A Vision and Eye-Care Professional Primer for Occupational Therapists
by Katherine J. Collmer, M.Ed., OTR/L
Vision Facts to Guide Assessment and Treatment:
The visual sense is the primary way in which we understand what we see. It is “our most far-reaching sense” and the one through which we obtain 75-85 percent of what we learn about ourselves and the world around us. (1, p. 3) Vision as a term is most often confused with that of eyesight. However, the terms are not interchangeable.
Eyesight consists of our level of visual acuity and our ability to recognize contrasts. It is a measure of our distance vision and does not effectively determine the efficiency of our near vision skills. It is also an indicator of eye health.
Vision is comprised of 17 skills, one of which is eyesight. (2) The measure of 20/20 eyesight and a healthy medical condition of the eyes does not entail the complexity of the visual system. “In addition to clear vision, an individual must have the ability to use his or her eyes for extended periods of time without discomfort, be able to analyze and interpret the incoming information, and be able to respond to what is being seen.” (1, p. 6)
Vision does not occur in the eyes but in the brain. The eyes are actually a part of the brain and act as the sensory receptors that collect light and transmit it to the visual brain (3) to “form a model of our world, to identify objects and events, to attach meaning and significance to them, and to establish their causal relations” for the ultimate production of adaptive behavior. The visual brain is influenced by the brain’s visual pathways and includes the vision that is used for action and that which is utilized for perception. (4) Neurons devoted to visual processing in the brain account for about 30 percent of the cortex with millions of optic nerve fibers carrying information from the retina to these areas. In contrast, touch and hearing are represented by 8 and 3 percent of the brain’s cortex, respectively, with each auditory nerve carrying 30,000 signals. (5)
Models of vision have been developed that emphasize vision as a learned process and one that organizes and manipulates space. It is the sensory system through which we understand the information collected through our other senses. It a movement pattern and is developed through the use of our motor skills, much like walking and talking. Vision provides the brain with accurate translation of the information collected through our eyesight. (1, p. 6) Therefore, vision plays a key role in learning and can influence the quality of learning through visual efficiency and visual information processing. Visual efficiency comprises the process of visual acuity and refractive error, accommodation, vergence, and ocular motility. Visual information Processing involves the higher level brain functions that include the non-motor aspects of visual perception and cognition, and their integration with motor, auditory, language, and attention systems. Deficits in either of these aspects of vision can result in some form of learning problem. Proper diagnosis of learning related vision problems therefore requires comprehensive evaluation of visual efficiency and visual information processing skills. (6)
Undetected vision problems can affect a child’s ability to learn in school by interfering with his ability to see clearly, interpret what he sees, and use his eyes to guide movement. Although vision screenings are performed by pediatricians and school nurses, their tests are designed to assess for visual acuity and do not reflect how well the eyes focus up close, track, or work together. Occupational therapists are in a key position to detect the common signs and symptoms that indicate a potential vision problem in these areas and that may be the cause of a reading, learning, or motor performance need. An efficient OT evaluation will include a vision screening that checks visual acuity, eye teaming, eye movement control, and visual motor integration. Therefore, it is important to understand and recognize the five most common symptoms that can identify a person is in need of a vision assessment by a developmental optometrist.
- Frequent loss of place when reading
- Slopping handwriting
- Eye fatigue or headaches after reading
- Avoidance of close work
- Attention problems (7)
In addition, it is important for occupational therapists to inform parents and teachers about the importance of early detection of vision-related problems by sharing visual behavior checklists (8) and resources about vision assessments (9) and vision therapy (2). Equally as important as recognizing early symptoms and sharing information about visual problems, occupational therapists should have a solid understanding about the areas of expertise for those professionals who specialize in eye care.
Eye-Care Professionals Guide
Maintaining eye and vision health relies upon regularly scheduled assessments that can alert us and our doctors to the presence of eye diseases and vision disorders. The early detection of these conditions depends upon the selection of the appropriate eye-care professional to address these specialized areas. There are four areas of expertise and levels of training that define the providers that address eye and vision health. (The following was adapted from References 10, 11, and 12.)
- Ophthalmologists (MD) are medical or osteopathic doctors who have completed college and at least eight years of additional medical training. They are licensed to practice medicine and surgery and specialize in the diagnosis and treatment of eye disease. Ophthalmologists diagnose and treat all eye diseases, perform eye surgery, and prescribe and fit eyeglasses and contact lenses to correct vision problems. In general, they use medical and surgical methods to treat eyes diseases and vision disorders.
- Optometrists (OD) are Doctors of Optometry and the primary health care professionals for the eye. Optometrists complete a pre-professional undergraduate education at a college or university followed by four years of professional education at a college of optometry. Following graduation, optometrists have the option to complete a one-year residency for additional training in a specific area of practice. They are licensed to examine, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures. They are trained to perform eye exams, prescribe and dispense corrective lenses, detect certain eye abnormalities, and prescribe mediation for certain eye diseases.
