VISION THERAPY
An Interview with Dr. Eva K. Strube
(www.avenuevision.com)
See Biography below
Dr. Eva K. Strube operates Avenue Vision in Golden, Colorado. Her fields of expertise are Vision Therapy, Geriatrics and Holistic Alternatives. She completed her doctorate degree in Optometry in Oregon. Pacific University College of Optometry was a great advocate of the theory of behavioral optometry, and Dr. Strube found a philosophical home in this school of thought. Read her complete biography at the end of the article.
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SOE: How do eyes work?
Eyes are part of the visual system. They gather light and they move through space looking for features like color, texture, depth and edges. From the eyes, light signals pass through the cranial nerve system, through the optic nerve and then pass through the optic radiations. About 80% goes to sensory cortex, which is where pictures are made in the brain, and 20% goes directly to motor centers. This 20% of visual input that goes to motor centers allow you to respond quickly to action that needs to be taken, reflexive action such as you are tripping and falling, you catch yourself. Or something is coming towards you so you get that really fast transmission.
But the brain is actually where vision happens. The visual cortex is in the back of the brain, in the occipital area. What happens there is it processes the information the eyes bring, to create understanding and meaning.
SOE: You talk about Vision Therapy on your website. Would you please define vision therapy?
The short answer is vision therapy is physical therapy for the eye/brain system. A little bit more about it is that it is a program of activity which are both sensory and motor that allows the person going through therapy to experience clearer and more accurate understanding and response to light information. So suppose you have an eye exam, and maybe your eyes are normal. You are not nearsighted and so on. But you also need to process and understand that information before you can act upon it. Vision therapy deals with the input. Glasses clarify the input, too, but VT deals with each eye's input and the putting them together and then the response as well.
Just because someone can see, doesn't necessarily mean that they are actually have good vision. People can see 20/20 and not have good vision.
It's not a highly generally accepted concept because those who are in the, what we would call the "traditional medicine field", don't look at things that way. They look at an organ just as an "end organ". They look at it and they say, "Well, there are good retinas, good nerves, and the eyes are transparent. There is no problem with this child or this person." And so they are missing the holistic part which says, "Well, this person can't read even though they have 20/20. There is something there that is not right.
SOE: You said it's not "transparent". Can you expand on that?
Well, it has to be transparent for you to see. The front of the eye is the cornea, a transparent dome. If you don't have transparency, you can't see. A scar, or if for some reason the cornea is cloudy, you don't see. Cataracts are in the eye and are not transparent.
SOE: So it is a holistic look at the eye you are performing, as opposed to just looking it's functionality or its motor skills?
Yes, we look at all of it because all of it is relevant. It's a system that depends on everything being in concert. And if it isn't, it doesn't work. And that is where vision therapy comes into play.
It can as simple a thing as dry eye can cloud the vision. Or it can be as complex as someone who has a lazy eye and an eye turn (i.e., eye turns in, eye turns out, wall-eyed, etc.) . So there is a lot to it. And that's why we have additional schooling to make sure we know what we are doing.
SOE: What are some eye exercises for blurred vision/eyesight from reading and computer work.
I would say one of my favorite things to teach people is visual hygiene on the computer. And visual hygiene means you give your focusing muscles a break from working within arms' length. You do that about every 10-15 minutes. You take a momentary break and you look at a small target, past 10-20 feet. Your goal with that visual break is to notice the visual details far away and make sure that it is clear.
The reason that is useful is because the focusing muscle, (the minimal work when it's at optical infinity and maximum work when it's up close) when working inside arms' length, it's operating and working as if you had a load on your arms. And then when you look far away and look at the details out there and refocus out there, it's as if you to shake your arms and you are not carrying that load for a minute or a second or however long you do that. You are releasing the focusing muscle by looking at something far away and observing the details in it.
Another practice that distresses the eyes is blinking. A lot of computer users, and sometimes people reading, they don't blink. They are staring and they don't want to miss anything. They just leave their eyes open. That is very harmful to the cornea. I teach them to go down the screen and at the bottom of every screen, take a deep blink. Take a voluntary blink. What happens is the tears are stimulated. They cleanse the ocular surface. This makes things more transparent and also feed the cells in the cornea.
This is a live thing - the eyeball. It is part of a human. It's not just like your camera. We think of it like a camera, but it really isn't. And it's alive and it needs oxygen,nutrients and moisture. So when you are on the computer, it is good to breathe and blink. So breathe and blink at the bottom of every page. And that begins to relax you and rest you. Part of becoming nearsighted is a lack of relaxation. So when I can get the person to breathe, blink, relax at the bottom of the page or every 5 minutes or whatever, set a timer on your watch, those kinds of things, as they begin to do that and make it a habit on their own, that is really great.
SOE: Why is it harmful to the cornea to not blink?
Because the cornea has to be wet. The metabolism, the nutrients coming from your tear film and the protective, there is actually lysozyme in there that fights bacteria. All that good stuff that you produce in your tears, if you don't blink it, doesn't get spread over the cornea. And then the cornea is unprotected and it becomes dried out and as it dries out, it becomes scaly and translucent. So it's like seeing through Scotch tape. It is blurry. So tearing is a real important function. That's one we have trouble with in Colorado because it is a dry climate so we get hot eyes and we need to put a few drops in or at least blink properly.
