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Vision Therapy — Developmental Optometry

Vision isn’t just about seeing well — it’s about how we interpret and interact with the world visually. Over 25% of school-aged children have visual issues that affect learning

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Effective vision comes down to the way the brain and eyes interact. Whether reading words on the board, catching a ball, or tying our shoelaces, we rely on our visual system to work properly in order to succeed in these and other tasks.

Someone can pass all vision screening exams and excel in reading the charts on the wall, but still struggle with poor hand-eye coordination, reading problems, diminished focus, strabismus, convergence insufficiency, and amblyopia —all of which can be effectively addressed through vision therapy.

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Vision Therapy and Vision Correction

The most common reason someone becomes nearsightedness is due to difficulty in physically focusing or difficulty in using the 2 eyes together as a team (binocularity).

Accommodation is the ability to physically focus the lens in the eye when we look at reading material or at a computer. When we look at a distance, for example, a child looking at the board in school, we must relax and change the focus of the lens in the eye. When someone has difficulty with the accommodation system, it often leads to someone becoming nearsighted.

When we read, we must point our eyes IN (converge), and when we look at a distance, such as the board in school, we must point our eyes OUT (diverge). When someone has difficulty converging and diverging, that too often leads to someone becoming nearsighted.

Children commonly spend a considerable amount of time indoors, using computers, smartphones, or video games. If the visual system does not function well when focusing (accommodation) or fusing (binocular vision), that can then cause a child to become nearsighted.

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Vision Therapy is Brain-Based Therapy

Vision Therapy enables a child to develop the visual skills needed to be able to focus and defocus, and to be able to use the 2 eyes in a coordinated manner. Vision Therapy is brain-based therapy. It is the brain that tells the eyes how and where to focus.

In addition to addressing vision improvement and improving the needed visual skills for schoolwork and everyday life, Vision Therapy is also implemented in other conditions:

  • Someone who has an eye that may turn (strabismus) or amblyopia (lazy eye).
  • Someone who has learning disabilities or reading problems
  • Someone who has attention deficit disorder (ADD)

Vision Therapy is a supervised treatment program designed to correct visual-motor (eye-based) and/or perceptual-cognitive (brain-based) deficiencies. Vision Therapy helps children and adults who have not developed the visual skills that are needed for effective reading, writing, and learning. These skills include:

  • Eye movement and focusing skills
  • Convergence
  • Eye-hand activity
  • Visual memory skills
  • Other neuro-visual functions.

Vision Therapy helps people build the ability to coordinate the two eyes (binocular vision) in the way a coach might help his team members coordinate. When the two eyes don’t work together as an effective team, then performance suffers. The affects reading, sports, eye contact, etc. Vision Therapy helps children and adults that have problems in using their visual system efficiently. At times children or adults have not yet learned or acquired the visual skills necessary. These are problems in Visual Development. At times, an individual may have had the skills, but lost them due to brain injury from trauma, stroke, lack of oxygen, etc.

Vision Therapy is based on the established principle that vision can be developed and changed. For example, our eye doctors in Old Bridge, NJ know that infants are not born with fully developed visual abilities and that good vision is developed through a learned process for children and adults alike.

Learning Disabilities, ADHD/ADD & Vision

Vision issues can cause significant behavioral and learning challenges for children. Often, these challenges manifest in ways that are often confused with

  • Dyslexia,
  • ADD or ADHD
  • Reading problems, and
  • Poor focus.

If you can’t make sense of what you’re seeing, sitting in school is pure torture. Vision problems are a barrier to focus and therefore result in poor behavior and school performance.

Very often, a diagnosis of ADD or ADHD is compounded by underlying vision problems. Sometimes, the diagnosis itself is in error and the behaviors and learning challenges are solely due to these visual conditions.

By addressing the underlying cognitive visual problems, Vision Therapy helps address the underlying causes of hyperactivity and concentration problems.

The result is improved behavior, focus, and life achievement. A meta study based on data of 75,000 children shows that children with visual problems that cannot be corrected by glasses or contact lenses, have double the rate of ADHD.

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Vision's Role in Learning

Learning is highly visual. When vision conditions disrupt the way we perceive and interpret information, a child’s learning is compromised.

Perceptual challenges in vision such as dyslexia, amblyopia, and convergence insufficiency can be effectively addressed through Vision Therapy. The regimen of technologically aided activities of work to significantly improve the accuracy and skill with which a child perceives and interprets visual information.

