“The eye can only see what the mind projects” The Talmud.
Vision therapy has matured into a viable conduit for helping vision disorders and also for enhancing human potential. Unfortunately, vision therapy has tended to be compartmentalized as something extra, over and above, the normal optometric prescribing of lenses. Primary care practitioners limit their perception believing that vision therapy requires elaborate training equipment and space in an optometric office. Quite often vision therapy is viewed as being primarily for children requiring frequent office visits.
In spite the power of vision therapy to be an ardent healing science, a limited percentage of optometrists provide this worthy service. As a result, vision therapy lacks the acceptance as a viable part of the armamentarium of mainstream health and vision care.
Over a 45 year period of practising light and lens oriented vision therapy on myself and patients of all ages an integrated model of vision has emerged. This means that altering how people see through their eyes affects more than their eyes and eyesight.
Current trends in brain/mind research points the way how an integrated model of vision care can affect the patient in a dynamic way. Integrated vision therapy recognizes the interconnection of the eye structures with the brain and mind of the human being. Lenses alter how light enters the eye and is used by practitioners for sharpening the visual acuity of their patients. In addition, at the level of the brain and mind, lens altered light can be structured as a vision therapy which deeply alters how the patient relates to themselves and their world through their eyes.
It is the aim of this article is to demonstrate that vision therapy also has a home within conventional optometric practise of vision examinations. What is needed is a shift in perceptual attitude in how light, colour and lenses affects the human brain and mind. Patients encouraged to use patching techniques, combined with looking through different colour gelatin filters before the eyes, can create more balance in vision as well as deeper levels of integration within the brain and mind.
Defocusing light entering one or both eyes can have a therapeutic advantage. This is accomplished by usually weakening the normal compensating lens prescription. When the value of this practise is recognised by more practitioners vision therapy will have its rightful place in the growing field of complementary medicine and primary and managed vision care.
Results of Vision Therapy:
Visual measurements of the eye and brain change as a result of vision therapy. Questionnaire analysis of patient’s responses to vision therapy reveal more changes than just the visual findings alone. Incorporating interdisciplinary approaches impact the patient’s life in measurable ways. Survival personality traits are altered by such an integrated form of vision therapy. Children who struggle to read and agonize over their low self-esteem change this behaviour. The patient discovers a more accurate perception of themselves that reflects a more conscious and present human being. Vision therapy appears to impact the brain and the mind in a way that permits more skilful perceiving by the patient.
This article addresses three questions that can contribute to vision therapy becoming the major therapeutic discipline it deserves to be:
i) Can brain and mind research more thoroughly explain and predict the behavioural and performance changes we obtain in vision therapy?
ii) Can we impact the visual system by modifying lens prescriptions in such a way that the patient enhances their potential for life?
iii) Is it possible to integrate the use of light and colour into primary vision care?
Evolvement of Vision Therapy:
As we know it today, vision therapy was founded upon a sequence of developmental steps. Skeffington provided the functional analysis of vision findings. Vision was able to be examined in terms of syndromes. From the analysis of visual findings we could read into how the human being adapts to their external environment.
The writings and teachings of many admirable clinicians formed the basis for the developmental process we use in vision therapy. The depth and understanding of vision included more than a static process of light entering the eye to generate eyesight. The developing visual system could be impacted as early as a few months after conception. Light activates processes of vision development in utero. The developmental unfolding of vision continues at a rapid rate from birth through the first seven years of life and thereafter. External and internal interferences in this process leads to delays in vision potential. A lack of vision development impacts the evolving behaviour of the person.
The late Optometrist Forrest summarized how the visual system succumbs to the stressors of modern day living. Measurements of the visual system are like a print-out of the adaptation of the person’s inner seeing. The visual findings reveal how the mind directs the brain to adjust its survival state in order to control how the eyes are to function.
Is The Brain and the Mind The Same Thing?
Traditionally, in vision therapy we talk about the eye as being controlled by the brain. In recent years, scientists have begun referring to the mind in addition to the brain. There is a growing distinction being made between the brain and the mind. Understanding these differences can help explain how light and lens oriented vision therapy affects the human being.
Schiffer refers to the brain as a “hunk of neurone chemicals and electromagnetic fields essential to the support and production of a person’s mind.”Damasio describes the brain as possessing “devices within its structure that are designed to manage the life of the organism in such a way that the internal chemical balances indispensable for survival are maintained at all times.”
Brain-imaging techniques such as PET (positive emission tomography) and FMR (functional magnetic resonance) scans clearly show “how different brain regions in a normal, living person are in use by certain mental effort, such as relating a word to an object or learning a particular face”, reports Damasio.
