An Introduction to Vision Training

by Francine Eisner

Copyright (c) Francine Eisner 2001 All Rights Reserved

1) What Is Vision Training?

2) Is This A Brain Problem Or An Eye Problem?

3) What Is The History Of Vision Training? How Long Has It Been Available?

4) Why Doesn't Everyone Know About Vision Training?

5) How Can I Tell If I Could Benefit From Vision Training?

6) How Do You Know That I Can Do It?

7) How Do You Know About Vision Training? What Is Your Personal History?

8) What About The Bates Method Of Vision Improvement? Is There Anything Useful In It?

9) Can You Describe a Typical Vision Therapy Session In Your Doctor's Office?

10) What Parts Of The Visual Apparatus Are Involved In Vision Training?

11) How Is It Possible That You Can You See Better, If You Don't Do Well In Your Office Practice Or Home Practice Session?

12) What Are Some Easy Vision Improvement Practices One Can Do Without Special Equipment?

13) What Are Some Bates Methods and Observations I Have Found Especially Useful?

14) What Home Practices Does The Vision Training Provider Prescribe?

15) What Side Effects May Result From Your Practice of Vision Therapy?

16) What Is A Typical Day Like For You, In Terms of Practicing Vision Exercises?

17) Are There Other Factors May Affect Your Vision and Vision Training Practices?

18) Can I Keep Doing This Forever?

19) Do I Need To Understand all the Unfamiliar Technical Terms used to Describe Vision and Vision Therapy?

20) Is Vision Therapy A Scientific, Medically accepted Practice?

21) WHO Can Benefit From These Exercises?

22) Are There Any Other Things One Might Do To Improve Vision?

23) What Books Are On Your List of Suggested Reading About Vision?




1) What Is Vision Training? (also known as vision therapy, visual training, behavioral optometry, developmental optometry ) It is a kind of physical therapy, or rehabilitative therapy for the brain and eyes. It is a progressive program, meaning that the beginning exercises are the easiest, gradually becoming more difficult, so that the flexibility and coordination of the eye muscles is improved. Students of vision training learn to control their eye muscles and are able to overcome many kinds of vision impairment which involve the muscles of the eyes. It involves improving visual skills such as eye teaming, depth perception, tracking, and vision-body (eye-hand) coordination. (See also orthoptics)

Most people who visit an optometrist know that any eye health problems will be detected and managed and that glasses or contact lenses will be prescribed if indicated. However, there are visual conditions that are best managed by optometric vision therapy. Some of these conditions are are weaknesses that a person is born with. Others are caused by accident or trauma. And of course the eye muscles and other parts of the eye will gradually weaken as a natural consequence of the aging process.This therapy enables an individual to learn more efficient ways to perform visually. It is a valuable adjunct to the prescription of eye glasses, contact lenses and the treatment of eye disease.

2) Is This a Brain Problem Or An Eye Problem? It is both, because the visual system involves the brain as well as the eyes. The eyes are literally physical extensions of the brain. Binocular vision problems may involve difficulties with how the brain processes visual info coming through both of the eyes.

3) What Is the History of Vision Training? How Long Has it Been Available? Vision therapy is not new. Physicians in the mid-1800s originally introduced many of the techniques that are used today. Modern Optometric Vision Therapy was introduced in the United States in 1928. Throughout the years, vision therapy has been called various names such as visual training, orthoptics, or eye exercises.

4) Why Doesn't Everyone Know About Vision Training? First of all, Vision Training is well-known in many parts of the world, but is best known with respect to vision problems in children. We have all seen children with strabismus, where the eyes are crossed. The daughter of one of my best friends had this condition, and it was corrected through the use of vision training. Children with attention deficit disorder often have difficulty with eye muscle coordination. The benefits for adults are well-documented, but are simply not well-known yet by the general population. But everyone knows the value of exercise in general. The practice of yoga, for instance, is well known to produce benefits in muscle flexibility and coordination. If practiced consistently, it helps to slow down the deterioration of one's muscles which are a natural consequence of the aging process. Vision Training will have this effect as well, but it targets the visual system. It requires persistence, more than anyting else, but the benefits are enormous.

5) How Can I Tell if I Could Benefit From Vision Training? First of all, you know your eyes better than anyone does. Think for a minute about the variability of of your vision. Do you see better at some times than at other times? This suggests right away that whatever is imperfect about your vision is not a fixed thing. If you recognize this, there exists the possiblity that muscle weakness, fatigue, and coordination problems may be at least part of your problem. Get a comprehensive eye exam, so you know if there is anything else afoot. There are eye conditions that there is no remedy for, and you will want to rule these out. If you hear the good news from your eye doctor that you do not have one of those conditions, like cataracts, glaucoma, or retinopathy, it is likely that you can benefit from vision exercises. Even if the doctor says that you are aging, and your lenses are less flexible now,there is hope that you can improve your vision.

6) How Do You Know That I Can Do It? I think you can do it because I was able to do it, and at an age when I was told that it probably was too difficult for me; I was too old. But I am a jewellery modelmaker, and I needed my eyesight to be very good for my work, and I needed my eyes to be strong so that I didn't suffer when I was using all that magnification equipment. I saw that my eyesight was getting worse and worse, for both close work and distance vision. I needed glasses to read, even if I hadn't been using my eyes much, and when I wasn't even tired. I was kind of desperate, actually. So I decided that it was worth the effort involved. Please remember that it is absolutely essential that you have a comprehensive eye exam before you seriously undertake vision therapy exercises. I cannot stress this enough. There is always the possiblity that you may have an underlying condition that cannot be improved through vision training, and this first has to be ruled out.

7) How Did You Know About Vision Training? What Is Your Personal History? I had known about it for years, because my family optometrists, Dr Evans and Dr Stein, are people I have known for my enitre life. I would sometimes be in the optometrist's chair, and Dr Evans would entertain me with stories of baseball leagues who sent some of their players to him to see if they could benefit from vision training. It seems that some of them were having trouble in the outfield, etc. He told me that on testing them, he could tell if their problems could be remedied through vision training. I never thought about having vision training myself, because I was lucky enough to be born blessed with very superior eyesight, much better than 20/20. I could see well at almost any distance, in dim and bright light. Many people are fortunate like this when they are young; others are not. But when I was about 33 years old, I suffered an eye injury on the job. I was working in a jewellery factory, without any glasses or goggles on to protect me, and a piece of metal broke off of what I was working on. It hit me in the right eye. It damaged my cornea, which is the clear covering over the front of the eyeball. I had to have emergency surgery to remove bits of metal from my eye, and I had a bandage on for awhile. After that my vision wasn't as good, but I really didn't want to think about it too much. Some time later, Dr Evans examined me and informed me that my eyes were not working in concert with each other. He said that my ciliary muscles which are used to focus the lens of the eye were in spasm, too, from the shock of the accident. He frankly didn't know how I was even able to do my work with that problem, and recommended vision therapy. When I started my therapy, I was forced to confront the inadequacies of my eyesight, and it was very upsetting to me, emotionally. I was given various procedures to practice in the doctor's office, and lenses to practice with at home. I found everything very difficult, and I was also forced to notice exactly how long it took me to focus the eye that had been damaged. There was a lapse of about 5 seconds in focusing, and when I finally did manage to focus, the image that I saw with my right eye was considerably smaller than the one I saw with my left eye. Mercifully, I did not suffer any permanent scarring of the cornea, since I somehow absorb scar tissue. Another bit of luck. This time I really needed it. I continued with my therapy for some time, but frankly I was not too dedicated. I was able to improve my focusing ability and the ability to use my eyes in tandem with eachother. The next time I underwent therapy, I was much more determined. I was 45 years old, and both my near vision and distance vision were getting progressively worse. I didn't want to go to see Dr Evans, because each time I went I needed a stronger prescription, just to read the newspaper. I kept using more and more magnification for my modelmaking work, and my eyes just felt so uncomfortable after doing this. I decided to try vision therapy again, although I was told that it would probably be too difficult for me since the flexibility of the lens was no doubt affected, due to the aging process. When I started my exercises I once again had a great deal of trouble, but somehow this made me more persistent and creative in my approach to it. I had difficulty with even the easiest lenses, so I tried doing things a different way than suggested. For example, instead of using a lens with a small reducing factor, I held the newspaper closer and closer to my eyes. This helped to "coax" my eyes into improvement. Soon I was able to use the practice lenses.There were many other things I tried, but most of all I decided to take notice of every single detail in my practices. I realized that being hyper-aware of what my eyes were doing was of utmost importance. Especially when I found something that worked. I will give many details of my vision therapy practices in the pages that follow. Most of these were homework ordered by Dr Evans and his partner, Dr Stein. Others are culled from the writings of other people who have had vision problems, and of course I came up with a few useful ideas myself. The result of all this? I practice vision exercises every day of my life, and I have been told that I now have the eyes of a 25-year-old. I have heard many anecdotes of successful vision therapy in other people, too. I am not the exception. And I think that you all could succeed at it, too. The benefits are too great for you not to give it a chance.

8) What Is The Bates Method of Vision Improvement? Is There Anything Useful in It? I had so much trouble with the regular vision training homework, as I stated before, that I did look into it when I started training again, at age 45. I do find it useful, to a certain extent. I read about the Bates Method in a book by Aldous Huxley, called The Art of Seeing. I knew that Huxley was a brilliant man; I had read many of his novels, and I had heard that his book on the Bates method was easier to understand than the one written by Bates himself. When Huxley was a teenager, he suffered an attack of keratitis punctata, an acute infection which left him with opacities in his cornea, farsightedness,and extreme blurriness. He was actually almost blind for 18 months. After that, his vision was still extremely poor; he was barely able to detect light with one eye, and only just barely able to see the largest letter on the Snellen (eye) chart at 10 feet. He used a hand magnifying lens at first, and then was promoted to eyeglasses. He suffered continual strain because it was such a strain to see anything. After some years he suffered a worsening in his eyesight, and fearing eventual absolute blindness, investigated some methods of visual improvement that he had heard of. He wrote very eloquently on the benefits of Dr Bates' methods, and those of his disciples. Huxley's book details his ability to read without glasses and without strain and fatigue through the use of these methods. My own experience was not quite so pronounced, but I certainly did find some of the Bates practices quite useful. This is especially true when one's eyes are middle-aged and need to be coaxed into "working out." Please be reminded that this essay is not a wholesale endorsement of the Bates Methods. They are a good start when one finds standard practices too difficult. The actual vision training exercises are more challenging, and I believe that they are necessary for the optimum recovery and improvement of visual functioning.

