How Vision Therapy Can Help Adults

TRANSCRIPT

0:00
It's never too late.

0:01

If you're at any age, we can manage eye teaming and focusing problems.

0:07

And so as an adult, often you think, oh, it's all too late, I'm too old to change.

0:12

No, we can do vision training and vision therapy on any age group.

0:16

If you're able to sort of come into the practice and get an eye exam,

0:20

then you, and we find the right kind of problems that we can sort of deal with,

0:24

then we can do it.

0:28

Many people assume that if an eye test comes back normal,

0:31

then vision can't be contributing to headaches, concentration problems,

0:36

reading fatigue, or difficulty focusing.

0:39

But vision is about far more than just seeing clearly on a chart.

0:43

Sometimes the real issue is how the eyes and the brain work together throughout

0:48

the day, especially during reading, screen use, study, work, or even driving.

0:54

Today I'm joined again by Paul Graham, Principal Optometrist

0:57

at Harmony Vision Care on the Gold Coast, to talk about behavioral

1:00

optometry and vision therapy.

1:02

What these terms actually mean, how they differ from a standard eye test,

1:07

and why both children and adults can experience hidden vision problems

1:11

that affect comfort, focus, and everyday performance.

1:15

For those who are new to the channel, my name is Paul Sallaway from Optics Digital.

1:19

We're an agency that helps eye care professionals to share educational

1:23

information with their communities through videos like this one.

1:27

So, Paul, good to catch up with you again.

1:29

Yes, great to be back. Thank you.

1:31

So, Paul, behavioral optometry

1:35

is a term that I see a lot on the internet,

1:39

but what does it mean in plain language?

1:42

Yeah, look, it's a little of an unusual term, and there's a number of different

1:45

professions that use behavior as part of it.

1:47

And the easiest way that I heard it explained was actually from a teacher who,

1:50

when talking to her parents when she was concerned about a child's sort of progress

1:55

at school, was that we're optometrists who look at visual behaviors.

1:58

And the idea being that, you know, we're looking at more than just sight,

2:02

how you're using your eyes for learning and moving through the world.

2:05

Where the name originally came from was human behavior back in

2:11

the sort of mid-century last year.

2:14

There was that with the emergence of trying to understand how

2:17

people think and psychology and all of those sorts of things.

2:20

They were trying to take a more holistic view that if humans spend a lot of their

2:24

day moving and doing things, and we call those kind of things behaviors.

2:29

How does vision fit within the whole totality of humans

2:35

doing things, so human behavior?

2:36

And so behavioral vision care or behavioral optometry was the term

2:40

that sort of came out of that.

2:42

So, what are some of the everyday signs that someone's

2:47

visual system may not be coping well, even if they can still see clearly.

2:52

Yeah, and that's the thing, a lot of people when they use the word

2:54

vision, they're really just talking about sight.

2:56

When, when we use the word vision, we're really looking at,

2:59

you know, how do you have the two eyes working together well as a team?

3:03

How well is the, the two eyes working together work with your focusing?

3:07

You know, we have two, two channels, but we only hopefully

3:11

only see one perception of the world.

3:13

So, a single world out there that we can see, but we've got two channels.

3:16

So, the brain has to create a single image of the world and keep

3:20

it clear at the same time.

3:21

And so we're looking at how well that sort of happens.

3:24

It's, you know, your eyes have muscles, they need to move, they need to move in

3:28

coordination with the rest of your body.

3:30

So, we loosely call that tracking.

3:31

So, how smoothly have you learned to use your eyes free of your head or your body?

3:36

And then the next phase is, if you are keeping the world single

3:39

and clear and you're able to move your eyes accurately,

3:42

are you able to understand and interpret what your visual input is?

3:46

And you also need to compare that to what your ears are telling you and what

3:49

the rest of your body is telling you through touch and smell

3:52

and those sorts of things.

3:52

And in vision, we look at being kind of a master sense that gathers all

3:57

that information around and attaches it to visual images so that when we see

4:01

something, it's not just the picture we see,

4:04

we have all that understanding about how we interact with it and all the other

4:07

things that go along with that particular object.

