FAQ | Visual Edge | Pheonixville

Prior to beginning Neuro-Visual Therapy, you will need an evaluation to determine the status of your visual system, and if Neuro-Visual Therapy will be beneficial to you. The evaluation checks multiple areas, including fixation and eye movement, accommodation (focusing), how accurately the eyes coordinate at distance and near (vergence skills), as well as visual processing and perception. The testing typically takes about an hour and a half to complete. Drops are not used during the evaluation, since the focus of the testing is visual function. Most people leave feeling fatigued, and some may need to nap when they get home. You will return after a week to review the results of the test, and will then be told if Neuro-Visual Therapy is recommended, as well as the estimated number of sessions.

Neuro-Visual Therapy is an individualized program using therapeutic procedures that help develop and improve visual skills. Different exercises and procedures are prescribed and monitored by the doctor, depending on the needs of each patient. Instruments, lenses, filters nda exercises are used to teach more efficient ways of obtaining and processing visual information. Neuro-Visual Therapy uses the eye-brain connection and neural plasticity (the brain is able to change and establish new connections at any age) to develop and strengthen neural pathways. This allows you to obtain, process and interpret visual information more efficiently.

Keep in mind that 80% of what children learn in school is done using their visual system, and 5-10% of children have an undiagnosed vision problem. Unfortunately, school vision screenings can miss many of these problems. Children who are struggling should have their visual function, not just their visual acuity (can they see 20/20?) assessed. That includes checking visual skills such as eye movement, focusing, and eye teaming. Difficulties in reading, writing or learning can be the result of a vision problem. Many children diagnosed with learning disorders have a visual deficit, which can be helped with Neuro-Visual Therapy.

When you look from far away to a near object, the lenses inside your eyes should automatically change focus (accommodate) to clear the object you are looking at. Anytime you shift your attention to another distance, your focusing system needs to shift to adjust to the new location. If there is difficulty in how easily, quickly, and accurately your eyes focus, or you are unable to maintain focus at a certain distance, there is an accommodative dysfunction.

Once you turn 40, the lens in the eye starts to become less flexible, causing focusing difficulty. This is not a dysfunction, it is a normal change that occurs to the lens, and requires different prescription lenses (bifocal or progressive) to compensate for the change.

Normally, children are able to focus quickly, and have the ability to focus a great amount. However, some children are unable to maintain focus for a long time while reading, or they may be unable to quickly change the focus of their eyes from near to distance, or distance to near.

Common symptoms of Accommodative Dysfunction include:

Blurred vision, or difficulty maintaining clear vision
Difficulty shifting focus from one distance to another
Print appears to move on page
Visual discomfort, eye strain and headaches
Fatigue
Reduced accuracy and inconsistent work, especially with prolonged time at task
Difficulty with concentration and attention
Avoidance of reading and writing

The coordinated movement of your eyes either closer inward (to look near) or farther apart (to look far) so that both of them point at the same object is called vergence. Your eyes moving in to look at close objects, such as a computer or book, is called convergence. This is a skill that is learned as babies reach out to grasp objects and look at them.

Convergence Insufficiency is the most common vergence dysfunction. It occurs when there is difficulty aligning accurately at an object that is near. This causes difficulty for students, who spend the majority of their school day working on near tasks, as well as adults who spend their time working on computers.

Common symptoms of Convergence Insufficiency include:

Double vision, or difficulty maintaining clear vision
Print appears to move on page
Visual discomfort, eye strain and headaches
Fatigue
Reduced accuracy and inconsistent work, especially with prolonged time at task
Difficulty with concentration and attention
Poor reading comprehension
Avoidance of reading and writing
Dizziness and motion sickness
Clumsiness, such as a tendency to bump into doorways and knock things over
Poor sports performance

A study done in 2008, the Convergence Insufficiency Treatment Trial (CITT), which was published in numerous optometric as well as ophthalmologic journals, clearly supports the efficacy of office based vision therapy for treating Convergence Insufficiency.

The results of the CITT can be found here.

Six muscles connected to the eye work together to accurately control eye movement. Oculomotor Dysfunction occurs when there is difficulty coordinating the eyes to fixate, follow an object, and move from spot to spot with accuracy. This commonly affects reading, handwriting, attention, and athletic performance.

