Eye Exercises: Visual Training for Eye Disorders

Visual training is the practice of exercising the eyes with the aim of overcoming vision disorders, in particular those relating to binocular function (i.e. vision difficulties stemming from the misalignment of the eyes). Eye exercises are also commonly used to relieve the eyes after long periods of focused vision (e.g. computer use). While eye exercises are commonly prescribed treatments for visual disorders, not all eye exercises have been proven effective in treating eye problems.

Visual training has been used for centuries, to treat visual disorders and other problems (e.g. academic performance). In its early days, visual training was typically applied to infants and largely involved strategically placing bright objects in the infant's environment to encourage it to look in particular directions. It was not necessarily applied for health reasons however. In some cultures where being cross-eyed was considered a mark of beauty, bright dots were drawn on children's foreheads to encourage them to look cross-eyed!

The practice of visual training by ophthalmologists began officially in 1928, when a branch of ophthalmology known as orthoptics was recognised in Britain for the first time. Since then, visual training has come to be practiced mainly by optometrists. The eye exercises currently involved in visual training have evolved significantly since its beginnings. In addition to numerous home-based eye exercises which typically involve shifting the focus of vision from near to distance objects, there now also exists a range of specialist equipment which is used to conduct supervised visual training in the office of an eye professional.

Despite its long history, scientific evidence regarding the effectiveness of visual training is limited and exists for only a few vision disorders. These are discussed below.

Strabismus/convergence disorder

Strabismus, also known as convergence disorder, is a condition in which the eyes are not properly aligned. It is the condition which visual training has most commonly been used to treat and the condition for which there is the best evidence regarding the effectiveness of eye exercises. There is evidence that eye exercises are effective in correcting convergence disorders in both children and adults and that a combination of office and home based therapy is more effective than home based therapy alone.

Amblyopia

Amblyopia is a condition in which one eye is more dominant than the other. It is commonly treated by patching the dominant eye, in order to encourage activity in the lazy or amblyopic eye. While scientific evidence regarding the effectiveness of this treatment is limited, available evidence suggests that patching the dominant eye improves vision in the amblyopic eye. Patching for six hours per day appears to be equally as effective as full time patching. There is also evidence that the risk of amblyopia recurring is minimised by gradual reduction in the length of treatment (to two hours per day) before cessation.

Brain or optic nerve injury

Available evidence shows that visual training in patients who retain some residual vision following a brain or optic nerve injury can improve their field of vision.

Conditions not affected by visual training

There is currently insufficient evidence to support the use of eye exercises for the following disorders:

Learning disabilities;Dyslexia;Age-related degenerative conditions such as macular degeneration and glaucoma;Refractive Errors; andPoor sports vision.

A range of eye exercises have been used in home and office based visual training with the aim of correcting visual disorders. These are discussed further below.

Pencil push up therapy

Pencil push up therapy is the eye exercise most commonly prescribed by ophthalmologists. It is an eye exercise in which a pencil is held directly in front, at arm's length. The pencil is then drawn slowly towards the nose. The exerciser follows the pencil with his/her eyes, trying to keep it in clear focus. When the pencil starts to appear as a double image, the pencil should be drawn away from the nose again. The exercise is repeated several times per session, for several sessions per day. The aim is to correct binocular visual disorders, in particular strabismus.

Lens fixation

Lens fixation is an eye exercise conducted with the assistance of an ophthalmologist, using a series of lenses of different strengths. The patient views an object through these lenses to train the eyes to adjust to different visual fields.

Prism fixation

Prism fixation is an eye exercise conducted with the assistance of an ophthalmologist in which the patient looks into a series of prisms with specific orientations. The orientation of the prism will depend on the condition being treated.

Shifting fixation

Shifting fixation is an eye exercise conducted with the assistance of an ophthalmologist in which the patient is required to change focus from near to distant objects. It is used to train the eyes to adjust to different fields of vision.