4:10

So, what would be some symptoms that somebody,

4:13

somebody might have a functional vision problem as opposed to simply

4:17

just an eyesight problem?

4:19

Yeah, so, you know, at the extreme, uh, you might get double vision,

4:22

so that the breakdown of keeping the world single, you might get

4:26

some blur that comes and goes.

4:28

It could be— and I think I've talked about this in the past— we've got— I would like

4:32

to break it into eye-related symptoms and performance-related symptoms.

4:36

So, an eye-related symptom is that you don't need to be an optometrist to kind

4:40

of think, oh, that kind of sounds like an eye thing.

4:43

So, if you're rubbing your eyes, if you're getting sore eyes,

4:45

if you're getting eye strain, if your eyes are pulling,

4:48

we've talked about blur and double vision.

4:49

Sometimes people will, will make the leap that maybe headache

4:53

could be a vision-related headache because it occurs when they're

4:56

doing a concentrated visual task like bookwork or study or using the computer.

5:00

And then you get into more performance-related headaches.

5:02

And so these are sort of things where you're not concentrating well,

5:05

or you can't— you're finding that you're not paying attention, or

5:08

you're not reading as well as you think you should, or you're losing your place,

5:12

or you're constantly having to go back and read something again

5:15

to retain the information.

5:17

And so they're more of those sort of softer signs that aren't necessarily

5:21

obvious as being a vision problem.

5:23

And, and in kids It can be simply that you've

5:26

got a child who's not performing to their potential, so you as a parent or you as

5:31

a teacher might have a sense the child is capable of a lot more and they're just not

5:34

achieving the kind of scores or output, and, uh, and so vision can be

5:39

a big part of that sort of problem.

5:40

And, and it doesn't take much of a basic eye teaming or focusing problem

5:44

in some cases to really pull apart someone's concentration,

5:47

and that then— those kind of problems extend into adulthood as well.

5:50

So, for something even like a routine daily activity like driving, then, so that's

5:57

if you're suddenly like finding that that's becoming

6:01

like more difficult or you're feeling some discomfort around that,

6:05

is it possible that that could be a functional vision issue?

6:09

Yeah, look, and it can be subtle.

6:11

It can be things like, why don't I feel comfortable driving at night anymore?

6:15

How come I don't feel comfortable driving in wet weather anymore?

6:17

And sometimes you might put it down to just pure confidence.

6:21

If you're getting a bit older, maybe you kind of go, well,

6:23

maybe I'm losing my, my skills and my reaction times are sort of slowing down.

6:28

It could be the person that is constantly taking a bit of, bit of paint off their

6:32

car whenever they park, you know, misjudging where they need to go.

6:35

And I do remember working with a lady who was getting vision-related headaches,

6:40

and partway through her therapy she came in quite excited and said that she no

6:44

longer has to take 10 goes to park a car, she just drives into the spot now.

6:47

And so for her, the, the vision problem

6:51

wasn't just her fighting the vision problem which created a stress-related

6:54

headache, it was impacting on her ability to judge depth in a car.

6:58

And, you know, she hadn't kind of equated it with

7:03

a vision problem, but it's very much about understanding where you are in space.

7:06

And it goes back to that word behavioral optometry,

7:09

the behavior of driving a car being impacted by how well our vision is

7:13

allowing us to do that with skill.

7:16

Okay, well, tell us how

7:19

Does an eye exam at Harmony Vision Care differ from a standard eye test?

7:23

So, what are some of the things that, that you do in your practice?

7:27

Yeah, if we look at what does a standard eye test mean, I mean, the,

7:29

the core things that we test as a profession, as optometrists

7:34

in general, is how clearly can you see.

7:37

So, that's a sight test on, on the chart.

7:39

If you're not seeing the chart clearly, then we do a refraction, which is

7:42

testing what the prescription is.

7:44

We do a— as a profession, we do a sort of fairly basic test of how

7:48

the two eyes are working together and how well the eyes move.

7:50

We eye health and pressures, and so internal eye health and front

7:54

of eye health, as well as pressure checking for things like

7:57

glaucoma and those sorts of things.

7:58

But as an optometrist who has a more holistic

8:03

approach, is how is vision enabling you to have a great life

8:07

and living up to your potential, we really want to then dive a lot more

8:10

deeply into how well do the two eyes work together.