Some of Huxley's observations follow

a) Ophthalmologists are obsessed with the physiological side of seeing; they ignore that there may be a mental aspect to vision.

b) When conditions permit, a sick organism tends to recover through its own intrinsic powers of healing. In other words, without the existence of natural healing powers, medicine would be helpless.

c) Artificial lenses do not eliminate the causes of defective vision. eyes fitted with these devices tend to become increasingly weaker and to require progressively stonger lenses for the correction of their symptoms.

d) A good teacher can often educate a victim of paralysis or accident into gradual recovery of function. If such things can be done for crippled legs, the same can be done for defective eyes.

e) Heightened powers of perception can improve a person's capacity for sensing and seeing.

f) On the Variability of Vision Defective eyes can have flashes of normal vision under a situation involving "dynamic relaxation."

g) The wearing of glasses confines the eyes to a rigid and unvarying state in which flashes of normal vision are quite impossible to detect.

h) Any inhibition of eye movement (such as staring, or immobilization by wearing glasses) lowers the powers of seeing.

i) Staring produces tension and psychological strain, and normal vision becomes impossible. When continuous and excessive tension is present, circulation is reduced, and the tissues of the body lose their resistance and their powers of recovery.

[Some of the practices I have adapted that Bates and Huxley developed are described in Section (13)]

9) Can You Describe a Typical Vision Therapy Session In Your Doctor's Office? A qualified vision training specialist (or provider) is usually an Optometrist, who is by training an expert in the use of lenses for vision correction. The first step is of course a comprehensive eye exam. The results of this will first of all indicate if a disease process is present which would not be improved through vision training. They also will reveal what weaknesses the potential vision training patient possesses, and will suggest what machines should be used and to what parameters they should be set if vision training is to begin.The vision training "laboratory" environment consists of many devices which contain lenses and prisms. These challenge the eyes and force them to work to produce coherent images using both eyes. Eyeglasses with colored lenses and polarized materials are also used in a similar manner. The beginning vision training patient will commonly experience strain when the eyes are thus challenged, and the eyes will shed tears. This effect will lessen as he becomes more adept. He learns to observe what his eyes are doing and to be aware of the feeling he experiences when his eye muscles are being worked, and when he is successfully able to see an image correctly. in time, he is able to discern what muscles are being worked. The computer is also used in training. The doctor will set up sessions in which the patient is given progressively more difficult things to do with his eyes. Some of these may involve the eyes having to rapidly focus at near and distant objects. Another has the eyes following objects moving around the monitor screen which appear at different distances. Doing this makes one aware of exactly which muscles are weak, and must be worked on. This all sounds so complicated, but good results are often dramatic and rapid. Actually, a common effect of training is that can see a bit better after just the first vision training session, even if you have a great deal of difficulty succeeding with the office vision training practice. The vision training session exercises both the muscles inside the eye, which change the shape of the lens, and those outside of the eye. Both muscle groups must work in concert with eachother for vision to be optimal. And a crucial part of vision training is home practice. Your vision training specialist will give you lenses, prisms, and cards for you to use at home. Commonly, one uses a lens to exercise one eye at a time, and after both eyes have become stronger, a "flipper" is used which challenges both eyes to focus at the same time. The use of these home devices is prescribed by the doctor depending on what the patient's visual weakness is. I can give you details of my own practices, but unless you all have exactly the same eye problems as I do, your practices would be somewhat different from mine. And as I stated before, I also recommend the Bates method as a starting point, especially if vision is very much impaired, or if the paient is as old as I am!

10) What Parts Of The Visual Apparatus Are Involved In Vision Training? Basically, the lens, the ciliary (intraocular) muscles, and the extraocular muscles. The brain itself is of crucial importance, since the information the eye receives is transmitted to the visual cortex via the optic nerve. The eye apparatus is the input device. All seeing actually takes place in the brain, as this information is processed.(Show Schematic Picture of Eye and other diagrams, of lens, etc short description of eye anatomy and brain involvement)

11) How Is It Possible That You Can You See Better, If You Don't Do Well In Your Office Practice Or Home Session? There is a mathematical concept called a "limit." A limit by any definition is something which is the maximum that can be achieved. A mathematical formula can often be depicted visually as a "function." A logarithmic function is a curve (see diagram) that reaches into infinity and never quite reaches the line called its limit or asymptote. Well, vision training exercises often put one's eyes through extreme motions that are actually quite unnatural, in order to strengthen the eye muscles. When the patient does not see the image with complete clarity, (the limit) he has often nonetheless improved his abilities. In my own experiences (in my home practices) I was unable to see images clearly when using some of the reducing lenses.Nonetheless, I found to my surprise that after using them for a time I no longer needed reading glasses. My goal was perfect clarity through the lens, and my vision did improve, although not to that absolute limit.

12) What Are Some Easy Vision Improvement Practices One Can Do Without Special Equipment? First of all, sometimes one is waiting for a bus or is on a train, and stranded without your home vision training materials. An excellent idea for someone with accomodative insufficiency, like me, is to focus on something very close, like a brooch or button on your coat, and then to look at something very far away. You can feel that your extraocular (outside) eye muscles first turn your eyeballs inward, and then outward as you look at some far-distant object. The ciliary muscles inside the eye must also work in both cases, changing the shape of the lens, trying to see the object with clarity. This is true regardless of how near or far the object you are focusing on is. Another practice is to do this with one eye at a time. Both eyes must be utilized for proper vision, but I have found this to be useful in determining the exact weakness one has. Once you can determine your weakness, you can devise methods to work the eye to improve it. If one has a weakness in near vision, try moving the newpaper closer than you usually can see it comfortably, just a bit. This is actually a much milder exercise than using a reducing lens.Try taking off your reading glasses, if you have been in the habit of using them. And try to relax, and scan the page of a newpaper or book. You can often see more than you would have expected. The same result is achieved if you try to look at print that is a bit too small to read, or the locations on a map. Blinking your eyes a few times will help them to focus. You can often discern words, unexpectedly. You can find objects to practice with everywhere The small print on a medicine bottle or on an advertisement, or a magazine that is printed poorly with not enough contrast in colors. You can move the page closer than you can see comfortably, also. Another good exercise is to look up and down, left and right, without moving one's head. This stretches the muscles that move the eyeballs. A good exercise for those muscles to do on the computer is to read a very long line of type, backwards and forwards, without moving the head. You will feel your extraocular eye muscles working. Find out what your visual weakness is, and work on it all the time. This is the real secret to success in vision therapy, for who has time for a designated practice session all the times you should be doing them? The key is to do some form of vision exercise every single day.

13) What Are Some Bates Methods and Observations I Have Found Especially Useful? Many specialists object to Bates and consider his methods useless. In my opinion, they are based on common sense,and the proof of this is that many of them have been entirely encorporated into standard vision training therapy. I believe that they are a very good starting point, but not challenging enough to produce as much vision improvement as can more modern practices utilized by vision training specialists. That is, unless one's eyesight is as impaired as that of Aldous Huxley. It is likely that standard vision training exercises would have been too difficult for him.

a) Boredom is a cause of visual malfunctioning. Try whatever it takes to make your home practices interesting. For instance, early in my training I was given a page of the telephone book to practice on, using reducing and magnifying lenses. I couldn't bring myself to do this regularly; it was so boring. Then I started switching the lenses as prescribed, but while reading an interesting book. I progressed rapidly from there, and was able to increase the length of my practice sessions as well.

b) Palming A Relaxation Technique The eyes are closed and covered with the palms of the hands

c) Breathing And Blinking the quality of circulation around the eyes can be enhanced by breathing without strain and natural blinking habits. Blinking also serves to lubricate the eyes

d) The Usefulness of Light We have an unnatual fear of light; sunning the eyes is a valuable technique

e) Procedures to Encourage Mobility Swinging, shifting, flashing

g) Memory As An Aid To Vision

h) Specifics Myopia, Hyperopia, Astigmatism

i) Some Difficult Seeing Situations Reading, Looking at unfamiliar objects, movies

14) What Home Practices Does The Vision Training Provider Prescribe? (See Practice Guide (link forthcoming).)

15) What Side Effects May Result From Your Practice of Vision Therapy? Think of what occurs when you undertake almost any new form of exercise. One result can be discomfort. Your eyes may feel "tight," and will probably water a good deal when you are working on some particularly difficult exercise. I find that this subsides over time. You can also experiment with your practicing schedule. For some people, more practice sessions per day are easier. And vision exercises can be done during a break in your work schedule. For example, after doing taxing close work with alot of magnification, you may feel better if you do some exercises in which you are gradually diverging your eyes. You will also most likely see almost immediate improvement after your first training session with your therapist. You can see better. You didn't think it possible...but it happened. But you have to keep doing it. You can expect improvement if you practice diligently, but if you stop for any length of time, you will backslide. Many of the exercises are unnatural motions for your eye muscles. This is intentional, so that the muscles can grow stronger and more flexible in response. Your everyday average activities will not have the same therapeutic effect on your eye muscles.