Patching

Patching is the practice of covering one eye with a patch to encourage the patient to use the alternate eye. In some instances the patient will be asked to carry out exercises, such as focusing on distant letters, while the dominant eye is patched. It is typically used as a treatment for amblyopia.

Eye exercises have also received increasing attention as a means of reducing temporary eye irritations induced by strain from long periods of focused vision. These eye exercises, which are discussed further below, are particularly relevant to, computer users who spend long periods of their working day focusing on a computer screen, and have a high risk of developing eye and visual disorders.

You are unlikely to be suffering from dry eye syndrome.

You are experiencing a number of symptoms of dry eye syndrome. To improve symptoms, blinking frequently may help, drink plenty of water and avoid rubbing your eyes.

Over the counter treatments are available from your pharmacy or optometry outlet. If symptoms persist speak to your health care professional.

You are very likely to be suffering from dry eye syndrome. Consult your eye practitioner or health care professional to determine what treatments are best to alleviate your symptoms.

This information will be collected for educational purposes, however it will remain anonymous.

Eye movement

Performing regular exercises to ensure the eyes move to their full range of vision is important, particularly for individuals who spend lengthy periods of time looking in a particular direction (e.g. at a computer screen or reading material). Individuals can exercise the eye's full range of motion by performing the following, simple exercise:

Sit upright, facing and looking forward;Without moving the head, look up and down;Then look left and right while continuing to face forward;Repeat the exercise several times, throughout the day, as the eyes become strained.

Vision rest

Individuals who spend lengthy periods of time focusing on computer screens need to rest their eyes by focusing on distant objects periodically. Computer users should look away from the computer periodically and find an object at least three metres away to focus on. This may be a picture or something outside the window. The individual should then focus on the object for a short period of time.

Clinical optometrists often suggest the "20/20/20 rule" for visual rest, that is, after 20 minutes of computer use, look at something 20 feet (6 metres) away, for at least 20 seconds. Computer programs with an appointment reminder function can be utilised to help computer users follow this rule.

Despite the lack of evidence for the efficacy of eye exercises in the treatment of most visual and other disorders, practitioners agree that eye exercises are not typically associated with eye damage, with one exception. A practice called sunning, which first arose in the 1920s but gained popularity mainly in the 1960s, in which an individual looked directly into the sun to normalise their vision, is now known to be associated with an increased risk of a number of eye diseases.

Eyes are sensitive instruments which can easily become injured or diseased from exposure to sunlight, because of the ultraviolet rays of the sun. Eye diseases associated with sun exposure include the deadly condition squamous cell carcinoma of the eye, as well as a number of conditions which reduce visual acuity, including cataract, ptergyum and age-related macular degeneration.

For more information, see Protecting Your Eyes from the Sun.

Helveston, E.M. "Visual training: current status in Ophthalmology" in Am J Ophthalmol, 2005, 140:903-10.Westone Services, Into the Internet: Occupational Health and Safety for Computer Users, 2008, available from: http://www.westone.wa.gov.au/ intotheinternet/ topic08/ index.htm?Rawstron, J.A. Burley, C.D. Elder, M.J. "A systematic review of the applicability and efficacy of eye exercises" in J Pediat Ophthal Strabismus, 2005, 42(2):82-9.Yan Z, Hu L, Chen H, Lu F. Computer vision syndrome: A widely spreading but largely unknown epidemic among computer users. Computers in Human Behaviour. 2008; 24(5): 2026-42.Australian Cancer Council, Eye Protection from Ultraviolet Radiation, 2006, available from: http://www.cancer.org.au/ file/ policypublications/ pseyeprotectionaug06.pdf

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Exercises To Do and Avoid During Pregnancy

Exercise during pregnancy is well recognised as being both a safe and beneficial practice for mother and foetus. So while all women should be encouraged to engage in physical activity no studies have yet identified “how much is too much” which makes it necessary to be cautious and speak with your doctor about your specific circumstances.

