What Makes Vision Therapy Work: Collin Welsch on Mindset, Tracking Progress, and Seeing the Whole Person

Denise interviews Collin Welsch, who previously worked as a vision therapist and was Hanah VanderMeulen’s therapist—offering listeners a rare view from “the other side of the table.” Collin shares how he unexpectedly found the field after a neuroscience background and rehabilitation work, then spent seven years in a busy vision therapy practice before eventually moving on to a completely different career.

Collin breaks down what he saw most often in clinic—kids and students struggling with reading and writing due to convergence insufficiency, accommodative insufficiency, and ocular motor dysfunction—and explains why these are some of the clearest areas to measure and track improvement. He also talks candidly about what actually leads to success: consistent attendance, home practice, goal tracking, journaling, and especially mindset and language (including his preference for replacing “hard” with “challenging” or “difficult” to keep patients engaged and empowered).

You’ll also hear Collin’s perspective on working with complex cases like TBI, why functional progress doesn’t always show up immediately in the numbers, and how expanding peripheral awareness and “free-space” activities can support binocular progress. He shares practical at-home ideas—including a surprising one: learning to juggle as a vision-and-body coordination challenge.

Resources mentioned in the episode:

• COVD (certification and conferences): https://www.covd.org/
• Vivid Vision: https://www.seevividly.com/doctor_locator
• WOW Vision Therapy website success stories: https://wowvision.net/category/success-stories/
• WOW Vision therapy on YouTube: https://www.youtube.com/@WowVisionTherapy/videos
• The Shape of the Sky, by David Cook: https://www.oepf.org/product/the-shape-of-the-sky/
  
  

Connect with Denise Allen:

Website: https://healingmysight.com

Healing our Sight Facebook Group: https://www.facebook.com/profile.php?id=100063570817348

*I do not benefit financially from any of the links or this podcast. This is a public service only.

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Transcript

Denise:  Welcome today to the Healing Our Sight podcast. I'm your host, Denise Allen, and today I'm happy to have with me Collin Welsch, who is. Was. I should say, Hanah VanderMeulen's vision therapist. So, I'm very excited to get the view from the other side of the table, so to speak. Welcome, Collin.

Collin: Oh, well, hello. Thank you for having me. Yeah, like you were saying, I. I worked with Hanah. I think if some of your listeners have listened to all your episodes, she was one of them more recently.

Denise: Right.

Collin: I think I also had done a little bit of, like, virtual discussion slash therapy with Melissa Daniels.

Denise: So, yeah, we've had Melissa on a couple of times.

Collin: Those two girls, if you've heard them.

Denise: Absolutely. Yeah. That is so awesome. So, we, we really want to know a lot more about how you got into vision therapy and your background there, how long you worked in the field, why you left, all that kind of stuff. So, tell us a little bit more about that.

Collin: Yeah, I think. I think my journey started kind of like everyone else and that knows about vision therapy because it seems like that's the first thing anyone says is what's vision therapy?

Denise: Right.

Collin: And, you know, I didn't plan on working in vision therapy. I had no idea what it was. I went to Central Michigan, got my undergraduate degree there. At that time, I was. I played hockey growing up through high school. So, I was thinking I was going to do the physical therapy route when it came time to actually shadow with physical therapists. I had met one who recommended a neuroscience degree, and I thought, okay, well, biomed kind of sucks, so let's try that out. And I started taking classes and that fell in love with it, graduated. And then I started working at Spectrum, their hospitals around the Grand Rapids area, doing like neuro, I would say rehab, you know, speech, physical therapy, OT. And then I had just found a posting online one day from this place called, Wow Vision Therapy and thought it was a hoax given the name. And then a couple years later found out, oh, wow. There is a reason behind the name. But, yeah, I just started working there and truthfully, after the first day or two, thought it would be really interesting. And then once I got into it, really fell in love with it and worked at that office for seven years, I think about two years in, I did the COVD certification and yeah, saw a lot of patients. It was fun. I like to really challenge myself. So, at the end of about seven years, I kind of felt like, you know, I wasn't being challenged. I had learned a lot of what vision therapy had to offer. So, I just decided to move on and down in North Carolina, building homes and remodels and putting additions on people's houses. So, there's the story.

Denise: They're probably really glad to have you, but the people in Grand Rapids are definitely sad to lose you.

Collin: Yeah.

Denise: Yeah. So, you didn't ever participate as a patient in vision therapy?

Collin: Right.

Denise: Your eyes were fine from the very beginning?

Collin: Oh, no. It.

Denise: No.

Collin: Oh, well, my. Well, I found. I did my initial evaluation. I had, you know, if we're talking numbers, I did really well. I would say the only thing that was a little bit laggy, and we can go into this later on in the discussion, but if you've done the visig graph to record your saccadic eye movements while you read, that was a little bit my. The. The speed and the duration of fixation. I forget some of the other aspects, but that was a little bit laggy. And I kind of attributed that to. I played a lot of, again, a lot of hockey. I think I had a couple concussions here and there.

Denise: Okay.

