20th Century vs. 21st Century Eye Evaluations
What is the difference between ophthalmology/neuro-ophthalmology and neuro-optometry?
In addition to saving and maintaining eye health, ophthalmologists perform surgery and prescribe glasses to help patients use central eyesight at a conscious level for identifying 20/20 letters (non-moving targets). The quality of central eyesight is often dependent on the stability of the peripheral eyesight. However, peripheral processing of moving targets is usually at a subconscious level. Eyeglasses prescribed for central eyesight do not necessarily address peripheral processing and are not sufficient in some patients – such as those who have autism or a brain injury.
In the emerging field of neuro-optometry, specially trained optometrists prescribe glasses to induce changes in physical and physiological functions that can improve overall visual comfort rather than just clarity. This emphasis differs from neuro-ophthalmology, which identifies and diagnoses physical and physiological conditions that manifest in visual impairments. More specifically, in neuro-optometric practices, emphasis is on expanding peripheral awareness and enabling the patient to navigate around three-dimensional space – part of ambient processing.
What are the differences between Mind-Eye testing, neuro-optometric rehabilitation and classic visual therapy?
Main difference is that Mind-Eye evaluations address eye/ear connections and prescribe lenses for peripheral awareness, with the goal being comfort rather than clearness. But, if needed, after the patient is stable, the Mind-Eye team also promotes neuro-optometric rehabilitation and classic visual therapy. Sometimes, if the core issue is an eye/ear disruption, stabilizing that sensory interaction with Brainwear™ glasses oftentimes enables the other visual skills to fall into place on their own.
COVD –College of Optometrists in Vision Development has been in existence for nearly 50 years. Optometrists here successfully use visual therapy. Emphasis is on eye-muscle control via external eyesight pathways of “Where is It?” and “What is It?” — also known as peripheral and central eyesight or aiming and focusing. Another aspect of COVD emphasizes vision therapy as associated with development of visual perception, remaining within the realm of “Where is It?” and dealing with those aspects of peripheral retinal processing that judge size, shape, location and speed and of central retinal processing that determine details and colors.
NORA — Neuro-Optometric Rehabilitation Association is an offshoot of COVD and has been in existence for 30 years. Optometrists here do neuro-optometric rehabilitation. Emphasis is on body posture and use of yoked prisms via the “Where am I?” pathway. If a patient’s body posture is stable, then NORA optometrists may prescribe visual therapy to solidify the external “Where is It?” and “What is It?” pathways (navigation and identification skills).
Many optometrists are members of both COVD and NORA.
Mind-Eye optometry is an offshoot of NORA and has been established for more than 25 years. Optometrists here do mind-eye evaluations that include eye/ear integration.
Both COVD and NORA offer rigorous fellowship programs. Mind-Eye is in the process of developing one. Currently, Mind-Eye has doctors with fellowships in both COVD and NORA
Mind-Eye testing emphasizes the mental and physical adaptations to environmental changes via the body pathways of “How am I?” “Where am I?” and the mind pathways of “Where is it?” “When is It?” and “What is It?” Those are influenced by the “Who am I?” pathway, which is addressed through individualized programs that give particular attention to whether or not a patient who is in “fight, flight or freeze” mode is innately a “fighter,” a “flighter” or a “freezer.” Emphasis is on how patients process and how the brain functions – namely, awareness and attention rather than eye muscles. People aim differently only when they are aware of a change; they focus only when paying attention to a target.
How does Mind-Eye testing differ from other optometric evaluation methods?
Most standard optometric evaluations rely on a system developed in the 1800’s. This 150-year-old testing system addresses only the clearness – 20/20 – of central eyesight by having the patient consciously look at non-moving targets across a darkened room. But, only about six percent of visual awareness comes from this kind of conscious focus on specific objects (see white ray in the diagram below). The majority of environmental signals passing through our retinas emanate from peripheral space – the space all around us (note the blue and green fields in the diagram). Yet, peripheral sight is rarely evaluated.
