Vision Performance Centre FAQs
Seeing is our dominant sense and about 80% of what we learn channels through our eyes to the brain for understanding. Vision problems may have a profound effect on learning, or how we make sense of what is seen. Deficient visual skills can cause learning interference; that is, students may not be reaching their academic potential, or who are working twice as hard to achieve their academic success.
For a growing child, the mind is equipped and motivated to learn. The brain is ready and we are naturally curious and want to learn more. For most children their eyes and visual system serve them well for learning and life. Almost all children learn and develop normally, including their visual systems – this normal visual development is expected. For example, assuming normal development, reading eye movements reach maturity toward the end of high school.
However, about 20% of children struggle in school. Of that 20%, over 75% of them have a visual impediment.
A visual impediment, or a visual sub-skill to learning that is developing at a slower rate, will manifest itself through our critical appraisal of the visual system. This critical appraisal challenges the 12 visual sub-skills to learning. These responses are compared to norms for the child’s age. If a visual sub-skill response is below one standard deviation (<1 SD) of the norm or the expected, then it is considered significant. Significant visual dysfunctions effect learning and may cause a child to struggle in school. Students may not be reaching their academic potential, or they may be working twice as hard to achieve their academic success.
You may sense you are struggling in your job or school; that is, you may not be reaching your visual performance potential, or you may be working twice as hard to achieve your success.
An eye exam is the first step. We recommend a Complete Digital Optomap Exam. If an eye exam has been completed within 12-months then it does not need to be repeated. The OHIP eye-exam benefit does not covers the investment for patients between 20 and 64 years of age; the investment is $229 for the digital retinal testing.
The second step is for you to complete a 2-hour evaluation of your visual sub-skills to acquiring knowledge. This evaluation goes far beyond the basic eye exam and 20/20 vision clarity. This evaluation is a critical appraisal of visual efficiency (eye focusing and teaming), reading eye-movements and processing of visual information skills. The investment for this evaluation is $250.
If the response of two or more of the 12 visual sub-skills are significantly below normal (< 1SD), then there is visual interference causing you to struggle with your visual performance; that is, you may not be reaching your job or school potential, or you may be working twice as hard to achieve your success.
The investment depends on the number of visual sub-skills that are developing at slower rate than normal. Vision therapy is scheduled over a 3, 4½ or 6-month period with an investment of $3000 to $6000. Patients interact with a vision therapist two-times per week, for 45-minutes per session. Progress evaluations are compared to the initial baseline findings every 6-weeks (or every 12th training session) to monitor success and target the vision training.
To initiate vision therapy, the first investment of $1500 is accepted. To track success, progress evaluations are completed every 6 weeks (or every 12th training session), the results are reviewed with the parents and the vision therapy protocol is further customized for targeted treatment. The next $1500 investment is paid at this 6 week time.
At the end of vision therapy, and included in your investment, is maintenance therapy which includes home support activities three times per week and office follow-ups with Dr. Gall every 1 to 3 months for about 6 months. Glasses or contact lenses are not included in the price of vision therapy.
We do not submit forms directly to the insurance company. We provide a detailed letter of the vision therapy fees with supporting documents which you may submit to your insurance company for reimbursement. Vision therapy treatment is considered medical and not related to eye exam, glasses or contact lenses.
Yes, after the review of your child’s evaluation, you will be provided with a detailed breakdown for the investment of the vision therapy with supporting documents. An insurance letter is provided with supporting documents.
To enroll, you must be recommended by Dr. Gall as being a candidate for the Vision Performance Centre – Enhancing Vision and its Connections through the evaluation and review process. It is best if you are motivated to achieve success, willing to work hard and make vision therapy a priority in your life.
Amanda, the Patient Care Specialist at the front desk, will book your first set of 12 vision therapy sessions, first progress evaluation with review, and take the initial investment deposit of $1500.
Heather, the Vision Therapist, will see you at the initial in-office vision therapy session. This initial session establishes biofeedback mechanisms you employ in the vision therapy to become more aware of where you eyes are and how to control you eye movements. Heather will also explain the home-support activities, its weekly tracking system, and provide you with you own vision therapy satchel to bring back at each in-office therapy session.