16) What Is A Typical Day Like For You, In Terms of Practicing Vision Exercises? There is no typical day.Every day is different. I have this piece of software now that I find alot of fun, since it's hard to get me away from the computer, anyway. On days that I use the software, I do Base In Vergence, which is hardest for me, because my eyes like most of all to converge. Then I do Base Out Vergence, Autoslide Vergence (which is both BI and BO) and Jump Ductance, which is the very hardest. I try to do this more than once. Some days I stick with lenses. I have been instructed to use minus lenses, to make my eye muscles work better at near vision, because modelmakers need to be able to see at close range very well. I get bored reading the phone book (as my doctors told me to do) so I use a minus lens on one eye at a time, reading a good novel, and starting at - .75 and working my way up to lenses that reduce even more. I use the flipper if possible, too, since it is what gets my accomodative muscles working together. When I'm working alot, it is helpful when I take breaks to use the computer program and the prisms a bit. My prisms are for vertical shift problems, which I have also. I have improved at this, though, because I have more challenging prisms now. I don't do every single exercise every day. Sometimes I use the "coin cards." The plain ones are for practicing Base Out. I've made some of my own on my computer that are more challenging, with smaller coins.The transparent one is the hardest; it's for Base In. Anyone who can do this one well I take my hat off to you! It's very difficult, but after I (at least try to) do it, I really do feel my eyes can focus much better.Sometimes I have to spend a whole day seeing customers and riding the subway. So I look at something very close, even my fingernail or a button, and then far away. Like small print on a billboard. Of course there are some days when even that much is not possible, training-wise. So I take a book to bed, and use my minus lenses, one eye at a time, until I realize that I am reading in my sleep...

* Please remember that these exercises are designed for ME, with my particular vision problems. When you get your eye exam, or find a vision therapy provider, you may be told to do other exercises. Everyone is different.

17) Are There Other Factors Which May Affect Your Vision and VisionTraining Practices? If you have any serious systemic medical conditions, such as diabetes or lupus, you may have additional eye or other problems. Your doctor will be the best judge of whether eye exercises will be too difficult for you, in this case. And some conditions specific to the eyes, such as glaucoma, cataracts, or macular degeneration are very serious. They cannot be improved through the use of vision training. But if you are basically in good health, and you are "warmed up," by walking or other exercise and your circulation is up, you may find that your eye muscles are at their most responsive. Caffeine often improves your exercise performance a bit as well. Watch out for this if you have high blood pressure. On the other hand, there are many drugs and medications which make your eye muscles temporarily weak (see APPENDIX C). So, if you are on some necessary medication, do not be surprised if you experience a temporary setback in your exercise program. Think of it this way You don't always have a good exercise day at the health club, but if you keep going, you will steadily improve, over time. By the way, your age is an important factor. I began training very late in life. Younger people can usually expect more rapid improvement in their visual functioning. Since I am a middle-aged person, I am battling of course what is called presbyopia, the hardening of the crystalline lens of the eye. I'm trying to keep it flexible for as long as I can...

18) Can I Keep Doing This Forever? Well, almost forever. But this life isn't forever. One can't really say at what rate the different parts of the body age. My doctors have some patients in their seventies who can still do vision exercises successfully. I'm lucky that my lenses still have enough flexibility that working my ciliary muscles is useful. Most people my age won't undertake something like vision training, so there is no "control," scientifically speaking. (Explanation of the scientific method during lecture) Any good exercise program will slow down the aging process, but of course we all will succumb to some illness or ailment eventually. Vision exercises will help slow the effects of aging on one's eyes, though, in many cases. Remember, I experienced this myself. My eyes had been worsening for both near and distance vision, and this has been reversed. I don't need glasses to read or to drive,now, and I can do acrobatics with my eyes, sort of. I can do things now that I couldn't do as a child when, of course, normal functioning of my eyes was so good it was completely effortless. The difference now is that I can feel my eye muscles working. It does take an effort for me,now, but it's not uncomfortable. I'm grateful that with this therapy, they do work well.

19) Do I Need To Understand all the Unfamiliar Technical Terms Used to Describe Vision and Vision Therapy? You probably will want to familiarize yourself with at least some of the terms. Many of them help to explain what you are doing when you practice the various exercises, and why. When you have your comprehensive eye exam, your doctor may tell you that you have "strabismus," or one of the terms that appears in the glossary (SEE APPENDIX A) It's been very helpful to me, knowing what is wrong with my eyes. It makes it easier to work on my problems when I know that I have "divergence insuffienciency," for example, and need to be able to feel my extraocular muscles working in order to improve my condition. It makes a person feel alot less...well...helpless. Especially when you encounter an exercise that is especially difficult. And many people are like this If you can visualize in your mind what your eyes are doing, you have the capacity to change and improve their functioning. Remember, this is an eye and brain problem. Anyway, since this worked for me, I think it will help you, too. And there's another thing Experts of all kinds like to toss around language that you can't understand. It makes a person feel kind of ignorant. I happen to think that people do this on purpose, for reasons of their own. For instance, before I got a computer, people made me feel very small when they used computer terminology. Which turned out not to be all that difficult to understand, by the way. Well, with this essay and its accompanying glossary about vision, you will feel empowered with understanding about the workings of your eyes! Trust me; you'll feel alot better knowing this stuff...

(show diagram of the eye)

20) Is Vision Therapy A Scientific, Medically accepted Practice? Vision therapy is not voodoo or a magic act, but a very well-documented practice. See Scientific studies on vision therapy, at the Indiana University School of Optometry web site, and Vision Therapy References for other publications. (See also Appendix B.) It is akin to other types of physical therapy, and is most widely-known as an aid for children with vision problems. Many ophthalmologists think that vision therapy doesn't work., but they are primarily concerned with diseases of the eye, and with surgery. They are not required to learn about physical therapies for vision improvement, as optometrists are, during their training. Similarly, in the USA, medical doctors have no required.training in herbal medicine or nutrition, and few of them consider learning about it to be worthwhile. So there is a rivalry between herbalists and medical doctors. Herbal medicine is very well-respected and researched in Europe, China, and India. MDs are ignorant of herbal medicine; ophthalmologists are ignorant of vision therapy. The problem is merely their lack of knowledge, and many professionals are loath to admit this. My answer to either situation is Try it! You may be quite suprised and pleased.

21) WHO Can Benefit From These Exercises? Anyone whose vision problems are related to muscle weakness or lack of coordination. The exercises take time, patience, and persistence. People whose work is especially stressful to their eyes, such as jewellers, designers, photographers, and computer users will find them especially valuable. Below are some tips for certain professions

Jewellers, Designers, etc

a) Have a comprehensive eye exam. Having the proper glasses will prevent further stress on your eyes, since they will correct whatever is your particular weakness.

b) If your vision does not need correction, wear glasses with non-corrective lenses. You will need to protect your eyes from damage due to possible accidents on the job.

c) If your work requires better than 20/20 vision, have your eye doctor prescribe magnification lenses in your particular prescription.

d) Frequently change the magnification you are using. This helps to prevent the lenses from losing their flexibility at varying distances.

e) You may find it useful to use your prescription magnification glasses with optivisors, etc for additional magnification. Many people experience eye pain or discomfort when using non-prescription magnifiers. The use of BOTH often remedies this.

f) Make sure that you have adequate lighting for your work, whatever is comfortable for you.

g) Take frequent breaks if your schedule permits, to practice vision training exercises of all kinds.

Computer Users

a) Have the monitor from 16 to 24 inches away from you. Excessively close computer work is a strain on one's eyes.

b) Frequently take a break from looking at the monitor, at least every 15 minutes. Look far away, at varying distances.

c) Use the largest monitor possible, with screen contrast, etc. so that resolution is maximized.

d) Location of Monitor The center of the computer screen should be 4 - 9 inches below your eyes. Your eyes work best with a slight downward gaze. If the computer screen is higher or lower than this, it causes an awkward posture that contributes to sore neck, back, or shoulder, and may also produce headaches. Also, your computer screen and other work should be located straight in front of you so that you don't have to look sideways or twist your body or neck to see them.

e) Lighting Bright lights or other bright objects in your peripheral vision can be uncomfortable. Use a relatively low-wattage bulb in your desk lamp if possible. Drapes can be used to shield one's eyes from daylight if necessary.

f) Look for anti-reflection screens that have been approved by the American (or other)Optometric Association.

g) Experiment Try varying the size and kind of typeface you use in your browser, word processing application, and other

programs during the course of the day. This serves as a kind of vision exercise itself.

h) Do vision training exercises as often as your work schedule permits. Vision training software is ideal for this purpose.

i) Blink on a regular basis; do not stare at the monitor. This sounds obvious, but people sometimes don't realize that they are staring. Blinking helps one to refocus the eye, and is also relaxing.

i) Get computer glasses if your eye doctor recommends this.These lenses are designed to accommodate the unique viewing distances and angles at a computer

22) Are There Any Other Things One Might Do To Improve Vision? Do whatever you can to remain in good health. It has been suggested that certain herbs and nutrients might promote the health of the visual apparatus. These include bioflavonoids such as quercetin and lutein, vitamins E, A, and C, and herbs such as bilberry. CoEnzyme Q10 ia another.Any nutrient that has the reputation of having Antioxidant properties would be a good idea. Of course nutritional supplements of any kind are an added expense. The most important thing is to eat a balanced diet containing all the essential food groups. Essential fatty acids (oils) which are polyunsaturated or monounsaturated help especially the nervous system and hormonal systems. Many people try to eat a very lowfat diet to keep their weight down, but if you eliminate too many beneficial fatty acids, your health will suffer. Of course try to get enough rest and do whatever is your favorite method of relieving stress. And what one doesn't do can often have more of a good effect than anything else. Smoking and drinking are well known to promote rapid aging, as do recreational drugs (Sorry!) so they are also not a good idea. Try to live a life of moderation, in terms of eating well and exercising regularly, in general. If you know that you have a medical condition, like diabetes, make sure that you keep your sugar level under control. Vision problems related to blood vessel problems are related to this disease, among other things. And no one lives a perfect life, healthwise, but most of us know what is actually really bad for us...