The mind on the other hand can be considered that part of a person who experiences, thinks and decides. The conscious mind has been described as the ‘movie-in-the-brain’. Damasio says the ‘movie’ is a “metaphor for the integrated and unified composite of diverse sensory images-visual, auditory, tactile, olfactory, and others-that constitutes the multimedia show we call the mind.” Still deeper in the mind is a sense of self where “we automatically generate a sense of ownership for the movie-in-the-brain.”
The function of the brain is to carry out the actual physical and motor operations. The role of the mind is to elaborate and manage the content of our experiences. It is the brain that first acquires sensory-motor information from the environment. The motor aspects of our brain are associated with our thoughts when we desire to understand. The mind then forms the content of this understanding. The sensory aspects of our brain have their natural extensions in feelings.
The Brain, Mind and Vision Therapy:
Vision therapy has built a model of visual processing making use of the eye and brain structure. Foveally focused light generates a central way of perceiving. This is a way of ‘looking’ that is digital, linear and precise. This kind of ‘looking’ vision clearly promotes an understanding of what is perceived. On the other hand, light stimulating the retina encourages a peripheral form of perception. This ‘seeing’ is more diffused, general and encourages feeling. This kind of vision demands a form of intuitive knowing.
The way light enters the eye is part of a developmental sequence that is arranging the conditions for sensory and motor activation of the brain tissue. Later, through the evolution of the mind, integration of this sensory and motor information leads to a deeper kind of vision.
From this model we can examine fusion and binocular stereoscopic vision in a penetrating way. In the absence of foveal or retinal suppressions and binocular vision we can assume that the patient’s brain is functioning at high potential. This includes quick processing of visual information through the mind with an ability for the person to fully participate in their life.
On the other hand, the loss of binocular vision, as is evident with suppressions and monocular patterns of looking, can point the way to understand the survival structuring of the brain under the directive of the patient’s mind.
Binocular Vision and the Mind:
Vision therapy strongly advocates the importance of binocular vision. But why? For greater potential of depth perception? Does binocular vision at the level of the mind mean that one can see more deeply into oneself? I have observed the varying degrees of breakdowns of binocular vision in patients using binocular methods of examination. I would predict that as many as 65 percent of entry point patients are not at their full potential for binocular vision.
Monitoring the behaviour of patients as they develop greater degrees of binocular vision gives insights into the changes in behavior that follows higher levels of integration in the mind. Greater binocular vision is more than what we measure as stereopsis at the level of the brain. Seeing more depth at the level of the mind implies being able to look more deeply into oneself.
The activation of binocular vision is a form of reintegration. This influences more than the visual system as we know it in the eye and the brain. The behavioural changes in patients reflect that vision therapy impacts the mind of the person as well. The improvements of fusion visual findings is an external manifestation of an integrated state within the human organism. This integration is dependent upon the unification of the central and peripheral visual processing mechanisms.
Schiffer’s methodology shows what happens when the patient is able to look more deeply into themselves. They find the suppressed wounded states and a way to successfully navigate into new perceptions and vision of themselves. Likewise, with therapeutic lens prescriptions, patching and light and color changing methods we can provide the patient with ways to become more balanced. This is the true medicine of integrated vision therapy where the person evolves into a new way of seeing themselves. This is the real power of light and lens oriented vision therapy.
Distress and Binocular Vision:
Under varying degrees of stress, the binocular processing capability of patients break down. Different survival states of mind lead to information being processed more through one eye than both. This is a monocular adaptation to distress. This means that distress either from an external source or self-imposed leads to subtle breakdowns in binocular vision processing. This may take the form of central foveal or parafoveal suppressions or more peripheral retinal suppressions.
Wearing polaroid analysers patients were exposed to tachistoscopic flashes of 4 numbers. Unbeknown to the patient the images were randomly flashed to either the left, right or both eyes. As the speed of the tachistoscopic flash was increased the greater was the tendency to respond in a more monocular manner. The faster the speed of processing caused a higher demand that led to more distress for the subjects.
Myopic lens prescriptions which fully compensate for the measured subjective refraction for 20/20 visual acuity also induce a breakdown of binocular vision a significant amount of time. Associated phoria measurements at 20 feet using the American Optical Vectograh projected slide was used to examine myopic patients with their full lens prescriptions in place. In 75 percent of cases an uncompensated associated phoria was recorded. The ‘fixation disparity’ measurement is assessing the inter-relationship or disintegration tendencies between the macular/fovea of the right and left eyes.
The disparity findings suggests that a full minus lens prescription lessens the possibility of being in a comfortable state of fusion. This state of disintegration further reduces the likelihood of a state of full fusion happening at the level of the brain. This means a very commonly prescribed myopic lens prescription for improving visual acuity at far can induce a brain state of less integration. The foveally driven focused light rays will more than likely lead to an over focused behaviour. This can be observed as a ‘thought’ based visual personality. This adaptation is the brain’s way of seeking the one part of the mind to dominate that is ‘looking’ or thinking form of behaviour.