There are some general guidelines which outline which exercises are recommended for pregnant women but the appropriateness of these activities will be largely determined by pre-pregnancy fitness level and previous exercise experience as this will dictate what intensity, frequency and type of activity can be safely maintained?by each individual?during pregnancy.

The body changes that occur in a woman while she is pregnant may interfere with the ability to engage in some types of exercise.

There is a significant increase in body weight during pregnancy that can make jogging and running uncomfortable. The change in body weight and weight distribution can alter balance and coordination making sports that require these skills challenging and even dangerous.

The ligaments and joints around the pelvic region will begin to loosen up as the pregnancy progresses in order to prepare the body for labour. For this reason activities which may impose a risk of injury in this area should be avoided. This is anything that requires quick changes of direction, jumping and jerky movements.

Physiologically, the increase in resting heart rate associated with pregnancy necessitates that women do not over exert themselves.

The decrease in blood pressure which occurs in pregnancy may also make some women light-headed and dizzy meaning that activities involving balance may be difficult.

It is recommended that pregnant women, with what is considered as a low risk pregnancy, engage in moderate intensity exercise for 30 minutes a day,?4 times a?week. Low risk pregnancies are those which are not otherwise constrained by medical or obstetric complications.

Depending on the woman’s individual medical history and exercise experience, the exercise program will need to be initiated differently. Your doctor can help you with this.

More information on Beginning an Exercise Program During Pregnancy.

What is classed as “moderate” intensity exercise is subjective and will be quite different depending on individual fitness levels. A good way to determine a comfortable intensity while exercising is through the talk test. If you cannot maintain a conversation during exercise then this is not considered to be moderate intensity and you should reduce the intensity of your physical activity until you can.

Appropriate physical activities to engage in during pregnancy are quite common sense. Any activities that have a low risk of falling, injury and joint and ligament damage should be chosen. This includes low impact activities that do not require too many quick changes to the centre of gravity or depend predominantly on balance.

Warm up

All exercise should begin with a warm up and cool down period. The hormones produced during pregnancy make women especially flexible in preparation for childbirth but this can lead to excessive stretching and pulling which can cause injury. Stretching should be done very gently, especially after the first trimester.

For more information on Warming Up Before Exercise.

Walking?

Walking is the most common exercise amongst pregnant women. Walking is safe for everyone, including pregnant women who are only just beginning to exercise. Walking has a low risk of falls and it is easy to control exertion levels. Brisk walking is low impact for joints and muscles yet still gives a total body workout and improves cardiovascular fitness.

Water sports

Some water sports such as swimming, water aerobics and water walking are safe and fun sports.

Swimming works almost all muscles in the body without the risk of overheating. Water aerobics is great for cardiovascular fitness. These water sports are safe as there is no risk of falling or losing balance and the water supports body weight so the risk of muscle strain is low.

Water activities are especially effective for women who experience back pain and leg swelling during pregnancy as it has been found to alleviate these symptoms.

Stationary cycling

Cycling is another good cardiovascular workout that will help improve leg muscle strength. During pregnancy stationary cycling is a better alternative because as your belly grows, especially in the third trimester, balance on a bike will be difficult.

Weight training

Studies to date on light to moderate resistance training using free weights and weight machines during pregnancy have found no adverse findings in patients that regularly engaged in the activity before pregnancy. Women who have never engaged in weight training prior to their pregnancy should not begin once they have conceived.

Studies have shown that there are benefits from engaging in weight training while pregnant. Improvements in strength and flexibility have been noted. This is turn will help the body adapt to the physiological changes that occur during pregnancy. Women may find they can tolerate their heavier body weight and altered centre of gravity better with muscle strengthening that is gained from training, especially focussing on lower back strength.

Running

Running is safe in moderation for women that were running frequently before they became pregnant. It is not advised that women that have never run before take up running during their pregnancy. Depending on the individual, the running regime may need to lessen in intensity and frequency.

