This poster was presented at the American Optometric Association's Annual meeting in Boston, MA 06/2016 The bottom line: The visual cortex has the capacity for experience dependent change (neuroplasticity) throughout life. Unfortunately, when it comes to the adult with binocular vision problems, this is not always recognized as being true even though there is strong clinical evidence to suggest a high level of adult neuroplasticity. Current research shows that adults tend to have numerous anomalies associated with the binocular vision system especially within certain populations. This case series demonstrates how those even approaching 70 years of age can benefit from optometric vision therapy.

1. 3241 South Michigan Avenue, Chicago, Illinois 60616
BACKGROUND
Optometric Vision Therapy is considered a viable treatment option for children with
various binocular vision disorders (strabismus, amblyopia and other dysfunctions of the
binocular vision system). Unfortunately, children with these disorders, if left untreated,
become adults with strabismus, amblyopia, convergence insufficiency, etc. Adults can
also acquire biocular vision dysfunctions through decompensated phorias and various
medical disorders such as stroke, concussion and mild traumatic brain injury.
Current research suggests that the human visual system retains a good deal of
neuroplasticity into adulthood and that even senior individuals can learn new ways
of seeing. Unfortunately, optometrists are less likely to suggest vision therapy to their
adult patients even though it has been shown to be effective for various groups within
the adult population.
CASE SERIES
The diagnostic data, therapy utilized and treatment outcomes are presented for
3 adults with strabismus. Case #1: LM is a 69 y/o WM who presented with severe
symptoms associated with one or more vision dysfunctions (intermittent exotropia
at near, convergence insufficiency, diplopia) that adversely impacted his quality of
life and interfered with his ability to work efficiently. After participating in a program
of optometric vision therapy it was noted (even 3 years post therapy), that all the
symptoms were improved or eliminated and that all the clinical findings were at or near
expected levels.
Case #2: MP is a 24 y/o WF with a post-surgical (surgery at age 5 years) intermittent
esotropia, convergence excess (variable), accommodative insufficiency and suppression.
Assessments up to 2 years after active vision therapy was concluded showed an
elimination or improvement of symptoms, clinical findings at expected levels and an
improved quality of life. She could even see the “3D” in 3D movies.
Case #3: The final patient (SP) is a 29 y/o BF with a 90PD IAXT, diplopia, accommodative
excess and oculomotor dysfunction. Once again upon concluding an active program of
vision therapy and even after 3 years had passed since participating in vision therapy,
all symptoms were eliminated and clinical findings were at expected levels. She was no
longer concerned about the cosmetic aspect of the eye turn as well.
Depending upon the patient noted above, anywhere from 29 to 42, 45 minute in
office vision therapy sessions with out of office home vision therapy resulted in
significant improvement in vision function and relief of symptoms for up to 3 years post
therapeutic intervention.
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A +,#
; Stephanie Lyons, OD+
; Kelsey Frederick OD+
; Rachael Barker, OD+
#
Illinois College of Optometry, +
Lyons Family Eye Care, Chicago, IL
Neuroplasticity and Vision Therapy for Adults:
A Case Series
CONTACT INFORMATION
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Illinois College of Optometry
3241 S. Michigan Ave. Chicago, Il 60616
dmaino@ico.edu
TABLE 1: Vision Therapy Sequence
DISCUSSION
The visual cortex has the capacity for experience dependent change (neuroplasticity)
throughout life. Unfortunately, when it comes to the adult with binocular vision
problems, this is not always recognized as being true even though there is strong
clinical evidence to suggest a high level of adult neuroplasticity. Current research shows
that adults tend to have numerous anomalies associated with the binocular vision
system especially within certain populations. This case series demonstrates how those
even approaching 70 years of age can benefit from optometric vision therapy.
CONCLUSION
Clinicians have repeatedly noted that adults can benefit from an active program of
optometric vision therapy. The improvement or elimination of symptoms associated
with various binocular vision disorders such as convergence insufficiency, strabismus,
and amblyopia; improve the patient’s quality of life and ability to function. As the
Baby Boomer generation moves into a retirement that is often unlike that of past
generations, they will pursue active interventions that allow them to do all they wish to
in an easy and comfortable manner.
Conditions frequently associated with aging, such as stroke, concussion and mild
traumatic brain injury, adversely affect vision function in the adult. These individuals will
seek out optometric vision therapy to improve their overall function and quality of life.
As we proceed into this millennium, the fastest growing population that need vision
therapy will be adults.
There is a growing body of research that clearly demonstrates that vision function in the
adult amblyope can be improved. There is also mounting evidence that those adults
who have an acquired brain injury and vision function anomalies can also benefit from
vision therapy as well.