- Developmental Optometrists (FCOVD) provide vision care based on the principle that vision can be developed and changed. They are health care professionals who obtain board certification from the College of Optometrists in Vision Development (COVD) to provide specialized services in behavioral and developmental vision care, vision therapy, and vision rehabilitations. Developmental Optometrists specialize in the treatment of functional vision problems, including difficulties with binocular vision, eye movements, and depth perception, as well as visual deficits following brain injuries and are skilled in the use of lenses, prisms, and optometric vision therapy. They perform functional vision tests to determine underlying vision deficits.
- Opticians are technicians trained to design, verify, and fit eyeglass lenses and frames, contact lenses, and other eyesight correction devices. They provide services through prescriptions supplied by ophthalmologists or optometrists.
A downloadable version of this resource is available at the Handwriting is Fun! Resource Page.
Katherine J. Collmer, M.Ed., OTR/L, is a pediatric occupational therapist who specializes in the assessment and remediation of handwriting skills and understands the link between handwriting skills and writing. In her current book, Handwriting Development Assessment and Remediation: A Practice Model for Occupational Therapists, she shares a comprehensive guide and consistent tool for addressing handwriting development needs. She can be contacted via her website, Handwriting With Katherine
Disclaimer: The information shared on the Handwriting With Katherine website, blog, Facebook page, Twitter page, Pinterest page; in the Universal Publishing Handwriting Teachers’ Guides; on any guest blog posts or any other social media is for general informational purposes only and should not be relied upon as a substitute for sound professional medical advice or evaluation and care from your physician/medical team or any other qualified health care providers. Therefore, the author of these links/posts take no responsibility for any liability, loss, or risk taken by individuals as a result of applying the ideas or resources.
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Scheiman, Mitchell. Understanding and Managing Vision Deficits a Guide for Occupational Therapists. 3rd ed. Thorofare, NJ: Slack, 2011. Print.
“Vital Visual Skills -.” COVD.org. College of Optometrists in Vision Development (COVD), n.d. Web. 26 Oct. 2015. <http://www.covd.org/?page=Visual_Skills>.
Hubel, David H. “Eye, Brain, and Vision.” Eye, Brain, and Vision. David Hubel, n.d. Web. 24 June 2015. <http://hubel.med.harvard.edu/book/b8.htm>. Text Publication: Henry Holt and Company, May 15, 1995
Milner, A.. David, and Melvyn A. Goodall. “The Visual Brain in Action.” Assc.org. The Association for the Scientific Study of Consciousness, n.d. Web. 26 Oct. 2015. <http://www.theassc.org/files/assc/2367.pdf>.
Grady, Denise. “The Vision Thing: Mainly in the Brain.” Discover Magazine. Discover Magazine, 01 June 1993. Web. 26 Oct. 2015. <http://discovermagazine.com/1993/jun/thevisionthingma227>.
Garcia, Ralph P., O.D., Steven B. Nicholson, O.D., Leonard J. Press, O.D., Mitchell M. Scheiman, O.D., and Harold A. Solan, O.D. “Optometric Management of Learning-Related Vision Problems, 2nd Edition.” Clin Exp Optometry Clinical and Experimental Optometry 89.6 (2006): 403-04. Aha.org. American Optometric Association, 2008. Web. 26 Oct. 2015. <http://www.aoa.org/documents/optometrists/CPG-20.pdf>.
Hong, Carole L., OD, FCOVD. “Vision Screenings & When to Refer for a Developmental Vision Evaluation: What Every OTR Should Know.” PediaStaff. PediaStaff, Inc., 26 May 2011. Web. 26 Oct. 2015. <http://www.pediastaff.com/blog/qa-ask-the-expert-vision-screenings-when-to-refer-for-a-developmental-vision-evaluation-what-every-otr-should-know-3592>.
Collmer, Katherine J., M. Ed., OTR/L. “Resources for Handwriting/Writing Development.” Handwriting With Katherine. Katherine J. Collmer, M.Ed., OTR/L, n.d. Web. 26 Oct. 2015. <http://www.handwritingwithkatherine.com/resources.html>.
“InfantSEE: A Public Health Program for Infants | Helping Infants to Establish a Lifetime of Healthy Vision.” InfantSEE. Optometry Cares – The American Optometric Association, n.d. Web. 26 Oct. 2015. <http://www.infantsee.org/>. InfantSEE®, a public health program, managed by Optometry Cares® – the AOA Foundation, is designed to ensure that eye and vision care becomes an essential part of infant wellness care to improve a child’s quality of life.
Mischio, Greg. “What’s the Difference between Optometrist vs. Ophthalmologist?” Vision Therapy Center. Vision Therapy Center, 14 Nov. 2011. Web. 26 Oct. 2015. <http://www.thevisiontherapycenter.com/discovering-vision-therapy/bid/75509/What-s-the-difference-between-optometrist-vs-ophthalmologist>.
“Difference between an Ophthalmologist, Optometrist and Optician.” Difference between an Ophthalmologist, Optometrist and Optician — AAPOS. American Association for Pediatric Ophthalmology and Strabismus, n.d. Web. 26 Oct. 2015. <http://www.aapos.org/terms/conditions/132>.
“About COVD.” COVD. College of Optometrists in Vision Development (COVD), n.d. Web. 26 Oct. 2015. <http://www.covd.org/?page=About_Us>.