Welcome to the Binocular Vision & Concussion Rehabilitation Clinic at Beyond Vision!

Dr. Mona Ubhi is excited to offer her expertise in Binocular Vision and Concussion Rehabilitation to Edmonton and its surrounding cities. Dr. Ubhi has advanced training in binocular vision, vision therapy, and concussion rehabilitation. For more information on Dr. Ubhi and her expertise, please read her bio here.

Learn more here: The Visual System, Binocular Vision Dysfunction Concussion Rehabilitation and Vision Therapy

The Visual System

How complex can the visual system really be, right? Here’s a small breakdown to help you understand the functional aspects of vision:

1. Central (focal) process: This process helps us identify objects using shape, color, size, and other visual details as cues.

2. Peripheral process: This process provides us information about our surroundings to allow us to navigate in our environment. The information includes where we are in space and where objects are in relation to us. The information from our peripheral process is integrated with information from other systems to assist us with balance, movement, coordination, and posture.

In addition to these two very important processes, an efficient visual system must have accurate visual skills:

1. Vergence: This is often referred to as “eye-teaming.” Our eyes are two separate organs that must learn to “team” or work together to look through various areas of depth, ranging from distance to near.

2. Accommodation: This is often referred to as “eye-focusing.” Like a camera lens that must change shape to focus on objects at various distances for the perfect picture, our eye has an internal lens that must act similarly. The lens is relaxed to look into the distance, but must work or focus to look at near. The lens is flexible and must be able to change shape rapidly and accurately to maintain focus appropriately on objects of various distances.

3. Tracking: This includes both saccades and pursuit eye movements. Saccades are rapid eye movements that we use to change fixation between objects, and are used to jump from one word to the next when we are reading. Pursuits are slow eye movements we use to maintain focus on slow-moving objects, such as a ball being thrown through the air.

4. Fixation: This is our ability to keep objects in focus.

Disruption to any one of the visual functions or processes listed above can affect orientation in space, our balance, movement, coordination, posture, and ability to complete regular daily tasks like reading, computer use, driving, and taking notes to name a few.

To add to the complexity, our visual system must work with our proprioception (body position), posture, and vestibular (balance) system in order for us to understand the world around us. Inefficiencies in the visual system can affect these other systems, and inefficiencies in these other systems can also affect vision.

Binocular Vision

What is Binocular Vision?

Have you ever wondered why you only see one image even though we have two eyes? This is called binocular vision. The brain receives information from both (bi) eyes (ocular) at the same time, and the information provided by each eye is slightly different. The brain uses these differences in information to form a clear image of our environment, from which we can judge distances and coordinate our eye movements. For a well-functioning visual system, the eyes will work cohesively, allowing for one clear picture of our environment to the brain.

What is Binocular Vision Dysfunction?

Research has shown that at least 10% of the population suffers from binocular vision dysfunction, but this condition is still not well known. Binocular vision dysfunction can occur if one of the complex functions of the visual system is not working adequately. This can include how the eyes work together, focus on objects, track, or relay the information from the eyes to the brain. Put more simply, a binocular vision dysfunction can occur when the eyes and brain do not work together in harmony.

Binocular vision dysfunction is frequently missed during a standard eye exam, since those suffering with these anomalies continue to have 20/20 vision. A thorough binocular vision assessment can detect small amounts of binocular vision dysfunction that tests during standard eye exams may not be sensitive enough to detect..

Causes of binocular vision dysfunction can include:

• Reduced vision in one eye (amblyopia)
• Loss of coordination between the two eyes (strabismus)
• Significant difference in prescription between the two eyes (aniseikonia)
• Small amounts of vision misalignment
• Inefficiencies with the accommodative (focusing) system
• Inefficiencies with saccadic and pursuit eye movements
• Brain injury, such as concussion, stroke, or similar neurological disorder
• Difficulties with how visual information is relayed to and processed in the brain
• Decompensation of the visual system
• Facial asymmetry
• Nerve or eye muscle abnormality

What are the symptoms of Binocular Vision Dysfunction?

Symptoms of binocular vision dysfunction can include any of the following:

• Headache
• Dizziness
• Anxiety
• Motion sickness
• Nausea
• Neck pain
• Head tilt or turn
• Learning/reading challenges
• Gait imbalance/clumsiness
• Difficulty judging distances
• Light sensitivity
• Blurred vision
• Double vision
• Eye strain
• Eye pain

How is Binocular Vision Dysfunction treated?

Treatment for binocular vision dysfunction can include the following in isolation or in combination:

1. Prescribed glasses, which may contain prism, anti-fatigue lenses, tint, or partial occlusion. The content of prescribed glasses is specific to each unique case. Some individuals may require more than one pair of glasses, such as glasses for distance, glasses for reading, and glasses for outdoor wear.

2. Vision rehabilitation, also known as vision therapy, which consists of visual activities that are designed to re-train normal visual function. In order for vision rehabilitation to be effective, active participation is required by the individual.