SOE: What are some other environmental stressors on the eyes, in addition to the computer and close-up work.
Light pollution at night, particularly for city dwellers. If you think about resting a light-gathering organ, which is what the eye is, it will need darkness. And so when you are in a place where you never experience darkness, the eye doesn't rest as efficiently as it should. Light does pass through the eyelid.
The surface of the eye is not like a windshield. Because it's alive and active, it needs certain ingredients for maintaining its transparency. oxygen and good quality tears. Air pollution is a stressor and dehydration is a stressor for eyes. Speeding is also a stressor. For example, people who are in sports, they would notice, along with the sore muscles, their eyes can get tired. Take the bobsled team, for instance. They have to go very fast for a short amount of time. But then they need recovery time. And if they get their recovery time, it all works out. Goggles help protect it from losing oxygen and water, but it doesn't protect it from speed because remember, your eyes are always processing. So the quicker that things are moving by, the more it has to process. That's why speed is a stressor.
But what about the video game marathon? Even if the image is across the room, the eyes are required time for the visual to rest. And they are not getting rest when they are doing those marathons. So if you were going into a marathon and you are a good gamer, then you should take a rest for 24 hours and don't do any screen time. "Reboot the system", if you will, and give your eyes a break.
Even when you fast forward your television, you could get some of that effect. If you are paying attention to the screen. If you're not watching it, then it doesn't matter.
Also, poor nutrition can stress the retina. It is well documented in our literature that people who have been heavy drinkers and give that up, they see better because there is improvement in their nutrition. Vitamin D and Vitamin A are important to their retinas, and more of these vitamins reach the retinas for non-drinkers than when they were drinking. And alcohol increases toxins, so there are nutritional issues and toxins. Of course, any system in the body is influenced by toxins.
Rods and cones are particularly sensitive to toxicity, and again that is the retina. Because they have the fastest flow of blood, the brain, the kidney and the retina absorb toxins at a fast rate. Tear producing glands are influenced by the liver and so toxins are important again. So there it is, all working together.
Lutein is a good ingredient. If you are digesting well, lutein supports macular function. The macula is the point of most acute vision. It really is a pile of cones. The pile of cones in the macula is shaped like a little volcano. And you point the center of the volcano where you want to see clearest. Think about having 50,000 tiny receptors (red, blue, and green cones), they are going to get lots of information. If you have macular degeneration and the pile of cones isn't a nice conical shape and they are sort of in disarray, the macula doesn't give you the data that you need. But by taking Lutein and Zeaxanthin, and by eating your greens (very helpful) it can help stave off macular trouble even though your genetics say yes, you are going to get it.
So I have my nutrition for the eye lecture. Purple, orange and green.
Purple are your berries, blueberry, blackberry, boysenberry, huckleberry, all those berries. They have bioflavinoids that are helpful to the retinal vessels. They support good nutrition in the retina. The orange are carrots, pumpkins, sweet potatoes, squash. And those are good for night vision because they carry betacarotene. Unless you are smoking and they haven't figured out that smokers don't do well with betacarotene. And dark, leafy greens which are spinach, Swiss chard, kale, turnip greens, collard greens, all those are good for color vision because they are good for the macular cones.
SOE: What is your opinion of the theory that men only see less colors that woman?
I disagree with that. I think that is a color naming issue. And it has to do with languaging. I think men just don't language their perceptions as well in that area. I think a man with normal color vision sees colors as well as a woman with normal color vision. Color deficiency is a function, we think, of the quantity of the receptors responsive to a given wavelength. For example, green is 555 nanometers is the wavelength of the green and at the middle of our spectrum. And 670 is red and maybe 490 is blue.
You have photoreceptors that are in there, we believe. We have some that are sensitive to red, some blue and then some green. And so, it's different variety and different texture. Let's say an average human has 12 blue, 12 red and 12 green sensitive receptors. Some people might have 10 of one and 8 of the other and 16 on another. Those people we call "color defective" because they see colors a little differently than the rest of us.
SOE: Your website states: "Vision Therapy sessions include procedures designed to enhance the brain's ability to control visual processing." What is visual processing?
As I stated, the light information system gathers and interprets response data, the interpretation of data and the comparison of stored memory is called "visual processing". Processing includes shape details, texture, depth perception, color, motion and prediction of motion, form consistency, spatial relationship (where am I and where is it - where is up and where is down), figure ground, visual memory and sequential memory.
To explain figure ground, let me give an example. I have a young person who came in and she couldn't read. The school had labeled her dyslexic. Well, she wasn't really dyslexic, she had a figure ground problem. If you are looking at a white page with black letters on it, you would be looking at the letters as the "figures" you want to pay attention to and the white as the "ground", which is the background. The way her system developed, she would see the white as the "figure" and the black as the "ground" and so it looked to her like lace. That's how she described it. And so it was hard for her to read because it was reversed like that. She did much better when she had a black background and white letters. Or she could be trained.
