Vision Therapy: Changing times, technology giving rise to new concerns, techniques

Keeping an eye on vision

Joseph Cataldo, 8, of Cedar Rapids wears glasses that make his eyes work independently during a vision therapy session a
Joseph Cataldo, 8, of Cedar Rapids wears glasses that make his eyes work independently during a vision therapy session at Cedar Rapids Eye Care in northeast Cedar Rapids on Tuesday, April 5, 2016. (Liz Martin/The Gazette)

Good eyesight means more than having 20/20 vision by nature or correction. The brain also needs to be in sync with the eyes, a process that begins in the womb and continues throughout a lifetime of changes.

Changing times, however, are changing in the way in which we see the world, and giving rise to vision therapies across various stages of complexity.


Technology is putting that world is at our fingertips, but our eyes need more distance.

Area eye care professionals agree that unless people of all ages who are plugged in give their eyes a rest, they can experience such side effects as eye stress, eye fatigue, headaches, blurring or double vision — and they may even need bifocals at a younger age than previous generations.

“Because of the technology, where we’re on the computer, iPad, iPhone more ... people are entering into bifocal powers earlier,” said DeAnn Fitzgerald, 57, of Solon, doctor of optometry and owner of Dr. D.M. Fitzgerald & Associates, 3225 Williams Pkwy. SW, Cedar Rapids.

Screen glare is a concern across all ages, leading to such countermeasures as wearing yellow-tinted glasses when working at a computer or having special coatings applied to corrective lenses to cut down on screen glare.

“Our biggest population right now with anti-reflective coating is children,” Fitzgerald said, “because more iPads and computers are in the classroom, and (kids) are complaining more and more of difficulties like headaches, eyestrain, (inability to) focus in. Then they get fidgety because that causes them to have lack of attention and concentration.

“That all flows together. If their eyes begin to bother them — if they’re scratchy, gritty, not able to see as sharp and clear and controlled — then they get wiggly and (have difficulty with) concentration and attention, because what’s their concentration and attention on? Wiggling. So it plays to their attention span,” she said.



Simple techniques like the 20/20/20 formula — looking at something 20 feet away, every 20 minutes, for at least 20 seconds — can help people who spend their work hours tethered to a computer, said Ryan Berger, 27, of Coralville, a doctor of optometry at Cedar Rapids Eye Care, 4207 Glass Rd. NE, Cedar Rapids. UV sun protection in sunglasses or other lenses also helps shield eyes from damaging rays.

In addition, Fitzgerald recommends getting up and moving every two hours. “If we’re not moving, our eyes and our brain begin to shut down,” she said, noting that distance and peripheral vision especially can suffer at any age.

Shooing kids outside for recess at school or playtime at home can help, as well as just keeping electronic gadgets out of preschoolers’ hands while their vision is developing.

“This is how big it’s becoming,” Fitzgerald said. “The Academy of Pediatrics ... said about a year and a half, two years ago, that children under the age of 5 shouldn’t even be looking at a phone, because (the academy) sees the implications of prescriptions changing — headaches, that sort of thing.

“That means the amount of time we’re spending up close is way beyond what we should be,” she said.

Vision Therapies

Both Fitzgerald’s practice and Cedar Rapids Eye Care offer specialized vision therapies to aid with everything from children’s eyesight deficiencies that hinder learning to injury- or post-surgical rehabilitation at all ages, as well as athletic acuity.

Seeing is believing for Joan Wieland of Independence, whose daughter, Jennifer, 7, has gone from a clingy child who struggled with reading and school to a confident learner who has improved “by leaps and bounds” after 21 of 24 weekly sessions of vision therapy at Cedar Rapids Eye Care, as well as occupational therapy at Witwer Children’s Therapy, also in Cedar Rapids.

Jennifer’s eyes weren’t working together to allow her to see letters, words and sentences across a straight line. The disconnect also caused balance problems, so smooth eye movement exercises are among the areas she has worked on with vision therapy team leader Maria Bryant.