The Mind-Eye Institute does not use central (20/20) eyesight as an endpoint; we evaluate comfort of peripheral eyesight and eye-ear balance, as well as hand-eye coordination and visual perceptual skills. Comprehensive evaluation includes measurements of visual performance, visual processing capabilities and sensory integration with other body systems. Goal is to find optimal ways of addressing symptoms that have not improved or resolved through standard approaches in order to improve patient comfort.
How much time is required for testing?
The amount and type of evaluations performed depend on patient goals and needs as well as the kind of symptoms/issues being addressed. Range can be as short as 90 minutes to as long as five hours.
Who May Need Mind-Eye’s Help
How young is the youngest patient evaluated?
The Mind-Eye Institute will test patients as young as four months of age. The purpose would be to catch warning signs, before the child starts developing skills that require interaction with the environment (namely, depth perception, reaching for objects, and sitting up).
What if a patient is non-verbal?
We can evaluate patients who are unable to speak. If a patient is silent, our team can adapt by using thumbs-up or thumbs-down signs, blinking or keyboard responses. We also have a light that determines when a patient is engaged with the surrounding environment or daydreaming. Our goal is to determine the optimal combination of lenses and other optometric interventions that allow a patient to engage with the environment comfortably.
Can Mind-Eye test a patient who is paralyzed ?
Yes, Mind-Eye examination rooms are wheelchair accessible. In terms of testing, we can make targets move or use the wheelchair for navigational games.
About Mind-Eye Evaluations
What does Mind-Eye testing include?
Kinds of testing performed will depend on patient needs. However, a comprehensive, first-appointment visual-processing evaluation is likely to consist of a refractive examination to check eyesight, including aiming, focusing and eye-teaming abilities; assessment of eye movement control at conscious, subconscious and unconscious levels; and a spatial awareness analysis, using Mind-Eye Institute’s patented Z-Bell Test℠.
The Z-Bell Test℠ is a simple but revolutionary method of checking a patient’s overall awareness of surrounding space and his or her integration of visual processing with awareness of auditory space. During the test, a patient reaches out, with eyes closed, and tries touching a ringing bell. If the patient cannot do so, a Mind-Eye optometrist places different types of glasses across the patient’s closed eyes until an optimal combination is found that allows the patient to be more accurate at locating sounds. Light still passes through the eyelids and activates parts of the brain not used for eyesight. Even with eyes closed, patients are still having to visualize surrounding space in order to locate the bell.
What can Mind-Eye test on infants?
Babies’ brains develop in utero. During the fourth month of gestation, connections develop between eye position and head position. If a mother is bedridden during pregnancy, or the baby shares the womb space as part of a multiple birth, the infant loses out on moving around, thus delaying a portion of the development of that eye/head position relationship.
At birth, central eyesight (20/20 clarity) is not yet formed. It comes later – like teeth. Instead, at birth, the baby develops peripheral awareness of movement and speed, location, size and shape of objects. Mind-Eye assesses how the infant adjusts to changes in posture, head position, and lighting and determines whether eye movement is isolated from head movement. There are innate, primitive survival reflexes that infants have for protection. Sometimes, if those are not sufficiently integrated, the infant will have a lag in development of postural reflexes.
What types of learning problems are assessed?
Mind-Eye evaluates a wide range of learning challenges, including reading and comprehension deficits; dyslexia; understanding of language, speech, writing and computation; problems with organizational skills; memory; and abstract reasoning issues. Included are patients diagnosed as having attention deficit hyperactivity disorder (ADHD), post-traumatic vision syndrome (PTVS) and autistic spectrum disorder.
About Your Therapeutic Eyeglasses
What is so special about the eyeglasses prescribed to me?
Can I order my lenses elsewhere?
We always give you your prescription if requested, but highly recommend having the lenses produced by the laboratory that the Mind-Eye Institute entrusts with their manufacture. Brainwear™ opticians apply advanced, digital surfacing technology to ensure precision in production of lenses and provide special care when positioning those lenses within desired eyeglass frames to ensure the centers are directly in front of each patient’s eyes.
