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An analysis of the professional perspective of vision therapy (VT) by eye care professionals allows understanding the current controversies about this therapeutic option of which aspects can be improved for its correct application in clinical practice. The aim of the current study was to analyse the perception of VT and the clinical protocols in this context followed among optometrists and ophthalmologists in Spain. A cross-sectional survey among Spanish optometrists and ophthalmologists. Google Forms tool was used to collect data via an online questionnaire divided into 4 sections (40 questions): consent to participate, demographic characteristics, opinion of the professional perspective of VT, and protocols. Only one submission from each email address was permitted by the survey tool. A total of 889 Spanish professionals answered (age, 25–62 years): 848 optometrists (95.4%) and 41 ophthalmologists (4.6%). VT was considered as a scientifically-based procedure by 95.1% of participants, but its recognition and prestige was considered as low. The main cause reported for this was bad reputation or perception of placebo therapy (27.3%). The main indication of VT according to the surveyed professionals was convergence and/or accommodation problems (72.4%). Significant differences were found in the perception of VT among optometrists and ophthalmologists (p ≤ 0.027). A total of 45.3% of professionals reported performing VT in their current clinical practice. A combination of training sessions in office and home was regularly prescribed by 94.5% of them, but with significant variability in the duration of such sessions. VT is perceived by Spanish optometrists and ophthalmologists as a therapeutic option with scientific basis, but with limited recognition and prestige, although with more negative perception among ophthalmologists. A great variability was found in the clinical protocols followed between specialists. Future efforts should be focused on creating internationally recognised evidence-based protocols for this therapeutic option. [ABSTRACT FROM AUTHOR]

Eye-tracking technologies (ETs) and serious games (SGs) have emerged as new methods promising better support for vision screening and training. Previous research has shown the practicality of eye-tracking technology for vision screening in health care, but there remains a need for studies showing that the effective utilization of SGs and ETs are beneficial for vision training. This study investigates the feasibility of SGs and ETs for vision training by designing, developing, and evaluating a prototype influenced by commercially available games, based on a battery of exercises previously defined by vision experts. Data were collected from five participants, including a vision teacher, through a user experience questionnaire (UEQ) following a mixed method. Data analysis of the UEQ results and interviews highlighted the current challenges and positive attitudes in using SGs and ET for vision training. In conjunction with UEQ indicators such as attractiveness and perspicuity, the stimulation of the vision training battery based on the user experience provided insights into using ETs and further developing SGs to better approach different eye movements for vision training. [ABSTRACT FROM AUTHOR]

This article shares a joint reflection of three practitioners who provided specialist support to one elite motor sport athlete. The 9-month program began with the broad aim of making the driver better prepared for performance at the highest level using the practitioners' experience. One practitioner specialized in athlete well-being and performance support, another in vision/perceptual training, and the final practitioner in heart rate variability. The practitioners developed a bespoke program of support, including vision training, slow-paced breathing, and self-awareness. Program effectiveness was determined through objective measures, such as physiological readings and subjective measures, including feedback from the driver and performance coach. Evaluation and reflections of the program suggest that the athlete successfully learned slow-paced breathing, improved functional vision, and enhanced preperformance preparation and in-race regulation. The athlete also perceived the support to be beneficial and had the desire to develop mind–body effectiveness in the future. [ABSTRACT FROM AUTHOR]

Education in the 21st century is called upon to prepare students with disabilities to enter a high-consciousness society where people can learn, think and react fast. The current review paper aims at investigating the role of fast learning in special education. We trace the essential indicators of speed learning with a special focus on those factors that are most relevant to learning disabilities. Afterward, we present evidence-based training techniques and strategies that rapidly rewire the brain and speed up learning. In addition, we examine the role of ICTs as essential training tools in speed learning. Finally, we discuss the role of metacognition in training fast and conscious learners. The results of this review showed that speed learning training techniques improve all those factors that accelerate learning such as spatial attention, visual span, processing speed, speed reaction, executive functions, metacognition, and consciousness. Most important, fast learning strategies meliorate control processes and spatial intelligence which is extremely fast and powerful. Metacognition provides learners with all those meta-abilites needed to enter a state of peak performance. This study also points to the option of including speed training strategies in schools to create inclusive learning environments and help students with or without disabilities to transcend their limitations and become conscious and high-capacity learners. [ABSTRACT FROM AUTHOR]

