- Visual Information Processing refers to the perception, cognition, and other brain processes that allow us to rapidly "feel" and extract meaning and understanding from what we are looking at.
- Rapid Automatic Naming is key to visual information processing as we only keep our eyes on targets for a quarter to third of a second before they jump onward to the next target. If one did not get the meaning the first time then it is necessary to bring the eyes back to the target again and again to achieve understanding.
- Visual information processing can be poor due to other vision issues such as binocular instability or eye tracking difficulties. Therefore it is important to diagnose and treat these other issues if present first before launching into a treatment program for vision information processing alone.
WHAT IS VISUAL INFORMATION PROCESSING?
Think of the visual system like the arm and hand. If you were to explore with only your hand, you would first need to grab hold or reach out to touch something. Only then can you feel the object to get meaning and information about it. Vision is just like this. First, we grab hold of objects by orienting our body and eyes towards the object and then precisely pointing them and focusing on the object. This is our "visual grab". Once the object is in our "visual grasp" we can then "visually feel" it to get meaning and information. This is brain processes such as visual perception, cognition, and thinking. The "visual feel" step usually happens in a fraction of a second because most of the time we are jumping our eyes onward to the next point. Therefore, visual information processing needs to happen very fast; most of the time in a fraction of a second. If one doesn't get the necessary visual information input, because of a poor visual grab, and the eyes dart onward, then it is necessary to look again & again to reach understanding.
Rapid Automatic Naming refers to the ability to rapidly recognize a symbol and convert the recognition to a verbally spoken name. For example, in a series of random letters or numbers imagine trying to call them out sequentially as fast as you can. To do this task you will have to point the eyes at each letter or number (visually grab it), and then take in the information (visually feel it) and send it to the language centers of the brain to then verbally express the proper symbol. If you are reading text fluently, the same sort of rapid processing takes place for whole words. In real life we usually read silently, so we are not limited to the speed of verbal processing, but it is still necessary to rapidly translate the symbols and words on the page into the meaning and understanding that is needed for good comprehension.
DIAGNOSING VISUAL INFORMATION PROCESSING DISORDERS
Most testing situations for visual information processing involve looking at symbols that are presented at near point distances. Some psychometric testing situations can involve hours of such presentations. It is therefore critical to make sure that the individual has adequate near point vision function and is able to sustain visual attention on near point vision tasks for a long enough to be able to complete the tasks. Otherwise, the results of such testing will not likely be a true representation of the person's perceptual and cognitive abilities.
At Vision Clinics of Development & Learning we begin by completing a full Functional Vision Evaluation to determine if near point vision issues are present before we launch into prolonged visual information processing testing. Issues such as binocular instability should be identified and treated as a precursor to therapy for visual information processing disorders. Binocular instability is difficulty establishing and maintaining clear and single vision in a sustained near point task. It is therefore more frequently a problem in cultures that value and stress reading, academic learning, and occupations that involve paper work or looking at computer screens for most of the day. Some children or adults do not report a lot of problems or symptoms because they have learned to avoid near point vision tasks. But avoidance can lead to poor academic achievement or a different career path compared to finding and addressing the issue early.
A Functional Vision Evaluation is necessary to diagnose binocular instability. Regular routine eye exams emphasize eye health and eye optics and often do not delve deep enough into functional vision and symptoms unless the patient specifically expresses problems, asks questions or has concerns. And for those children and adults that have just learned to avoid a lot of near point activities such as reading they may not have many symptoms or concerns but still be falling behind in their achievement potential due to the problem. While being able to clearly identify small letters on a card means eye focus is happening at that moment, it doesn't mean that eye focusing is working well over an extended reading task. In order to function well, the eyes need to be healthy and any need for eyeglasses should be taken care of. Next, a Functional Vision Evaluation will take an in-depth assessment of binocular vision, eye focusing, and eye tracking in the context of the visual challenges the individual faces in development, school, work, or recreation. A Functional Vision Evaluation looks at abilities to maintain single and clear vision over time when involved in a dynamic vision task like reading.
Once issues such as Binocular Instability are addressed, Visual Information Processing testing is more appropriate and accurate.
Only an eye doctor (Optometrist or Ophthalmologist) has the tools to perform a Functional Vision Evaluation. Not all eye doctors have the interest or training to perform a Functional Vision Evaluation.