Oculomotor Skills are:

Fixation – the ability to maintain eyes on a target
Pursuits – the ability to follow a moving target smoothly and accurately
Saccades – the ability to look from one target to another target accurately

Common symptoms of Oculomotor Dysfunction include:

Moving head excessively when reading
Difficulty paying attention
Using a finger or marker to keep place while reading
Losing place or skipping lines when reading
Poor reading comprehension
Reading slowly
Print appears to move on page
Visual discomfort
Reduced accuracy and inconsistent work, especially with prolonged time at task
Difficulty with concentration and attention
Avoidance of reading and writing
Inconsistently sports performance
Motion sickness

The cornea is the clear outer portion of your eye. Like a camera lens focuses the picture, the cornea helps focus what you see onto the retina. Using advanced therapeutic curves, the Ortho-K process gently reshapes the front surface of the cornea. The hydraulic forces created by the tear film beneath the therapeutic retainer flow across the corneal surface. This continuous action redistributes the corneal cells, reshaping the central curvature. The corneal curve will be either steepened or flattened depending on your prescription. The newly shaped cornea then focuses light clearly onto the retina.

Strabismus is a misalignment of the eyes, so that they do not fixate as a pair. One eye (or the eyes may alternate) can deviate inward, outward, up or down. If it is only one eye, it can lead to Amblyopia or “lazy eye.” Strabismus is usually caused by a defective signal from the brain to the eye muscles causing poor muscle control. It is not due to weak eye muscles.

It is normal for babies to occasionally have an eye turn during the first few months of life, as they are learning to control their eyes.

Although surgery is sometimes recommended to help align the eyes, it usually only offers only a cosmetic solution. It also does not address the underlying problem of poor muscle control. Numerous peer-reviewed scientific studies report success rates for strabismus surgery ranging from 30% to 80%. Success is defined as cosmetic improvement only, which means that following the surgery, the patient's eyes maintained a straight appearance, but depth perception was not necessarily present.

Most cases of strabismus can be treated with Visual Therapy instead of surgery. The brain controls eye movement and alignment. If the brain does not pay attention to and fuse the images from the two eyes into one to create a 3D image, Visual Therapy can be used to reinforce those brain connections, and provide a functional, rather than cosmetic solution.

More information on strabismus is available here.

Optometrist - an eye doctor who has earned the Doctor of Optometry (O.D.) degree.

This consists of three to four years of undergraduate studies, followed by four years of education at a school of optometry. A one year post graduate residency is optional. Optometrists are required to fulfill continuing education requirements to stay current on information in eyecare, as well as to maintain their license.

Optometrists examine eyes for vision and health problems, prescribe glasses and contact lenses, prescribe medications, monitor and treat multiple conditions, such as glaucoma and dry eye. Some optometrists choose to specialize in fields such as low vision care or vision therapy.

Ophthalmologist - a medical (MD) or osteopathic (DO) doctor specializing in eye surgery.

Ophthalmologists generally complete four years of undergraduate studies, followed by four years of medical school, and a minimum of three to four years of hospital-based residency in ophthalmology. Ophthalmologists are required to fulfill continuing education requirements to stay current on information in eyecare, as well as to maintain their license.

Ophthalmologists are licensed to perform eye exams, diagnose and treat disease, prescribe medications, and perform eye surgery (such as cataract surgery and Lasik). Many ophthalmologists will choose a specialty, such as glaucoma, retinal disorders, or cataract surgery.

Amblyopia is a condition where one eye doesn’t see clearly, even with corrective lenses, despite the eye being healthy. It is caused by an interruption in the development of vision, with the dysfunction occurring in the brain. This condition can sometimes occur as a result of strabismus.

Amblyopia can be treated at any age. It is more effective to use active therapy as opposed to passive patching. Prolonged patching can lead to difficulties with binocular vision (using both eyes together). If the visual system does not have input from both eyes to the brain, the brain connections for binocular vision are not being developed.

The American Optometric Association recommends that healthy adults from age 20 to 40 receive an eye exam at least every two years. Contact lens wearers should be seen every year. If you are at risk for eye problems due to a family history of eye disease, diabetes, high blood pressure or past vision problems, your doctor of optometry may recommend more frequent exams. In between examinations, if you notice a change in your vision, contact your doctor. Detecting and treating problems early can help maintain good vision for the rest of your life.