8:13

That's also known as binocular vision or convergence.

8:16

Or eye teaming.

8:17

How well can you focus?

8:19

The technical name for that is accommodation, but we just

8:22

call it focusing skills.

8:23

When we look at eye movements, we're not just looking to make

8:25

sure that the muscles are intact.

8:27

Often a standard test is really about do the muscles work fully, whereas

8:30

we're looking at how well do they work. Do you—

8:33

they're effectively a fine motor system, and so we might understand things like

8:38

fine motor control in hands and fine motor control of speech.

8:41

We want to understand the fine motor control that eyes actually are,

8:45

and so What's the finesse in how you track and follow things?

8:49

And those, those are really critical parts to everyday life.

8:53

And eye teaming, focusing, and tracking problems are a lot more

8:56

common than eye disease, particularly in youth and young adults.

8:59

And so we want to make sure that we're testing all those things.

9:02

And for us, that's a standard.

9:03

We do that comprehensively every single patient that we see.

9:07

And that's a core difference, is we hang so much importance on those

9:10

doing visual skills rather than just whether you can see clearly or not.

9:14

So, we talked before we started about that famous scene from the movie

9:19

Philadelphia where Denzel Washington says to— he's the lawyer and he says to his

9:22

client, explain this to me like I'm an 8-year-old.

9:24

So, I just want to make sure that I understand this, explain this

9:27

to me like I'm an 8-year-old.

9:29

So, eye teaming, this is the ability to focus both eyes

9:33

at an object correctly, is that right?

9:34

Yeah, and if we think about looking along in space, we want to be able to

9:39

point the eyes at the same point in space and allow the brain to easily

9:43

create one image out of two inputs.

9:45

So, I mean, if they're not working well together, then, then at the extreme,

9:49

you might get some problems with keeping the, the two images aligned,

9:53

in which case you might get some double vision or some ghosting

9:55

or sliding of images.

9:57

A lot of people avoid that by putting lots of concentration in, so it could be

10:01

an eye strain or a headache symptom.

10:03

You may not get the double vision, but yes, one of the more obvious signs is

10:07

that you're, you're sort of, you know, you're getting this kind of slip and,

10:10

and double vision something that we hope would normally happen automatically,

10:15

but it's all about having both eyes pointing to the same

10:18

point in space that you're interested in.

10:20

So, somebody who maybe has a— some— I think it's strabismus,

10:24

like some sort of their eyes are not quite aligned as they should be,

10:29

though that would be something that you would pay attention to, or pay

10:33

particular attention to in that case?

10:35

Yeah, so you've got various types of strabismus, so basically we also

10:40

call it People do call them squints.

10:42

It's a relatively old term.

10:43

We call them eye turns because that's a very obvious way of stating it.

10:47

You know, you're trying to point your eyes here,

10:49

but one eye wants to turn in or one eye wants to turn out.

10:52

And, and certainly we want to rule out any sort of rare but serious problems that

10:57

come, that are, that cause an eye turn.

10:59

The vast majority of eye turns we see are from more developmental issues that people

11:03

develop an eye turn at an early age and it carries on through to to adulthood.

11:07

Okay, so that's, that's eye teaming.

11:10

I'm— and you mentioned focusing, so I know, I know it's probably an analogy

11:14

that you don't like, but think of it like focusing a lens of a camera.

11:17

That's really what we're talking about here, isn't it?

11:19

Like the lens, the crystalline lens in, in the eye.

11:22

Yeah, so we've got this, uh, when we're young, uh,

11:24

under 40, we have this, lens that can actually change shape.

11:28

And so we use a muscle to adjust the shape of the lens, which allows us to adjust

11:33

how— where we're how well we're keeping the world clear

11:36

from distance through to near.

11:37

And so that's where the word accommodation comes from.

11:40

We call it sort of focusing.

11:41

And you can have a number of different ways that focusing might

11:44

not be working well. There could be an accuracy issue.

11:47

You may not understand exactly where to position your focusing.

11:50

And again, it either becomes blurry or you're having

11:53

to constantly adjust it, which requires concentration.

11:57

You might have issues readjusting your focus.

