“My brain is freaking out right now!”

Smith, NathanMeet Nate. He is a super sweet, smart 8 year old currently in a 6 month therapy program for Convergence Insufficiency. Here, you see him working with prisms on the walking rail. Prism lenses are a key component of vision therapy programs and are considered a medical device. They should only be used under the guidance of a qualified doctor.

A prism causes light to bend toward the base, which changes the location at which light falls on the retina. This causes a shift in the space the patient is viewing. Nate is wearing yolked prisms – there is a prism over each eye; both turned in the same direction (up, down, left, right). The first step of a yolked prism activity deals with awareness. I want to see if the patient is aware of the shift in space, and in what direction. Nate was very observant, and quickly told me which way things appeared to have shifted as soon as I turned the direction of the prisms. His visual awareness has grown a great deal in the last few weeks of therapy.

If you look closely, you can see the thicker part of the prism he is wearing is on his right, which means everything he is seeing appears to be shifted to the left. This can make it quite difficult to balance on a beam! As he tried to walk across the beam, Nate exclaimed “My brain is freaking out right now!” Which is kind of the point. This was another observant statement, as he was very aware of the mismatch he felt between what he was seeing and what he felt as he was moving through space. This mismatch can feel quite disorienting at first, almost like you are on the tilt-a-whirl and about to fall over. Imagine the visual and spatial skills you would obtain once you are able to not only walk across a balance beam, but doing so while your entire view appears to be shifted. Nate has learned some new skills so far in his vision therapy program, and with this activity we are working on his spatial awareness and ability to adapt. Because the prisms throw his vision into a state of disequilibrium, he needs to adapt and match his motor input to his new visual input.

Nate worked hard on this activity. Though it took a few tries and changes to his posture and thought process, the smile on his face when he managed to successfully walk the entire length of the beam was just another example of the pride and sense of accomplishment vision therapy patients feel as they gain new skills and control through their individualized therapy program…and that’s what this is all about. Great job, Nate!



What’s the difference between an optometrist and an ophthalmologist?

1f8e64ab768cff20fb8a8ac8ccc0046aOphthalmologists are medical doctors (MDs) who specialize in the health of the eye. When they assess vision, it is a confirmation that the eye is healthy and there is no disease. Their main focus is on surgery.

Optometrists are vision specialists (ODs, optometric doctors) who help people maximize the functional aspects of vision. When they assess the medical aspects of eyecare, it is because healthy eyes allow for better vision (with each eye and with both eyes as a team). Their training usually addresses the art of providing comfortable lenses for seeing with two eyes. They are also trained in the diagnosis and management of eye conditions and diseases as well as systemic diseases impacting the eye. It is a broad scope of training, and depends on the specific doctor and his or her specialties.

Pediatric ophthalmologists do conduct surgery related to eye-teaming. Unfortunately, vision rehabilitation and visual processing skills are not part of their training, and their opinion of vision therapy varies from doctor to doctor. Opthamologists are generally surgery focused, as they are surgeons. Unfortunately, surgery only corrects the cosmetic issue with eyes, and not the neurological issues of vision disorders. This is why generally vision therapy is the best treatment for an eye turn, or in some cases of a very large turn, a combination of surgery and vision therapy.

Developmental optometrists who specialize in vision therapy (“VTODs” such as Dr. Jacobi) undergo a considerable amount of post-doctoral training to enhance their understanding of vision development, visual information processing, visual rehabilitation concepts and techniques. Certifications for this include university-accredited residency programs and Fellowships attained with various post-doc organizations such as the COVD (College of Optometry and Vision Development), where Dr. Jacobi received his certification.  Continuing education is also an important aspect of such certification.

If you or your child are in need of a comprehensive eye and vision assessment, I suggest beginning with a developmental optometrist, especially when there are problems which interfere with the ability to read, learn, comprehend, or even to pay attention. Sometimes, a person can have a vision disorder without realizing it, and a developmental optometrist can implement things to correct it before it becomes  a bigger problem for the patient. Most optometrists assess sight at distance and don’t test vision, eye teaming and sight and vision at near (where kids spend most of their day looking). When managing strabismus (eye turns) or amblyopia (lazy eye), I again suggest a VTOD for a more complete rehabilitative approach. In cases where the turn is so large that surgery is needed in addition to vision therapy, Dr. Jacobi will refer a patient to a trusted ophthalmologist for collaborative care.

I hope this information is helpful to you! We understand that when you or your child is experiencing any difficulty, all of the information out there can be overwhelming and it is difficult to determine where to start. As with any profession, levels of expertise and competency will always vary based on individual experience and inspiration. At our office we specialize in contact lenses, dry eye, low vision and vision therapy. Dr. Jacobi is board certified with the COVD and has been working with children and adults with vision disorders for decades. We are passionate about what we do, and who we serve, and we would love to help more patients achieve the success they aspire to.

What if you saw letters like this?


Today we discovered that our patient sees any print within arms reach as though it is overlapped. And no one ever knew. She has had eye exams before, but her specific difficulties and diagnoses were not discovered until she came to see Dr. Jacobi for a comprehensive eye exam with a developmental optometrist. She sees 20/20 and her sight is fine, which is why other eye doctors did not diagnose her with any vision difficulties. But when she reads she has to pick which word makes more sense in the context and not surprisingly she HATES writing. I realized this when she couldn’t read anything with both eyes open within 12 inches of her face. With one eye covered, she can read the letters, but with both eyes open she would squint her eyes, tilt her head, close an eye…She said it looked blurry like black blobs… so I had her draw exactly what she saw. This is what she drew.