This case series supports the concept that adults from 20 to 70 years of age benefit
from optometric vision therapy. As a provider of primary eye and vision care, it is your
responsibility to diagnose, treat or refer for treatment these individuals so that their quality
of life is maintained and ability to function within an increasingly complex world enhanced.
Table 1
Vision Therapy Sequence
Monocular Biocular Binocular Integration/Stabilization
Oculomotor Oculomotor Oculomotor Oculomotor+Accommodative+
Accommodation Accommodation Accommodation vergence+Hand-eye
Hand-eye Hand-eye Hand-eye simultaneously
Anti-suppression Anti-suppression
Vergence
Table 2
Symptoms/Problems
LM
Initial Symptoms/Problems
Eye strain while reading, falls asleep while reading, intermittent blur, diplopia, loses place while reading,
headaches, must use large print books, fatigue, may lose job because of errors made due to poor vision
function, Attention problems
Post Vision Therapy
All areas improved or problems eliminated, uses normal sized print, job going well (Last evaluation 3
years post vision therapy. All improvements maintained)
MP
Initial Symptoms/Problems
Cannot judge distance well, blurred vision, headache, cannot see 3D in 3D movies,
Post Vision Therapy
All symptoms/problems eliminated or improved, Can see 3D when watching 3D movies, Better depth
perception while driving, No HA’s (Last evaluation 2 years post vision therapy. All improvements
maintained)
SP
SB Initial Symptoms/Problems
Diplopia, struggles to keep eyes straight, does not like her appearance when eye turns outward
Post Vision Therapy
All problems eliminated or improved, eyes now straight most of the time, no diplopia, cosmetic
appearance improved significantly (Last evaluation 3 years post vision therapy. All improvements
maintained)
Table 2
Case History
LM MP SP
OCD Birth control No meds
Sleep apnea No allergies No allergies
Prilosec No previous VT No previous VT
Environmental allergies
Vitamins, Omega-3, Supplements
Treated previously for CI
TABLE 2: Symptoms/Problems
TABLE 2: Case History
TABLE 3: Examination Findings
Table #3
LM Examination Findings (not all tests were given at all evaluations. (Ocular health unremarkable)
Initial Findings
BVA (OD/OS) Refractive Error Stereo/W4D EOMS/Pursuits/Saccades CT NPC Phoria (N) Vergences (N) Acc
20/20-;20/20 +.50-.50x010 - Random Dot Full/+4/+4 undershoots 10-20 XOP near 24/26” RL 11BI near BI X/25/12
+.50-.75x145 4-5 W4D near IAXT near BO X/35/30
Suppression ?
Post Vision Therapy
20/20; 20/20 +0.25 -0.50 x 132 +Random Dot Full/+4/+4 -undershoot 10 XOP near To Nose RL 12 BI near BI 20/18
+0.75 -0.25 x 139 9/10 Wirt Circles No strab noted BO 20/18
4 W4D Dist/Near
MP Examination Findings (not all tests were given at all evaluations. (Ocular health unremarkable)
BVA (OD/OS) Refractive Error Stereo/W4D EOMS/Pursuits/Saccades CT NPC Phoria (N) Vergences (N) Acc
20/20; 20/20 +1.00 -0.25 x 005 -Random Dot Full/+4/+4 6PD IET To Nose 6 BO Suppression MEM AM
+1.00 0/10 Wirt Circles BI/BO Facility Blur +/-
Variable/Suppression
W4D
Post Vision Therapy
20/20; 20/20 +1.50 -0.25 x 010 + Random Dot Full/+4/+4 3 EP To Nose 3 BO BI 14/12 MEM PL OD
+1.50 -0.25 x 165 3/10 Wirt Circles BO Off Scale +.50 OS
4 W4D Dist/Near (No suppression) Facility
8 CPM (+/-2.00)
SP Examination Findings (not all tests were given at all evaluations. (Ocular health unremarkable)
BVA (OD/OS) Refractive Error Stereo/W4D EOMS/Pursuits/Saccades CT NPC Phoria (N) Vergences (N) Acc
20/20; 20/15 -6.25 -1.00 x 100 + Random Dot Full/+3/+3 15 XOP Dist To Nose 10 BI Suppression MEM
-5.00 -1.00 x 160 5/10 Wirt Circles 25 BI IXT Near Variable
4 W4D Dist Facility
2 W4D Near Blur (-)
Post Vision Therapy
20/20;20/20 -6.25 -0.75 x 100 + Random Dot Full/+4/+4 8 XOP To Nose 8 BI BI/BO MEM
-5.00 -0.75 x 180 10/10 Wirt Circles Off Scale +.75 OD/OS
4 W4D Dist/Near No Suppression
An adult patient
using the
Brock String
to improve
positive fusional
vergence.