23) Suggested Reading

* The Art of Seeing by Aldous Huxley

* Stereogram by Cadence Books This book is a very good start for practicing Base In (distance) Exercises. Seeing Stererograms is much easier than regular training. It is also alot of fun!


Accommodation- (eye focusing) the eye's ability to adjust its focus by the action of the ciliary muscle, which increases the lens focusing power. When this accommodation skill is working properly, the eye can focus and refocus quickly and effortlessly, which is similar to an automatic focus feature on a camera. The ciliary muscles must contract to adjust for near vision, which causes the eye's crystalline lens, which is flexible, to be squashed. For distant vision, the ciliary muscle must relax and the eye's crystalline lens is stretched out. The ability of the eye to accommodate does decrease with age due to the crystalline lens becoming less flexible causing a condition called presbyopia. (See Presbyopia)

Accommodative Fatigue- This clinical condition is also called Ill-Sustained Accommodation. It is the inability of the eye to adequately sustain sufficient focusing over an extended time period. The most common sign or symptom is blurred vision after prolonged near work such as reading and using a computer. In addition, such patients often have asthenopia (eyestrain), general fatigue, headaches and nausea, excess tearing, and an unusual sensitivity to light. Clinical signs include normal amplitude of accommodation, decreased PRA, and the patient generally fails the +/-2.00 D flipper test. Plus lenses (glasses or contacts) and vision therapy are effective in treating this condition.

Accommodative Esotropia- this clinical condition is an excessive inward turning of the eye caused by an overactive convergence response as the eye focuses on an object. More common in farsighted (hyperopic) children. This is treated with plus lenses (glasses or contacts) to decrease the accommodative demand and to straighten the eyes. In some cases, vision therapy and corrective lenses are prescribed. (Please note that Accommodative Esophoria is a condition similar to accommodative esotropia but lesser in extent.)

Accommodative Excess (AE)- This clinical condition is also called accommodative spasm. It is an over focusing, over stimulation of the focusing action of the crystalline lens causing an inability to relax the focusing system which may result in blurry vision when focusing at distance objects. Other symptoms include holding near work closer than normal, headaches with near work (such as reading or using a computer), eyestrain associated with near work, and possible double vision. Clinical signs include patient accepts more minus on accommodative rock but blurs with plus lenses, lower NRA than PRA, dynamic retinoscopy findings indication of over accommodation and/or slow relaxation of accommodation, and reduced or erratic distance visual acuity. Vision therapy is an effective treatment option.

Accommodative Infacility- (clinical condition) a difficulty changing eye focus from distance to near. Symptoms include eyestrain associated with near work (such as reading or using a computer), periodic blurring of distance vision especially following sustained near visual work, tendency to hold near work closer than expected, headaches with near work, and possible double vision. Clinical signs include patient will have difficulty with both the plus and the minus lens (fails +/- 2.00 D flipper test), low PRA and NRA, and poor recoveries on Bell Retinoscopy. Vision therapy is an effective treatment option.

Accommodative Insufficiency (AI)- This clinical condition is also called non-presbyopic accommodative insufficiency. It is an under focusing, a lack of focusing ability at a near distance. Symptoms include eyestrain, blurred vision, occasional or constant when doing near work (such as reading or using a computer), occasional unusual sensitivity to light, excess tearing, headaches, and general fatigue. Clinical signs include patient will have difficulty with a minus lens, low amplitude of accommodation, low PRA and higher NRA. Vision therapy is an effective treatment option.

Accommodative Vergence- a convergence response (to turn the eyes inward) which occurs as a direct result of accommodation. (See Vergence and also Amplitude of Accomodation)

AC/A Ratio- accommodative convergence / accommodative ratio (measured in prism diopters/diopters). This is the numerical expression for the relationship between the amount both eyes simultaneously turn inward (converge) in response to an increase in optical power of focusing (accommodation) by the eye's lenses. The normal ratio is 4:1.

Acuity- sharpness or clearness of eyesight. It is a measure of the finest detail a person can see. The Snellen chart is used to test visual acuity. This chart contains rows of letters, numbers, or symbols in standardized graded sizes, with a designated distance at which each row should be legible to a normal eye. (See "Near Acuity" and "Distance Acuity")

After-image- the eye's ability to still see an image during eye blinks and even after the viewed object is no longer present. The most common example is seeing light after the flash of a camera.

Alignment- proper fusing (uniting) of images to each eye.

Amblyopia- (also called "lazy eye.")The unexplainable loss or lack of full development of the vision in one eye. It is not fully correctible with glasses or contact lenses, and has not been traced to any particular eye health problem. Sometimes it is the result of crossed eyes or a great difference in the refractive (light-bending) error between the two eyes.

AMD or ARMD (age-related macular degeneration) Disorder characterized by the gradual loss of central vision due to a damaged macula (which is made up of retinal cones necessary for sight).

Ametropia- any optical error such as hyperopia, myopia, presbyopia, or astigmatism that can be corrected by glasses or contacts. Also called refractive error

Amplitude of Accommodation (AA)- a measurement of the eye's ability to focus clearly on objects at near distances. This eye focusing range for a child is usually about 2-3 inches. For a young adult, it is 4-6 inches. The focus range for a 45-year-old adult is about 20 inches. For an 80-year-old adult, it is 60 inches.

Aniseikonia- unequal retinal image sizes in the two eyes, usually from different refractive errors. (See Iseikonic Lens)

Antioxidant - Substance that inhibits oxidation and can guard the body from the damaging effects of free radicals. Molecules with one or more unpaired electrons, free radicals can destroy cells and play a role in many diseases. Antioxidants may help prevent macular degeneration and other serious eye diseases.

Aqueous humor - Clear fluid in the eye that both provides nutrients and determines intraocular pressure.

Asthenopia- eyestrain, symptoms include excessive tearing, itching, burning, visual fatigue, and headache. May be related to uncorrected refractive error, accommodation (eye focusing) disorder, or binocularity (eye teaming) disorder.

Astigmatism- Blurriness of vision at all distances, a common vision condition which is usually caused by the front surface of the eye having a slight irregularity in shape.

Base-Down (BD) Prism- the base (thickest end) of the prism is downward and it causes the eye to move up. Used to measure or treat a binocular dysfunction (eye teaming problem). Sometimes incorporated in glasses.

Base-In (BI) Prism- the base (thickest end) of the prism is towards the nose and it causes the eye to diverge (straighten or move out). Used to measure or treat a binocular dysfunction (eye teaming problem). Sometimes incorporated in glasses.

Base-Out (BO) Prism- the base (thickest end) of the prism is away from the nose and it causes the eye to converge (turn in). Used to measure or treat a binocular dysfunction (eye teaming problem). Sometimes incorporated in glasses.

Base-Up (BU) Prism- the base (thickest end) of the prism is upward and it causes the eye to move down. Used to measure or treat a binocular dysfunction (eye teaming problem). Sometimes incorporated in glasses.

Behavioral optometrist- A doctor of optometry who specializes in the practice of vision therapy. Also known as a vision training provider.

Bifocal Glasses- eyeglasses that combine two lenses with different refracting powers, one for distant and one for near vision. Often prescribed for people with presbyopia.

Binocular vision when both eyes aim at the same target at the same time, working together as a well-coordinated team, equally and accurately (See also stereopsis)

Binocular depth perception- the ability to perceive with one's eyes that space has three dimensions, particularly depth. Also, the ability to judge relative distances between objects

Binocular vision impairment- a defect in vision in chich one's two eyes do not work together as a well-coordinated team. This results in a partial or complete loss of binocular depth perception and stereoscopic vision. At least 12% of the population has some kind of binocular vision impairment.

Break Point- measurement, the point at which a person can no longer fuse (unite) two images into one.

Cataracts- A condition in which the normally clear lense of the eye becomes cloudy, resulting in clouded and or blurred vision. (Cannot be corrected by the use of vision training) Cataracts may be caused by aging, eye injuries, disease, heredity, or birth defects. Surgery is a treatment option. The affected lens is removed and is replaced with a substitute (implant) lens or with a special type of contact lens. Generally the success rate of cataract surgery is over 90%, if the eye is otherwise healthy.

Ciliary Body- a structure directly behind the iris of the eye and contains the ciliary muscle. (See diagram of the eye)

Ciliary Muscle- a band of muscle and fibers that are attached to the lens that controls the shape of the lens and allows the lens to accommodate (change focus).

Comprehensive eye exam- A comprehensive eye examination should include the testing of the following visual skills which are aspects of normal, healthy vision (see below)

Acuity-Distance visual acuity (sharpness, clearness) at 20 feet distance.

Acuity-Near visual acuity for short distance (specifically, reading distance).

Focusing Skills the ability of the eyes to maintain clear vision at varying distances.

Eye Tracking and Fixation Skills the ability of the eyes to look at and accurately follow an object; this includes the ability to move the eyes across a sheet of paper while reading, etc.

Binocular fusion the ability to use both eyes together at the same time.

Stereopis binocular depth perception.

Convergence and Eye Teaming Skills the ability of the eyes to aim, move and work as a coordinated team.

Hyperopia a refractive condition that makes it difficult to focus, especially at near viewing distances.

Color Vision the ability to differentiate colors.

Reversal Frequency confusing letters or words (b, d; p, q saw, was; etc.)

Visual Memory the ability to store and retrieve visual information.

Visual Form Discrimination the ability to determine if two shapes, colors, sizes, positions, or distances are the same or different.

Visual Motor Integration the ability to combine visual input with other sensory input (hand and body movements, balance, hearing, etc.); the ability to transform images from a vertical to a horizontal plane (such as from the blackboard to the desk surface).