Collin: So that sharpened up and to answer your question, no, I definitely participated. I would do everything. Everything that the patient would do during vision therapy session. And then when they would leave, I would, you know, come up with new ideas or take it home with me. So, I was pretty constant doing visual therapy.

Denise: So as you're doing it with the patient, your vision was improving too, is what you're saying?

Collin: Yeah. The speed. Speed. I would say my saccadic eye movement speed. Accuracy, Feeling of control. Definitely. Yeah.

Denise: Okay.

Collin: I would say stamina, too. On days where I would see seven plus patients, you know, at the. It didn't matter how much vision therapy I had under my belt. You know, at the end of that day, it was like, I'm exhausted, but I think anyone would be.

Denise: Oh, absolutely. Did you see more success when patients had certain issues over other issues?

Collin: Well.

Denise: Or tell us a little bit about your model. I guess how you.

Collin: Yeah, yeah. I guess it would be how you define success.

Denise: Okay.

Collin: The biggest population of patient that's coming through the door is going to be your reading and writing. Your kiddos that are booking the CIAI omd. I would say those.

Denise: And not everyone that listens is going to know what all those terms mean. So. Yeah, they all are.

Collin: Yeah. So the. The kiddos. I would say the elementary kiddos that would come in and they're being brought in by their parents because they are starting to get reports of being delayed in reading and writing and every single time it would come up, convergence insufficiency, accommodative insufficiency, and ocular motor dysfunction. So, in that near space, having visual stress, not having the eye teaming, I would say strength, or not even strength, but, you know, being able to maintain your eye teaming at a near space, being able to control your focus and then coordinate your eyes in a structured manner. Those three things are very easy to track in the clinical setting with numerics and tests. And so, a long answer to your question is, I would say those are, those would be like, the easiest, just because as adults, on the other side of it, on the clinical side of it, it would be the easiest for us to show each other. Well, this person did this, this person did that. The tracking ability was just kind of straightforward. Okay, definitely that would, that would be the easiest.

Denise: That mostly in children. Or did you see adults with tracking issues too?

Collin: Oh, yeah, I would say adults. And again, I did, I would work across the board. So, the kiddos, teenagers, high schoolers, and then young adults getting into their continued education. Yeah, I would have cases of that.

Denise: What do you think it takes to succeed in vision therapy? I hear a lot of people say, oh, I tried vision therapy and it didn't work. And I would say, well, maybe you didn't do it long enough, but I was wondering what you're take is.

Collin: Yeah, my take. Well, and the answers to your questions might not be direct, but I'm getting somewhere with it. Sure. So, the biggest thing that I learned, and I'm going to take this with me to my grave, is how effective the Socratic method is. People don't like to be told that they're doing something wrong. People don't like to be told that. They don't be like to be told anything. They don't like to be told what to do.

Denise: Yeah.

Collin: And so, I quickly realized the power behind the Socratic method and to, you know, answering that question, you know, okay, so vision therapy didn't work. Well, now we're going to start to have a discussion about why did it not work. And that's where I know the more discussion goes on, the more I can pull out and pinpoint the answer to why, why it didn't work. It's so ironic because we're in vision therapy and so much of the clinical side of it, I feel like, is observing. And it's not just vision, it's observing people. And what comes along with people, one of the things is, is language. And, and when you listen to how, how people use their language. You can start to pick up on things. So, I had lots of protocols for different aspects during the therapy. One of my big protocols was pretty much every time people would come through the door and I would hear them start to use the word hard. Okay, well, I. That I would say, no, we're not going to use that word anymore. We're going to eliminate that from our voc. And I would tell kids all the way up to people in their 80s, it's like, no, we're not going to use that word, because that word is a defeating word. It's just a. This is too much now. I'm done with it. I'm fleeing from it. And when I started to promote that, I would actually see and I think Hanah, I could tell. because I could tell Hanah would. Hanah definitely used the word hard when she first came in. And I think when I was listening to her on your podcast, I almost heard. I thought I heard her, like, catch herself and use it in inserting difficult or challenging. Because that was what I would teach these patients that I worked with was, no, let's not use hard. Let's use something that essentially means what you're going through right now, but it's not the end all. You can do something about that. Yeah, it's challenging or it's difficult, but you can still do something about it.

Denise: Well, we can also do hard things, but we don't always want to say that we can.

Collin: Yeah, yeah, that's right.

Denise: That's great, though. So, you channel the language to a more effective outcome then.

Collin: Yeah, language. And again, I did seven years in vision therapy. I'm not a nutritionist expert in the physical movement of the body, you know, etc. Etc. I'm not a speech language path. You know, I'm none of those things. There are professionals out there that I would absolutely say, you know, all I can tell you is this. Now, if you want to elaborate on that aspect of who you are, then pursue these other aspects of health care. Sure. But I would keep an eye out all the time for what I would observe and, you know, mobility, posture. Yes. The vision, the language. But I would just treat people as a whole and not as these, you know, parts of. Of who they are.