As a result of Vision Therapy, your child’s vision problems are addressed, learning becomes much easier. This means improved ability to focus, learn, and excel, socially as well as academically.

Special Needs & Vision

Special needs such as autism, cerebral palsy, down syndrome, and other conditions often mean a child struggles with hand-eye coordination.

Children with these challenges, or anything else requiring occupational therapy, is very likely to gain immensely from Vision Therapy. A regimen of customized focus and perception exercises will improve depth perception and fine motor skills.

  • 45% of patients with down syndrome have strabismus/cross eye
  • As many as 40% of autistic people have strabismus/cross eye
  • Estimates of the incidence of strabismus in children with cerebral palsy go as high as 88%, Vision Therapy has shown to be effective for children with cerebral palsy.

Convergence Insufficiency

This near-vision problem is the leading cause of eyestrain, blurry vision, and double vision. Research demonstrates that the traditional focus exercise often called “pencil pushups” are ineffective. The only consistently effective treatment for convergence insufficiency is office based Vision Therapy.

A study of almost 700 5th and 6th graders indicated that convergence insufficiency is much more common than many assumed with 13% of students having CI, as well as demonstrating that of the children who showed three signs of CI, 79% where classified as being accommodative insufficient as well.


Amblyopia (also called lazy eye) is a condition defined by the loss or lack of development in an eye unrelated to any eye health problem. Strabismus is a condition defined by eyes that do not align. Both of these conditions are adaptations to a visual system that is unable to coordinate the vision from both eyes.

In 1740, a French naturalist named Marquis de Buffon discovered if he patched the fixing eye in a person with unilateral strabismus that the acuity in the amblyopic eye would improve.

Contemporary research has found patching to be only partially effective. Furthermore, wearing a patch can be even more socially alienating for a child than the eye condition itself.

Unlike patching, Vision Therapy incorporating techniques such as Monocular Fixation in a Binocular Field and technology such as Vivid Vision Virtual Reality has consistently found to be an effective treatment for strabismus and amblyopia, resulting in sustained and significant improvement.

Vision Therapy For Adults

Vision Therapy is not only for children. Adults have as much need and can benefit from Vision Therapy as well. At times, a problem first manifested in childhood, but was never addressed. At times, the problem reaches a critical point in adulthood and becomes more debilitating.

Vision Therapy is often more effective for adults because they are usually more motivated to improve their visual abilities, whereas children may not understand that they have a problem or how that problem may affect their interests or future.

Many people have visual problems sustaining near-centered work, including reading, writing, and computer use. When people have trouble using both eyes together or can’t focus for great lengths of time, they do not simply grow out of these problems. Children with visual problems often become adults with visual problems.

Vision Problems Can Affect Your Life

Adults will figure out many ways to compensate for their visual problems so that they can continue with any strenuous visual work they need to do. This leads to their coming home from work extremely tired although all they did was sit at a desk and do paperwork.

Children, on the other hand, will just tend to avoid tasks that are difficult or make them feel inadequate. The proper lenses along with vision therapy make a tremendous difference in an adult’s ability to function at work or sports, just as with children of school age.

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The following is a video by Susan Barry, PhD about her experience with Adult Vision Therapy:

This video is more comprehensive and goes into a lot more detail about the visual process:

Here is another great video which explains what 3D movies can tell you about your vision:

Learning Disability & Vision: What Does Research Say?

The Connection Between Learning Disabilities and Vision

60% of learning disabled students failed two or more binocular vision tests according to research by the Waterloo School of Optometry. The study was performed on students who had never received an eye exam and did not wear glasses or contacts. The research confirmed that children with learning disabilities, especially reading related learning disabilities have an extremely strong chance of having binocular issues (problems with the eye working together).

How Many Students Have Binocular Vision Problems?

According to research performed by The AAO 32% of university students had Binocular Vision Issues. The conclusion of this study is:

“Because these dysfunctions have a negative effect on performance, appropriate vision evaluation for this population is extremely important. In this study 31% of the students needed Vision Therapy for symptoms such as eye strain, double vision and headaches.

Vision Therapy: Reading & Dyslexia

Reading is the perfect example of a complex visual task that requires skills such as eye tracking and focusing (accommodation), eye teaming and coordination (Binocularity).

