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The impact of vergence and accommodative therapy on reading eye movements and reading speed

Abstract

Background: Most studies investigating the impact of optometric vision therapy on reading speed and reading eye movements utilize ocular motility and visual processing procedures. Only one study has reported the impact of accommodative and vergence therapy alone on reading speed, but only with three subjects. Methods: Six patients with symptomatic accommodative/vergence anomalies received vision therapy along with objective eye movement recordings before and after therapy. Therapy consisted of procedures to treat accommodative and vergence skills - no saccadic or ocular motor procedures were utilized. Results: Each of the patients showed clinically significant improvements in reading speed and eye movement efficiency. Conclusions: Accommodative and vergence therapy alone has the potential to improve reading speed and reading eye movements. Ocular motor therapy may not be necessary for some patients with accommodative/vergence disorders who also demonstrate reduced reading speed and poor reading eye movements. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Strengthening the eye movements seems thus important. Research on ocular motor problems following brain injuries (Wilhelmsen, 2000) and ocular motor deficits among pupils (Gallaway & Boas, 2007) show that structured exercises can reduce the amplitude of unsteady fixation, strengthen the binocular vision, improve VA through better accommodation and lead to improved reading skills. Accommodative ability in particular is poor in learners with albinism (Karlén & Milestad, 2019). ...
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Albinism is a huge challenge both socially and educationally in Tanzania and many other countries. Pupils with albinism are normally encouraged to read with a fixed gaze due to their nystagmus, and there are doubts about whether refraction improves their reading. The aim is to get more knowledge about their functional vision as a fundament for educating pupils with albinism. The article presents a case study with three pupils from a primary school in Tanzania who went through a functional assessment of vision using standardized methods and a new eye-tracker software measuring smooth pursuits. The assessment reveals large individual differences not only in visual acuity but also in ocular motor functions. There is a need for better understanding of the vision challenges these pupils face so that professionals can develop more suitable methods in school for securing their education.
... In order to assess eye movements quantifiable diagnostic and interventional protocol is required. Oculomotor deficiencies can be rectified or at least the deficits can be minimized by appropriate optometric vision therapy (Streff, 2011 andGallaway, 2007). These therapies can be performed on children with ASD to try and improve their visual behavior. ...
... [12][13][14] Some studies confirmed a strong correlation between vergence facility and reading speed 15 and a positive effect of accommodative and vergence therapy on reading speed. 16 Based on all these findings we assume that a more accurate vergence postulation whilst holding the LCD screen in the hands might also be the reason for the better performance in reading numerals that was found in the present study. ...
Article
Background: Visual ergonomics has an impact on visual performance in reading. Based on the assumption that reading from an LCD screen held in the hands provides more accurate information about the distance to the object than reading from a screen, which has no contact with our body, this study assessed the influence of the proprioceptive input on the speed of reading and on accommodative and pupillary responses and their micro-oscillations. Methods: Participants (n = 47; all emmetropic, non-amblyopic), were asked to read in their minds two-digit numerals presented on a 10-inch LCD screen at 40 cm distance. In one condition, the participants held the screen in their hands; in the other, the screen was placed on the holder and there was no body contact with the participant. The number of numerals read in 90 seconds was recorded. Accommodative and pupillary responses were measured with Power Refractor 3 at a 50 Hz measurement rate. Results: The number of numerals read was greater for the condition with proprioceptive input than in the condition without contact. The mean pupil size and the average accommodative response were similar in the two conditions. The rate of change in pupil size showed a steeper decline in the condition without the proprioceptive input compared to the condition with this input. The increase in the lag of accommodation with time was similar in both conditions, as well as pupillary and accommodative micro-oscillations. Conclusions: When the screen was held in the hands, reading of numerals was faster and resulted in less pupil size change over the 90-second test interval. This indicates that proprioception might influence some aspects of visual performance.
... Coordination of the three oculomotor systems (version, vergence, and accommodation) is important for efficient reading. 32,33 What remains to be investigated in more detail is determination of which therapeutic regimen is most efficacious, and in turn most cost effective. Studies need to compare treatment options systematically to determine whether certain techniques have an additive effect on M-cell functioning, with resultant improvement in reading fluency. ...
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Purpose: Children with reading disability frequently exhibit reduced sensitivity to motion, as assessed by coherent motion thresholds (CMT) and critical flicker frequency (CFF). A retrospective analysis was conducted to evaluate whether there was a correlation between reading fluency as measured by the Test of Silent Word Reading Fluency (TOSWRF), reading rate (as measured with the Visagraph II Eye Movement System), and pseudoword decoding (as measured with the pseudoword decoding subtest of the Wechsler Intelligence Achievement Test, WIAT-II), and these two visual motion sensitivity tests. Methods: 68 children between the ages of 7-16 years presented to the principal investigator's optometric practice for a vision therapy evaluation between June 1st 2010 and March 31st 2011. As part of the standard protocol for vision therapy evaluations, they were assessed using the CMT, CFF, TOSWRF, WIAT-II (pseudoword decoding subtest), and Visagraph II. The patients were divided into reading ability groups based on the published recommendations from the TOSWRF manual. Individuals at the 25% or below level were labeled as poor fluency, individuals in the 26th to 74th% level were labeled average fluency, and those in the 75% or higher level were labeled as good fluency.