Denise: Okay. Well, there's definitely more to us than our eyes. Right. And we don't always address any of those other issues at the same time. Right, Right. Yeah. So, what was your favorite type of issue to work on or favorite age subject?

Collin: Well, I liked. I loved working with the kiddos. I feel like that was getting, prepping me for, you know, having my own future family and they were just a hoot to hang out with. But all fun and games aside, you know, regardless if it was a, a youngster or an adult, it would just be so awesome to see the transformation that they would go through. When I first started and I didn't know what I was doing and I won't name names, but there was a kiddo that was about four with cerebral palsy and he just such a defeated, defeated little guy. You know, he's got ankle braces on, comes in a wheelchair, he can barely walk, but like fine motor is just nonexistent. And he knows that he's, he's very, I would say, globally aware of his disadvantages. So being able to draw a straight line or a circle, I mean out of the, out of the equation wasn't, you know, some letters, some numbers and then he was, he was there pretty much the seven years I was there on and off. He started to make huge leap right around the end of fifth grade and he was well advanced in reading and writing amongst his peers. So, we're reading at almost a high school level.

Denise: Wow.

Collin: So, to see something like that go on was awesome. I liked working with the kiddos. I liked working with teens, adults. I, I liked working with the patients who would be there longer than the short, the short-term patients because I got to know them more and I felt like I got to be a bigger impact with them.

Denise: Well, they were the ones that were sticking to it also. Right?

Collin: Yeah. Yeah, yep. The commitment, the matched commitment.

Denise: Yeah.

Collin: The, I think the most frustrating type of patient. This is no slam on any diagnosis. Bring whatever you got. But definitely the, the most wearing and frustrating would be the traumatic brain injury. Yeah, that would be, that'd be a big challenge. The challenge with that, I believe was depending on the severity, there might be such a severe injury where it's like you really need a full time caretaker to take you from therapy to therapy to therapy, to keep this investment, to keep a schedule to, to improve upon, you know, the injury that you suffered. And that's not what you're receiving you, it's just your family member brand. Yeah. And when it's so spotty, when you're missing sessions and you can't keep track of anything, can't, you can't track anything you're doing at home. I see that you might think here and here is improving, but I, what, what I have seen from patients and what I think you are able to achieve there's so much more opportunity that we're not tapping into there and that's, that's really difficult to be a part of.

Denise: Yeah. So, a traumatic brain injury patient really needs someone advocating for them all the time is what I'm hearing you say.

Collin: Yeah, yeah. If they're, if they're an outpatient. I think there needs to be a bigger emphasis on a day-to-day caretaker to keep the person on track, even if they don't want to. Because a lot of the TBI, a lot of the brain injury, you have the emotional swing aspect of it and they really just need to be told, no, that's. No, that's not how it's going to go. This is how it's going to go whether you like it or not, because it is for your own good and your decision-making abilities are impacted because you had a head injury.

Denise: Yeah. Which may be hard to convince them about, I guess.

Collin: Yeah, yeah. That's a big challenge.

Denise: That's very challenging. I think a lot of people may not even know that vision therapy is something that people with traumatic brain injury can benefit from. So, I'm glad you brought that up. Definitely. It's still a big challenge. But there are people that do improve dramatically because they've done vision therapy. Oh, yeah, I'm having that kind of an injury. Yeah. You mentioned when we were chatting earlier that you had a model that you put all your patients through. Can you tell a little bit about that?

Collin: Yeah. So, I kind of think of it as, well, a few different things. One I would say is like a mindset model. A mindset of how do you, when people come through the door, how are you initially anticipating what vision therapy is? And I used the, the Skeffington model of vision. I would use that model and I would tell people. This simplifies things because what I hear a lot of the time is confusion or, you know, missing expectations or et cetera. I loved using the model because it broke into a simple way to understand how your vision is constructed. And I would emphasize that to everyone. And it doesn't have to just be that type of model. It's just having an actual model and then communicating that with your clinician or with your therapist really on, on how you're perceiving, starting therapy and then going through the therapy with the adult patients. A lot of the. Another big thing that I would do would be to have them journal. Journal pretty frequently, if not daily, at least like, you know, multiple times a week. Because what I noticed was patients, they would put a lot of emphasis on the clinical numbers and on the exam, and I get all nervous and get all worked up. And then what I would see a lot of time is people would lose sight of the big picture and where they started, and they would get very dialed into the little details of the process. And that's where I would encourage everyone. That's what Hanah did. That's what a lot of the long-term patients that I worked with, I had them journal and it really helped because I would just remind them, look back to where you were and look at what you've written. Now look at where you are. So that reflection, I think is really helpful, especially for the adult patient. And then the model that I would do in terms of during therapy and with the tools that we had, there was, I would say, a certain core amount of activities that I would do with everyone, and then there were certain protocols that I would follow with, say, your strabismus patient, your amblyopia patient. But I would, for the most part, I would pretty much do all the same activities with everyone. I found it to be more helpful how we are observing what the patient is doing and whatever the activity may be and then how we communicate with that.

Denise: Yeah.