Connections from the eyes run through many areas of the brain. Even a “mild” concussion can cause significant vision problems. If symptoms persist beyond three months, Visual Therapy can help.

Common symptoms caused by brain injuries can include:

Blurred vision, either at distance or near
Double vision
Headaches with reading or computer work
Poor reading comprehension
Loss of place when reading
Loss of peripheral vision

It's a fact of life that vision changes occur as you get older. But these changes don't have to compromise your lifestyle. Knowing what to expect and when to seek professional care are important steps to safeguarding your vision. As you reach your 60s and beyond, you need to be attentive to warning signs of age-related eye health problems that could cause vision loss. Many eye diseases have no early symptoms. They may develop painlessly and you may not be aware of changes to your vision until the condition is quite advanced. But wise lifestyle choices and regular eye exams can significantly improve your chances of maintaining good eye health even as you age. The American Optometric Association recommends annual eye examinations for everyone over age 60. See your doctor of optometry immediately if you notice any changes in your vision.

It is very safe. However, as with any medical device, there are risks. The small risk of infection and corneal neovascularization is no greater than other contact lenses worn overnight. With good hygiene, proper lens care, and following all wearing instructions the risk is minimized. The risk is further reduced in our patients by having in office progress checks throughout the year. At each progress check we will monitor your ocular health and the retainers will be inspected. A deep enzymatic cleaning will be periodically performed to ensure continual good health and efficacy of treatment.

That depends on your plan. There are many different health and vision insurance companies, and each company has different policies. As stated in the insurance section, we do not directly bill any insurance plans. You may wish to check with your company if you have out-of-network benefits for your eye examination and glasses or contact lenses.

If you are checking for Functional Vision Assessment or Therapy benefits, please ask your I nsurance company if they will reimburse you for the following codes>>>>>

There are three codes we use for our vision assessment: 92002, 96112, 92060. We encourage you to check with your insurance company ahead of time to see if they will cover these codes.

There are four codes that we use for vision therapy: 92065, 97110, 97112, 97530. We encourage you to check with your insurance company ahead of time to see if they will cover these codes..

The length of the program depends on your diagnosis, frequency of appointments, as well as how much time is spent on home exercises. With a simple diagnosis, regular visits, and consistent work at home, some of our patients have completed their program after ten sessions. More typically, most patients need between twenty and thirty sessions. An evaluation is performed after every ten sessions to determine the progress made, and decide on treatment moving forward.

The newer oxygen permeable materials used in Orth-K retainers were FDA approved for overnight wear since 2002. The FDA approval was the result of an extensive clinical trial that showed the materials are safe to use for overnight wear. The Ortho-K retainers allow high amounts of oxygen to reach the cornea, significantly minimizing complications. Proper care and wear of the retainers further minimizes the risk of complications.

When your eyes fixate, align, focus and move together, a new world of vision is discovered. After completing a program of Neuro-Visual Therapy, you may find that:

Learning becomes easier
Reading level and speed increases
Improved comprehension
Time spent on homework decreases
The ability to follow moving objects improves
Judgement of depth is more accurate, and you are less clumsy
Sports performance improves
Motion sickness diminishes
Seeing objects nearby or at a distance improves
Visualizing mental images becomes easier

The rate at which patients experience improvement varies. Progress is expected to be seen by the first re-evaluation (after ten Neuro-Visual Therapy sessions).

Visual Edge is an out-of-network provider for all medical insurance companies. If you have any coverage for Visual Therapy, it would be through your major medical policy, not vision insurance.

Most insurance plans have exclusions for vision therapy, meaning that it is not a covered benefit. Others may cover it for a specific diagnosis, or for a limited number of appointments. You can contact your insurance company to determine what coverage is available according to your policy. We will provide you with diagnoses and procedure codes when reviewing the results of your evaluation.

If a visual dysfunction is found during your exam, Visual Therapy can be beneficial, regardless of whether your insurance company chooses to cover therapy or not. If finances are a deterrent, we will work with you to be sure you can receive the services you need and deserve. Even with little or no insurance coverage, many patients choose to invest in vision therapy.