Computer Vision Syndrome (CVS)- the complex of eye and vision problems related to near work that are experienced during or related to computer use. Its symptoms include eyestrain, dry or burning eyes, blurred vision, headaches, double vision, distorted color vision, and neck and backaches. The condition is caused by various internal and external factors. Treatment options may include prescription glasses and/or vision therapy.

Cone- light-sensitive retinal receptor cell that provides sharp visual acuity and color discrimination. (see also Rod)

Cornea- is the transparent front-most surface of the eye. Provides most of an eye's optical power.

Convergence- the ability to use both eyes as a team and to be able to turn the eyes inward to maintain single vision up close.

Depth Perception- the ability to judge relative distances of objects. (See Stereopsis)

Diabetic retinopathy - Leaking of retinal blood vessels in advanced or long-term diabetes, affecting the macula or retina. Vision can be seriously distorted or blurred.

Diopter (D)- a measurement of the refractive (light bending) power of a lens or a prism (pd). The strength of prescription glasses and contacts are measured in these units. For example a lens that is 0.50 diopter (D) is very weak, where as a lens that is 10.0 diopter (D) is very strong. Eyecare practitioners use it in eyeglass and contact lens prescriptions. A negative number refers to nearsightedness, while a positive number refers to farsightedness. For example, someone with -8.00 diopter lenses is very nearsighted, while someone with +0.75 diopter lenses is only slightly farsighted.

Diplopia- double vision.

Distance Acuity- the eye's ability to distinguish an object's shape and details at a far distance such as 20

Divergence- the ability to use both eyes as a team and be able to turn the eyes out toward a far object.

Dominant Eye- the eye that "leads" it partner during eye movements. Humans also have dominant hand, foot, eye, and side of the brain (not necessarily all on the same side).

Duction Test- a test of the eye's ability to turn inward or outward while maintaining single, binocular vision with the gradual introduction of progressively stronger base-in or base-out prisms.

Dyslexia- a learning disability in which a person has difficulty with letter or word recognition. Children often are of normal or above normal intelligence; however, they have difficulty reading and sometimes naming pictures of objects. This is caused by an inability of the brain's language centers to decode print or phonetically make the connection between the word's written symbols and their appropriate sounds. This is not caused by a vision disorder. Dyslexia cannot be cured and will never be outgrown. Appropriate teaching methods can be taught to help those with dyslexia overcome their weakness by using their strengths.

Emmetropia- normal vision, no correction needed

Extraocuar Muscles- six muscles that move one eyeball, includes lateral retus, medial retus, superior oblique, inferior oblique, superior rectus, and inferior rectus.

Eye Hand Coordination- the ability of our eyes to guide our hands, also called visual motor integration.

Facility of Accommodation- a measure of the ease and speed of the eye(s) to change focus

Floaters Small specks that pass across your field of vision, these are clumps of cells inside the transparent gel filling the eyeball in front of the retina.

Focusing skills the ability of the eyes to maintain clear vision at varying distances

Fovea- center of the retina that can produce the sharpest eyesight. Contains a high concentration of cones and no retinal blood vessels.

Fusion- the union of images from each eye into a single image.

Glaucoma An eye disease in which the internal pressure of the eyeball increases to the point that the optic nerve can become damaged, resulting in severe vision loss and even blindness (Not correctible by the use of vision training)

Hyperopia (also known as "farsightedness") A vision condition in which distant objects are usually seen clearly, but close objects are not able to be brought into proper focus.

Iris- the colored part of the eye located between the lens and cornea; it regulates the entrance of light.

Iseikonic Lens- eyeglass lens that magnifies or minifies image size. Used for correcting image size difference between the two eyes.

Lens - The nearly spherical body in the eye that focuses light rays onto the retina. The lens itself is a multilayered structure (something like an onion). In young people it is normally perfectly clear and quite elastic. As one ages its elasticity is reduced. In fact after the age of about 45 the lens' ability to change in shape is considerably reduced. That is why people over the age of 45 almost always require glasses to read and/or to see distant objects. It is not unusual for people in their 50's and older to wear bi-focal or even tri-focal lenses.

Low vision - Also called partial sight. Sight that cannot be satisfactorily corrected with glasses, contacts, or surgery. Low vision usually results from an eye disease such as glaucoma or macular degeneration.

Lutein - An antioxidant that is found throughout the body, but is concentrated in the macula. Lutein is believed to help protect the eyes from free radical damage caused by the sun's harmful rays.

Macula- the most sensitive part of the retina that is about the size of a pinhead and is where our most detailed vision occurs.

Minus (-) Lens- concave lens, stimulates focusing and diverges light. The lens is thinner in the center than the edges. It is used in glasses or contact lenses for people who are nearsighted (myopia).

Myopia (also known as "nearsightedness") A common vision condition in which a person can see close objects clearly, but lacks the ability to see distant objects with the same clarity.

Near Point of Convergence (NPC)- the closest point at which the two eyes can maintain a single united image.

Near Point of Convergence Test- measures the patient's ability to point the eyes at an approaching object and to keep them fixed on the object as it reaches the patient's nose. Normal range is 0 to 4 inches away from the nose.

Ophthalmologist- an MD who specializes in surgery and diseases of the eye. A small number of ophthalmologists work in conjunction with vision therapists or orthoptists.

Optician- is a professional in the field of designing, finishing, fitting and dispensing of eyeglasses and contact lenses, based on an eye doctor's prescription. The optician may also dispense colored and specialty lenses for particular needs as well as low-vision aids and artificial eyes.

Optic Nerve- is a bundle of nerve fiber that connects each eye to the brain and transmits images from the retina to the brain. It is also the largest sensory nerve of the eye.

Optometrist (OD)- a health care professional who is state licensed to provide primary eye care service. These services include comprehensive eye health and vision examinations; diagnosis and treatment of eye disease and vision disorders; the detection of general health problems; the prescribing of glasses, contact lenses, low vision rehabilitation, vision therapy, and medications; the performing of certain surgical procedures; and the counseling of patients regarding their surgical alternatives and vision needs as related to their occupations, avocations and lifestyle. The optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete a residency. Some optometrists are also vision therapy providers.

Orthoptics- Literally means "straightening of the eyes. It dates back to the 1850's but is limited in scope to eye-muscle training and the cosmetic straightening of the eyes. Vision training is an expansion of this. It involves the training of the eye-brain connections involved in vision also, and has progressed in this century as have advancements in the knowledge of neuroscience.

Plus (+) Lens- convex lens, relaxes focusing and converges light. The lens is thicker in the center than the edges. It is typically used in glasses or contact lenses for people who are farsighted (hyperopia). Although it may also be prescribed for other visual conditions as well.

Polaroid Lens- a lens used in sunglasses which consists of two glass or plastic surfaces with a plastic lamination between the two surfaces, and designed to reduce reflected glare.

Presbyopia- A natural part of the aging process, it occurs when the crystalline lens of the eye loses its enough of its flexibility so that the accomodative muscles of the eye can no longer bring close objects into clear focus. Usually, it becomes noticeable when a person reaches their early to mid-forties.

Prism- a wedge-shaped piece of glass or plastic that bends light. Used to measure or treat a binocular dysfunction (eye teaming problem). Sometimes incorporated in glasses. (See "Base-Down Prism", "Base-In Prism", "Base-Out Prism", "Base-Up Prism", "Yoked Prism" (link forthcoming))

Pupil- the opening at the center of the iris of the eye. It contracts (dilates) in the dark and when the eye is focused on a distant object. It opens and closes to regulate the amount of light the retina receives.

Pursuit Test- measures the eyes ability to follow a moving target.

Refractive Error- condition in which parallel rays of light are not brought to a focus upon the retina because of a defect in shape of the eyeball or in refracting media of the eye. Also called ametropia. Results in conditions like astigmatism, hyperopia, myopia, or presbyopia.

Refractive Power- a lens' ability to bend parallel light rays into focus, as measured by power diopters. In general, the greater the curvature of a lens and the greater the difference between center thickness and edge thickness, the higher the index of refraction and the greater its refractive power. Refractive power can also refer the strength of a person's contact lenses or glasses.

Refractive Media- the parts of the eye that light travels through before being focused on the retina includes the cornea, crystalline lens, aqueous, and vitreous. (See diagram of the eye)

Retina- the innermost layer of the eye, a neurological tissue, which receives light rays focused on it by the lens. This tissue contains receptor cells (rods and cones) that send electrical impulses to the brain via the optic nerve when the light rays are present.

Rod- light-sensitive retinal receptor cell that works at low light levels (night vision). A normal retina contains 150 million rods.

Saccades Dysfunction- a condition in which the individual's ability to scan along a printed page and move his eyes from point to point is inadequate. Symptoms include frequent loss of place while reading, skip or transpose words, and have difficulty comprehending because of an inaccurate eye movement. Vision therapy is an effective treatment option.

Sclera- the white protective covering of the eye

Stereopsis The product of good binocular vision, where the separate images from the two eyes are combined successfully into one three-dimensional image.

Strabismus (also known as crossed eyes, wall-eyes, or wandering eyes) A visual defect in which the two eyes point in different directions.In some cases these eye misalignments are not obvious to an untrained observer. One eye may turn either up down, in, or out, while the other points straight ahead. The result of this condition is a partial or total loss of stereo and binocular depth perception.

20/20 -the expression for normal eyesight (or 6/6 in countries where metric measurements are used). This notation is expressed as a fraction. The numerator (1st number) refers to the distance you were from the test chart, which is usually 20 feet. The denominator (2nd number) denotes the distance at which a person with normal eyesight could read the line with the smallest letters that you could correctly read. For example, if your visual acuity is 20/100 that means that the line you correctly read at 20 feet could be read by a person with normal vision at 100 feet. The Snellen chart is used to test visual acuity (sharpness of eyesight). This chart contains rows of letters, numbers, or symbols in standardized graded sizes, with a designated distance at which each row should be legible to a normal eye. The Snellen letter is constructed so as to subtend an angle of 5 minutes of arc (5/60ths of a degree) at a specified distance from the eye. Each portion of the letter subtends an angle of 1 minute of arc (1/60th of a degree).