Background: Convergence insufficiency may be treated by visual exercises designed to increase convergence while maintaining single, clear, binocular vision. However, compliance with treatment is problematic, as patients often cease treatment when symptoms start to improve and before treatment is complete. The purpose of the present study was to assess the feasibility of using gamification of vision training to: (a) treat convergence insufficiency; and (b) improve compliance to treatment in comparison to a conventional treatment over a six-week treatment period.Methods: Two interventions, anaglyphs and a virtual reality game of Snakes, were evaluated for their effectiveness in treating adults with convergence insufficiency. The prescribed training regimen was 20 minutes, three times per week for six weeks. Vision was assessed before and after the treatment period. Participants also filled in the Core Elements of the Gaming Experience Questionnaire to gauge impact of game design on compliance.Results: Eighteen participants (mean age 20.8 ± 1.8 years) met the inclusion criteria for convergence insufficiency and nine participants were randomly assigned to each intervention. Repeated measures analysis of variance showed a significant effect of visit for near point of convergence (F1,16 = 38.32, p < 0.0001), near positive fusional reserves break (F1,16 = 21.94, p < 0.0001) and recovery (F1,16 = 26.87, p < 0.0001), but not of intervention type. Total time played was significantly longer for the virtual reality Snake Game than the anaglyph intervention (p < 0.0001), which translated to mean compliance of 82 per cent and 51 per cent respectively.Conclusion: Gamification of vision training in a virtual reality environment is feasible and associated with increased compliance, hence may be a useful strategy to treat convergence insufficiency. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate whether a reduction of the accommodative lag is possible by training the accuracy of accommodation using auditory biofeedback. Accommodation responses were measured in thirty-one young adults with myopia for dioptric target distances of 2.0, 2.5, and 3.0D using an eccentric infrared photorefractor. For the biofeedback training, subjects were randomly assigned to an experimental (n=15) or a control group (n=16). Subjects of the experimental group were provided with two tones while fixating a target, one tone was related to their accommodative response and the second to the target distance. Their task was to match these tones. The control group did not receive any auditory biofeedback. Two different training methods were applied, a continuous training of 200s, and ten consecutive sessions of 20s each. The training effects on the lag of accommodation (change Δ) were highly variable. Regarding the entire study group, the observed change in the accommodative lag was greater at closer distances, while no difference between the two training methods was revealed. Nevertheless, seven experimental subjects reduced their lag by ⩾0.3D (3.0D target distance: Δlong=-0.29±0.20D, Δshort=-0.24±0.21D). This reduction was also seen in two control subjects. Remeasurement revealed that the average training effect cannot be preserved over a period of 5-7days. The current investigation has shown that the accuracy of accommodation can be trained in some subjects using auditory biofeedback for target distances of 2.5D or closer. [ABSTRACT FROM AUTHOR]

This research tested the hypothesis that the successful treatment of convergence insufficiency (CI) with vision-training (VT) procedures, leads to an increased capacity of vergence adaptation (VAdapt) allowing a more rapid downward adjustment of the convergence accommodation cross-link. Nine subjects with CI were recruited from a clinical population, based upon reduced fusional vergence amplitudes, receded near point of convergence or symptomology. VAdapt and the resulting changes to convergence accommodation (CA) were measured at specific intervals over 15 min (pre-training). Separate clinical measures of the accommodative convergence cross link, horizontal fusion limits and near point of convergence were taken and a symptomology questionnaire completed. Subjects then participated in a VT program composed of 2.5 h at home and 1 h in-office weekly for 12–14 weeks. Clinical testing was done weekly. VAdapt and CA measures were retaken once clinical measures normalized for 2 weeks (mid-training) and then again when symptoms had cleared (post-training). VAdapt and CA responses as well as the clinical measures were taken on a control group showing normal clinical findings. Six subjects provided complete data sets. CI clinical findings reached normal levels between 4 and 7 weeks of training but symptoms, VAdapt, and CA output remained significantly different from the controls until 12–14 weeks. The hypothesis was retained. The reduced VAdapt and excessive CA found in CI were normalized through orthoptic treatment. This time course was underestimated by clinical findings but matched symptom amelioration. [ABSTRACT FROM AUTHOR]