Once the associated phoria findings were measured in the myopic patients, plus lens spheres were added equally before both eyes. In over 80 percent of the cases the visual distress as implicated by the associated phoria findings were eliminated when the spherical minus lens prescription was reduced by between +0.50 and +1.50. By lowering the spherical minus lens prescription the intensity of foveally focused light was reduced. In addition to the visual findings changing a significant number of the patients reported that even in spite of the loss of between 2 to 3 lines of visual acuity they loved the ‘feeling’ and ‘comfort’ they felt with these lenses.
Functional Visual Fields and Distress:
This visual distress concept has been further examined by measuring functional visual fields as recommended by the College of Syntonic Optometry. In a study with children with reading delays, a significant reduction in visual field size was reported. Under the stress of trying to read the reaction of the autonomic nervous system is to become sympathetic dominant which results in a smaller visual field measured with not only white, but also coloured targets of varying sizes. It should be pointed out that these visual field measurements were done using a stereo campimeter rather than a conventional visual field instrument. This ‘tunnel like’ vision was remedied by the child looking through specific coloured filters that restored balance within the autonomic nervous system. With larger visual fields the children were more able to benefit from reading instruction.
‘Dual-Brain’ Psychology and Vision:
Research on epileptic patients, where the corpus callosum was surgically cut as a way to control seizures, produced a plethora of theories about how the two halves of the brain work. The hypothesis that each half of the brain controlled different functions was proposed.
Harvard University Psychiatrist, Frederick Schiffer, says: “Each side of our brain possesses an autonomous distinct personality with its own set of memories motivations and behaviours.” He shows “how using the technique of visual stimulation can activate the specific regions of the brain that harbour both traumatic and joyful memories.”
In visual science it is clear that foveally generated impressions travel to both hemispheres of the brain. In addition, retinally stimulated fibres of each eye more specifically transport light impressions to either the right or left hemispheres of the brain depending on which visual field is activated.
More precisely, an image perceived in the right visual field is primarily recorded in the left brain hemisphere and visa versa. Using this information Schiffer, conducted patching experiments with his patients. He designed patching goggles that would let light reach the eye in specific retinal locations. While his patients wore these goggles he had them talk about their experiences.
Schiffers’ ‘patching’ therapy resulted in patients discovering dormant memories in one or both hemispheres. In many cases they ‘woke up’ to their past painful or ‘wounded’ states. Using electroencephalograhy and brain scanning methodology he measured the activity of the brain while patients wore his ‘lateralising’ goggles. His findings showed that information via light travelling from one visual field results in brain activity associated with one hemisphere more than the other.
Schiffer’s findings implicate that the brain has the ability to bury, or in visual terms, suppress information that is too painful to see. In vision therapy we routinely talk about a suppression of vision in one eye. In certain cases we are even more specific and make a distinction between a foveal versus a retinal suppression. We can even specify a right eye foveal or left eye retinal suppression.
The implication of Schiffer’s work is far reaching. The prescribing of normal compensating lens prescriptions can increase the likelihood of disintegrated states of patient’s minds. From Schiffer’s point of view perhaps the patients like such sharp visual acuity with their full strength lens prescriptions because the state of disintegration further embeds the ‘wounded states’ to one hemisphere of the brain. In this way the mind directs the brain to compensate for this lack of integration. It might do this by lateralising information to one brain hemisphere. What is uncomfortable to see is buried and tried to be forgotten.
The findings of Schiffer offer a glimpse into why vision therapy that promotes higher orders of binocular vision results in such definite behavioral changes in the patient. Reducing suppression tendencies asks the patient to remember events and times related to their blocking their vision through the mind. As they achieve better binocular vision so the patients resolves issues from their past. A deeper integrated way of seeing is the inner clarity and depth to live a more undeniable way now. Perhaps, the myriad of binocular disturbances will one day be used to diagnose and predict the precise states of mind of the patient.
One way to experiment with this question is to examine how altering the way light enters the eye directs the patient to look and see in a more skilful way. Through questions one can examine the behavioral changes when the patient looks and sees in a more binocular manner.
The first step in the development of integrated vision is for all the components of each monocular vision to be fused at the level of the brain. This is binocular stereoscopic vision in the brain. Fusion can now also be described at the level of the mind. Integration in the mind is when understanding (thoughts) and knowing (feelings) are united. For this mind integration to happen requires the human being to more fully experience themselves. The patient discovers themselves as being in their world, being conscious of their presence. Orfield hints at this way of seeing in the mind: “Space world is a mental perception of “how far is far” and “how deep is deep” and “how wide is wide.”
