As we discussed in the last article (Eye Accommodation Disorders, VT Series Part 3), there are two major categories of accommodative disorders—accommodative insufficiency and accommodative excess.
The overall objective of vision therapy is to strengthen the muscles and help fine-tune the accommodative response to make it more accurate. Therefore, generally speaking, the exercises discussed in this article can be used to help improve either condition.
The following examples are only some of the more common exercises used during accommodative disorder vision therapy. They are not all inclusive. Your doctor will personalize a unique plan for you based on your abilities and diagnosis.
The following activities are listed in order from more basic exercises and become more advanced. Remember that monocular activities focus on one eye’s individual accommodation abilities. Binocular activities include fine tuning the accommodation of both eyes together as a system.
Monocular Accommodative Push Ups as an Eye Exercise
The accommodative push-up exercise focuses on fine tuning and expanding each eye’s amplitude of accommodation individually.
You will be asked to wear an eye patch over one eye to ensure it is truly a monocular activity. Next, you will be asked to focus on a small target.
The target will be brought toward your nose while you focus on keeping it single and clear. When the target blurs, the target will be pulled farther from your nose, and the process is repeated—like performing normal push-ups!
The goal of this exercise is to increase and equalize the amplitude of accommodation between the two eyes.
Monocular Letter Chart Accommodative Facility
Like the accommodative push-up exercise, the monocular letter chart accommodative facility exercise is also performed with each eye individually (i.e. one eye will be patched).
A letter chart with small letters will be placed across the room. You will hold a similar eye chart in your hand—about 40 cm from your eyes.
You will be asked to alternate between reading letters from the far chart (relaxing accommodation will accomplish this) and then reading letters from the chart you are holding in your hand (stimulating accommodation will accomplish this).
The test will be altered based upon to abilities, holding the near letter chart farther away (for example 45 cm from your eyes) will require more relaxed accommodation whereas holding the near letter chart closer to your eyes (for example 35 cm) will require more accommodation.
Over time, the speed and ease of completing the activity will be monitored and recorded. The ultimate objective of this activity to improve the speed and accuracy of each eye’s accommodative response in an individual matter.
Monocular Lens Sorting
In the last article, we discussed how different powered lenses stimulate (minus lenses) and relax (plus lenses) the accommodative system.
This activity is again monocular, meaning one eye will complete the activity while the other is patched.
The patient will be given a box of lenses ranging from minus to plus. Using solely the accommodative system, the patient will be asked to look through the lenses and put them in order from most minus (requires the most accommodation) to most plus (requires the least accommodation).
The purpose of this exercise is to help the patient to understand what accommodation feels like.
Monocular Accommodative Rock
The monocular accommodative rock is the last exercise we will discuss that is performed one eye at a time.
You will be given a near letter chart, or a reading target, to focus on. The doctor will then place a plus lens in front of your eye. In order to see the letters clearly, the patient will need to relax their accommodation. He or she will let the doctor know when this is accomplished and the target is seen clearly.
Once the plus lens is “cleared” the doctor will flip the bar and place a minus lens in front of the patient’s eye. In order to see the target clearly, the patient will need to simulate their accommodation. Once this is accomplished, the doctor will flip back to the plus lens, and the process is repeated.
Over time, higher powered lenses will be used to increase the amount of accommodation that is being stimulated, or relaxed.
The objective of this exercise is again to equalize the accommodative abilities between the two eyes.
Bi-Ocular Accommodative Rock with Loose Prism
This is the first exercise in which both eyes will undergo the exercises at the same time!
Your doctor will use a special lens called a prism lens to make the image of one eye appear above the other (essentially making you see double, one image on top of the other).
Once the images are separated and you are seeing double, the doctor will place a plus lens in front of one eye and a minus lens over the other eye.
The plus lens will relax the accommodation of one eye whereas the minus lens will stimulate accommodation of the other.
The patient will then be asked to read a few letters off the “top” image and then read a few letters off the “bottom” image. When looking at top vs bottom image, the patient will essentially be isolating the accommodation of each eye to clear the image.
Over time, the lens powers can be increased to make the exercise more difficult.
The purpose of this exercise is to improve the accommodative facility (stimulation and accuracy) of the accommodative system.
Binocular Accommodative Facility (Binocular Lens Rock)
What is important about this activity is that we want to watch for suppression—intermittently “shutting an eye off” because the image is not clear or the accommodative system of one of the eyes is too weak.
This is another reason as to why we focus on the monocular tasks first in the therapy plan, as we need the accommodative abilities between the two eyes to be about equal to conduct this activity effectively.
To watch for suppression, the patient will be asked to wear red-green glasses and look at a near target with letters in red and green. If suppression is present, the letters will appear blacked out and the patient will be unable to read them.
Next plus lenses will be placed in front of both eyes and the patient will be asked to read a few letters. Then the bar will be flipped and minus lenses will be placed in front of both eyes. Again the patient will be asked to read a few letters.
This process is repeated several times and the amount of suppression, speed, and ease of activity will be monitored and recorded.
The ultimate objective of this activity is to increase the speed and efficiency of the accommodative system while also avoiding suppression.
Distance Rock Eye Exercises
The last exercise we will discuss today is the distance rock. The distance rock is most similar to the monocular letter chart accommodative facility exercise, but instead of using just one eye to look at the chart far away and then up close, both eyes will be open.
The activity is then performed the same way as the monocular letter chart accommodative facility exercise (reading a few letters off the far chart, then reading a few letters off the near chart, repeated).
This is the most difficult of the activities as it requires both eyes to work together to view the far chart and near chart clearly and accurately.
The objective of this activity is to work on stimulating and relaxing the accommodative system of both eyes together equally and accurately, as many times in a row as possible.