Vergence- to turn the eyes horizontally (convergence- inward or divergence- outward). Accommodative vergence, fusional vergence, proximal vergence, and tonic vergence are needed to maintain single vision.

Vergence Facility- a measure of the ease and speed of the eyes to change from a converging to diverging position.

Visual Field- the total area that can be seen while looking straight ahead. (See "Tunnel Vision" (link forthcoming).) (Note Perimetry is the method of testing an eye's field of vision.

Visual-Motor Integration (VMI)- after visual data is gathered, it is processed and combined in the brain with information from movement (eye hand coordination).

Visual-Motor Skills- the ability of our eyes to guide our hands (eye hand coordination, visual-motor integration).

Visual Pathway- route of the nerve impulses from the retina along the optic nerve, and optic nerve radiations to the brain's sensory cortex that is located at the base of the skull.




Vision Therapy Texts

Vision and Visual Dyslexia (ed by JF Stein, CRC Press, 1991)

Optometric Management of Nearpoint Vision Disorders (MH Birnbaum, published by Butterworth-Heinemann, 1993).

Clinical Pediatric Optometry (LJ Press, BD Moore, published by Butterworth-Heinemann, 1993).

Clinical Management of Binocular Vision (M Scheiman, B Wick, published by JB Lipincott, 1994).

Binocular Anomalies Diagnosis and Vision Therapy, 3rd ed (JR Griffin, JD Grisham, published by Butterworth-Heinemann, 1995).

Applied Concepts in Vision Therapy (ed by LJ Press, published by Mosby, 1997).

References to Textbooks, Articles, etc.

Subject Vision Therapy
Title Workouts for the eyes
Author(s) Toufexis, Anastasia
Journal Time
Date February 13, 1989
Pages 86

Subject Vision Therapy
Authors(s) Dr. John R. Griffin and Dr. J David Grisham
Book Binocular Anomalies - Diagnosis and Vision Therapy
Date 1995
Publisher Butterworth-Heinemann

Subject Vision Therapy
Author(s) Dr. Leonard J. Press, editor
Book Applied Concepts in Vision Therapy
Date 1997
Publisher Mosby

Subject Optometric Vision Therapy
Title Definition of optometric vision therapy
Author(s) American Optometric AssociationDate June 1991

Subject Optometric Vision Therapy
Title Fact sheets on optometric vision therapy
Author(s) American Optometric Association
Date June 1992

Subject Efficacy of Optometric Vision Therapy
Title Future of Visual Development/Performance Task Force.
Report on the efficacy of optometric vision therapy
Author(s) American Optometric Association
Journal Journal American Optometric Association
Vol. 59(2)95-105, 1988

Subject Vision Therapy
Title Vision Training Revisited
Author(s) Keogh, Barbara; Pelland, Michelle
Journal Journal of Learning Disabilities
Vol 18(4)
Date 4-1985
Page(s) 228-236

Subject Learning Disabilities and Vision
Title Identification of children with vision problems that interfere with learning. Vision and learning disability
Author(s) Greenstein T
Journal American Optometric Association
Vol. 1976, p. 95-114

Subject Accommodation Problems, Accommodative Problems
Title Accommodation Deficiency in Healthy, Young Individuals
Journal Journal of Pediatric Ophthalmology

Subject Convergence Insufficiency
Title Convergence of Amplitude Insufficiency
Journal Annals of Ophthalmology
Vol. Sept. 1983

Subject Ocular Motility
Title Correlation between Cognitive Processing and Ocular Motility
Journal Optometry and Vision Science
Vol. 1993

Subject Vision and Learning Disabilities
Title Hidden Eye Problems Can Block Learning
Journal Learning Magazine
Vol. July/August 1991

Subject Vision and Learning Disabilities
Title Learning Related Visual Problems
Organization ERIC Clearing House on Handicapped and Gifted Children
Address 1920 Association Drive
City Reston, VA 22091, Vol. 1981

Subject Vision and Reading
Title Meta-Analysis of the Relationship Between Visual Perceptual Skills and Reading Achievement
Journal Journal of Learning Disabilities
Vol. January 1982

Ciuffreda KJ, Kenyon RV, Stark L. Different rates of functional recovery of eye movements during orthopedic treatment in adult amblyope. Invest Opthal & Vis Sci 18(2)213-219, 1979.

Cohen A., Lieberman S., Stolzberg M., Ritty J. The NYSOA vision screening battery -- a total approach. Journal of the American Optometric Association, 1983; 54 979-84.

Cooper J. Orthoptic treatment of vertical deviations. J Am Optom Assoc 59(6)463-468, 1988.

Cooper J, Selenow A, Ciuffreda KJ, Feldman J, Faverty J, Hokoda S, Silver J. Reduction of aesthenopia in patients with convergence insufficiency after-fusional vergence training. Am J Optom & Physiol Opt 60(12)982-989, 1983.

Daum K. Accommodative insufficiency. Am J Optom & Physiol Opt 60(5)352-359, 1983.

Daum K. The course and effect of visual training on the vergence system. Am J Optom & Physiol Opt 59(3)223-227, 1982.

Donmoyer R. Kos. At-risk students portraits, policies, programs, and practices. Albany, NY State University of New York Press, 1993.

Education Commission of the States.Securing our future the report of the national forum for youth at-risk.Denver, CO,1988.

Flax N, Duckman R. Orthoptic treatment of strabismus. J Am Optom Assoc 49(12)1353-1360, 1978.

Johnson R., Zaba J. Examining the link between vision and literacy. Journal of Behavioral Optometry, 1994; 5(2) 41-43.

Johnson R., Zaba J. Vision screening of at-risk college students. Journal of Behavioral Optometry, 1995; 6(3) 62-65.

Kran B, Duckman R. Divergence excess exotropia. J Am Optom Assoc 58(11)921-930, 1987.

Liu JS, Lee M, Jang J, Ciuffreda KJ, Wong JH, Grisham D, Stark L. Objective assessment of accommodation orthoptics 1. Dynamic, insufficiency. Am J Optom & Physiol Opt 56(5)285-291, 1979.

Rouse M. Management of binocular anomalies efficacy of vision therapy in the treatment of accommodative deficiencies. . Am J Optom & Physiol Opt 64(6)415-420, 1987.

Selenow A, Ciuffreda K. Vision function recovery during orthoptic therapy in an exotropic amblyope with high unilateral myopia. . Am J Optom & Physiol Opt 60(8)659-666, 1983.

Simons H, Grisham J. Binocular anomalies and reading problems. J Am Optom Assoc 58(7)578-587, 1987.

Solan HA. Learning disabilities, Chapter 21. In AA Rosenbloom and MW Morgan, Principles and Practice of Pediatric

Optometry. JB Lippincott, Philadelphia, 1990; p. 486.

Suchoff IB, Mozlin R. Vision screening of an adolescent inner city population a high rate of failure and low compliance on a follow-up care. Journal of the American Optometric Association, 1991; 62(8) 13-18.

Suchoff I, Petito GT. The efficacy of visual therapy Accommodative disorders and non-strabismic anomalies of binocular vision. J Am Optom Assoc 57(2)119-125, 1986.

Swanson M. At-risk students in elementary education effective schools for disadvantaged learners. Springfield, IL; Charles C. Thomas Publishers, 1991.

Weisz CL. Clinical therapy for accommodative responses transfer effects on performance. J Am Optom Assoc 50(2)209-214, 1979.

Wick B. Accommodative esotropia efficacy of therapy. J Am Optom Assoc 58(7)562-566, 1987.

Wick B, Wingard M, Cotler S, Schieman M. Anisometropic amblyopia Is the patient ever too old to treat? Optom and Vis Science 69(11)866-878, 1992.

Wick B, Cook D. Management of anomalous correspondence efficacy of therapy. Am J Optom & Physiol Opt 64(6)405-410, 1987.

Virginia Department of Education. Literacy Passport Exam, 1988.

Some Books For Everyone (See also the websites re Literature)

Cva Classroom Visual Activities A Manual to Enhance the Development of Visual Skills By Regina G. Richards. Classroom activities for all ages to help develop visual skills. Objectives, success criteria and detailed instructions are included for each activity in this book. Ideal for educators.

Developing Your Child for Success By Kenneth A. Lane, O.D. Designed to help children avoid early school failure. The first few chapters discuss the many factors involved in the reading process. The majority of the book is devoted to over 630 activities that will help give children the necessary perceptual-motor skills needed to succeed in school. Activities are divided into eight categories, including visual-motor, ocular motor, laterality, sequential processing, and more.

Eye Q and the Efficient Learner By James A. Kimple. Written by an educator who is also the father of four children with learning difficulties, this book discusses the nature of visual development and the importance of the visual system to school success. Includes sections on the role of the school and the unfortunate labels that are placed on children who are having trouble; the behavioral optometry approach to helping to solve learning-related vision problems, including a "red flags" list of symptoms; some basic common sense parenting tips; and an illustrated section of home and school activities, games and exercises to enhance functioning in specific areas. Recommended for parents and educators.

Eyes on Track A Hands on Guide to Improve Students' Eye Tracking & Vision By Kristy M. Remick, O.D., Carol A. Stroud, B.S. and Vicki Bedes, O.V.T., Vision Therapist. This book is an educator's guide to improve students' eye tracking and vision perception for grades 1-6. Contains 60 pages of eye games to improve eye tracking and vision perception skills.