... 2,[13][14][15][16][17][18][19][20][21][22][23] Treatment of vision problems (with vision therapy or prism) has been found in a group of studies to result in either a decrease in reading related symptoms 24,25 or improved reading performance. [26][27][28][29][30][31] The impact of these visual skills on learning stems from the extensive near visual demands in the classroom. One study found that the average elementary school child spends 54% of classroom time engaged in reading and desk work each day, with an additional 21% in copying tasks utilizing neardistance-near viewing. ...
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Most school vision screenings test only visual acuity. There is a need for a valid, easily administered test that screens for a wider variety of learning-related vision problems. Visual Efficiency RAting (VERA) is a software program designed for schools to detect both routine vision problems and visual skill problems. The purpose of this study was to compare the VERA visual skills screening with the optometric assessment of binocular, accommodative, and ocular motor skills. One hundred fifty-four children from grades 3 through 5 were evaluated using the VERA visual skills screening, a clinical battery of visual skills testing, the Convergence Insufficiency Symptom Survey, and 2 reading tests. The sensitivity of VERA in detecting visual skills problems was 45%, and the specificity was 83%. Sensitivity increased to 64% and specificity to 100% in smaller groups of children when overlays of symptoms, classroom behaviors, and reading skills were included. VERA has fairly good sensitivity and very good specificity in detecting visual skills problems. Given that the majority of visual skill deficits currently go undetected, VERA can be considered a reasonably effective method of in-school visual skills screening.
Conference Paper
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A review of the literature details the risk factors associated with visual efficiency problems, and the link between visual efficiency, visual perception and information processing. The current literature clearly shows there is evidence linking the above, as well as showing that by managing visual efficiency we can improve the potential to further develop our visual processing capacity. The current literature also demonstrates there is still a need for more epidemiological studies as well as developing controlled studies to investigate the impact visual efficiency problems have on our capacity to process visual information.
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Background: This study is aimed at determining whether reading rate and oculomotor control during reading, could be improved in adults with home-based computerized saccadic eye movement therapy. Methods: Sixteen Japanese foreign students in the U.S. served as subjects and were randomly divided into two groups; a computerized eye movement training (CEMT) group and a control group. Subjects in the CEMT group received 5 weeks of home-based computerized saccadic eye movement training while subjects in the control group received no comparable training or intervention, other than diagnostic evaluations. Results: CEMT group demonstrated significant improvement in all Visagraph II measurement parameters after intervention, except for duration of fixation and reading comprehension. Subjects in the control group demonstrated no significant pre-post differences.
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Background: Approximately one in ten students aged 6 to 16 in Ontario (Canada) school boards have an individual education plan (IEP) in place due to various learning disabilities, many of which are specific to reading difficulties. The relationship between reading (specifically objectively determined reading speed and eye movement data), refractive error, and binocular vision related clinical measurements remain elusive. Methods: One hundred patients were examined in this study (50 IEP and 50 controls, age range 6 to 16 years). IEP patients were referred by three local school boards, with controls being recruited from the routine clinic population (non-IEP patients in the same age group). A comprehensive eye examination was performed on all subjects, in addition to a full binocular vision work-up and cycloplegic refraction. In addition to the cycloplegic refractive error, the following binocular vision related data was also acquired: vergence facility, vergence amplitudes, accommodative facility, accommodative amplitudes, near point of convergence, stereopsis, and a standardized symptom scoring scale. Both the IEP and control groups were also examined using the Visagraph III system, which permits recording of the following reading parameters objectively: (i) reading speed, both raw values and values compared to grade normative data, and (ii) the number of eye movements made per 100 words read. Comprehension was assessed via a questionnaire administered at the end of the reading task, with each subject requiring 80% or greater comprehension. Results: The IEP group had significantly greater hyperopia compared to the control group on cycloplegic examination. Vergence facility was significantly correlated to (i) reading speed, (ii) number of eye movements made when reading, and (iii) a standardized symptom scoring system. Vergence facility was also significantly reduced in the IEP group versus controls. Significant differences in several other binocular vision related scores were also found. Conclusion: This research indicates there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination (including cycloplegia), in addition to a comprehensive binocular vision evaluation.
Article
The effect of writing and reading training on preferred font type and size in low-vision students was evaluated in 35 children. An ophthalmologist confirmed low vision according to ICD-10-CM. Children identified the font type and size they could best read. The writing subtest of the Jebsen-Taylor Hand Function Test, read in 1 min., and legibility as measured by the number of readable written letters were used in evaluating the children. A writing and reading treatment program was conducted, beginning with the child's preferred font type and size, for 3 months, 2 days per week, for 45 min. per day at the child's school. Before treatment, the most preferred font type was Verdana; after treatment, the preferred font type and size changed. Students had gained reading and writing speed after training, but their writing legibility was not significantly better. Training might affect the preferred font type and size of students with low vision. Surprisingly, serif and sans-serif fonts were preferred about equally after treatment.
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