Interventions

While visual acuity cannot be improved by therapy, compensatory strategies, environmental modifications, and interventions can enhance a person's ability to engage in everyday activities

Consultation with Eye Care Professionals
Contact eye care professionals, such as optometrists or ophthalmologists, for concerns regarding visual acuity

Strategy Suggestions:

1. Increase Contrast
   
   

   • Enhance contrast between objects to make them more distinguishable

   • Use high-contrast labels for edges of stairs or items to improve visibility

2. Background Patterns
   
   

   • Simplify backgrounds to reduce visual strain and sensory confusion, such as on placemats, rugs, or dishes

3. Additional Lighting
   
   

   • Increase lighting during therapy interventions or in areas of the patient’s home to minimize shadows and glare

4. Magnification
   
   

   • Increase the size of text and objects

   • Use magnification tools to aid with detailed tasks

5. Organizing and Simplifying the Environment
   
   

   • Reduce clutter to decrease visual scanning demands

   • Label shelves, cabinets, etc., with high-contrast labels or text

   • Keep frequently used items in a well-lit, uncluttered space

   • Use high-contrast tape on stair edges or furniture edges to reduce fall risks

6. Assistive Technology
   
   

   • Depending on the patient’s needs, suggest voice-activated devices or features for alarms, clocks, or phones

Methods for Managing Double Vision

1. Eye Patching or Occlusion
   
   

   • Use an eye patch or non-corrective eyeglass lenses with opaque tape to occlude one eye partially or fully, depending on the patient's visual deficit

   • Partial Occlusion: Apply opaque tape medially on the lens of the non-dominant eye to block the central visual field while maintaining peripheral vision. Gradually reduce the width of the tape as improvements are made

   • For detailed instructions, refer to this guide on occlusion techniques

2. Eye Exercises
   
   

   • Active Eye Movement Exercise:

     • Cover the unaffected eye and encourage the patient to move the affected eye toward the direction of weakness

   • Binocular Movement Practice:

     • Practice movements requiring both eyes to work together

   • Complete exercises 4–5 minutes several times a day

   • Refer to sections on smooth pursuits and convergence insufficiency for tracking and convergence activities

3. Activity-Based Interventions
   
   

   • Flashlight Tag: Follow a moving light with both eyes to improve tracking and alignment

   • Tracing Shapes: Use a pen or laser pointer to trace shapes and patterns

   • Pencil Push-Ups: Bring a pencil slowly toward the nose while focusing on a single point

   • Vision Therapy Software: Utilize tools such as Neuropsych Online or Sanet Vision Integrator for guided therapy

Home Modicaitons + Additional Strategies

1. Increase Lighting

   • Increase lighting during therapy interventions or in areas of the patient’s home to minimize shadows and glare

1. Organize and Simplify the Environment

   • Reduce clutter to decrease visual scanning demands

   • Label shelves, cabinets, etc., with high-contrast labels or text

   • Keep frequently used items in a well-lit, uncluttered space

   • Use high-contrast tape on stair edges or furniture edges to reduce fall risks

2. Increase Contrast

   • Enhance contrast between objects to make them more distinguishable

   • Use high-contrast labels for edges of stairs or items to improve visibility

Smooth Pursuit Exercises & Activities 

1. Simple Tracking Activities

• Pen or Finger Tracking: Use a pen or therapist’s finger to guide the client’s gaze in slow, controlled movements (e.g., horizontal, vertical, circular)

• Flashlight Tracking: Have the client follow a moving beam of light across a wall

• Swinging Object: Suspend a ball at eye level and guide it to swing slowly; ask the client to follow it with their eyes

2. Complex and Dynamic Activities

• Tracking with Cognitive Load: Introduce tasks such as counting, naming objects, or reciting letters while tracking a moving target

• Balance Integration: Combine tracking with balance challenges using tools like a balance board

• Obstacle Courses: Create visual navigation tasks where the client must track moving objects while avoiding obstacles

3. Games and Technology

Using interactive games, board games, or computerized program games can be used for visual tracking training in addition. Here are a few suggestions to make smooth pursuit training more engaging while improving focus and coordination;

• Cup and Ball Tracking Game: Place a ball under one of three cups and shuffle the cups. The patient tracks the ball’s location visually and guesses where it is. Gradually increase speed or complexity to challenge the patient

• Football Route Game: Display dotted football routes and ask the patient to visually track the movement. Incorporate questions for cognitive engagement, such as:

  • "Where was the ball thrown?"