Studies show that lenses can have either a positive or negative impact on brain function. Lenses failing to meet exacting standards will not necessarily have an optimal effect. Brainwear™ lenses are designed to stimulate specific portions of your retina in accordance with your unique circumstances and prescription. If you have your lenses made elsewhere, we cannot promise that they will have the desired effect.
Will I have to wear my new eyeglasses all the time?
That question is impossible to answer without a thorough evaluation of your symptoms and circumstances. You may have to wear them full-time or just during a portion of the day. Following your first appointment, your optometrist will recommend a wear schedule and time frame.
How long will it take to receive my new eyeglasses?
The laboratory entrusted with the manufacture of your lenses exceeds national governmental standards for preciseness. With advanced Brainwear™ technology, lab opticians ensure everything that the Mind-Eye optometrist has prescribed for you. Also, Brainwear™ lenses go through a Measure-to-Measure℠ quality control process. The process involves five measurement checkpoints to make sure the manufactured lenses are exactly where they need to be. At any point in that process, a professional with quality control responsibilities can reject the lenses and request their re-manufacture. Rejection can extend your wait time but guarantees the lenses you do receive are exactly customized to your requirements.
Your Expectations During Recovery/Rehabilitation
What is normal to expect when I begin wearing my new prescriptive eyeglasses?
Some patients call our Brainwear™ therapeutic lenses “magical” because they bring them immediate or near-immediate relief from symptoms or problems that have been challenging them. Others notice more gradual, positive changes or may require a period of adjustment to the new lenses as brain and sensory systems adapt. The period of adjustment might be marked by physical symptoms, including some visual discomfort or headaches. It takes time for the brain to form and use a new habit, so sometimes the adjustment time might be three or four weeks.
How many different sets of prescriptive lenses do patients typically require? How often must prescriptions be changed?
Patients may only require one or two sets of lens changes or need as many as seven or eight, depending on their symptoms, recovery progress and comfort level. The Mind-Eye goal is to address symptoms and improve comfort through retinal stimulation without overwhelming a patient’s sensory systems. After the initial evaluation, each patient is given a recovery plan that will map progress and estimate how many changes of lenses the patient might need. The Mind-Eye team will make a more accurate determination of lens changes and calculate rate of change following a second appointment and evaluation of how well the patient has reacted to the first set of therapeutic eyeglasses.
I think something might be wrong with my lenses. What should I do?
If you are experiencing a health emergency, go to your nearest hospital emergency department immediately. Otherwise, please contact the Mind-Eye optical department for assistance.
Note that the lenses the Mind-Eye prescribes are usually atypical of those acquired from a standard optometry practice, because our Institute team is prescribing glasses for comfort, not necessarily 20/20 eyesight clarity. Each patient experiences different feelings and comfort levels throughout the recovery process. That’s why the Mind-Eye team is here to help you every step of the way. Many patients we see have 20/20 eyesight with their current lenses (or their eyes alone without lenses). However, they have poor comfort. By giving up a tiny portion of clarity, the comfort level often improves so much that the small eyesight difference is not even noticed.
What kind of health insurance does the Mind-Eye Institute accept?
Because of the nature of Mind-Eye’s unique tests and advanced procedures, many elements of the examination are not covered under standard health insurance plans. Oftentimes, CPT codes for Mind-Eye procedures are not included in Medicare, which is the reason why they may not be reimbursed by health insurance providers.
Following your initial appointment, you will receive an itemized invoice, listing optometric procedure, diagnosis and therapeutic codes. You can then submit this information to your insurance carrier for evaluation and full or partial reimbursement, depending on your coverage plan. Our patient care advocates can assist you through this process.
We recommend that, prior to your first appointment, you contact your insurance carrier and request pre-approval in order to maximize your coverage. Sometimes, insurance providers will give you forms for both you and your optometrist to complete. We can also give you some potential procedure codes in advance so that, when you contact your carrier for pre-approval, the company can determine whether a portion of your Mind-Eye appointment will be reimbursable.