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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

Home » Vision Therapy in Old Bridge, NJ

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.

eye care, children vision therapy

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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eye exam, vision issues at school

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.

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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 was born and raised in south Florida. She attended Nova Southeastern University, where she obtained her Bachelor of Science in Biology, Bachelor of Science in Vision Science, and Doctor of Optometry. Dr. Tiomno moved to New Jersey in 2019 to complete a residency program in Vision Therapy & Neuro-Optometric Rehabilitation at Family Eye Care and is now an Associate Doctor in our office. 

Dr. Tiomno 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 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 currently working toward her fellowships in the American Academy of Optometry and the College of Optometrists for Vision Development. 

In her free time, she enjoys playing tennis, traveling, spending time with her loved ones, and learning new recipes.

Call Us 732-993-3420

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Serving Vision Therapy Patients from:

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

  • brock string exercise Thumbnail.jpg
    Vision therapy uses different types of exercises to strengthen lagging visual skills. The Brock string exercise is commonly used to treat convergence insufficiency, amblyopia (lazy eye) and strabismus (eye turn).
  • Dissociated Vertical Deviation Thumbnail.jpg
    Dissociated vertical deviation (DVD) is characterized by a slow upward drifting of one eye when the patient fixates with the other eye. Learn more about DVD and find out how vision therapy treats this condition.
  • Anomalous Retinal Correspondence Thumbnail.jpg
    Anomalous retinal correspondence (ARC) is a binocular condition often associated with strabismus (eye turn). Learn about ARC and how it can be treated.
  • Learning Related Visual Problems Overview
    There are a number of vision problems that affect learning and schoolwork. At times, Learning Disabilities, and ADD/ADHD may actually have an underlying vision component.
  • little girl autism
    Autism Spectrum Disorders describes a large range of mild to moderate to severe disorders. Each requires a unique approach to serve that child’s needs.
  • lazy eyes
    These terms are often often confused with one another.  Learn what these mean.
  • patient
    Our patients and parents talk about the profound improvements achieved through effective Vision Therapy.
  • ortho cc
    Here are a few of the common questions asked by our vision therapy patients.
  • Vision Therapy for Anisometropia Thumbnail.jpg
    People with anisometropia experience blurred vision because each of their eyes refracts a different amount of light. Left unaddressed, one eye becomes significantly weaker than the other, potentially leading to permanent vision loss. Vision therapy addresses anisometropia and strengthens the weaker eye.
  • Vision Therapy for Adult Thumbnail.png
    To succeed in most professions, one needs to have strong visual skills. If these skills are deficient in any way, performance can be adversely affected. Fortunately, vision therapy can help.
  • Convergence Insufficiency Thumbnail.jpg
    Children often struggle with learning and sports as a result of undiagnosed vision problems — most commonly Convergence Insufficiency (CI). CI has been shown to affect a child’s reading ability, attention and overall school performance. Learn how vision therapy can treat this condition thereby leading to more success in school, work and in sports.
  • Vision Therapy for Kids Thumbnail.jpg
    Studies show that children with vision problems are twice as likely to be diagnosed with ADD or ADHD as compared to their peers. Learn how vision therapy can help maximize your child's visual skills to reach their full potential.
  • little boy skipping on road.jpg
    Children with special needs are more prone to developing vision problems than the general population. These visual deficits often hamper their academic achievements. Read on to learn how vision therapy can help these children achieve their full potential.
  • Functional Vision Exam Thumbnail.jpg
    Just because someone has 20/20 vision, doesn't mean that they can see well. A large percentage of students pass vision screenings with flying colors, yet still experience serious functional vision issues impacting development, life functions and learning. Only a Functional Vision Exam can evaluate whether all essential visual skills are working correctly.
  • Children Vision Assessment
    Have your child take our quiz to discover if he/she has functional vision issues that stand in the way of his academic achievement and quality of life.
  • Syntonic Phototherapy Thumbnail.jpg
    Syntonic phototherapy (light therapy) uses visible light frequencies (color) to improve visual attention and decrease any symptoms associated with various eye problems. This therapy benefits those with double vision, eye strain and fatigue, headaches, reduced peripheral vision, and more.  
  • Symptoms Indicating A Visual Efficiency Problem Thumbnail.jpg
    Poor visual skills can affect many areas of life and can negatively impact performance at school, the office and on the sports field. Read on to find out the most common visual efficiency problems, and how vision therapy can help.
  • Myths Misconceptions
    Unfortunately, people think that eye surgery will correct an eye that turns in or out. In fact, those who have had eye surgery in order to “correct” a crossed eye, often need additional surgeries because the eye turn often returns.
  • Third Cranial Nerve Palsy Thumbnail.jpg
    When the third cranial nerve is damaged it can affect how your eye functions, leaving your eye unable to control specific actions. Learn about third cranial nerve palsy and how it can be treated.
  • Retained Primitive Reflexes and Vision Thumbnail.jpg
    Primitive reflexes are essential for the brain to develop. They start in utero and continue to develop as a child grows. However, retained primitive reflexes can result either from a problem at birth or during the first initial months of life. Vision therapy can help resolve retained primitive reflexes.
  • Nystagmus and Vision Therapy Thumbnail.jpg
    Nystagmus is a complex optical condition that causes involuntary eye movements and blurred vision. Fortunately, vision therapy can help.
  • child at the school Thumbnail.jpg
    Beginning in adolescence and through their early 20s, young people should undergo annual functional eye exams that assess the visual skills necessary to succeed in school, sports, and everyday life. The start of the new school year is a good time to get these visual skills checked.
  • Board Certified
    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.
  • patching lazy eye.jpg
    Amblyopia, commonly referred to as Lazy Eye, occurs when the brain and the eye are not working in unison, resulting in decreased vision in an eye that otherwise seems healthy. The only treatment available which treats the amblyopia and not just the symptoms is Vision Therapy, also called Development Optometry.
  • Eye Drops for Dry Eyes Thumbnail.jpg
    A Sixth Nerve Palsy (also known as CN VI palsy, or Abducens nerve palsy) usually causes double vision that began suddenly.
  • Three Young Boys Basketball 1280×853
    Seeing "20/20" isn't the only measure of good vision although it is certainly important, but good vision involves a set of several skills, including depth perception, peripheral visual field awareness, eye-hand coordination, reaction time, and more.
  • Insurance and Costs for Vision Therapy
    Click for more.
  • patient 2
    We are proud to share the success stories of our vision therapy patients.
  • thumbnail Dizziness and Balance Problems.jpg
    What exactly is a brain injury? Does a brain injury affect one’s ability to read?
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    Click for more about our vision therapy articles.
  • child read book utssss.jpg
    Click for more.