  • "Which route did the ball follow?"

  • "If I want to throw to player number 5, what route does the QB need to follow?" Use straight lines, zigzags, and circular patterns to diversify the task

  • Click here to download the printable sheet

• Moving Obstacle Challenge: Slowly roll or throw objects across a table or floor. The patient visually tracks them and catches or retrieves the objects. Gradually increase speed or vary object sizes to build complexity

4. Functional Vision Tasks

• Cooking or Meal Prep: Incorporate tasks where clients visually track utensils or ingredients

• Community Mobility: Practice following moving vehicles or scanning busy intersections

Key Principles of Smooth Pursuit Training

• Focus on Accuracy Before Speed

• Start Simple, Then Add Complexity

• Engage Both Eyes Together

• Make It Functional to everyday task

Visual Saccades: Enhancing Rapid Eye Movement Skills

Visual Scaddes Exercises & Activities

1. Simple Saccade Exercise:

   • Use two or more stationary targets, such as letters, high lights/markers, numbers, or symbols, placed at varying distances in front of the patient. Cue the patient to shift their gaze between targets

   • Gradually increase the distance between targets to challenge coordination

   • Incorporating Movement:

     • Move one or more targets while the patient tracks back and forth

     • Use metronomes to add rhythmic pacing 

2. Games and technology

Interactive games, board games, or computerized program games can be used for visual tracking training in addition. Here are a few suggestions to make smooth pursuit training more engaging while improving focus and coordination;

• Number or Letter Scanning:

  • Place a randomized array of numbers or letters on a page. Ask the patient to locate specific sequences (e.g., 1 to 10 or A to Z)

  • Time the task to track improvements in speed and accuracy

• Card Sorting and Matching:

  • Spread out a deck of cards and call out suits or numbers for the patient to locate visually

  • Grade-up intervention by adding distracting elements or placing cards further out in their peripheral vision 

• Occupational Memory Match Game

  • Engage the patient in a matching game with cards. For added challenges, use conceptual matches like matching related pairs (e.g., "toothbrush" and "toothpaste")

  • Click here to download memory match game

• Obstacle Course Scanning:

  • Set up an obstacle course with labeled checkpoints for the patient to visually locate and verbally identify while navigating the space

• Reading and Text-Based Exercises:

  • Have the patient read sentences or paragraphs, underlining specific words or letters as they scan for targets

• Functional Vision Task

  • Simulate daily activities requiring rapid eye movements, such as finding items in a cluttered drawer or kitchen cabinet

  • Practice scanning environments for hazards while walking

Visual Field Deficits Exercises & Activities 

1. Scanning Training

   • Teach the patient to use organized, efficient search patterns:

     • Linear patterns for structured tasks like reading

     • Circular patterns for unstructured environments

   • Encourage consistent wide head turns toward the blind side

   • Practice quick shifts of attention between central and peripheral visual fields

2. Environmental Modifications

   • Enhance contrast between objects to make them more distinguishable

   • Use high-contrast labels for edges of stairs or items to improve visibility

   • Simplify backgrounds to reduce visual strain and sensory confusion, such as on placemats, rugs, or dishes

   • Reduce clutter to decrease visual scanning demands

   • Label shelves, cabinets, etc., with high-contrast labels or text

   • Keep frequently used items in a well-lit, uncluttered space

   • Use high-contrast tape on stair edges or furniture edges to reduce fall risks

3. Assistive Tools

   • Introduce anchoring techniques, such as placing brightly colored lines on the margins of reading material to guide eye movements

   • Use tactile feedback tools like a cane for walking

4. Compensatory Techniques

   • Teach the patient to start all tasks on their affected side to counteract neglect tendencies

   • Establish routines to minimize visual scanning demands (e.g., organizing items in predictable places)