While frequent moderate intensity exercise is safe and recommended for pregnant women there are some sports that will increase the risks of injury, stress and other complications. Some activities will simply be too uncomfortable or tiring. It is important that women who are planning to exercise while they are pregnant are aware of what exercises they should avoid including:

Heavy weight training lifts that involve maximal isometric muscle contractions are thought to put too much stress on the cardiovascular and musculoskeletal system;Holding your breath during difficult positions during yoga or while weight training. If you are ever not breathing during any exercise this is a clear indication you are over-exerting yourself and you need to stop immediately;Exercises lying on your back after the first trimester of pregnancy should be avoided to reduce the risk of affecting blood flow to the foetus and hypotension from vena cava?compression by the uterus;Exercises which involve lying on the stomach;Some abdominal strengthening exercises will be very uncomfortable due to muscle weakness and the development of abdominal seperation, a?condition where?called diastasis recti.?This occurs as a result of the growing uterus;Standing still for long periods of time is not recommended;Contact sports and high-impact sports such as ice hockey, soccer and basketball can risk abdominal trauma, excessive joint stress and falls;Scuba diving should be avoided as the pressure can result in birth defects and foetal decompression sickness;Any activities that increase the risk of falls should be avoided in order to reduce the risk of injury to you and your foetus. This includes sports such as gymnastics, horseback riding and water skiing;Any activities which require changes to the centre of gravity should be avoided as this can cause balance problems. This includes vigorous racquet sports such as squash and tennis;Any sports at altitude may induce altitude sickness which in turn can reduce the oxygen supply to the foetus. This does not appear to be the case for moderate intensity exercise at altitudes anywhere up to 2,500m but if you want to exercise at altitudes above this upper limit you should be guided through appropriate acclimatisation and make modifications to you activities as guided by your doctor. If you experience symptoms of altitude sickness including excessive shortness of breath, chest pain and light-headedness and weakness, you must stop exercising immediately and seek medical aid.

?For more information about pregnancy and exercise, including pre-pregnancy exercise, suitable types of exercise, risks and benefits of exercise and exercise myths, see Pregnancy and Exercise.

?For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see Pregnancy.

For more information on fitness and exercise, including stretches, types of exercise, exercise recovery and exercise with health conditions, as well as some useful videos, see Fitness.National Collaborating Centre for Women's and Children's Health. Antenatal care: routine care for the healthy pregnant woman. Clinical Guideline March 2008 2nd ed. RCOG Press; London: 2008. [Full Text]Sydney South West Academy of Sport Policy Statement: Exercise During Pregnancy [online]. SWSAS [cited June 2010]. Available from: URL: http://www.swsas.org.au/documents/pregnancy and sport policy.pdfDavies GAL, Wolfe LA, Mottola MF, MacKinnon C. Exercise in pregnancy and the postpartum period. Joint SOGC/CSEP Clinical Practice Guideline. 2003; 129: 1 - 7. [Full Text]The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Endorsed statements [online]. Pregnancy in Sport - Guidelines for the Australian Sporting Committee, 2002 [cited Apr 2010]. Available from: URL: http://www.ranzcog.edu.au/womenshealth/endorsedstatements.shtml? Mottola M. Exercise Prescription for Overweight and Obese Women: Pregnancy and Postpartum. Obstet Gynecol Clin N Am. 2009; 36: 301–16. [Full text]Gavard JA, Artal R. Effect of exercise on pregnancy outcome. Clin Obs Gynecol. 2008; 51(2): 467–80. [Abstract]Nutrition Australia: Physical Activity During Pregnancy [online]. Sports Nutition 2010 [cited June 2010]. Available from: URL: http://www.nutritionaustralia.org/national/resourcesAmerican Congress of Obstetricians and Gynecologists: Exercise during pregnancy [online]. ACOG 2003 [cited June 2010]. Available: URL: http://www.acog.org/publications/patient_education/bp119.cfmSleeping positions during pregnancy [online]. American pregnancy association, 2010 [cited July 2010]. Available from URL: http://www.americanpregnancy.org/pregnancyhealth/sleepingpositions.html

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