Collin: So, in terms to generalize the actual therapy model, I would always start off with a basic couple activities. I would hit one on your gross motor capability, your saccadic eye movement, your accommodation, if you're pre presby, your binocular function, your spatial awareness, and then your visual processing information, your ability to visualize and process visual information. So that was kind of the model. And then, you know, I could go into little tidbits into each of those different sections.

Denise: Okay.

Collin: I could dive deeper into that. But I always would emphasize, you know, starting on something basic and then seeing how the patient did. Let's see where we could go from there.

Denise: Okay.

Collin: How we can make it more complex. After they understood why we were doing it, what we were doing, what to place their attention on.

Denise: Okay, well, and one of the things that I was thinking as you were talking when I did my first couple of years of vision therapy, the numbers really didn't change. And that was very discouraging. And at one point, my doctor said, what's your goal here? Do you just want your eye to be straight? Do you want to see in 3D? And I said, well, I want my eye to be straight, and I want to see in 3D. I want everything, you know, and that's the point where we, you know, kind of took a break because I didn't want to do surgery. And when I came back and I tried syntonics, and then I did surgery after that, that's, you know, when everything changed. But thought it was maybe interesting to point out that even though my numbers didn't change, I've been teaching my brain things. Right. During that whole time frame. And so, when I came back to therapy right after my surgery, everything just clicked at that point. And sometimes a matter of figuring out what the missing piece is.

Collin: Yeah. When you set goals, you know, now you got. I just want to reiterate; I haven't done this in two. I haven't been at that office in two years. But we did have that same kind of structure. So, we had a goal sheet that we would give out to every patient, and then that we would track that in terms of. Do you feel it's still, subjectively, do you feel like it's still the same? You know, pick out five goals from this list. We got a backside if you want to put something personal that's not on here, and then track it every, let's say, eight to 12 weeks. Do you still feel the same about this goal? Do you feel like it's improved? Do you feel like it's achieved? I would do the same thing with this symptom checklist. It had, I would say, about 30 different symptoms, you know, one through four (in) severity. And I would literally go down and tally the rows and tally it up on the total and over time, do the same thing every eight to 12 weeks and, you know, continue to make that information available for the patient to see.

Denise: Right.

Collin: So, yeah, heavy emphasis on the track and having the goal track. What are you doing about it? Tracking it and then seeing the progress come along.

Denise: Okay. And that was probably one of the key things. And the people that you saw making more progress. Right. Is the fact that they were willing to track all of that and continue to make goals and continue to just while showing up.

Collin:  Showing up to their schedule of visits. Yeah, showing up because I know life happens. But make it priority one.

Denise: Right.

Collin: And showing up, doing it, going through it.

Denise: Yeah, I think, yeah, very definitely. Can you share some of the success stories that come to mind?

Collin: Oh, yeah. Well, so I kind of already elaborated on my one buddy with the CP that, you know, maybe huge gains. So, he was bilateral amblyopia, alternating esotropia. He was about 20/40 or so at the start. Well, I think actually it was about 20/60 at the start, and then about 20 or so the afters of turn.

Denise: Did you say both eyes had amblyopia? What were you saying?

Collin: Yeah. Bilateral. Yeah.

Denise: Okay.

Collin: So. Yep.

Denise: Explain a little bit for people what that. What that entails when it's both eyes, because I think a lot of people think that it's only usually one eye that's seeing less.

Collin: Well, when you have amblyopia, you could have bilateral amblyopia. There are different types of amblyopia. So, you have strabismic amblyopia, you have refractive amblyopia. The occurrence, you're going to typically see more of the refractive amblyopia. And just one eye bilaterally.  The occurrence of it is just not as high. With the strabismic amblyopia, you know, typically speaking, you're going to be a constant unilateral strabismic. So, you're going to. Your eye that's turned, you're suppressing that eye. And over time, the amblyopia just takes over and you're just not using your eye anymore. I had a patient that came to us, I would say in her mid-50s, if she, if she hears this and I got that wrong. Sorry. And she was a constant left exotrope. And she was hand motion maybe 2400. And then she did about two and a half years. She journaled with me. She stuck it out. She gained control of team in her eyes. And I want to say at the near, she was down to like 20/30 and in the distance kind of the last time I was there, right around the 20/80 to 20/100.

Denise: Wow.

Collin: And you know, she wrote. I would definitely recommend anyone listening to this go check out Wow Vision Therapy. Check out their YouTube channel or their website or the Facebook page. They do a great job at advertising, but they share a lot of the success stories. And that's where this one patient I'm talking about, she had a lot of different successes.  I actually challenged her not only in the therapy room, but I challenged her to get out and to pick up a different hobby in life that was. She was a professor. So, you know, all vision at near point and that. She was a professor and then she was doing visual therapy, and that was it. So, I'm like, okay, so what's your behavior besides just this visually? And she ended up going to the batting cages. She ended up doing archery. She went on a vacation, I think in Scotland and hiked a mountain right off the coast. One of the successes that she talked about was she played piano and you know, at some point during the therapy, all of a sudden realized that she had a whole left side of her body.