Specific lens combinations, which are not necessarily the best visual acuity lens prescription, can encourage a better looking and seeing integration. When wearing these spectacles the patient has the experience of being more integrated. This means they are less in survival. They discover more about their true nature. A lens prescription in this way becomes a form of vision therapy. The increased integration in the patient’s mind can explain why certain lens prescriptions seem to produce life changing effects.
Practitioner Implemented Integrated Vision Therapy:
How can you the practitioner make use of integrated vision therapy?
After you have determined the most suitable lens prescription for the patient, let the patient look through these lenses while you do an associated phoria assessment at the far distance. This can be equally beneficial for hyperopic patients. If the patient reveals a ‘fixation disparity’ reduce the minus or plus equally before both eyes until there is binocular stability. Place this lens prescription in a trial frame and record the patient’s visual acuity under full room illumination. Let the patient sit quietly for a minute or two while looking around the room. Encourage them to breath. Observe if the visual acuity changes over time . Also, ask the patient how this lens prescription feels once you have an idea of the visual acuity level.
If the resultant visual acuity is between 20/20 and 20/30 prescribe this ‘therapeutic’ lens as their primary lens prescription for everyday activities which may include day time driving. If you feel that patient needs higher levels of visual acuity, say for occupational reasons, then prescribe a second pair of compensating lenses which provide maximum visual acuity.
Altering Monocular Patterns of Visual Adaptation:
In cases where there is a strong dominance of vision through one eye consider reducing the visual acuity of the more dominant eye. This is best achieved by increasing the plus effect in myopic patients and reducing plus in hyperopes. I carefully explain to the patient the distinction between a regular compensating lens prescription and these ‘therapeutic’ eyeglasses. In other words, the therapeutic lens prescription is not always a replacement for the normal compensating lens prescription. Instead, they are receiving a home-based integrated vision therapy program in the form of spectacle lenses. This can require a second pair of eyeglasses.
The purpose of this process is to increase the probability of binocular vision that promotes more balance and deeply impacts the patient’s mind and their life. Have the patient keep a visual diary of the experiences they have. They write down everything they experience, feel and observe. This written record illustrates the changes in behavior over time.
Another option is to alter the light gradient by using opaque sticky tape patching over the dominant eye. Patching is done in the safety of the patient’s home and in 20 minute segments six days per week. The patching can increase by one minute per day and can be extended to a maximum of four hours. This form of patching increases the light intensity to one eye and restores balance between the central (fovea) and peripheral (retinal) relationship. This form of integrated vision therapy is a step toward integrating binocular fusion possibilities. In turn it is likely that thoughts, feelings and emotions are integrated in the mind.
Adding Coloured Gelatin Filters During Patching:
When the foveal suppression patterns are deeper coloured filter patching can be helpful. There are sympathetic stimulating colours of red, yellow and orange. Green, blues, violet and indigo are parasympathetic stimulating colours that
tend to bring about relaxation and a slowing down.
In the monocular phase, add a yellow and red filter before the open eye while sticky taping the dominant eye. The patient follows the same procedure of 20 minute increments as above. Encourage a diary record of their experiences and feelings. Looking through colour can activate buried emotional states. Provide the patient with the reassurance that they can check in with you if they have questions.
Binocular Use of Coloured Gelatin Filters:
When the monocular skills are equal as determined by more equal visual acuities or less suppression tendencies, then the coloured filter patching can be done in a binocular manner. In the case of stimulating the retinal/foveal relationship a yellow green filter in combination can be placed directly on the spectacle lenses to be used in doors. If the patient tends to foveally suppress one eye then add an additional red in front of the dominant eye. This acts as a patching device by slowing done the transmission of the light. The brain has to learn to accept the faster travelling light through the usual suppressing eye.
At the level of the brain the above integrated vision therapies are disruptive and demand of the person to “change their mind”. Former patterns of dominant thinking style leads to more feeling. Excessive feeling transforms into precise thinking. Thoughts, feelings and emotions integrate into the patient more distinctly recognising their authentic self.
Evidence exist that conventional vision therapy provides behavioural changes that affect the well being of the patient while addressing a wide variety of vision conditions. Vision therapy can reach many worthwhile people. In this paper a review of a brain/mind theory, clinical experience and research in binocular vision reveals how an integrated model of vision therapy can be used by all optometrists, not only those who specialise in vision therapy.
Suggestions have been provided for modifying lens prescriptions, the use of patching and colored gelatin filters as a way to alter light gradient in one eye which affects the brain and mind. In this way, more citizens of the world can benefit from being increasingly integrated through their visual systems.
It is the responsibility of the profession of Optometry to set the stage for vision therapy to be recognized as the leading modality for high level vision. This will permit more people to have a peaceful view of their life and of others. It is proposed that light, lenses and the mind are the potent medicine of Optometry.
(A copy of this paper can be requested together with references)