11:59

So, you're spending time doing near work, and then when you look up and away,

12:04

it's blurred and it takes some conscious time for your distance

12:07

vision to become clear again.

12:09

And some people might get it in the reverse direction,

12:11

that it takes time to adjust back.

12:13

So, there's a— there's a— not whether you can just simply get things

12:16

clear, but how flexible is your visual system when you keep changing

12:20

where you want to look.

12:21

And then obviously, as we get into sort of aging process, that flexibility gets lost.

12:26

This time it's not completely gone, it's still there.

12:28

So, we still need to manage focusing well into sort of late adulthood as well.

12:33

Yeah, I guess that's what I'm interested in, is that like for all of us, as we,

12:37

as we get older, that accommodative function is going to diminish.

12:43

So, but in like in your practice, if you're seeing those kinds of

12:48

difficulties in younger people, people who shouldn't be experiencing

12:52

presbyopia, not an age-related loss of function, they're usually having

12:56

problems with function that's often lifestyle-based.

12:59

For the vast majority of people, a lot of the focusing issues are just

13:02

from the sheer amount of near work and device use we do nowadays.

13:06

And so a lot of it is helping you manage keeping up with that level

13:10

of near workload.

13:11

And my sort of position that most problems actually do start in the focusing system—

13:15

it's, it's designed to be this dynamic thing where we're constantly

13:18

changing where we're looking.

13:19

And what do we do in modern life is we sit still and we look

13:22

at two-dimensional screens.

13:23

And so our focusing system fatigues.

13:25

So, that's another thing we can add in, is that you've got focusing accuracy,

13:28

focusing flexibility, and simply, do we just get some fatigue

13:32

in the focusing system?

13:33

And tracking here, where, like, in practical terms, we're talking about,

13:37

like, for example, the ability to track a line of text across a page.

13:41

Is that right?

13:42

Yeah, and I'd like to talk to people about— there are two types of

13:46

ways that we use the word tracking.

13:48

The first being is you have a tracking problem, and that is

13:51

you do not move your eyes very well.

13:53

And so that can be something where you never learnt the fine motor skills very

13:56

well as a child, and that carries on through.

13:58

It gets a little better as we age, but there might sometimes be

14:01

a few signs that we see there.

14:02

You might end up with a tracking problem from a concussion or some other sort

14:06

of brain injury or a virus, so that you can actually

14:09

have issues with how smoothly you're able to use your eyes or how,

14:12

how well you do a saccade.

14:14

So, a saccade is, is a jumping eye movement moving from one point to another,

14:18

whereas those smooth eye movements we call pursuits.

14:21

And then you can have tracking symptoms.

14:22

And so yours is a great example of, you know, losing place

14:27

when you're on a screen, losing place when you're trying to read.

14:30

So, you lose track of where you are.

14:32

Now what we do is we then try and work out which part of your visual skill profile

14:38

is leading to the tracking symptom.

14:41

And it could be an eye teaming thing because you're fighting keeping the two

14:44

eyes pointed on the page, and so it's this loss of binocular vision

14:48

that then results in you losing track of where you are.

14:51

It could be a focusing problem, same thing, you start concentrating so

14:54

hard on keeping things single and clear that you lose track of where you are.

14:58

And then finally, maybe you've got a problem in

15:02

how you actually move your eyes.

15:04

So, if you're, so if you're into sports like cricket,

15:08

baseball, something that involves a lot of like hand-eye coordination, then,

15:11

then if you do have tracking problems, that's something that would really,

15:14

you know, be a big, a big deal, I think.

15:18

Yeah, absolutely.

15:19

And a lot of those sports anticipations there, but if you can't follow it up

15:22

with a good eye movement, then yeah, you're going to be not performing

15:25

at your best, that's for sure.

15:27

Okay, so we've talked about, you know, functional vision and what it is.

15:32

Now What exactly is vision therapy?

15:35

So, you know, it comes under lots of different names,

15:38

so vision therapy, vision training, orthoptics,

15:41

neuro-optometric rehabilitation.

15:44

So, vision therapy, I like to say to my patients, it's like

15:47

physiotherapy for your visual system.