Background: Vision training has become a component of sports enhancement training; however, quantifiable and validated improvement in visual performance has not been clearly demonstrated. In addition, there is minimal literature related to the effects of vision training on sports performance and injury risk reduction. The purpose of the current investigation was to determine the effects of vision training on peripheral vision and concussion incidence. Methods: Vision training was initiated among the University of Cincinnati football team at the beginning of the 2010 season and continued for four years (2010 to 2013). The sports vision enhancement was conducted during the two weeks of preseason camp. Typical vision training consisted of Dynavision D2 light board training, Nike strobe glasses, and tracking drills. Nike Strobe glasses and tracking drills were done with pairs of pitch-and-catch drills using footballs and tennis balls, with instructions to vary arc, speed, and trajectory. For skilled players, "high ball" drills were the focus, whereas for linemen, bounce passes and low pitch drills were stressed. Reaction time data was recorded for each athlete during every Dynavision D2 training session. We monitored the incidence of concussion during the four consecutive seasons of vision training, as well as the previous four consecutive seasons, and compared incidence of concussions (2006 to 2009 referent seasons v. 2010 to 2013 vision training seasons). Results: During the 2006-2013 pre- and regular football seasons, there were 41 sustained concussion events reported. The overall concussion incidence rate for the entire cohort was 5.1 cases per 100 player seasons. When the data were evaluated relative to vision trained versus referent untrained player seasons, a statistically significant lower rate of concussion was noted in player season in the vision training cohort (1.4 concussions per 100 player seasons) compared to players who did not receive the vision training (9.2 concussions per 100 player seasons; p<0.001). The decrease in injury frequency in competitive seasons with vision training was also associated with a concomitant decrease in missed play time. Discussion: The current data indicates an association of a decreased incidence of concussion among football players during the competitive seasons where vision training was performed as part of the preseason training. We suggest that better field awareness gained from vision training may assist in preparatory awareness to avoid concussioncausing injuries. Future large scale clinical trials are warranted to confirm the effects noted in this preliminary report. [ABSTRACT FROM AUTHOR]

Background: Vision training is rapidly becoming a component of sports enhancement, but quantifiable and validated improvement in visual performance has not been clearly demonstrated in high-caliber and/or collegiate athletes. We have performed vision training for the last three seasons on the University of Cincinnati baseball team's hitters. The goal for the work was performance enhancement, and for monitoring purposes, we measured stereopsis pre- and post-vision training. Methods: From the preseason (January) 2011 through to the end of the season (May) 2013, all hitters in the University of Cincinnati baseball team underwent regular vision training. Out-of-season training was 20 minutes twice per week, and in-season was 20 minutes once per week. Traditional stereopsis (Stereo Fly) was performed and recorded. Vision training typically consisted of: Dynavision light board, Brock string, strobe glasses, Eyeport, saccades, and near-far. Results: The players consistently came into the season with stereopsis of 23.7 ± 1.0 mm, and six weeks of training increased this stereopsis to 36.9 ± 0.49 mm (p<0.0001). Discussion: There was a consistent and significant improvement in stereopsis measured by Stereo Fly with the baseball team after 6 weeks of vision training. Equally, the stereopsis returned to baseline out of season. Temporal benefits seemed to continue post-6 weeks of vision training. We conclude that in a population of healthy and high-caliber athletes, stereopsis can improve with training and suffer from detraining effects as well. We suggest that vision training for sports that require good stereo acuity be considered. [ABSTRACT FROM AUTHOR]

This review has the purpose of retracing the work of Professor Bernard Sabel and his group over the last 2-3 decades, in order to understand how they achieved formulation of the 'Residual Vision Activation Theory'. The methodology proposed is described, from the first studies in 1995 with High Resolution Perimetry requiring a six-months training period, to the new technologies, such as repetitive transorbital Alternating Current Stimulation, that require ten days of training. Vision restoration therapy has shown improvement in visual responses irrespective of age at the training, lesion aetiology and site of lesion. The hypothesis that visual training may induce network plasticity, improving neuronal networks in cortical and subcortical areas of both hemispheres, appears to be confirmed by recent studies including observation of the cerebral activity by fMRI and EEG. However, the results are quite variable and the mechanisms that influence cerebral activity are still unclear. The residual vision activation theory has been much criticized, both for its methodology and analysis of the results, but it gave a new impulse to the research in this area, stimulating more studies on induced cerebral plasticity. [ABSTRACT FROM AUTHOR]