3. Referral to other health care specialists, if required.

If you suspect you may have a binocular vision dysfunction, book an eye exam with one of our Optometrists today.

Concussion Rehabilitation:

Vision is one of our primary senses and is used to derive meaning from what we see in our environment. While reading this text, your brain is controlling how your eyes track, coordinate, and focus, and how the incoming information is processed. Studies estimate that more than 60% of the brain’s function is related to vision. This means that any neurological injury, such as a concussion, stroke, whiplash, or brain lesion, can result in a visual dysfunction. Often, these visual dysfunctions can be overlooked as a cause of symptoms since a person with neurological injury can continue to have 20/20 visual acuity and healthy ocular structure.

What is Post-Traumatic Vision Syndrome?

Post-traumatic vision syndrome (PTVS) is caused by damage to regions of the brain that are involved in visual function. This damage, which is often undetectable with MRI or CT scan, can lead to persisting and disabling symptoms. Studies have shown that symptoms continue to persist beyond a month in up to 15% of people with a concussion.

What are the symptoms of Post-Traumatic Vision Syndrome?

Type and degree of symptoms can vary from one individual to another. These symptoms can include:

• Headache
• Dizziness/Vertigo
• Nausea
• Light sensitivity
• Blurry vision
• Double vision
• Eye strain, fatigue, or “pulling/tugging” sensation around the eyes
• Difficulty with reading/computer work (ie losing place, re-reading content, words moving or blurring)
• Intolerance to looking at screens
• Difficulty with remembering visual information and/or reading comprehension
• Difficulty sustaining near work or reading for periods of time
• Slow shift of focus from near-to-far or far-to-near
• Difficulty tracking objects
• Difficulty with concentration and attention
• Difficulty being in busy or crowded environments
• Difficulties with balance or depth perception
• Motion sensitivity (ie difficulty with things moving in the environment, scrolling on a screen)
• Difficulty with busy patterns
• A sensation of the floor, ceiling, or walls tilting
• A sensation of not feeling grounded
• Postural shifts/veering off when walking
• Difficulty with memory

Testing for Post-Traumatic Vision Syndrome:

Damage to the visual system cannot be seen in most cases on CT scan, MRI, or with standard optometric testing. A person can have 20/20 vision and healthy ocular structure, yet still experience the debilitating symptoms listed above.

A thorough visual assessment should include standard optometric testing (visual acuity, visual prescription, and dilated eye health exam), assessment of functional visual skills (including vergence, accommodation, and tracking), spatial awareness, visual midline shift, visual- vestibular function, visual processing skills, and visual field. It is also important to determine if the cause of the symptoms are a result of visual dysfunction, or from another system affecting the visual system.

Treatment for Post-Traumatic Vision Syndrome:

Treatment can include any of the following in isolation or combination:

1. Prescribed glasses, which may contain prism, anti-fatigue lenses, tint, or partial occlusion. The content of prescribed glasses is specific to each unique case. Some individuals may require more than one pair of glasses, such as glasses for distance, glasses for reading, and glasses for outdoor wear.

2. Vision rehabilitation, also known as vision therapy, which consists of visual activities that are designed to re-train normal visual function. In order for vision rehabilitation to be effective, active participation is required by the individual.

3. Referral to other specialists for other systems that may be affected. This may include:physiotherapy, chiropractor, massage therapy, occupational therapy, speech therapy, and cognitive therapy, to name a few.

If you suspect you may have Post-Traumatic Vision Syndrome, book an eye exam with one of our Optometrists today.

Vision Therapy

What is vision therapy?

Vision therapy is an individualized treatment program consisting of visual exercises used to rehabilitate the visual system and reduce visual symptoms. These prescribed exercises are tailored to the individual’s specific visual needs. Visual techniques and skills are taught at each appointment, and supplies are provided for these techniques and skills to be practiced at home.

What is involved in vision therapy?

The vision therapy program requires in-office vision therapy sessions, where visual techniques and skills are taught and practiced. These visual techniques and skills are then to be practiced at home. Home therapy reinforces the skills and quickens the overall rehabilitative process. The frequency of vision therapy appointments will depend on what the doctor feels would best suit the individual’s needs.

How long will vision therapy take?

The length of time required for rehabilitation of the patient can depend on many variables, including diagnoses, complexity of the dysfunctions involved, and the patient’s motivation. For example, a patient who does not have a brain injury would recover faster than one who does have a brain injury. A patient with a sports concussion may rehabilitate faster than one who had a concussion as a result of a motor vehicle accident. A patient who is motivated to be compliant with completing the exercises at home on a daily basis will rehabilitate faster than one who does not. Each person is different, therefore treatment time can vary from one person to another.

Do patients “graduate” from vision therapy?

The short answer is yes. Most patients do not require further therapy once rehabilitation has occurred. On occasion, a patient may require “maintenance therapy” once or twice a week to maintain their visual skills.