15:50

You're being put in a situation where the activities are to highlight how you

15:55

currently do things, and usually it means that we're

15:58

highlighting how well you're not doing them.

16:00

Highlighting the dysfunction and giving a controlled environment

16:04

with someone who's coaching you in the right direction

16:07

on how to learn how to get the two eyes working together better,

16:11

learning how to focus, learning how to combine focusing with eye

16:13

teaming and with tracking, and sometimes visual processing.

16:17

So, it's really building visual skill through eye exercises.

16:22

Obviously, you know, hopefully if you've been watching

16:24

the channel enough, it's not about muscles,

16:26

it's about the brain and the brain's ability to send the right signals and

16:30

combine the information in the right way.

16:32

And so we're just providing an environment where we go through these activities

16:35

that give you feedback on when you're doing it well and when an opportunity to

16:39

do it better if you're not doing it well.

16:40

So, you're— we're setting up a system where you're actually making these little

16:43

mistakes and you're, you're practicing so that those mistakes

16:46

become less and less, and you'll be building visual skill at the same time.

16:49

So, so a vision therapy program then would be something that people do at home,

16:54

but then they, they come into your clinic periodically for follow-up visits

16:58

and additional training, I guess. Is that right?

17:01

Yeah, look, we find the most successful form of vision therapy is

17:05

one that has an office-based component because you really need that skilled

17:08

person giving you one-on-one feedback to how you're doing an activity and

17:13

directing your attention in the right way.

17:14

Sometimes if you've got a vision problem or something, some aspect of your vision's

17:17

not working well, you feel the consequences of it,

17:20

but you might not be aware of what, what is actually happening.

17:23

And it's a bit like a physiotherapist or even a sports coach saying, hey,

17:26

when you swing your racket that way, do you notice what happens to your left foot?

17:30

When you, when you do this particular visual activity,

17:32

this is what we're noticing.

17:34

Can you now do it a different way and pay attention to that?

17:36

So, having that one-on-one coaching is ideal.

17:38

Now we do that directly in the clinic, so people come in and have a one session

17:43

per week with the vision therapist.

17:45

We see people from all over the country and all over the world, so we've got some

17:50

prolonged experience even before COVID of doing a telehealth version of that.

17:53

So, we still have their weekly session, but it's online as opposed to in person.

17:58

And then the critical part is that they're also doing some home activities in between

18:02

to kind of reinforce what they've been learning with the vision therapist.

18:05

And then we didn't need to do it long enough to make those new skills

18:09

something the brain wants to hang on to.

18:11

So, effectively, we want them to become a habit.

18:14

Interesting.

18:15

All right, well, uh, just a quick reminder,

18:17

if you're watching this and getting value from this, uh, interview with Paul,

18:20

then, uh, please do us a big favor and hit the like button because helps us out with

18:25

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18:30

All right, Paul, so is this all just for kids, or

18:34

can adults have these problems too?

18:37

For example, you know, after concussion, for example, is this something that you,

18:41

that you see many patients who are about, who are also, who are adults?

18:45

Yeah, and I would say probably even though kids can be exposed to sort of having

18:49

concussions, we probably, a lot of our concussion patients are

18:52

adults and And if we look at eye-teaming issues and binocular vision issues—

18:56

and binocular vision dysfunction is a term that's actually gaining

19:02

some sort of presence.

19:04

More and more people are sort of hearing about binocular visual dysfunction.

19:07

And you can have— I'll break it down into sort of three,

19:10

sort of loosely three ways that you can have a binocular visual dysfunction.

19:14

You either developed it when you were young because you didn't learn how to use

19:17

the visual system properly to begin with.

19:20

And the second one is that you developed one by over time through stress

19:25

on the visual system, and that's doing lots of near work.

19:28

And quite often adults I see with a binocular visual dysfunction or eye

19:31

teaming issue have had that problem since primary school.

19:34

And you'll ask, you'll ask some adults and say, uh, did you always find

19:38

reading a bit of a struggle?

19:39

And they kind of go, yes, how did you— why did you ask that question?

19:42

It was like, well, you've got this eye teaming issue that I

19:45

can tell you've probably had for decades and probably had it in school.

19:49

And so it it's— they've shaped their life around what they can and can't do

19:53

because of this binocular vision problem.

