FUNCTIONAL VISION EXAM

What is Functional Vision?
Functional vision is how the entire vision related system – the brain, eyes and the visual pathways — work in a combined way to assist people interact together with the environment. Functional vision includes the below visual skill areas:

Binocularity/Vergence:
Occurs when the eyes align to concentrate on an equivalent point on an object and work together during a coordinated and precise way. Proper teaming of the eye allows, single, efficient comfortable depth perception and vision.

If the 2 eyes aren’t both aligned at a fixed point, the brain won’t be able to correctly combine the image from each eye. When this happens, an individual will experience diplopia and lose 3D depth perception. Poor eye teaming can also cause eyestrain and fatigue.

Eye Focusing/Accommodation of eyes:
This encompasses your ability to ascertain an object clearly, and your ability to shift focus between objects at different distances.

For example, an individual may have difficulty keeping reading focused and should experience intermittent or constant blur. Or a student could also be ready to see the text during a book clearly but have difficulty shifting focus from the book to the board and back.

Eye Movement (Ocular motility) Saccades and Pursuits:
This includes your eye’s ability to keep fixation on a moving object through space, move fixation from one object to a different, or sustain fixation on a stationary object.

Tracking a ball or a flying butterfly and moving eyes across the current line of text, both require efficient and precise eye movements. Maintaining of the eye contact when talking and listening to people is an example of sustained fixation on stationary objects.

In order to correctly understand a patient’s vision, a group of standardized tests is employed to gauge visual processing. Below are the different aspects of vision that are candidate for evaluation. Since vision is a learned process, these areas are often improved through vision therapy.

The following areas may be assessed:

• Visualization – the power to make representation and manipulate details in one’s mind. This is important in reading comprehension and math.
• Visual–Motor Integration – evaluates the power to match motor output with visual input. It is important for accuracy in handwriting and efficiency as well as for the hand-eye coordination in sports.
• Visual Sequential Memory – the ability to recall words or objects in the sequence as they appear. A deficit in this particular area may end in misreading words words which look like ‘saw’ and ‘was.’
• Visual Discrimination – the power to differentiate between two similar looking objects, shapes, or words like ‘horse’ and ‘house.’
• Visual Closure – the power to possess a part of the data and infer the remainder. This is a crucial skill in reading speed and math.
• Spatial relations – the power to perceive the position of two or more objects in reference to one another and in reference to oneself. This is a crucial skill in problem-solving, high-level math, and proper spacing between words when writing a sentence.
• Spatial Orientation – required to understand and recognize object direction. A deficit of this area can cause letter (b, d, p, q) and number (6 vs. 9) reversals.
• Laterality – the understanding of lefts and rights of the patient and in space.
• Directionality – understanding the right orientation of letters and numbers.

At Caring Vision Therapy, we believe in a developmental approach towards our vision therapy program. For that reason, we would like to make sure the patient’s vision has matured from all developmental levels. For this reason, we assess certain primitive reflexes (that developed in-utero and early post-natal) which may still be hindering the visual development process. If primitive reflexes are still retained (or present), the patient are going to be given a series of movement activities to integrate them. This provides the patient with the necessary control over their cognitive and movement process!

We assess the following primitive reflexes:

• Moro – aka: startle reflex
• Tonic Labyrinthine Reflex – results in the head-righting reflex
• Spinal Gallant – may lead to fiddling and wetting of the bed if retained
• Asymmetric Tonic Neck Reflex – results in crawling and cross-pattern movement
• Symmetric Tonic Neck Reflex – helps the vision system aim close to far
• Palmar Reflex – may cause poor handwriting or speech delays if retained