Jennifer also eagerly wears her glasses that have prism correction lenses, designed to help her eyes work in sync so she won’t see letters and words in a jumbled order or experience balance problems.

She now has less visual stress and fatigue; has improved awareness of her surroundings, depth perception and peripheral vision; can identify letters better; has improved coordination; better reading comprehension; better handwriting; more interest in sports and movement; is trying new things; and is quickly memorizing music at her piano lessons.

Insurance helps defray part of the cost, but out-of-pocket expenses estimated around $1,200 is money well spent, her mother said.

“If they suggest something to help your child, I feel like if you don’t do it, to try to make it happen, you’re always going to wonder,” Weiland said. “You can at least do it, and if it doesn’t work, at least you know you tried your best to help with it.”

“It’s fun when we see (test) scores go from below the first percentile up to the 70th percentile,” Bryant said. “It’s awesome, and it’s in her. We feel like we’re helping that true potential come through. The confidence change in Jennifer has been fantastic.”

Most issues are resolved in 12 to 24 weeks of therapy, Bryant said. If the therapies aren’t working, patients are referred to specialists in other areas, from occupational and physical therapy to eye surgery.

If surgery is needed, patients may return for follow-up vision therapy, in the manner of post-surgical therapy following something like a hip replacement, Bryant said, to make the muscles strong, coordinated and flexible.

Bryant, 47, of Cedar Rapids, has a big binder full of success stories, including her favorite one — her son’s. In third grade, he could barely write, went through summer school and saw a specialist to see if there was something wrong with his hands.


“Turns out, he had double vision,” Bryant said. One eye was higher than the other, so vision therapy brought his eyes into alignment.

“He got clarity, and with clarity, he could see what he was supposed to write. Holy cow, here he is a year later, writing in perfect cursive,” she said, pointing to his writing sample in the binder.

“This is my son. This is why I do this,” she said, noting with pride that he’s now a high school freshman, getting good grades and taking an advanced placement class.

“You have to keep looking, and no one specialty has all the answers,” she said. “That’s a really big take-away. We never claim that we have an answer. We never say that we cure dyslexia — that’s a very different neurological process. ...

“We’re all about helping kids meet their potential. ... What we tell parents is that vision therapy is all about strength, coordination and flexibility of these extra-ocular muscles — those six little muscles around the eyes that help your eyes do everything they need to do. A lot of our kids have 20/20 vision. ... (Testing) tells you how well you see a fixed target at a fixed distance. If you’re seeing double, even if it’s perfectly clear, but double, it doesn’t work. That’s why we work on that coordination,” she said.

“We work on exciting the central area of the brain to coordinate. If we only work these little tiny muscles around the eyes, not much of the corpus is excited, but by doing gross motor movement, getting the center area of the brain excited, it’s like exciting an information super highway for the brain, getting the eyes to learn how to coordinate.”


Patients who have suffered a stroke, traumatic brain injury or concussion also may respond well to vision therapy.

“The principles are the same,” said Christine Winter-Rundell, 38, of Hiawatha, a doctor of optometry and developmental optometry at Cedar Rapids Eye Center. “Vision is learned.”

The actual therapies, however, are tailored individually, according to each patient’s needs.


Winter-Rundell’s colleagues, as well as Fitzgerald’s team, work not only with rehabilitation but also with athletes for sports vision enhancement, to improve such things as peripheral vision, hand and eye coordination, balance and reaction times.

Both eye centers employ cutting-edge tools, from specialized screens with timed exercises utilizing lights, numbers and/or images, to specially designed balance boards and high-tech balls.

“With vision therapy and vision rehab, we’re wanting to get the sensory integration between the eyes and the body,” Fitzgerald said. “Seventy percent of your brain is dedicated to vision in some fashion; 80 percent of all sensory goes through your eyes; 90 percent of individuals who have a concussion, traumatic brain injury or stroke will have one or more problems with their eyes. It’s powerful.

“In the concussion world, vision is one of the top things they’re screening for, for help in diagnosis, management and treatment,” Fitzgerald said. ”It’s a big deal.”

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