Denise: Well, that improved her (playing). Is that what you're saying?

Collin: Yeah. Yeah. Well, and you start to hear the. I don't know, I just would get so excited when the people would go through these things, through therapy and, and then pull out all these different aspects in their life that brought surprise to them and excitement, enjoyment. I thought that that's what it was all about. That to me is what healthcare is all about.

Denise: So those were activities that she wouldn't have been able to do prior to the therapy.

Collin: I don't think she probably would. No, I don't think she would have gone out and done archery. But I emphasize, you know, you have to actually go and do something that involves you moving around in free space. Kind of get back to the, the Skeffington model of, you know, where am I, where is it and then what is it? And I take all that information and put it into higher cognitive speech and communication. That's what the Skeffington model is. And that's, that's how I see in her scenario is like, okay, well, your behavior on a day-to-day basis is reading, teaching, and then coming here, right? And at what point in your everyday life are you putting your attention on? Okay, so like where, where am I and what is telling me where I am in this three-dimensional space? And then where, where are these things in relevance to myself? And then. No, everyone wants to go when they get into vision therapy, everyone wants to tell you about the little detail. And I didn't care about the little detail, okay, because the little detail is super easy to suppress and won't lead you anywhere. And I'm really, right now, I'm really in depth talking about strabismus and amblyopia because that's what this pertains to. And everyone wants to hunt for that detail, that little, little detail. And there's a big old world out there. And you know, we just bubble ourselves into these small spaces and that's not. You  gotta do something different with your vision and your visual behavior.

Denise: So get out of the (box). Is what you're saying.

Collin: Yeah, get out of the world. There's a big old peripheral world out there.

Denise: Okay. Yeah, well, that's one of the things that Melissa mentioned too when she was on, is that whole peripheral awareness that once you do that part, then all the other stuff becomes easier. That's why she wrote that course on Mastering Periphery because, you know, that was a big deal to her.

Collin: Oh, yeah. That's what her and I talked a lot about. And seriously, like a ten of 10 times, everyone would come through that door and they would tell me, this is hard, and they would want to tell me all about the little detail. And I abandon all of that. And let's not talk about anything detail oriented. Let's get down to the basics of discussion. And it kind of sounds. I think it's a little bit awkward when you're standing there talking with an adult and you're going over all these, like, philosophical, like discussions of space and time and orientation. But II wasn't joking and I would be serious about those discussions because that's the type of insight and attention that I would see a big benefit for the patient.

Denise: Okay, excellent. Was there an exercise that you would do with pretty much everyone that you could share with us today? Like someone wanted to go try it. Is there something.

Collin: Yeah, there. Well, okay, so I think in, like, categories, if we're specifically talking about strabismus and amblyopia, back to the whole protocol thing. There's a whole protocol that you gotta follow. And you first have to address suppression. And it's a trackable adaptation that. It's a active adaptation that your brain is making to suppress an image because your eyes can't team it together and formulate a unified image. So, it's an active process and it's a trackable improvement or a trackable, you know, to stop suppressing, to get rid of the suppression and to learn how to not suppress an image that's trackable. And you start it. You start with, what material are you using and at what distance are you doing in that? So, the brain, you know, red and green, the color, that would be like a level of how easy or difficult it is to suppress an image. There's different materials to it. The distance at which you are suppressing versus not suppressing, that's all trackable information. So, I would have heavily emphasize in the front end turning both eyes on and getting through the suppression, because there's no point proceeding in the therapy if your tendency is to suppress and neglect an age. If a patient, if they can't achieve the simultaneous with respect to one certain diagnosis,  The intermittent XT divergent excess patient, they go into a reverse order. They'll typically come in with some stereopsis, they'll start to struggle into the flat fusion aspect. And the simultaneous perception is very difficult. And how you can visualize that in a symptom or how you can, you know, how you can see that in symptoms is going to be, you know, they can team their eyes generally in the morning or at specific times of the day, but when they're tired or fatigued, all of a sudden you see the eye turning way out and losing control of it and not being aware of that happening. So that's the reverse order, but for the most part, 99% of the time, you're going to be doing the anti suppression, getting both eyes to recognize and then, then it's all, that's the best part of it all is coordination, how to coordinate them together. Right, well, how to coordinate them together, use them.

Denise: And that was tricky in my case because when we turned the eye on, I started to get some double vision. We were trying to avoid double vision and. Yeah, now I gotta figure this part out.

Collin: Yeah, well, and, and I'm just gonna be blatantly honest because I don't work in the field anymore. I don't have a boss.

Denise: Yeah.

Collin: But it, if I were back in it again, I would, I, I would encourage everyone not to fear the double vision as clinicians because I would hear a lot of clinicians and their, wow. Their hesitancy with turning double vision on. And I would challenge that because you can turn double vision on in the therapy room and you might be able to turn it on outside the therapy room.

Denise: Right.