Each module of 12 vision therapy sessions, home-support activities and progress evaluations are repeated until the prescribed vision therapy is complete. Some maintenance therapy may be implemented to ensure long-term success.
If you are recommended to have vision therapy and choose not to enroll, then you may always decide to enroll later in the future.
If it has been over one year since their last evaluation with no vision therapy, then a 2nd evaluation should be repeated for comparison.
If you are recommended to have vision therapy and you choose not to enter the program, then the below standard visual sub-skills identified will continue to be internalized and manifest themselves as visual performance struggles; that is, you may not be reaching your job or school potential, or you may be working twice as hard to achieve your success.
Vision problems that are related to learning are treatable – 9 out of 10 patients are successful at driving their neuro-plasticity to improve their visual skills, given diligent effort. If vision problems are left undetected, or un-treated, then the learning-potential gap widens over time, and even restricts the success of other remediation efforts.
When Dr. Gall recommends vision therapy, he believes the patient will be successful at the Foundations for Learning Centre. Success is measured by the elimination of any defiient visual sub-skills to learning by driving the patient’s neuroplasticity through vision therapy. There is a very high rate of success if the parents make vision therapy a priority in their child’s life, and the child is motivated and diligent with their weekly-tracked home support activities.
Heather, our Vision Therapist, works very hard at finding the motivating factors for each patient to achieve success. The beginning of success is achieved taking small stepping-stone increments in visual skill development which lead to bigger ones. In the first 2 to 4 weeks of vision therapy, patients begin to feel the internal-drive of motivation (intrinsic motivation) because of their new found awarenss of success, confidence in their abilities and fresh accomplishments at school.
What happens if the vision therapy does not work? We will have a good indication of the level of success at the first progress evaluation after 6-weeks (12 in-office sessions) of vision therapy. After the first progress evaluation, Dr. Gall will review your child results, rate of success and discuss options for continuing vision therapy.
Six of the twelve visual sub-skills are domains of visual efficiency, or skills for intake of visual information.
- Equal Visual Acuity
- Focusing (accommodation) – clear focus on objects closer than 1 M
- Eye Teaming – aligned eyes looking at objects closer or farther away
- Eye Tracking – accuracy
- Eye Tracking – speed
- Reading Eye Movements
An impaired binocular vision system may produce symptoms which include eyestrain, fatigue, burning eyes, blurry vision, excessive tearing, red eyes, words that jump on the page, turned eye, or headaches. These symptoms may be worse when tired, or with prolonged use of the eyes while watching a movie or driving, or doing near tasks like reading and working on a computer.
The remaining six of the twelve visual sub-skills are domains of visual information processing, or making sense from what is seen.
- Right-Left Awareness
- Form Perception
- Visual Processing Speed
- Visual Attention
- Visual Memory
- Visual Motor Integration
Processing of visual information is vision perception. Vision perception is an activity of the brain, between the visual input from the eyes and the act of conceptualization (making sense from what is seen). Visual experiences are organized into percepts in the brain that assimilate into conceptualization and understanding of the idea.
For a growing child, the mind is equipped and motivated to learn. The brain is ready and we are naturally curious and want to learn more. However, the process of vision perception is developmental (not just simple growth) and requires sensory experiences. Perceptions develop from sensory inputs, like vision, hearing and touch. These perceptions assimilate from simple into more complex visual percepts. For example a pre-school child, over time with experiences, develops a perception of a dog; the child assimilates or connects the word “dog” to their household pet, to the pet’s name, to the sound of a bark, to the smell of a wet dog coming in from the rain, to the neighbour’s dog and to other breeds of dogs from a book, to develop an ever increasing understanding of a dog.