Yes! Thanks to neuroplasticity (the brain is able to change and develop new connections at any age), patients of any age can benefit from Neuro-Visual Therapy. Our adult patients have had visual dysfunctions since childhood (children with visual dysfunction grow into adults with visual dysfunction), as well as visual dysfunction following illness or injury. Regardless of the reason for the deficit, all have shown tremendous improvement following a program of Visual Therapy.

One of the benefits of starting a program of Neuro-Visual Therapy as an adult is motivation. Adults are able to understand the benefits and necessity, and improvement of skills with a decrease in symptoms is motivation in itself.

Dr. Sue Barry, a well know neuroscientist and college professor has written a book, Fixing My Gaze, and done lectures on her experience of growing up without depth perception. As a child, she had several surgeries to straighten her eyes. As she says, the surgeries made her eyes look straight, but did nothing to address depth perception. You can see some of her presentations at:

Learning to see in 3D

Fixing my Gaze

Dry eye patients are often successful with the Ortho-K process. The retainers are only worn at bedtime and because your eyes are closed while you are asleep, there is little tear evaporation. If dryness is a factor, tear supplements may be added. Ortho-K provides a dry-eye patient with freedom from scratchy contact lenses previously worn during the day. However, it depends on the cause and severity of your dry eyes. If you have a dry eye disease due to severe arthritis or collagen vascular disease you might not be a candidate. A comprehensive exam will give us a better idea of your chances for success.

People who are Myopic, also referred to as being “Near-Sighted” or “Short-Sighted” have difficulty seeing objects clearly that are in the distance. The reason objects (the board in school, signs while driving) are blurry in the distance is because of elongation of the eye. As little as 1/3mm of additional axial length (the length of the eye from front to back) will require 4 steps of change to the prescription to see clearly in the distance.

Nearsightedness, or 'myopia', typically starts in early childhood and will require glasses or contact lenses to see clearly for activities like viewing a whiteboard at school. Nearsighted children may experience an increase in their nearsightedness as they grow, resulting in a greater reliance on glasses or contacts. Simply, as your child's eyes continue to grow the myopia also grows.

There are several predictors for a child’s risk of developing progressive myopia. Having one or more of the risk factors increases the likelihood that your child’s myopia will advance. These risk factors include:

Age of onset of Myopia. There is a direct correlation between how young you are when first needing help to see distant objects and ending up with higher levels of correction.
Parents who are nearsighted. A person with one near-sighted parent has three times the risk of developing myopia – and if both parents are near-sighted, six times the risk of being nearsighted.
Spending too much time on near tasks.
High accommodative lag, high AC/A ratios, and esophoria at near (These are Functional Vision Evaluation measurements that should be checked during an annual eye examination).
Under or over-corrected vision (incorrect glasses, or having no glasses when they are needed) has been shown to promote onset and accelerate progression of myopia.
Insufficient time spent outdoors

The short answer is…Put down the digital devices and get outside to play. Doesn’t matter what form of exercise, just do it… outside.

The following suggestions should be considered:

Annual comprehensive eye examinations (including functional vision assessment, not just an acuity check) to catch early signs of myopia, before it fully develops can help with developing an individualized plan for your child to slow onset and progression of myopia.
When using a computer, ensure it is properly positioned to avoid eye strain and take breaks every 20 minutes by looking across the room for 20 seconds (the 20/20/20 rule).
Smart phones are popular for children and teenagers’ texting, social media, reading and games - but too much screen time is linked increases of myopia.
Outdoor activities (sports or play) of at least 90 minutes a day can reduce the risk of myopia – There is evidence that exposure to outdoor light is beneficial in slowing onset and progression of myopia.

After a comprehensive eye examination, with a functional vision assessment, your eye doctor can recommend additional treatments that could be implemented.

Specialty contact lens designs and orthokeratology offer the effective vision correction options to slow the progression of myopia.
Previously, multifocal glasses lenses were shown to mildly slow the progression of myopia, though not to the same degree as contact lenses, and only for particular individuals with eye muscle teaming problems. Specialty designed glasses lenses are part of ongoing research studies. Though not yet available, initial reports show promise.
Atropine eye drops have been shown to slow progression of myopia. As with any medication, before prescribing, the possible side effects must be considered.

