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Does vision therapy help with reducing blurriness or words seeming to jump around on the page?

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Answer transcribed from Brightway's Interview with Dr. Bryce Appelbaum

It absolutely should in at least most cases. I mentioned before the three most important visual skills and abilities for reading: our tracking system, which is our oculomotor control, our focusing system, which is our accommodation, and our eye teaming system, which is our binocularity. When those are working together, reading is something that is not avoided in most cases and something that's pretty easy where you can stay engaged, comprehend what you’re reading, and take words and turn them into sentences, pictures, and have a story flowing in your mind.


Oftentimes, the blurriness of words moving on the page is the brain under stress and trying to establish order from a disordered environment. Binocular instability is really common after head injuries, and that is a fragile eye teaming system. It’s like if you're lifting a heavyweight with your bicep, the muscles would start to shake once you're at your limit. Oftentimes aligning the eyes in one particular place for too long allows for this fight back and forth which can make it seem as if the words move. You could also lose fixation to the point where sometimes it even becomes double, which stems from a mismatch in space terms of where you're perceiving something to be and where you’re actually aiming your eyes. 


Going back to our discussion of the “where” and “what” pathways, I also think that the blurriness is almost always related to the accommodation or focusing system. If our brain is functioning the way that it's wired, you make a determination unconsciously of where the screen is and you know how to focus your eyes in order to see a single clear image. However, what often happens with a head injury is usually one of three kinds of profiles that are most consistent with head injuries. It could be a tendency to over-focus accommodation, which focuses the eyes in front of where the page is and causes a constant strain or stress on the system. That's somebody really trying to take in this area but is overdoing it and overriding that focal central processing. You can also get a lag of accommodation, which is actually focusing the eyes behind where the screen is because it's so hard to keep those muscles constricted. The third profile is that you can sometimes get a combination of those two, where one eye is starting to focus in front of the page and the other is starting to focus behind the page so that essentially, you don't have to use both eyes at one particular distance. That's an adaptation that comes with time.


Again, you couldn't teach your brain to do that if you tried because it's not how the brain is wired. However, if there is a kind of binocular rivalry or competition over which eye to use. That's one way that our brains are phenomenal at adapting, especially in response to stress from our environment. They still try to figure out a way to be successful by using the eyes independently of each other, which is one option. The other option is to just avoid the task of reading from screens which, with more substantial head injuries, is not even being considered at the time because of this flood of input that our brain can't filter. It's a really interesting way of thinking about vision and for someone that doesn't come from the vision world, a lot of this isn't necessarily intuitive.