19:56

And often it'll pop up again.

19:57

So, someone who might work with their hands gets into a management position where now

20:02

they're doing a lot more office work, and here comes this problem where they're

20:06

having trouble concentrating and getting headaches and eye strain,

20:09

and they think it's the computer when, when in fact it was an underlying

20:13

vision problem they've had sitting there their entire life,

20:15

and they've just perhaps avoided some of the activities that trigger the symptoms.

20:19

And then you have, you know, IT issues that come from injuries,

20:23

brain injury and concussion.

20:24

And concussion's thankfully getting a lot

20:26

more, a sort of common awareness

20:31

around, and we certainly see it in sport.

20:33

I mean, we're seeing 20-something-year-old athletes getting their AFL

20:39

and Rugby League careers cut short, because of multiple concussions.

20:44

And if you, if you look at the stats, you sort of at least 50% of people who

20:50

get what we call a post-concussion syndrome, and that's a— and that's where

20:54

you are still having concussion symptoms past the recovery

20:58

time, 2 weeks for adults, 4 weeks for children.

21:01

And so 50% of those people with PCS, or post-concussion syndrome,

21:04

have vision problems, and typically the kind of visual problems

21:08

that you need to test eye teaming, focusing, and tracking.

21:11

In order to pick them up and then therefore have the means to treat them

21:16

through lenses and vision therapy.

21:18

And that's when we get into the terms like neuro-optometric rehabilitation.

21:22

So,, you know, that's a particular type

21:24

of vision therapy when we're talking about concussions and other forms of brain

21:29

injury where you had— it's presumed you had good visual function before

21:34

the incident, and now we're doing rehab to try

21:37

and restore as much function as we can after afterwards.

21:40

So, this could be something that affects maybe older people who've had falls,

21:43

for example, you know, that's a common type of occurrence.

21:47

So, people who, like, you know,

21:49

maybe they've had that kind of incident and now

21:53

they might feel that they're feeling dizzy, or maybe they're, you know,

21:57

their just general confidence is not up to what it was before.

22:00

That could be a functional vision problem, is that right?

22:04

Yeah, look, you get sensitivity to movement in your

22:06

peripheral vision, you might become sensitive to lights

22:09

and patterns, you start And this is the challenge

22:12

with concussions, is that you have a concussion,

22:14

it puts you at a higher risk of having another one

22:17

because your balance and your ability to judge space and also your

22:21

cognitive processing can be affected.

22:23

And so you're at high risk of having another concussion, which is why when

22:27

athletes have concussions, they take them off the field,

22:29

and sometimes for weeks, because they want to make sure they're not

22:31

put in a position where they're at high risk of getting another one.

22:35

But it can be an innocuous thing.

22:36

So, in the sort of later decades in life when we're at higher risk of having

22:41

cardiovascular incidents, so stroke being one of them.

22:45

You can have your vision impacted by a stroke.

22:49

If we're talking more concussion injury, obviously that's a knock to the head.

22:53

You know, there are obvious things like having a car accident or,

22:57

you know, tripping over and hitting your head heavily, but it can sometimes be

23:00

caused by the most innocuous things.

23:03

Um, you know, a tissue box falling out of the cupboard on your head and just

23:06

hitting your head the wrong way.

23:08

And we've seen concussions from people attending to their push bike

23:12

and the handle hits them in the head when it tips over, and they get this,

23:16

relatively severe symptoms and consequences from what looks

23:19

like a relatively mild event.

23:20

And then you see players and athletes getting these massive

23:24

big belts during the game, and then there's no concussion.

23:27

And so we've got to stop tying the severity of what the accident looks

23:31

like with the severity of the symptoms.

23:33

Sometimes it can be actually quite a small thing.

23:35

And so if you've had a small accident and you don't feel like you're

23:38

seeing as well, or using your vision as well,

23:41

or balancing as well, or judging space as well from even just

23:44

a small accident, then you need to be thinking that there's

23:46

some sort of post-concussion syndrome involved.

23:49

Okay, you mentioned, neuro-optometric rehabilitation.

23:54

Another term which I see used a lot is orthoptics.

23:59

How are these things similar or different to behavioral optometry?

