VPD.
Is a condition where vision has aberration that is often misdiagnosed and rarely treated or investigated in UK. The condition is often misdiagnosed as “Malingering” or “Hysterical Loss of Vision (Amblyopia); both of which are inappropriate terms. Children who have learning or behaviour problems often exhibit this phenomenon. Sufferers of VPD, often have difficulties describing what they are experiencing, they complain that they have trouble seeing or can not see right, despite having passed all standard sight tests and did not require corrective glasses. The onset of this condition may be caused by/or aftermath of many conditions that include:
· Trauma (Minor Psychological or Physical)
· Change in environment and demand for better concentration (new job, new classroom etc.)
· Suppression or retention of other primitive reflexes which inflict some visual disturbance or imbalance.

Typically, this condition affects children and although able to read letters and not require any corrective prescription lenses. Their ability to read the chart is often reduced and their performance varies during the test. Typically the child has a dull worried and unwell expression. Chin tucked in, large pupils and introverted personality.

Some of the typical clinical signs:
· Restricted tubular/tunnel or spiral visual filed between 5-10 degrees from fixation (5 degree field may indicate that the brain is only processing about 3% of the normally available visual information, compared to 80% of the learning received through the eyes.)
· Difficulty in reading the letter chart. This may be variable during the test, often better when looking at single letters.
· Difficulty reading small print.
· Flat uninterested reading manner.
· Poor eye movement and tracking skills.
· Poor focusing control.

A restricted range of clear near vision causing problems; as with VDU, often necessitating a leaning forward posture that may lead to neck and shoulder problems. Large pupils that do not constrict well at near and do not maintain constriction in bright light. This can lead/indicate light sensitivity (Photopsia). A child will find it difficult in sitting still and/or concentrating for long periods of time. Frequently very low powered plus lenses or “yoked” prisms can have a marked improvement, both in ability to read and increase the visual field (stronger lenses will make things worse and not better as may be expected).

Behaviour:
The observed behaviour is associated with the child’s attempts to “focus in on target” or “stick to” a near vision task. When there is a requirement to sit still and pay attention, the effort involved can cause imbalances in Orientation (Spatial Awareness, own position to objects viewed in space), and Discrimination (Ability to identify and relate to what is seen).

Out studies and research have also shown that without appropriate therapy, the more the child tries to force better achievement, the worse things become, Children lose patience and ideas seem to fly out of their heads leading to severe and poor short-term memory (Short Term Memory Deficit Disorders). This leads to marked low esteem and a significant loss in self-confidence. If stressed, sufferers show a dull facial expression (light has been switched off), tuck in their chin and frown as they try to concentrate. They tend to lose their place, mix things up, reversing letters or words even if previously they did not show any signs of the above. This may be transient or persistent.

Confusion:
The main difficulty appears to be an adapted imbalance between Neuro-visual motor controls (the system that controls looking), and the Neuro-visual sensory controls (the system used to provide sight), which in turn causes an imbalance between the central and peripheral visual system. The effect of this imbalance is to reduce the visual fields and suppress details. This in turns, make this possibility to relate to visual information and other sensory information or past experience more difficult, if not impossible.

The Way Forward:
There are a number of ways to bring a total return to normal vision:-
· GP/Ophthalmologist/Neurologist Psychiatrist/Paediatrician
· Educational Psychologist/Counselling
· Orthoptist
· Behaviour Optometrist/Specialist Optometrist

Vision Therapy:
A combination of eye, co-ordination and perceptual exercises can improve by developing the visual system so that it can cope with the demanded stress without resorting to shutting down the visual system. These activities are designed to improve the Fields, Fixation, Focus, Fusion and Flexibility of the individual. The therapy concentrates on many visual functions and aim to improve the following areas.
1. Visual Verbal Sequential Memory
2. Visual Verbal Associative Memory
3. Visual Sequential Memory
4. Visual Symbolic Sequential Memory
5. Verbal symbolic associative Memory
6. Auditory Verbal Sequential Memory
7. Phonological Awareness
8. Phoneme Discrimination

Syntonic Phototherapy:
Syntonic optometric Phototherapy is a branch of ocular science dealing with the application of selected light frequencies through the eyes. It has been used clinically in the field of United States of American optometry for over 70 years for the treatment of visual dysfunctions such as with restricted visual fields, Lazy eye therapy, learning disorders, stress and trauma, brain injuries and emotional disorders. It is a quich therapy and its results have been well documented with over 91% success rate. It is pioneered and practiced by few well selected centres in the UK and UA. It takes between 4-24 weeks for the true effect to be noticed.

ChromaGen Haploscopic Filter Lenses:
This therapy is with the use of subject-preference colour filters where the spectrum of light is affected through the introduction of the special colour spectacle lenses (or contact lenses) in order to address the imbalance of light entering through the eyes hence creating the true light perception. The filters are worn from selected hours through the day to full time wear, depending on the condition presented. The lenses won the Millennium Award for Innovation, and the Zeidan Centre has established it self a leader in this field with over 1700 cases seen already and with 94% success rate documented.

TEST – Example Questions.
Can only be marked by qualified assessor.

Please indicate if any of the symptoms listed below apply. You must indicated “N” only if it does not apply in full, i.e. if you think it is possible or may occur then you should indicate “Y”.
1. Difficulties in following verbal / written instructions:
2. Is there any hearing problems:
3. Difficulties in telling time (reading clocks):
4. Difficulties in finding the word to express themselves:
5. Poor hand/eye coordination (fine handwriting/parallel lines):
6. Short attention span/easily distracted:
7. Tendency to reverse letters (e.g. d/b, p/q) or miswrite (s/z, v/x, n/h):
8. Poor reading skills:
9. Words reversals (e.g. Was/Saw):
10. Reluctant to read aloud or reading to others:
11. Poor homework and presention of written work:
12. Great efforts and labour in completing homework or simple task:
13. Poor or no organizational skills:
14. Difficulties in copying words from books/blackboard/OHP:
15. Becomes frustrated with tasks leading to tantrums/bad temper:
16. Poor self esteem due to literacy difficulties:
17. “It is unfair” and “Why me” attitude because others do better:
18. Poor/gross mistakes with simple words:
19. Good at oral communications to ideas, reluctant to put in writing:
20. Good at practical skills e.g. with Tools, DIY, drawings:
21. Poor short term memory or poor working mental memory (maths):
22. Difficulties with sequence logic or number/words relationships:
23. Difficulties with place value/ratio value/fractions value:
24. Difficulties in estimating answers/use of finger counting:
25. Misreads familiar words e.g. Home=House, Mother=Mum:
26. Reluctance to have a go at reading difficult words or simple tasks:
27. Drifts away from looking at texts when reading/loses reading place:
28. Little or no expression and intonation with reading:
29. Doesn’t recognize the same word on next page or else where in the story:
30. Uses finger with reading, loses patients, irritable with reading:
31. Attempts to spell phonetically:
32. Difficulties in distinguishing Vowel sounds from Vowel Combinations:
33. Poor use of capital letters and punctuation, capital letters in mid word:
34. Messy handwriting to hide poor spelling, leading to dislike of writing:
35. Reluctance to ask for help or being helped by parents;
36. Negativism and bad temper when faced with even simple school task:
37. Whining and sibling rivalry;
38. Cannot read what he/she wrote:
39. Dictation is fair, but copying is poor to impossible:
40. Word blindness, misses out words altogether and can skip a line: