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Optometrist evaluationEyegames: Easy and Fun Visual Exercises: An OT and Optometrist Offer Activities to Enhance Vision! was co-authored by Lois Hickman and Rebecca Hutchins, an occupational therapist and an optometrist, and is a must read. This is a three part series based on this book, following our recent review, Eyegames: Easy and Fun Visual Exercises.

In Eyegames, Part 1: An Optometrist’s Perspective on Vision Therapy you were introduced to Rebecca Hutchins to gain insights into visual processing issues from a behavioral optometrist’s perspective. In Eyegames, Part 2: Visual Perception Problems, we presented visual perception problems and how to identify them. This final part will look at what happens during a behavioral optometrist’s evaluation and briefly look at a treatment plan.

Steps to a Behavioral Optometrist’s Evaluation

  1. Evaluate as would another eye care professional (Hardware): eye health, refractive status, visual field
  2. Developmental evaluation (basic Software): Binocularity=Fusion, Following=tracing, Focus=accommodation, Fixation=vergence & versions, Flexibility=able to change (aim or focus), Fatigue
  3. Non-oculomotor vision problems: Spatial disorientation, Motion Sensitivity, Photophobia or Light sensitivity
  4. Perceptual Vision Deficits: visual discrimination, figure ground, closure, visual memory, visual sequential memory, form constancy, visual spatial organization skills
  5. Consideration of non-visual issues: stress, family dynamics, geographical distance, child’s mood and ability to attend and interact, insurance coverage, etc.

If obvious deficits are discovered in the first two or three areas, Rebecca may not get to some of the others. Unique from her colleagues, who do extensive perceptual testing prior to entrance into vision therapy, Rebecca does not perform perceptual testing until she feels that the basic software abilities are functioning fairly well. With special needs children, she tends to limit a lot of testing, especially on an initial visit.

An Open Ended Treatment Plan
Rebecca and her therapists work from the diagnoses determined in the initial evaluation. Each therapy session is designed to encourage visual exploration into one or more of the deficient visual skill areas. Appropriate activities are planned, but they are always observing, always ready to change and follow the lead of the child at that time. After each session, they may jot down ideas for the future, but the therapy session is not set in stone, it is fluid to allow for creativity and innovation between the therapist and child.

Home activities are assigned to be done preferably five times a week. After about 8-10 sessions, Rebecca re-evaluates, using the same testing sequence initially used and then compares the responses and reactions. Rebecca can then determine improvements needed, areas that still need work, and whether the child should continue weekly, move to biweekly, or take a break for a month or so.

Progress Noted
When progress is noted, Rebecca allows room for integration and consolidation of skills and/or for the child to reach a different developmental level. Rebecca most frequently sees definite improvement after two plus months of weekly therapy.

Bonus Activity: Light through the Tunnel
Use nonblinking holiday lights that are enclosed in a plastic tube. These lights can be strung through play tunnels or large barrels to invite quadruped play activities. Toys can be scattered through the tunnel or hidden in pockets along the inside of the tunnels by using different kinds of closures, such as buttons, zippers, snaps, and Velcro.


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An “Ism” is our coined term synonymous with a “challenge”. Many children, with or without a diagnostic label, experience various challenges throughout their developmental years which are impacting them in the classroom and at home. At Special-Ism, the Ism is our focus. We do not look at the diagnostic label, instead, we look at the Isms and offer solutions no matter the diagnosis.