24:04

Yeah, so look, there's a— there's lots of different overlaps between, you know,

24:09

eye exercises, orthoptics, vision training, vision therapy,

24:11

neuro-optometric rehab.

24:13

So, they all use activities to develop skill.

24:17

Some of the labeling comes from the philosophy behind it.

24:20

So, orthoptics and eye exercises take a more mechanical approach to

24:25

what the visual system is doing, so it's about moving the muscles around.

24:30

Vision therapy from a perspective of a behavioral optometrist is you're

24:34

wanting to put the person to learn how to understand where they are in space

24:39

and how they coordinate, and their eye movements are just part

24:43

of that overall understanding where you are in space and when judging where other,

24:47

other things are in space in order to behave and act in the world.

24:50

And so some of the activities on the surface might look the same,

24:54

but the emphasis might be a little different, or how far we take them

24:59

and practice them from an outcome point of view is quite different.

25:04

And so if we're doing a convergence activity to try and train someone

25:08

whose eye teaming becomes uncomfortable here, for us, as

25:13

someone from a behavioral vision care perspective, it's not about just pushing

25:16

and pushing and pushing the muscles.

25:18

Because if we do like an NPC, or if we just want to look at a pencil as

25:22

an example, and we've got the two eyes turning on it,

25:24

there's not a lot of difference between turning that eye by itself that way,

25:28

this eye by itself this way, how come you can't do it together?

25:32

It's not about the muscles being a problem, it's about your brain

25:34

understanding how to do the activity.

25:36

And so it's how we're directing attention to the patient and getting them to really

25:41

understand where they're looking.

25:42

And so that's where there's a much more of a therapy component about it,

25:45

and that's a much more useful, we think, way of, of looking at vision.

25:49

Because ultimately it's got to be good something for something when you train it.

25:53

If you just train someone to kind of push their eyes together, doesn't mean they can

25:56

do it in the real world when they're trying to think of other things.

25:59

And then neuro-optometric rehab

26:04

is vision therapy, but part of what comes

26:06

on when you do additional training in neuro-optometry,

26:11

you need to understand that the way those vision problems might present differently.

26:17

You also need to work with those patients a little differently as well, because

26:21

some of the things— you've got to take things a lot more slowly because often

26:25

movement in their visual, in that peripheral vision is

26:28

quite triggering for them.

26:30

And so it's not a matter of just being good at vision therapy,

26:32

it's also understanding that category of patient and how you have to work

26:35

with them, even though again on the surface

26:37

the activities might be the same, but it's more you change the way you

26:40

execute them for that population of patient.

26:43

Okay, well, just to wrap up, Paul, if there's one

26:48

key message that you'd like viewers to take away from this discussion about

26:52

behavioral optometry and vision therapy, what would it be?

26:56

Look, it's never too late, you know.

26:58

If you're, you know, at any age, we can manage eye teaming and focusing problems.

27:05

And so as an adult, often you think, oh, it's all too late, you know,

27:08

I'm too old to change.

27:10

No, we can do vision training and vision therapy on any age group.

27:14

If you're able to sort of come into the practice and get an eye exam,

27:17

then you— and we find the right kind of problems that we can sort of deal with,

27:21

then we can do it.

27:22

So, you're never too young to benefit from having your, you know,

27:27

eye teaming issues dealt with.

27:28

All right, Paul, well, really helpful information as always

27:31

for people on the Gold Coast who are worried about their vision.

27:35

How can someone get in touch with Harmony Vision Care?

27:38

So, we've got

27:39

www.harmonyvisioncare.com.au

27:41

as our website.

27:42

You can— there's a wealth of information on there.

27:44

You can find booking links to be able to book online.

27:48

You can also call us on

27:50

07 5520 5900.

27:52

If you want to ask questions or email, again, the links are on the website,

27:56

and you can find us on Facebook.

27:58

And if this conversation has been helpful, then please remember to like,

28:05

subscribe to the channel, and share this video with a friend,

28:09

family member, or colleague who you think might benefit from the information.

28:13

All right, well, thanks for watching everyone,

28:14

and, we'll see you next time. Bye, Paul.

28:16

See you next time. Thank you.