Pro's Edge Vision Training for Golf By Lawrence D. Lampert, O.D. Learn the hottest techniques available to take strokes off your golf game!

Seeing Is Achieving Improve Your Child's Chances for Success By Donald J. Getz, O.D. This practical guide is written in a simple and straightforward style. The author explains why kids with "good eyesight" can still have poorly developed vision and perception, and how you as a parent or teacher can spot the telltale signs. This book gives case histories of typical childhood vision problems, and how they have been helped with vision therapy. Book includes home activities.

Smart Medicine for Your Eyes; A Guide to Safe and Effective Relief from the Most Common Eye Problems By Dr. Jeffrey Ansel, O.D. Covers basic eye care, eye disorders, and treatments including information on vision therapy. Laypersons won't find the book hard to follow; it is written in a way that is easy to understand.

Thinking Goes to School Piaget's Theory in Practice with Additional Thoughts By Hans G. Furth and Harry Wachs, O.D. Discusses Piaget's theory of intellectual development. Contains illustrated actives and strategies to help a child develop to his full potential.

UNDERSTANDING AND MANAGING VISION DEFICITS A GUIDE FOR OCCUPATIONAL THERAPISTS By Mitchell Scheiman, O.D. Written for occupational therapists to gain knowledge about vision, screening for vision problems, vision problems associated with learning disorders, brain injury, and developmental and sensory disabilities.

Visual Ergonomics in the WorkPlace By Jeffrey Ansel, O.D. This book is a must for any one who spends time on a computer.

When Your Child Struggles The Myths of 20/20 Vision What Every Parent Needs to Know By David Cook, O.D. Written for parents about their children's vision, how to detect if their child is struggling unnecessarily and where to turn for help. Included are sections on understanding 20/20 vision, visual abilities and how to find help. The author uses case histories to illustrate the various vision disorders described in the book. In addition to these sections, the author lists research on vision and vision therapy, additional reading and a glossary of terms.


http://www.opt.indiana.edu/vtlit/vtlit.html University of Indiana College of Optometry

Literature on Accommodative Disorders,Amblyopia,Convergence Disorders, Intermittent Exotropia, Strabismus (General), Clinical Textbooks, Vision Training (General), IU School of Optometry Library Information

http://www.visionhelp.com/ The Vision Help Network provides nationwide referrals for

optometric vision therapy and related diagnostic services












http://www.visionscience.com/ An Internet Resource for Research in Human and Animal Vision







http://www.vision-therapy.com/VT_Equipment.htm SOURCES OF VT EQUIPMENT and PRODUCTS ONLINE

http://www.homevisiontherapy.com/ THE PEOPLE WHO MAKE THE SOFTWARE

http://www.homevisiontherapy.com/doctors_state_index.htm PROVIDERS WHO USE THE


http://www.covd.org/links.html COVD,THE ORGANIZATION MY DOCTORS BELONG TO

http://www.DoctorErgo.com/ COMPUTER VISION SYNDROME

http://www.mic.ki.se/Diseases/c11.html EYE CONDITIONS & DISEASES




Other Suggested Readings on Visual Perception

Spatial Vision, Russell L. DeValois & Karen K. DeValois, Oxford Science Publications, 1988

Fundamentals of Sensation & Perception, 2nd Edition, Michael W. Levine & Jeremy M. Shefner, Brooks/Cole Publishing Co. 1991

Visual Perception The Neurophysiological Foundations, Lothar Spillmann & John S. Werner (Eds.) Academic Press, 1990

An Introduction to the Biology of Vision, James T. McIlwain, Cambridge University Press, 1996

Sensation and Perception, 3rd Edition, E. Bruce Goldstein, Wadsworth Publishing Co. 1989

A Vision of the Brain, Semir Zeki, Blackwell Scientific Publications, 1993

Human Color Vision, 2nd Edition, Peter K. Kaiser & Robert M. Boynton, Optical Society of America, 1996

Color Vision, Leo M. Hurvich, Sinauer Associates Inc., Publishers, 1981

Handbook of Perception and Human Performance, Vol. 1, Sensory Processes and Perception, Kenneth R. Boff, Lloyd Kaufman, Jame P. Thomas (Eds.) John Wiley and Sons, 1986

Color Vision Perspective From Different Disciplines, Werner G.K. Backhaus, Reinhold Kliegl, John S. Werner, Walter de Gruyter, 1998

Human Visual Orientation, Ian P. Howard, John Wiles & Sons, 1982

Vision and Visual Dysfunction, John Cronly-Dillon, General Editor, CRC Press, Inc. (This source contains 16 volumes each edited by an emminent visual scientist. It covers virtually aspects of visual science.)

From Pigments to Perception, Advances in Understanding Visual Processes, Arne Valberg and Barry B. Lee, Plenum Press, 1991

Dictionary of Visual Science, 3rd Edition, David Cline, Henry W. Hofstetter, John R. Griffin, Chilton Book Co. 1980

The Measurement of Appearance, Richard S. Hunter, John Wiley & Sons, 1975

Seeing The Light, Optics in Nature, Photography, Color, Vision, and Holography, David Falk, Dieter Brill, David Stork, John Wiley & Sons, 1986

Eye, Brain, and Vision, David Hubel. Scientific American Library, 1988

Seeing Contour and Colour, J.J. Kulikowski, C.M. Dickinson, and I.J. Murray, (Eds.) Pergamon Press, 1989

Aging and Human Visual Function, Robert Sekuler, Donald Kline, Key Dismukes, Alan R. Liss, Inc. 1982

Mechanisms of the Mind, Colin Blakemore, Cambridge University Press, 1979

Visual Agnosia, Disorders of Object Recognition and What They Tell Us About Normal Vision, Martha J. Farah, MIT Press, 1990

Light, Michael I. Sobel, The University of Chicago Press, 1987

The Retina, An Approachable Part of the Brain, John E. Dowling, Belknap Press of Harvard University Press, 1987

Helmholtz's Treatise on Physiological Optics, Volumes I and II, James P.C. Southall (Ed.) Dover Publications, Inc. 1962 (translation of the original)

The Vertebrate Retina, Principles of Structure and Function, R.W. Rodieck, W.H. Freeman and Co. 1973

The Vertebrate Eye and Its Adaptive Radiation, Gordon Lynn Walls, Hafner Publishing Co. 1967

Visual Illusions, Their Causes, Characteristics & Applications, M. Luckiesh, Dover Publicaitons, 1965

Optics, Sir Isaac Newton, Dover Publications, 1952 (reprint of the original)

The Analysis of Sensations, Ernst Mach, Dover Publications, 1959 (translation and reprint of the original)

Light, Colour and Vision, Yves Le Grand, Chapman and Hall, Ltd., 1968

Physiology of the Retina and Visual Pathway, G.S. Brindley, Edward Arnold (Publishers) Ltd. 1970


http://www.yorku.ca/eye/how-to.htm THE JOY OF VISUAL PERCEPTION A BOOK ON THE WEB


i. How To Use This Book
ii. Preface
iii. How to prepare for a school project
1. Introduction
A. Glossary
2. Questions for the Professor
3. Fun Things In Vision
4. Master Diagram of the Eye
5. Visual Acuity
6. Visual Sensitivity
7. Color/Color Vision
8. Measuring Spectral Sensitivity
9. Distance Perception
10. Shape Constancy
11. Spatial Frequency Adaptation
12. Adapting to Darkness
13. Motion Perception
14. Physics of the Visual Stimulus
15. Fourier analysis; basics
16. Point & line spread functions
17. Some Basic Neurophysiology
A. Eye Cross Section
B. Neurons
a. Retina
b. Receptors
C. Receptive Fields
18. Phototherapy
19. Physiological Response To Color
20. Interesting links which connect you to perception relevant home pages
21. Subject Index
22. References
23. Suggested Readings in Visual Perception


Drugs Which Can Affect Near Vision A Useful List

Joanne L. Smith B.Sc., Ph.Phm.*

J. Raymond Buncic, M.D., F.R.C.S.(C)t


This paper documents a list of drugs that cause problems with near vision, by virtue of effects on accommodation, occasionally refractive error and diplopia. It is meant as a reference aid to the clinician when confronted with problems of focusing on near objects or print.There are many drugs that have been reported to interfere with near or reading vision, producing blurring, decreased accommodation and diplopia. This paper lists the drugs that have been reported in the literature to produce symptoms which interfere with near vision.Case reports for the listed drugs vary greatly from many to few. The drugs have been divided into the following categories those causing (A) blurring at near, (B) diplopia and (C) induced myopia. Those drugs which only rarely cause these symptoms have been omitted.

(From the Departments of Pharmacy* and Ophthalmology, The Hospital For Sick Children, Toronto, Ontario, Canada

Requests for reprints should be addressed to Dr. J. Raymond Buncic, Department of Ophthalmology, The Hospital For Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G lX8)





Chlorpromazine 14-23 8
Clozapine 5 8,14
Fluphenazine 1.2-4.3 8
Haloperidol 6.8-16 8
Loxapine 12,14
Perphenazine 7.4-17.8 8
Pimozide 20 8
Risperidone 1-2%, >/= 10% 11
Thioridazine 0.6-18 8
Thiothixene 20 8
Trifluoperazine 4-10 8
Antidepressants 8,9
Bupropion 5.3-15% 11
Doxepin 20 8
MAOls, for example
Phenelzine 1.5-17%) 8
Tranylcypromine 9%(2-10%) 8
Maprotiline 4% 11
Nefazodone 9% 11
SSRls, for example
Fluoxetine 3-4.5% 8,11
Fluvoxamine 6.3% 14
Paroxetine 4% 11
Sertraline 4% 11
Tricyclic Antidepressants,
for example
Amitriptyline 7.5-35% 8
Clomipramine 18-20% adults 8
Desipramine 2-6 8
Imipramine 1.2-17% 8
Nortriptyline 5.5% 8
Trimipramine 6% 8
Zidovudine <2% 14





Acetazolamide 12
Acetylcholine 12
Alprazolam 12
Amantadine 0.1-1% "visual disturbances" 6
Ambutonium 12
Amodiaquine 12
Amoxapine 12
Amphetamine 12
Amphotericin 14
Antazoline 12
Baclofen 12
Bendroflumethiazide 12
Betamethasone 12
Bethanechol 12
Biperiden 12
Captopril 13
Carbachol 12
Carisoprodol 12
Cetirizine 13
Chloramphenicol 12
Chlordiazepoxide 0.1% 8
Chlorothiazide, 12
Chlorthalidone 12
Cinchocaine (dibucaine) 12
Cimetidine 12
Clemastine 12
Clonazepam 12
Clonidine rare 14
Clorazepate 12
Cocaine 12
Cortisone 12
Cyclopentolate 12
Dapsone 11
Dexamethasone 12
Dextramphetamine 12
Diazepam 0.14% 8
Diethylpropion 12
Diflunisal <1% 14
Dimenhydrinate 11
Diphenhydramine 12
Diphtheria Polio Tetanus Vaccine 12
Diphtheria Tetanus Vaccine 12
Diphtheria Vaccine 12
Disopyramide 12
Dronabinol 12
Droperidol 12
Echothiophate 12
Emetine 12
Ergot 12
Ethanol 12
Ethopropazine 12
Fenfluramine 12
Fluorometholone 12
Fluorouracil 12
Flurazepam 12
Ganciclovir <1% (amblyopia) 14
Gentamicin 11
Hashish 12
Heroin 12
Homatropine 12
Hydrochlorothiazide (transient) 14
Hydromorphone 12
Indapamide <1% 14
Iodine, Iodine Compounds 12
Isoniazid 12
Isopropamide 12
Levodopa 11
Lorazepam 12
LSD 12
Marijuana 12
Medrysone 12
Meprobamate 12
Mesalamine (5-ASA) ? 11
Mescaline 12
Methamphetamine 12
Methazolamide 12
Methotrimeprazine 12
Methylene blue 12
Methysergide 12
Metolazone, 12
Midazolam 12
Morphine 12
Nalidixic acid 12
Naproxen 12
Neostigmine 12
Netilmicin <0.1% 11
Nitrazepam 12
Olanzapine rare 11
Olsalazine ? 11
Opium 12
Orphenadrine 12
Oxazepam 12
Oxymorphone 12
Penicillins 12
Pentamidine (aerosol) <1% 14
Pentazocine 12
Periciazine 12




Felbamate 3.4-6.1% 11
Fluoxetine 0.1-1% 14
Gabapentin 5.9% 14
Isotretinoin/oral retinoids 6
Lamotrigine 27.6% 11
Pergolide 2.1% 11
Procarbazine 6
Topiramate 6.3% it




Streptomycin 12
allopurinol 12
amantadine 1
ambenonium 1,12
amphotericin 2
anagrelide (>5%) 11
antazoline 12
Antidepressants, MAOIs 12
e.g. phenelzine
Antidepressants, tricyclics 12
e.g. amitriptyline
Antidepressants, SSRIs
e.g. sertraline (0.1-1%) 11
Antidiabetic agents, oral 1,12
e.g. glyburide
Antihistamines (most) 1,12
e.g. chlorpheniramine,
aztreonam (??l%) 11
Penicillamine 1
Phenformin 5
Phenothiazines 7, 12
e.g. chlorpromazine
Phensuximide 12
Physostigmine 12
Pilocarpine 12
Prochlorperazine 1,5,7,12
Promethazine 1,5
Quinine 1
Spironolactone 1,5,12
Sulfonamides 1,5-7,10,12
Tetracyclines (rare) 1,5-7,12
Timolol 12
Trimeprazine 12
bacitracin 12
baclofen 1,12
Barbiturates 1
e.g. pentobarbital
Benzodiazepines 12
e.g. diazepam
Beta-adrenergic blockers 12
e.g. propranolol
bupropion (??0. 1%) 11
carbamazepine (high doses) 12
carisoprodol 12
chlorprothixine 1, 12
cisplatin I
clindamycin 12
clomiphene 1,12
colchicine 1,12
colistin 12
Corticosteroids 1
e.g. betamethasone, prednisone
cytarabine (intrathecal route) 1
danazol 1, 12
dantrolene 1, 12
diazoxide 12
diethylpropion 12
digoxin 12
disopyramide 1
dronabinol 12
edrophonium 1,12
ethanol I
ethchlorvynol 1,12
ethionamide 12
ethosuximide 12
ethotoin 12
fenfluramine 12
flecainide 12
floxuridine 12
fluorouracil 12
gold salts 1
guanethedine 12
hexachlorophene 1, 12
insulin 1,12
Iodide derivatives 1
e.g diatrizoate
iodoquinol 12
isocarboxazid 12
isoniazid 12
ketamine 1,12
labetalol 1
levodopa 1,12
lithium I
Local anaesthetics 1, 12
e.g. bupivacaine, lidocaine
marijuana 12
mephenytoin 12
meprobamate 12
methanol 1,12
methocarbamol 1,12
methsuximide 12
methyldopa I
metoclopramide 1, 12
metocurine 1,12
metronidazole 12
methylene blue 12
mexiletine 12
mitotane 12
neomycin I
nitrofurantoin 12
Non-steroidal antiinflammatory drugs 1,12
e.g. ASA, ibuprofen
norepinephrine 12
olanzapine (51%) 11
Opiate analgesics (withdrawal) 1,12
e.g. morphine, Pentazocine
Oral antidiabetic agents 1
e.g. glyburide
Oral contraceptives 1,12
orphenadrine 1,12
pemoline 12
penicillamine 1,4
Penicillins 12
phencyclidine 1,12
polymyxin B 12
pralidoxime 1,12
primidone 12
procarbazine 12
pyridostigmine 1,12
quinidine 12
rabies vaccine, globulin 1, 12
retinol (Vitamin A) I
risperidone 11
selegiline 11
succinylcholine 1, 12
tacrine (0.1-1%) 11
Tetracyclines 12
e.g. tetracycline
tetrahydrocannabinol (THC) 12
thiothixene 12
tocainide 12
tolazamide 1,12
trazodone 11, 12
trichloroethylene 12
trimethadione 1
tubocurarine 12
valproate/divalproex 13
vinblastine 12
Vincristine 12
Vitamin D I





Acetazolamide 1,5,6
Alcohol 12
ASA 1,5,12
Betaxolol 12
Bromocriptine 4,6
Carbachol 12
Clofibrate 12
Corticosteroids 1,6,12
Diuretics e.g. chlorthalidone, 1,5,6,12
Droperidol 1
Ethosuximide 12
Haloperidol 1
Hyaluronidase 1, 12
Ibuprofen 1,12
Isoniazid 5
Isosorbide dinitrate 12
Isotretinoin, etretinate 1, 12
Methacholine 12
Methazolamide 12
Methsuximide 12
Metronidazole 6
Neostigmine 12
Opioids e.g. codeine, morphine 1,12
Oral contraceptives
Penicillamine 1
Phenformin 5
Phenothiazines 7, 12 e.g. chlorpromazine
Phensuximide 12
Physostigmine 12
Pilocarpine 12
Prochlorperazine 1,5,7,12
Promethazine 1,5
Quinine 1
Spironolactone 1,5,12
Sulfonamides 1,5-7,10,12
Tetracyclines (rare) 1,5-7,12
Timolol 12
Trimeprazine 12

Note These lists are not all inclusive. Some drugs which have been reported to cause blurred vision, myopia or diplopia were omitted because they are rarely used in clinical practice.


1. Pavan-Langston D, Dunkel EC Handbook of Ocular Drug Therapy and Ocular Side Effects of Drugs. Toronto Little, Brown and Company, 1991.

2. Dukes MNG (ed) Meyler's Side Effects of Drugs,

13th ed. New York Elsevier, 1996.

3. Davies DM (ed) Textbook of Adverse Drug Reactions, 4th ed. New York Oxford University Press, 1991.

4. Anon. Ocular adverse effects of systemic therapy minimizing the risks. Drugs Ther Perspectiues 1994; 31416.

5. Johnston L Ocular toxicity-of systemic drugs.On Continuing Practice 1988; 15(3)2-6.

6. DiPiro JT, Talbert RL, Yee GC et al. (eds) Pharmacotherapy. A Pathophysiologic Approach. 3rd ed. Stamford, CT Appleton & Lange, 1997.

7. Harrison RJ Ocular adverse reactions to systemic drug therapy. Adverse Drug Reaction Bulletin 1996; 180683-6.

8. Baker SJ, Messini AJ Blurred vision and psychotropics. Aust J Hosp Pharm 1995; 2547-8.

9. Oshika T Ocular adverse effects of neuropsychiatric agents. Incidence and management. Drug Safety 1995; 12256-63.

10. Young LY, Koda-Kimble MA (eds) Applied Therapeutics The Clinical Use of Drugs, 6th ed. Vancouver, WA Applied Therapeutics Inc, 1995.

11. Kastrup EK, Hebel SK (eds) Drug Facts and Comparisons, 1998 Edition. St. Louis Facts and Comparisons, 1998.

12. Fraunfelder FT (ed) Drug-Induced Ocular Side Effects and Drug Interactions, 3rd ed. Philadelphia Lea & Febiger, 1989; pp. 494-580.

13. McEvoy GK (ed) AHFS 98 Drug Information &

Supplements. Bethesda, MD ASHP, 1998.

14. Gillis MC (ed) Compendium of Pharmaceuticals and Specialties. 33rd ed. Ottawa Canadian Pharmacists Association, 1998.

Key words drug side effects, blurred vision, diplopia, myopia.

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Revised December 10, 2002