Collin: But you can pretty quickly pick up on how easy it is for an individual to turn it right back off. And  I would be a betting man to say that there's not, there's probably, you know, less than a handful of people out there ever that have gotten stuck with double vision. Never been able to do anything with it. That's when I did it for seven (years), I met a lot of people and talked to a lot of people in vision therapy for, you know, seven years or so. And I never heard of someone who couldn't, who had intractable diplopia, who couldn't do anything about it.

Denise: There's a lot of people that say that on the Facebook groups, though. I've seen it several times. People have said, oh, I have double, permanent double vision is the word they even use. Yeah. And it makes me really sad. I can't imagine who told them it was permanent, why they think it's permanent, and how that could even be the case, really, you know.

Collin: Well, double vision is confusing. Yeah, I know. Like, I mean, even a lot. Like  I, we would hear, you know, here and there, you know, everything that we're seeing and we're testing and we're going through says this person's getting a lot better. But they're telling us they're still struggling like crazy with double vision. And then we get into the exam room and they're telling us double vision, and we're like, okay, cover an eye. Still double vision. So, there's different parts that go into perceiving the double vision and the confusion that comes with it. It might not be a binocular, you know, mismatch.

Denise: Okay.

Collin: Yeah. I mean, anyone that, that has again, back to language and discussions with people. Talk to people, and if something doesn't make sense that someone is saying, then find another person to talk to about it, because there's probably someone out there that does understand it and will be able to help you out.

Denise: Yeah, that's what I encourage people to do when I'm on the Facebook groups, too. I say, hey, you know, I wouldn't just listen to one person. And most of my guests have actually had the experience of talking to multiple people before they find the person that's actually able to help them, because they may not see the right kind of doctor or even the right doctor in the field to get to where they need to be.

Collin: Yeah, I was on the two different Facebook pages. I think it was like, vision therapy, parents unite, and another one. Or I was on it for a little bit, and after a while, I just couldn't take it anymore because it just was like, oh, just cut. Just go find your local office. Because this is a hodgepodge of diagnosis and opinions just being thrown around all over the place. And, you know, you have to go through a comprehensive vision evaluation. And there's what, 16, 18 different tests just in the exam room, and then continue that and go to an assessment of visual processing. That's where you're going to go through, you know, like I said, the visigraph with the saccadic eye movement while you read. And you're going to go right down through all these different tests for visual processing that's going to actually give you a comprehensive report of your vision. And then someone who's certified, someone who's dedicated to vision therapy, who has a good track record of helping patients say that's what you need to do.

Denise: I agree completely. So did you ever discuss with your patients nutrition or any other wellness factors that would impact their vision when you were a therapist?

Collin: You know, sleep, nutrition, exercise, the, the three. That's the extent of what I would tell everyone. And I would, I would be blatantly. Because I would want the same type of respect from all of the other players in healthcare. You know, I don't necessarily know. And I think adults have a big problem with not being right all the time and not knowing things all the time and being vulnerable and that's okay. And just being. I'm all about being honest. And so, you know, I would, I would be honest with people and say besides just telling you that you need to have a good nutrition, a good sleep routine and some routine exercise, you know, I couldn't tell you much more than that. But I will go with you. And I did do that. I will go with you over to the physical therapist. You know, I will go over with you to the speech therapist. You know, I want to work with these people. I think that we could all get further as a healthcare field if we were to take that type of mentality for sure. But I'm so optimistic for vision therapy. With the technology improvements, I think vision therapy now more than ever can just explode. I don't know if you've seen the most recent thing that I had seen was like the new Apple, the VR headset that they're coming out with.

Denise: Yeah.

Collin: Wildly expensive, but I'm so interested to know like the retinal scans with that because that the back to this visograph thing is like this old. You know, it looks like goggles that you would wear in a scientific laboratory. And it just, it looks so janky and half of the time, like the alignments wouldn't work. Seeing that to now seeing things like that Apple headset come out. There's so much possibility for, for the technology improvements. I mean, even when I was there, just seeing the improvement over that duration from the Vivid Vision we, I think halfway into. When I was there, we got an Optics Trainer. Yeah. So, the, the retinal scan aspects of it have drastically improved and I think are just going to continue to improve. You know, same thing with. You're just getting a lot more. Different targets, different variations of, you know, to keep attention. Burnell. It seemed like they would come out with new and new things every year. That was fun. It was fun to see, you know, new stuff to look at. There's stuff to talk about. Yeah. So, yeah, I'm very optimistic that, I mean, vision therapy is going to continue to grow and reach more people. And I think technology is a big part of that.

Denise: Okay, for sure. Definitely. When people finish their vision therapy in the office that you worked at, did you give them follow up types of things to do to kind of maintain where they were? What did that look like?