If you are living in Washington State, USA near the Bellevue or Bothell area, you can schedule a Functional Vision Evaluation at the Vision Clinics of Development & Learning
If you are reading this from afar, then the following directories can be helpful in locating a doctor who can perform a Functional Vision Evaluation:
TREATMENT OF VISUAL INFORMATION PROCESSING DISORDERS
The Visual Information Processing programs at the Vision Clinics of Development & Learning concentrate on Rapid Automatic Naming skills development as related to words and word segments. While some reading programs emphasize training sound-symbol relations (phonetic awareness and phonics) it is also important to work on rapid visual processing and naming skills.
If we have identified near point vision dysfunctions such as binocular instabilities, or eye tracking concerns then we usually address this first. However, many of our treatment protocols for these conditions include simultaneous work with visual information processing, so we are actually addressing some of the issues early on in the treatment plan. When involved with vision therapy, there is always the need to look at targets so in many instances we are presenting symbols of various sorts that need to be processed quickly and accurately at the same time we are working on two eye coordination or eye tracking. While our treatment might be more focused on the two eye coordination or eye tracking concerns to start, we are also making progress with the visual information processing goals too.
When we get to the point where we are focused entirely on the visual information processing concerns most often we begin to target the specific area of struggle. For example, if a child is behind in reading, then the program will emphasize the rapid automatic processing of vowel-consonant combinations and whole words. Our protocols usually combines clinic visits once per week and prescribed home activities that take about 30 minutes per day five days per week. At our clinic we use computer programs that send us data over the internet to coach and monitor the prescribed home activities. The home activities are essential in our opinion for the successful improvements in visual information processing. It is much like going to the gym for physical conditioning. If you only go to the gym one day per week, you make minimal gains, but if you go to the gym 5 days per week you make tremendous gains. Without appropriate home activities, vision therapy will take a lot longer to complete. In some instances where a patient or family lives excessively distant from our clinic, we can get good results facilitating a home based treatment approach with only 1x per month clinic visits, but such an at-a-distance protocol has to be appropriate and is considered on a case by case basis.
Most insurance plans consider straightforward Visual Information Processing therapy to be educational in nature, not medical. Therefore it doesn't qualify for billing to a medical insurance plan. It is considered educational therapy and is paid for privately just as tutoring would not be considered medical and would be paid for privately.
But when there are medical vision issues like binocular instability that need to be treated medically these vision dysfunctions may be billable to insurance. As mentioned before, when treating these near point vision dysfunctions we are often working simultaneously with visual information processing tasks. Binocular Instability, and more specifically the convergence insufficiency type, is a condition that is increasingly covered by many insurance plans as there is a good research evidence concerning its identification and treatment. This does not mean, however, that insurance coverage can be guaranteed. Even with an insurance plan that says they "cover" treatment, you may still find there are large copays, deductibles, and coinsurance to deal with before you realize any benefit. Almost no insurance plan will cover the entire costs for a treatment plan even if they say you have coverage. For example, the software and other prescribed home therapy items and monitoring is usually paid privately or through a flexible spending account. Also, even when an insurance plan covers the treatment sessions they typically only cover a 30 minute appointment. Progress visits are medical doctor visits in general so they are more frequently covered with less problems.
Some insurance plans have specific exclusions for "Vision Therapy" in which case they may cover once per month doctor's visits for an at-a-distance program, but they will not cover the in clinic treatment sessions. You will have to look up the details of your insurance plan to determine if there are such exclusions. Sometimes it is hard to find such information and it becomes necessary to call your insurance plan to ask them specifically. Here is the question you can ask them that has the proper language and codes: "Does my insurance plan cover vision therapy or orthoptics 92065 for a diagnosis of convergence insufficiency H51.11?" and then ask "are there any exclusions of vision therapy for my plan?" and finally ask: "are there any prior authorization requirements?". Remember, you have to first complete a Functional Vision Evaluation to reach an official diagnosis and prescribed treatment plan, and even if seems like it should be covered there can still be obstacles and coverage is never guaranteed.
There are many other visual dysfunctions that can occur simultaneously with visual information processing dysfunctions. For example, binocular instability, strabismus, reflex problems, visual-vestibular problems, fixation and orientation problems, rhythm and timing problems, body knowledge/coordination problems. Sometimes a processing problem is the result of dysfunctions in these other areas. Treatment of visual information processing alone is not meant to address these problems. Some of these problems will need to be addressed before visual information processing treatment can begin. Some of the problems can be addressed simultaneously with treatment for visual information processing. The eye doctor will determine the best strategy, sequence, and emphasis in treatment plan selection.
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