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  • Sarah McGoldrick

A Personal Journey in Vision Therapy



“My wife and I were pregnant with twins and found out that one of the twins had an issue with his heart and would not make it to term,” Nikolakakis said. “He passed away at 25 weeks gestational and it triggered the birth of Gabriel at 26 weeks and one day and he was born at 900 grams (2 lbs). The doctors told us at the time all the possible neurological complications that could possibly occur and they also included learning disabilities, autism, and Cerebral Palsy.”

Nikolakakis is a Vision Development Optometrist and Adjunct Clinical Instructor, University of Waterloo School of Optometry. He said it was a visit from a friend that lead him to discover his son's complex visual issues.

“It was when Gabriel was about 2 years of age that an optometry colleague came to my house and noticed that Gabriel had a primitive re ex called Asymmetrical Tonic Neck Re ex (ATNR) showing that normally disappears at 3 months of age and mentioned how vision therapy could support him.”

He said he was intrigued and that he would do anything to help his son, which took him on the path to Vision Therapy Education.

“The clinic has been open for one month now and we already have six children with learning disability challenges being supported and many many more to come,” he said.

His own experience with his child and the process of working through vision therapy with him has given him a broad insight into the treatment process.

“So that started my vision therapy education journey through an organization called the Optometric extension Program (OEP). The other motivating factor was that my nephew was also diagnosed with mild autism,”he said.

The four-part program that took over one year to com- plete. He said two signi cant events raised his belief level in the impact and the di erence vision therapy can make in people's lives not only as vision therapist but as an eye care practitioner as a whole.

“In our second of four courses, there was a colleague in the class with a strabismus (eye turn) all her life. As we were learning all the techniques of that section the instructor would use her during demonstrations.

“It was impactful as we were shown what a learning disabled child goes through not just from a vision process standpoint but also from a behavioural one,” he said.

With five minutes left in the course she saw 3D for the rst time in her life and experiencing that was life changing for her and for the rest of us in the class,” he said.

“It was impactful as we were shown what a learning disabled child goes through not just from a vision process standpoint but also from a behavioural one,”he said.

The second event happened in the third of four segments that were all about learning disabilities and autism.

“There was a standardized screening tool that we learned about that determines if a child has an ocu- lomotor and or a perceptual problem called a DEM (developmental eye movement) assessment.”

He said the process takes about two minutes to run and is quite e ective to then ask deeper questions in the history to determine if the child is having any particular issues that we may be able to address from a vision therapy standpoint.

He noted Vision therapy can help with reading speed, reading comprehension, attention de cit disorders, hand-eye coordination, balance, brain injury, strabismus (eye turns), and amblyopia (lazy eye). Vision therapy is a clinically proven, safe, non- invasive treatment. Vision therapy provides the patient with the right opportunity to develop new neurological pathways relating to the control of the eyes, and the perception and processing of the incoming information.

“It was impactful as we were shown what a learning disabled child goes through not just from a vision process standpoint but also from a behavioural one,” he said.

Nikolakakis said the depth of the communication to support children that see 20/20 but complain of headaches, eyestrain, having letters move on the page and just not seeing right to a possible solution has been the most gratifying gift that OEP and this education has given him so far.

Vision Therapy is only successful when used to de- velop the appropriate visual skills on someone who is lacking those abilities, and when it is done in the proper way. Similar to other areas of health care, the approaches of di erent practitioners can be variable leading to variability in results.

“Developmental optometrists understand that learning is a multi-faceted phenomenon and that learning disabilities usually have numerous etiological possibilities,” he said. “These may include health, psychological, occupational, and physical problems; as well as speech and auditory, educational, neurological and nutritional issues.”

Vision therapy in Canada remains a growing area of research and service within the eyecare industry.

Nikolakakis recommends the not- for-pro t organization Canadian Optometrists in Vision Therapy and Rehabilitation (COVT&R) (

“Some amazing diagnostic tools are the DEM and a readalyzer infrared eye tracking system. This allows the coordination of the eyes to be quantified, analyzed and compared against expect- ed norms for the age of the child,” he said adding it can also be used as a visual tool for parents to have an idea of how the child's eyes move when he/she reads.

He said it provides a baseline so later on in the vision therapy process, the parents and child can see the progress in the child's reading ability and the data supports the practitioner as to the improvements as well.

Though it may be the child dealing with the visual issues, it is important for the entire family to be a part of the treatment.

“The parents are an integral part of the process and there is homework that needs to be done. The child and parents both have goals that are set at the beginning of the process and are usually quite motivated throughout in order to achieve the desired outcomes,” he said adding as with anything in life it takes work, however, we try turning home "work" into home "fun".

Nikolakakis said the overall success rate of vision therapy in children is growing adding it depends on the desired outcome.

“If all the testing is indicating there may be a problem and all the sugges- tions for home therapy is followed and the in-o ce therapy is done weekly the success rate is quite signi cant,” he said.

The number of years required to participate in vision therapy is very much individual based. He said signi cant changes can occur with as little as providing therapeutic corrective lenses and/or 10 weeks of therapy. He added most changes will occur in less than a year however there are cases that can last over a year as well. He noted there are many kinds of vision therapy based on the many reasons a child may be su ering from an eye health issue.

“There are di erent applications of vision therapy that can support many people. These include traumatic and acquired brain injury rehabilitation examples include concussions, strokes, tumors and their e ect on the vision process,” he said.

“With regards to my son, I understand now how vision therapy is a piece of a puzzle that is supported by many amazing people and professions adding their expertise pieces to the puzzle including osteopathy, physiotherapy, occupational therapy, Feldenkrais practitioners and the list goes on,” he said. “It has allowed some unbeliev- able milestones for Gabriel and how all this is supporting him and how he is inspiring me to continue to help so many others.”

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