According to Dr. Debra Walhof M.D, member of the National Center for Learning Disabilities. “It is important to remember that normal sight may not necessarily be synonymous with normal vision…” Learn more about reading and vision therapy.

eye care, vision therapy quiz

About Dr. Roth

About Dr. Tiomno

Dr. Roth is Board Certified in Vision Development and Vision Therapy by the College of Optometrists in Vision Development. He is a Fellow of the College of Optometrists in Vision Development.

The College of Optometrists in Vision Development (COVD) is a non-profit, international membership association of eye care professionals. COVD provides board certification for eye doctors who are prepared to offer state-of-the-art services in:

  • Behavioral and Developmental Vision Care
  • Vision Therapy
  • Visual Rehabilitation

These specialized vision care services develop and enhance visual abilities and correct many vision problems in infants, children, and adults.

The COVD International Examination and Certification Board process includes a rigorous evaluation of the eye care professional’s knowledge and abilities in providing developmental and behavioral vision care for patients. Optometrists who successfully complete their certification process are Board Certified in Vision Development and Vision Therapy and are designated Fellows of COVD (FCOVD).

Dr. Steffani Tiomno Viveros was born and raised in south Florida. She attended Nova Southeastern University, where she received her Bachelor of Science in Biology, Bachelor of Science in Vision Science, and Doctor of Optometry. Dr. Tiomno joined Family Eye Care in 2019. 

Dr. Tiomno Viveros has a passion for helping others and has wanted to be an Optometrist since the age of 14. From the moment she steps foot in the room, you can tell she truly cares about what she does. She enjoys the challenge that every patient requires something different. It certainly keeps the day interesting! She provides care to infants, children, adults, and seniors; she evaluates and treats for medical issues, eyeglass and contact lens needs, double vision, brain injuries, and so much more. 

While in school, Dr. Tiomno Viveros participated in two medical mission trips, to Costa Rica and Ecuador, with Student Volunteer Optometric Services to Humanity (SVOSH). She plans on attending more trips like these throughout her career to help those in underdeveloped countries. She is a fellow of the American Academy of Optometry (FAAO) and she is working toward a fellowship in the College of Optometrists for Vision Development (FCOVD). 

Dr. Tiomno Viveros is a proud member of the Sayreville Lions Club.  In her free time, she enjoys traveling, spending time with her fiancé Jon and dog Jayce, and trying new recipes.

Dr. Tiomni is certified with the Visual Snow Initiative Treatment Protocol by Dr. Shidlofsky & Dr. Tsang. Learn more about Visual Snow Syndrome.

Get to know Dr. Tiomno Viveros:

Q: How did you decide to become an optometrist? What's your story?

A: When I was about 10 years old, I got my first pair of eyeglasses. A few years later, I started to wear contact lenses. The optometrist was always a positive experience, as my entire family saw the same group of doctors each year. During my teenage years, I grew increasingly passionate about math and science, and helping others; after contemplating, a career in healthcare made the most sense for me, and I quickly fell in love with Optometry. 

Q: What are your most important values regarding patient care and why?

A: I strive for quality care for each patient. That is part of the reason I joined a private practice, to be able to spend time speaking with each of my patients, getting to know them and how they use their eyes, and help them solve their vision problems. 

     I stand for collaboration with other specialists to provide the best care to each of my patients. I am happy to work with other eye care professionals, and other medical providers to ensure that each patient is being treated with the most complete and high-quality care.

Q: Please share one of your favorite patient stories.

A: There are so many.  One of my favorite stories is a patient who came in with double vision for several months and stopped driving because of it. After his first visit and identifying the problem, he was able to see single with a special type of prism and start driving again. 

Q: What would you want every patient to know regarding the importance of their Eye Health?

A: I feel that annual comprehensive eye examinations are vital. I have diagnosed many problems during patients’ annual exams and helped to fix these problems before they get worse.  There is a lot of eye disease that can happen without feeling any symptoms, and if patients wait until they have symptoms, it is often too late to restore vision. 

Q: What makes you excited to come to the office every day?

A: My passion is helping others.  Whether it is to prescribe a new pair of eyeglasses and seeing the smile on my patients’ faces when they can see more clearly, or to give children a good first experience at their first eye exam appointment, or to improve a patient’s quality of life through Vision Therapy or Visual Rehabilitation.  These types and many other success stories make me truly enjoy what I do. 

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Serving Vision Therapy Patients from:

Old Bridge | East Brunswick | Woodbridge | Edison | and throughout New Jersey