Conventional wisdom for treating dyslexia, learning disabilities, or autism traditionally favors medication and/or special education.
Neither of these attacks the root of the problem, which is impaired neural organization and orientation. While vision disorders are certainly not responsible for all these conditions and individual difficulties, treatment has often demonstrated dramatic results.
1 F. Flach, et al. “Visual Perceptual Dysfunction in Patients with Schizophrenic and Affective Disorders versus Control Subjects.” Journal of Neuropsychiatry and Clinical Neurosciences 4 (1992): 422-27.
2 Melvin Kaplan, Vertical Yoked Prisms (Duncan Oklahoma: Optometric Extension Program Foundation, Inc., 1978-9).
3 Frederic Flach, Melvin Kaplan, “Perceptual Dysfunctions in Psychiatric Patients,” Comprehensive Psychiatry, 24: July/August 1983. 4 Melvin Kaplan, Visual Training (Santa Ana, California: Optometric Extension Program Foundation, Inc. 1987-8) Curriculum II, vol. 60.