Spatial memory and sequential memory are important. Predicting motion is important. Motor planning is "where am I stepping next?" All of that is part of your processing in the brain.
Babies are like these wonderful little sponges and they process and learn all this information. And that's why you want to have your baby have a lot of sensory experience. So, for example, at this lady's house where she cared for my son, she had a carpeted area. She had tile in the kitchen. She had a wooden deck. She had grass. She had a sandbox. She had gravel underneath the swing. And she had a tree stump which was great for little kids. They could crawl up it. She had all these different textures in her home. And what they (babies) do is they match tactile, and of course, the mouth, you know because they have to test everything with the mouth. The match all of those with what they are seeing. "Oh, there's a blob. What does it feel like?" "What does it taste like?" "What does it look like?" And they put that all together and they create a memory. If they see a similar blob in a different circumstance, then they have to check that against their memory banks and say, "Is this the same kind of blob?"
..........Let's touch it
..........Let's taste it
..........Let's look at the color
...............Is it the same?
And then they can conclude, yes it was the same. Oh, that must be the same puppy or whatever.
So that is how that develops. So my son has fantastic vision and he has never had any issues. And part of it was because he had that very early experience with all these different textures. She let them crawl all over the place. She believed in kids playing outdoors every day.
And when they were swinging, they got the peripheral. That is really important because your peripheral gets developed. Crawling is important because it gives you left and right. A child who doesn't crawl will likely have difficulty determining which is left and which is right because they never figure out where the middle of the body is. But when they crawl, they figure that out.
Because they alternate hand and foot. When you alternate, the part that stays still is the center of your body. But if you never do that, you skooch or you are always pulled up by an adult, and you never end up crawling, then you never, ever understand where the middle of the body is so left and right is really confusing for that you. Of course, you can be trained to know Left and Right in vision therapy. People can learn that, although they are not as proficient as when they are really little. But they can learn it.
There is another question I thought you might ask after you know all these things. And that is, why does the general public not know about this information?
Well, the first thing is because we take our bodies for granted, including vision. Usually because it functions so well that we don't need to pay attention to it. And then because most doctors don't take time to evaluate or remediate the sensory-motor aspects of vision. I am unusual in that way. I do take heed of it.
SOE: What is another exercise one that you might recommend to people?
There are yoga eye stretches. You can do these to wake your eyes up or you can do them to relax them for sleep. You can do it under the lids, with the lids closed, if you wish. Basically you look as far as you can to your right. And then you move your eyes in giant circle. You look up as far as you can, left as far as you can and down as far as you can. Then you go back the other way to reverse it. Then I have them make a cross - top to bottom, left to right. Then an X - diagonally. So that is yoga eye stretches. That would be one that would be a good habit. Almost anybody could do that.
SOE: Remember those 3-D posters that were out several years ago? What does it do for the eye when looking at these 3-D posters and see the hidden objects?
When you are looking at a Magic Eye picture, what you are doing is you are focusing on one distance, but your eyes are pointing to another distance. So it gives you flexibility between those two systems, the focusing system and the eye pointing system. It allows you to have a little freedom. If you can do it, you have freedom between those two systems. Whereas, in our regular 3-D world, you are always focused and pointed at the same object. So the two systems are designed to be together and working, and that's what the play is. It's fun and different for you to look at one place and then your eyes are focused in a different place and that's what allows you to see the image. I actually send people down to the corner bookstore to buy them.
It's just like having a basketball hoop on your garage. The game is silly, but it has muscular impact. Could be positive.
SOE: Not until you said it, did I think of my eyes as really alive. I treated them more like a camera. I will start treating my eyes better and hopefully after reading this, people will give the eyes the credit that they need before there is a problem with them.
Biography
Dr. Eva K. Strube was born in Sheridan, Wyoming, but spent much of her youth in Bloomington, Indiana where she graduated 5th in her high school class of 825. She won a scholarship to the Instituto Mexicano-NorteAmericano at age 15, which led to fluency in Spanish. Wanderlust led her west where she attended New Mexico Highlands University and majored in Math with a minor in Spanish.
After teaching math for a couple of years at Wagon Mound High School she went back to school and completed her doctorate degree in Optometry in Oregon. Pacific University College of Optometry was a great advocate of the theory of behavioral optometry, and Dr. Strube found a philosophical home in this school of thought. The last year of her optometric education, Dr. Strube was chosen by the student senate of the university to represent them in the American Medical Student Association trip to the People’s Republic of China, observing the many unique aspects of traditional Chinese Medicine.
Shortly after graduation, she met and married her husband, Robert. Taking board exams in various states, Dr. Strube found herself again drawn to the Rocky Mountains, and brought her family here where she bought the Golden practice from Dr. E.A. Bader. A person of varied interests, Dr. Strube enjoys music, comparative religion, is an advocate for environmental conservation, and the advancement of the station of women around the globe. She enjoys public speaking, especially with young people, and has a passion for behavioral optometry. She and her husband have one son Daniel and various cats.
Dr. Strube can be contacted at (303) 279-3713 *** www.optometristsnetwork.org/strube *** www.avenuevision.com
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