School-Age Myopia typically begins at ages 5 to 7 and continues until 18 years of age. Although dependent on several contributing factors that are best determined during a comprehensive eye examination, the latest studies show that the earlier treatment is initiated, the better the outcome. This is because children with an earlier onset of myopia commonly have a higher rate of progression and thus a greater final degree of myopia.

If you are a parent who has been wearing glasses or contacts most of your life (to help you see better in the distance) you may remember repeatedly needing stronger glasses/increased powers yourself. You may be asking, besides the inconvenience of having to wear correction, what’s the problem with that. The answer lies in the cause of needing stronger glasses. That increased power is a result of the elongation of the eye. In cases of excessive elongation, there is a correlated increased risk of ocular diseases, such as retinal detachment, myopic macular degeneration, glaucoma and cataracts.

Retinal detachment: A condition that occurs when the retina, the thin layer of tissue lining the inside of the eye, pulls away from the outer walls of the eye.
Myopic maculopathy: The elongation of the eye causes a stretching that leads to the deterioration of the central portion of the retina causing irreversible vision loss.
Glaucoma: Studies show people with myopia have a 2-3x greater risk of developing glaucoma, a condition that causes damage to the eye’s optic nerve.
Cataracts: A clouding of the lens of the eye that can cause changes in vision. Though cataracts can affect everyone as they age, they often develop sooner in patients with myopia.

Undergoing Myopia management today could lessen the eye health risks of tomorrow.

Frequently Asked Questions

Is Visual Edge accepting new patients?

What age patients can be seen at Visual Edge?

What is a Developmental/Behavioral Optometrist?

What is Orthokeratology?

Can I park on Church Street?

What can I expect during a Functional Visual Skills Evaluation?

At what age should my child have an eye examination?

What is the difference of a school screening and a comprehensive eye examination?

Why is Visual Edge the best?

What is Neuro-Visual Therapy?

This is what the questions will look like?

Who can Benefit from Neuro-Visual Therapy?

Can Patients with special needs be seen at Visual Edge?

Not sure how many questions you want

How is Vision related to Learning?

My child is on the autism spectrum, can they be seen at Visual Edge?"

What is an Accommodative (Focusing) Dysfunction?

Must I schedule an appointment?

What is Convergence Insufficiency?

Is the Vision Improvement Permanent?

If you don’t take my Insurance, can I still be seen at Visual Edge?"

What is Oculomotor (Eye Movement) Dysfunction?

How Does Ortho-K Reshape the Cornea?

I already have a prescription; can I choose glasses from Visual Edge?

How do Ortho-K Retainers Feel?

What is Strabismus (Eye Turn)?

What is the difference between an Optometrist and an Ophthalmologist?

What is Amblyopia (Lazy Eye)?

What is a Developmental/Behavioral Optometrist?

What sort of Vision can I expect?

How quickly will my vision improve?

What is Diplopia (Double Vision)?

I am a healthy adult; how often should I have an eye examination?

How long does the visual improvement last?

What is Post Concussion Vision Syndrome?

I am over 60 years old; how often should I have an eye examination?

How safe is the Ortho-K process?

Will my insurance reimburse me for my exam, glasses or therapy sessions?"

How long is a program of Neuro-Visual Therapy?

Are Ortho-K retainers Safe to wear overnight?

What forms do I need to bring?

What changes can I expect after Neuro-Visual Therapy?

Does insurance pay for Visual Therapy?

Who is a Good Candidate?

Is there scientific evidence that Neuro-Visual Therapy works?

Is Age a Factor?

Why Are Children Good Candidates?

Can Neuro-Visual Therapy be beneficial at any age?

What If I’m a Current Contact Lens Wearer?

Can I See While Wearing the Retainers?

What If I Wear Bifocals, Reading Glasses or Progressive Lenses?"

What About My Vision While In The Ortho-K Process of Reshaping?

What if I Used to Wear Contacts, But Stopped Due to Discomfort?"

Can a Patient with Dry Eye use Ortho-K?

What is myopia?

What ages should be monitored for School-Age Myopia (Progressive Myopia)?

Contributing factors of progressive /school-aged myopia:

What can you (the family) do to slow myopia?

What else can be done to manage (slow down) myopia?

What age should myopia management be started

I wear glasses, why should I be concerned with my child needing glasses?"

Which eye conditions are related to progressive myopia?

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