Abstract: This study evaluates the effect of accommodative facility training in myopes and emmetropes. Monocular accommodative facility was measured in nine myopes and nine emmetropes for distance and near. Subjective facility was recorded with automated flippers and objective measurements were simultaneously taken with a PowerRefractor. Accommodative facility training (a sequence of 5min monocular right eye, 5min monocular left eye, 5min binocular) was given on three consecutive days and facility was re-assessed on the fifth day. The results showed that training improved the facility rate in both groups. The improvement in facility rates were linked to the time constants and peak velocity of accommodation. Some changes in amplitude seen in emmetropes indicate an improvement in facility rate at the expense of an accurate accommodation response. [Copyright &y& Elsevier]

In 2000, the UK’s College of Optometrists commissioned a report to critically evaluate the theory and practice of behavioural optometry. The report which followed Jennings (2000 ; Behavioural optometry – a critical review. Optom. Pract. 1: 67) concluded that there was a lack of controlled clinical trials to support behavioural management strategies. The purpose of this report was to evaluate the evidence in support of behavioural approaches as it stands in 2008. The available evidence was reviewed under 10 headings, selected because they represent patient groups/conditions that behavioural optometrists are treating, or because they represent approaches to treatment that have been advocated in the behavioural literature. The headings selected were: (1) vision therapy for accommodation/vergence disorders; (2) the underachieving child; (3) prisms for near binocular disorders and for producing postural change; (4) near point stress and low-plus prescriptions; (5) use of low-plus lenses at near to slow the progression of myopia; (6) therapy to reduce myopia; (7) behavioural approaches to the treatment of strabismus and amblyopia; (8) training central and peripheral awareness and syntonics; (9) sports vision therapy; (10) neurological disorders and neuro-rehabilitation after trauma/stroke. There is a continued paucity of controlled trials in the literature to support behavioural optometry approaches. Although there are areas where the available evidence is consistent with claims made by behavioural optometrists (most notably in relation to the treatment of convergence insufficiency, the use of yoked prisms in neurological patients, and in vision rehabilitation after brain disease/injury), a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated. [ABSTRACT FROM AUTHOR]

Abstract: Joseph Eye Hospital''s low vision services identified, assessed and advised 125 children with a vision better than light perception in two blind schools in Tamilnadu. This paper presents the situation before and after the low vision interventions and the need for integration in mainstream school. A multidisciplinary team of eye care and rehab personnel assessed all children, prescribed surgery and/or devises and provided advice to child and teachers. Environmental modifications and educational guidance were also recommended. Factors and difficulties in integrating these children in mainstream schools were also noted. Routine clinical data, such as etiology and causes of low vision, presenting and best acuities and the like were recorded. Qualitative data such as input needed and problems encountered by all parties to promote integration in local education were collected. Results show that education of children with low vision in blind schools can lead to vision-related and educational problems. The conclusions highlight the visual improvements in children with low vision in the blind schools and their impact on the possibility for inclusion in local schools. Strategies to ensure that children do not unnecessarily go to blind schools and to overcome barriers to this goal are illustrated, using the experiences from this study. [Copyright &y& Elsevier]

Abstract: The purpose of this paper is to illustrate the visual status of children with multi-handicap and possible low vision, including results of assessment and training. All children with multiple disabilities, i.e., 123, who were screened from July 2002 to July 2004 were included. They were mainly identified through disability programmes around Joseph Eye hospital''s low vision service in Tamil Nadu, South India. A complete clinical and functional assessment and visual rehabilitation was done in all cases. All the children were screened by the same multidisciplinary team of eye care and rehabilitation personnel. Data such as sex, ages, causes and aetiology of low vision, devices prescribed and the use of flexible and multiple assessments are presented. Outcomes of use of devices, best use of vision and vision training, if needed, are outlined. The close cooperation between child, parents, and staff of training programmes and the low vision services is seen as a vital ingredient for success. Finding, assessing and training the children are not possible otherwise. [Copyright &y& Elsevier]

The author stresses the importance of words in communication and how they should be used in optometry. He says that optometric organizations need to be careful and deliberate when choosing a name which reflects who they are and what they do. He relates that for several years they were debating the words used to describe what they do to help their patients achieve success and to improve their quality of life. He emphasizes the need to change the words they use to conform with the scientific knowledge available to us.