Activities and Games

• Item Cancellation Tasks

  • Use worksheets with symbols, letters, or numbers. The patient identifies and marks out specified targets

• Sticky Note Hunt

  • Place sticky notes in a room, and ask the patient to locate them while walking. Increase difficulty by adding more notes or spreading them out further

• Hidden Object Posters

  • Engage the patient in finding objects on detailed posters, such as “Where’s Waldo?” Increase the challenge by setting time limits or specifying object categories

• Laser Pointer Tracking

  • Shine a laser pointer in various locations and have the patient visually track it. To increase the complexity, ask them to describe the location of the laser

• Interactive Computer Programs

  • Use the following computer program to train scanning and attention

    • Neuropsych Online

    • Parrot Software

    • Vision Builder

• Card Sorting and Matching Game:

  • Spread out a deck of cards and call out suits or numbers for the patient to locate visually. Place cards further in the patient's affected peripheral vision 

  • Engage the patient in a matching game with cards. For added challenges, use conceptual matches like matching related pairs (e.g., "toothbrush" and "toothpaste")

  • Click here to download memory match game

  • Grade-up intervention by adding distracting elements or placing cards further out in their peripheral vision

• Balloon Volleyball

  • Inflate a balloon and play a simple game of volleyball. This encourages visual tracking, head movement, and scanning.

• Obstacle Navigation Course

  • Create a course with chairs, cones, or other objects. Ask the patient to walk through it, paying attention to obstacles in their path. This reinforces scanning and spatial awareness

Convergence & Accommodation Insufficiency Exercises & Activities

Strategies Suggestions

Gradual Progression of Difficulty

• Start with simple tasks focusing on one eye (monocular) and progress to binocular tasks

• Gradually increase task complexity and visual demand as the patient improves

Integration of Vision Therapy Tools

• Use convergence exercises such as pencil push-ups or Brock string to improve near-point focus

Environmental Modifications

• Increase lighting during therapy interventions or in areas of the patient’s home to minimize shadows and glare

Activities & Games

• Pencil Push-Ups
  
  

  • Hold a pencil at arm’s length and slowly bring it toward your nose while having the patient focus on the tip of the pencil. Stop when the object doubles or blurs, then move it back. Repeat several times

• Brock String Exercise
  
  

  • Use a string with beads placed at various distances. The patient focuses on one bead at a time while keeping it single and clear, alternating focus between near and far beads

• Hart Chart Reading
  
  

  • Place one chart at arm’s length and another at a distance. Alternate reading letters or words from the near and distant charts, emphasizing clarity and focus

• Interactive Ball Toss Game
  
  

  • Toss a small ball back and forth with the patient. Vary the distance and incorporate tasks like catching letters or numbers written on the ball to combine convergence and cognitive engagement

• Target Switching Game
  
  

  • Place objects or cards at different distances around the room. Have the patient quickly switch focus between near and far objects, identifying each item aloud

• Convergence Dot Game
  
  

  • Draw two columns of dots on a card. The patient slowly crosses their eyes to align the dots, creating the perception of a third dot in the middle. Practice for 5-10 minutes daily

• Table Air Hockey
  
  

  • Play table air hockey to challenge the patient’s ability to shift focus between near and far targets while maintaining hand-eye coordination

• Ping-Pong Practice
  
  

  • Practice ping-pong to improve visual accommodation and eye-hand coordination

• Riddle Matching Game
  
  

  • Provide a riddle on a piece of paper and place matching answers as pictures on a wall. The patient reads the riddle, shifts focus to the wall, and identifies the correct answer

• Bead String Patterns
  
  

  • Show the patient a picture of a pattern (held at eye level) and have them recreate it on a table using beads, encouraging focus shifting

• Cornhole Adaptation
  
  

  • Place targets at different distances. The patient picks up a beanbag (looking down) and throws it to a designated target (looking forward), practicing near-to-far accommodation

• Interactive Map Search
  
  

  • Provide two maps at different locations or angles. The patient shifts focus between them to find and match information. Have the patient scan the map or mark it:

    • Simple: Find one location

    • Intermediate: Follow a route or identify multiple landmarks

    • Advanced: Use directions (north, south) or compare distances between locations