Collin: Yeah, I, I would say it's a case to case dependent. You know, some people, they would, you know, at the end of it they would have zero symptoms. They would have no prism in their glasses,, no crutch, nothing. They'd be out riding a jet ski in the Gulf of Mexico and it's like, you know, come back in a, come back in six months and then after that come back in a year or two years and then if you know everything's still hunky dory, then I think you're pretty much good at that point. There were some that maybe needed a brush up once a week, twice a week and then some that, you know, that it’s not just going to happen in a year or two. This is where we started and this is where we got to. And then here's the tools that I wanted you to continue with and continue tracking and practicing along with those, you know, routine six-month check ins. Yeah, but we never would have someone leave that wasn't confident about leaving. We were always there to be a resource for continued improvement.

Denise: Right. So, you're kind of telling me it just depends on the person, right?

Collin: Yeah, yeah. I mean and I, I was big on the homework stuff, so I think it all has to do with the tracking. So, no one wants to do something repetitively that they're not seeing improvements from. What a big life challenge. It's like, okay, so I've been exercising and working out for six months and you know, it's great. But now like, you know, how do I challenge myself or what's the new fun thing to do about this while continuing to do it, it's just keeping your attention on something that is so repetitive.

Denise: Yeah.

Collin: Do I necessarily think that like Sue Barry, she, she talked about how she would keep, you know, a Brock string with her or keep, you know, little tools with her and practice like every morning or what have you. And if that's what it takes, then by all means. Yeah, so yeah, I would definitely varies. The big challenge is how do you keep your attention on it as I, I'm sure that you have experienced.

Denise: Yeah, for sure.

Collin: Yeah. So, I think physiological diplopia. Because getting back to diplopia, it's such a confusing thing. How do you make sense of it?

Denise: Yeah.

Collin: Where do you even start.

Denise: And for people who don't know what diplopia is, that's just the fancy word for double vision, right?

Collin: Yeah, yeah. Double vision, Yep. I think one of the things that I would do most frequently is play with my eye alignment, change my eye alignment in free space to create double vision. And then I would, you know, ask myself, all right, which aspect, which image? If I do this feeling, how do the images change? The physiological diplopy aspect of it is like, you know, if I see one up close, Now I'm seeing two of my iPad in the distance, or vice versa. Now I'm seeing two pens because I'm looking at my iPad, and I would find myself doing that, like, quite frequently a lot of the time in my car with a windshield. A windshield is such an easy thing. Wouldn't recommend it while you're driving. But if you're sitting in a parking lot or you're a passenger or something, you know, you can fixate on something up close on the windshield. And then, it's all about that simultaneous awareness, not the sequential thinking, but simultaneously, okay, this is what I'm seeing here. And then what am I perceiving elsewhere?

Denise: Okay.

Collin: And tapping into that awareness. So, I think just alone, what I just described is a huge part of learning how to control your eyes and how to team them together. You don't necessarily need, you know, a fancy Bernell target or a VR headset to do that. You can start to do that when you're sitting on the bus and you got the rows of the handrail things. And when you're looking at one up close and they're splitting off in the distance, you know, you can start to teach yourself all about your vision.

Denise: Yeah.

Collin: One eye can see a little bit better than the other. That's going to always be a thing.

Denise: Yeah. I've noticed there's a certain distance that I'm. I have a tendency to see in double vision. See double in. And it's. Trying to think how many feet it probably is maybe 50 ft away. And so probably around 50. Yeah. And so, I try to just in that moment think, okay, well, where's my periphery? You know, to kind of relax my periphery a little bit, because that was kind of one of the magic things that I learned when I went to the COVD meeting. Right. And that seems to just kind of relax things a little bit enough that I can pull it back together and not have the double vision at that distance. So that was the distance that was most problematic during my therapy.

Collin: The distance.

Denise: Yeah, that particular distance. Not like even far distance. Wasn't in double.

Collin: Okay.

Denise: Just that particular distance. And so, when I see it again, I'm thinking, okay, I need to review whatever I learned before I need to do some of my exercises. I need to kind of focus in again on what my eyes are supposed to be doing.

Collin: Yeah. Well. And okay, so here's an interesting. You know our eyes are separated by a distance. Right. All vision at any distance in space is convergence.

Denise: Yeah, Right.

Collin: And that's something that when I first started working, it seemed like everyone, all you got to do, you gotta work on convergence with exotropia or CI, and you gotta work on that. You gotta work on divergence for your et, for your esotropia or your esophoria. And sure, there's the. The kind of. The protocol of like, you know, the eso. How do you perceive space? You know, are you short on space? Are you thinking sequentially? That's a very ESO centric type of thinking. No, there's definitely those constructs of one versus the other. However, getting back to what I said, all binocular vision is a convergence of your eyes at any point in space. It doesn't matter if it's 20, 50, 100 ft in the distance or 18 inches in front of your face, your eyes are still having to converge.

Denise: Yeah.

Collin: And mechanically speaking, that's what I would emphasize. I'm like, okay, divergence, yeah, sure. But that's. We're not going to sit here and practice diverging ability and expect you to have control over your eyes team. And you're going to get that from your ability. Ability to converge your eyes on target regardless. So that was one of the things that used to drive me crazy. But the other thing I was thinking of. I gotta look, I forgot what the name. I have this book. I was fascinated by the doctor who wrote it because he talks about all that has to go into periphery and space. A lot of things that I learned were actually from him. The Shape of the Sky.