A child is equipped to learn using their brain (computer hardware) and the activity of perception (the software) from sensory inputs. Readiness to learn is the ability to integrate sensory sub-skills into a cognitive whole, or making sense from what is seen. These sub-skills include visual information processing skills. For example, before their first day of school, a child develops the percept of a dog through sensory inputs and experiences. In school, during the active process of learning, previous knowledge is assimilated into new knowledge and the perception of a dog increases in depth and scope. To get there, visual sub-skills are employed to develop these new perceptions. Visual sub-skills of visual information processing include recognizing that the letter “d” in “dog” is not a “b”, finding the word “dog” on the page, quickly retrieving the perception of a dog, appropriate allocation of visual attention on the word “dog” and not on the other words on the page, visualization of the word “dog” in the sentence with the boy and finally being able to copy the word “dog”.
With effort, these sub-skills of visual information processing become well developed and accurate. With repetition and positive sensory feedback, the conscious effort to process visual information (e.g. the word “dog”) becomes less and less until it take place un-consciously or without effort. The concept of the word “dog” and not on the other words on the page, visualization of the word “dog” in the sentence walking with the boy, and its associated perceptions become automatic. The visual sub-skills are on auto-pilot; there is automaticity in the perception of the word “dog”.
For some children, automaticity of vision perception to make sense of what is seen, or un-conscious effort of visual information processing sub-skills, is not robust. One or more sub-skills may be fragile and lose their auto-pilot mode with slight stress or while learning to read. For other children, just a single or small cluster of sub-skills may have not reached the level of automaticity – both causing learning interference.
Dr. Gall provides the highest level of care for his patients since 1995. Dr. Gall is an optometrist who cares for patients and is excited when they reach their potential and achieve success. His interest in vision therapy stems from a genuine desire to care for the visual problems of patients and emphasizes a never ending effort to be certain that they receive the optimum treatment. Dr. Gall strives to be certain that his patients understand their visual condition, are aware of the treatment options, and receive optimal care from his office and other professionals to whom he refers.
From the beginning, Dr. Gall has offered vision therapy as an option for success. In 1993, Dr. Gall received his Doctorate in Optometry, then in 1995, he received his Master of Vision Science in the area of binocular vision after which he started his practice. In 1999, he received his Fellowship from the American Academy of Optometry (AAO), earned by only 5% of optometrists who give back to the profession in terms of research and leadership. Dr. Gall has written numerous peer-reviewed research papers as part of his on going clinical research in vision therapy. Due to his expertise in this area, Dr. Gall has been invited to review manuscripts for publishing. In the fall of 2010, he moved his practice to a larger facility and opened the Foundations for Learning Centre – the Vision and Learning Connection. In 2015, after two years of studying, Dr. Gall was awarded the Diplomate status in Binocular Vision, Perception, Pediactric Optometry (Diplomate BVPPO) from the AAO for which there are only about 40 optometrists in the world including two in Canada.
Vision therapy starts with simple and basic vision-skill development in the needed areas. As skills improve, the program builds on success and adds "loading" factors and repetition to build automaticity. Automaticity allows these new learned skills to be easily transfered to real life activities and owned for life-long learning.
Dr. Gall’s Vision Therapist, Heather, plays a vital role in caring for patients and motivating them to achieve success. She has a Bachelor of Arts degree in Psychology, over 4 years of experience with vision therapy and works closely with Dr. Gall while providing individualized vision therapy.
The philosophy of the Foundations for Learning Centre – the Vision and Learning Connection, is based on the work of Drs. Mitchell Scheiman and Michael Rouse (Optometric Management of Learning-Related Vision Problems, 2nd Ed. 2006), Drs. Mitchell Scheiman and Bruce Wick (Clinical Management of Binocular Vision, 4th Ed. 2014) and Drs. Sidney Groffman and Harold Solan (Developmental & Perceptual Assessment of Learning-Disabled Children: theoretical concepts and diagnostic testing. 1994) which are guiding references for any practice offering vision therapy.
The first session will be an individual session to learn the exercises and home support activities. The next sessions may be individual or there may be another patient present. In the real world, there will be other people around and it is best to learn to work in an environment with distractions.
Amanda, our Patient Care Specialist at the front desk, will coordinate the re-scheduling of the missed in-office vision therapy session and the booked progress evaluation accordingly. For clear communication, please provide at least 24-hours notice if your child cannot make a booked session.