Can you imagine being a young child in a classroom trying to keep up when this is how things look?? And these kids are often labeled as lazy, ADD, etc. These are the kids who are quick to give up and say they can’t, who tell me they just want to be smart, who cry when we tell they they are smart-we just need to help their eyes work better together. These are the moms that cry in the therapy room because they feel so bad they never knew. These are also the kids who learn during vision therapy that they can achieve great things- who gain confidence and success. The kids who make me fight back tears on their VT graduation day while mom cries and we discuss how far they’ve come. The good news is we can definitely change her life. This is why we work so hard and this is why we are so passionate about what we do!

Vision Therapy is truly life-changing. Kids often don’t know how to describe what they see, and they often think everyone sees that way. This is why it is so important to take your child to a developmental optometrist. If you are not in our area, go to covd.org and search for a board certified optometrist who is a fellow at the college of optometry in vision development.

Eye Exam VS Vision Screening…Tomato Tomahto?


Is a vision screening the same as an eye exam…. or a “online eye exam?” This is a common question. Many schools and pediatricians perform vision screenings…does your child still need an eye exam in-person with an optometrist?

The answer is 100% YES, because a vision screening is not the same as a comprehensive eye exam, and neither is an eye exam done online. Vision screenings at the school or pediatrician’s office are designed to detect obvious problems with SIGHT. As you have learned from our previous blog posts, sight is only one component of vision. Children who pass vision screenings often have vision problems that affect their learning. It is better to have an optometrist examine your child, and BEST to have a developmental optometrist perform the exam. This is because developmental optometrists, like our very own Dr. Jacobi, are certified in vision and learning development and test for vision issues that vision screenings as well as other optometrists often miss.

Another important thing to mention, is that vision screenings do not check the health of a person’s eyes. A vision screening is the first step to detecting an issue, but a comprehensive eye exam with a developmental optometrist will provide you with much more information in regards to the performance and health of your child’s eyes.

The American Optometric Association (AOA) recommends that children have their first comprehensive eye exam at 6 months old, and (providing that there are no issues), again at age 3, just before starting Kindergarten, and annually thereafter. Because we believe in the importance of this, we offer free comprehensive eye exams for children who are entering Kindergarten.

Summer is a great time to schedule an eye exam for your family! Make sure that your children begin the school year ready to learn. Should your child need to begin vision therapy, getting a head start over the summer is very helpful! And don’t forget about yourself – whether you have a family history of eye disease, dry eyes, allergies, need specialty contacts or vision therapy – we are your friendly and knowledgeable eye care professionals.

Vision Therapy for the patient with TBI

So you know that Vision Therapy can be life changing for children and adults with vision related learning difficulties…but did you know that it can also be life changing for a person with a traumatic brain injury? This includes someone who had a concussion, stroke, car accident, fall, etc…and Vision Therapy can make a dramatic difference!

Our Chief Vision Therapist, Amanda, spent the weekend at a workshop learning more about how we can best serve our patients with TBI. It is best to seek treatment sooner than later, but even if your injury was years ago and you are still experiencing symptoms, Vision Therapy may change your life!

A person who has experienced a TBI may have many unfortunate vision-related symptoms including headaches, dizziness, double/blurred vision, poor balance and coordination, bumping into things, and often just a feeling that something “isn’t right.” Sometimes Vision Therapy alone is enough to help someone feel “normal” again. Other times, we will work with occupational therapists and physical therapists to form a cohesive team to help the person experience the most rehabilitation possible for them. No matter what your age, studies have shown that it is possible to create new neurological pathways and “retrain the brain.”

The human body is an amazing thing and it’s fascinating how all of our body systems are connected. Vision Therapy can have a profound impact on a person in ways that can be surprising and wonderful.

Congratulations Delaney!

Miss Delaney graduated yesterday! Her growth throughout the program has been AMAZING. She has gained a huge boost to her confidence and independence and she went from missing 23 reversals on her initial evaluation to missing ONE on her final eval. On her final evaluation, she tested WAY above average on nearly everything! Her mom mentioned that she is more independent and confident, she can READ, and she is doing things that she could never do before. What an amazing girl and an amazing transformation. Delaney we are so proud of you! Keep up the hard work and remember YOU CAN DO IT!

Congratulations Fernie!

Fernie was 4 years old when she started our Vision Therapy Program 9 months ago.

She was scheduled for surgery for her eye turn, but when her parents found our website and information about vision therapy, they brought her in to see Dr. Jacobi one week before the surgery was scheduled to be performed.  She was prescribed 9 months of vision therapy. Fernie came every week to see her vision therapist and worked hard at home with mom and dad. Surgery was cancelled and today we are celebrating her graduation!

Fernie has successfully learned how to control her eyes so that they do not turn out and are able to work well together to give her great vision! As she has said, she is now able to control whether she sees 1 of her dad, or 2! Her parents report that she is much happier and has grown so much. She is ready to start school in the Fall!

Congratulations Fernie, we are so proud of you!