Denise: The shape of the sky. Okay. Yeah.

Collin: Took me a second. It's been a while. Yeah. Dr. Cook. That's what it was. Shape of the Sky. Wow. I would 100% recommend that book. That was. That was a great one. And just have patience with it. Have you read it?

Denise: I have the book. I haven't read it yet.

Collin: Oh, shoot. It's a good one. It's really good. And if you ever get the opportunity to hear Dr. Cook talk, just. Wow.

Denise: I met him at the conference.

Collin: Yeah. Incredible.

Denise: That was fun.

Collin: Yeah. Yeah. He. I can't say enough things about his ability to educate specifically on the spatial strabismus aspect of it. I. When I was doing my interview for certification with COVD, I interviewed with Dr. Hillier, Carl Hillier in San Diego. I think he is phenomenal. And it seems like his emphasis was on attention and vision processing, visual information processing. I mean, as I've had. I bought one of his lectures from one of his COVDs that was, it was great. And I can't forget about the guy who brought me into all of it. Can't say good enough stuff about him. Dr. Fortenbacher. He was a wealth of knowledge and someone who just, you know, day in and day out works to help everyone. So, meet a lot of good people in the field.

Denise: Yeah. Awesome. Do you have recommendations for what people can do at home or. I know you. You're going to recommend that people go in and be evaluated. But what can people do at home?

Collin: Yeah. I would start to build, build your toolbox. Some of the things they're not in a crazy amount of money to get some of the things you can find online. Some of them you can find. So, like targets, red, green targets would be probably a big one. And I would always emphasize having a plan with your optometry, with your developmental optometrist. But you know, on your say, break time or on your home therapy, I would build, build the toolbox, have lots of red, green targets. Well, here's, here's one that I actually loved and I, I learned how to do it and I taught it was. I put it into part of our sports protocol, taught a couple of different teenagers how to juggle.

Denise: Okay.

Collin: Which if you, if you think about juggling, it's actually, it's so much of a visual activity. So, when. And it's all gravity. Again, this comes back to the whole Skeffington model. But you throw a ball up in the air, it makes an arc and then it comes back down. Right. And visually speaking, you could. If you're not the one, if you're just watching an object be tossed, well, you're still having to fixate on that target and pursue it. So, you're still. There's part of an ocular motor portion of that and they accommodate of that, you know, seeing it clear, the feedback to your brain. And then what I loved about it was the timing because it incorporated all of that, it incorporated actually physically doing something with your body coordination and then the, the, the visual information, the sequential, the visual. Sequential memory, you know, plays A role in that, and I think that's a big part. I loved visual sequential memory, but, yeah, all those different skills are wrapped in. Into, you know, acting like a clown. Juggling.

Denise: Yeah. But I have.

Collin: That was one that people.

Denise: I've tried to teach myself to juggle, and it's very challenging.

Collin: Yeah.

Denise: For me. Yeah, yeah.

Collin: Yeah, it is. It's very challenging. And I started off just doing one and then timing it, so I would throw one, and then the other I would throw when my first one got to the peak, and then. And then I started to, you know, incorporate three and trapped it countless times. Very frustrating. But eventually, it's just like riding a bike. Get back up on there and do it.

Denise: Well, apparently, I need to get back.

Collin: On and do it. You can do it. I know. You can do it. I know. No, you can do it.

Denise: Okay, well, I'll work on that again.

Collin: Well, you'll have to let me know what. We'll have to FaceTime again. You can just show me in real time. Yeah. Okay.

Denise: That's a good challenge. Yeah. I think everyone should take that challenge.

Collin: Yeah. Seriously. I think that should be part of everyone's vision, their protocol.

Denise: That's. Yeah. Excellent.

Collin: Now. Now the challenge is how many people are gonna actually take you serious.

Denise: Well, but that was very serious advice that you just gave.

Collin: Yeah, yeah. It said. Yeah, it was. It was.

Denise: So. And. And why not do something that has the potential to be fun also? I mean. Yeah, that's  excellent. I think it's. Everyone should try it.

Collin: That's. Yeah.

Denise: Yeah.

Collin: Never hurts to do a little clowning. Yeah.

Denise: Do you have any last words for people today?

Collin: Last words. Yeah, dude. I would. My last words to everyone that would be listening is, you're definitely not alone. There's countless people out here who are going through exactly what you're experiencing. It's all about finding the right people to help you out. There's plenty of people out there to help you out. And regardless of how in the moment something feels, regardless of how awkward something might be or how challenging it might be or the stress that you're currently going through, keep at tracking your ability. Keep at working at it, because you will be able to improve. And. And then when you reflect back on it, it is the most beautiful thing. So, the. The answers. The answers. The answers lie within, for sure.

Denise: Awesome. Thank you so much. Thank you for listening to the Healing Our Sight podcast. I'd love to hear from you. If you like this episode, please share it and please join our Facebook community at Healing Our Sight to leave suggestions or comments. Have a great day.