Optometry & Visual Performance 132 Volume 14 | Issue 2 | June 2026 jerky pursuit movements. External and internal ocular surface examination were unremarkable. Based on the poor MAF and BAF, low NRA, low esophoria at near, and low MEM results, the patient was diagnosed with accommodative excess.14,15 Based on poor eye movements, she was diagnosed with oculomotor dysfunction.14 Based on the increased symptoms during VOMS, she was diagnosed with vestibulo-ocular dysfunction.14 Optometric vision therapy (OVT), which included accommodative therapy (lens sorting, lens rock, Hart chart, binocular accommodative rock), oculomotor therapy (Brock string, tranaglyphs, vectograms, wall saccades, computer HTS program), and vestibulo-oculo reflex exercises, was recommended to help relax the accommodative excess; improve her fixation, saccadic, and pursuit ability and accuracy; and reduce symptoms. She completed 10 weeks of inoffice optometric vision therapy with 30 minutes of daily home exercises. Vision therapy protocols, based on Scheiman and Wick13 and Scheiman and Rouse,14 consisted of 10 inoffice sessions (40 minutes each) and 30 minutes of daily home exercises. The patient reported improved visual quality after seven sessions and greater comfort with reduced fatigue upon completion. Final outcomes are presented in Table 2. Notably, the monocular and binocular accommodative facilities were improved to 15 and 14 cpm in the OD and OS, respectively. Additionally, the NRA increased to +2.25 D. She used spectacles primarily for driving and prescription sunglasses outdoors. Although she did not return to skating, she successfully enrolled in two academic courses, reported easier reading, and her BIVSS score improved to 31 (59%), with only occasional mild headaches. Case Report 2 A 20-year-old female basketball player sustained a concussion with a concurrent neck injury in 2017 after falling backward. She remained conscious, was hospitalized briefly, and was discharged the same day. In 2018, she reported persistent severe headaches, and MRI revealed gray matter changes. Following physiotherapy, she was cleared to resume sports but experienced a second concussion during a game, leading to disorientation and withdrawal from athletic activity. Post-injury, she was diagnosed with Ehlers-Danlos syndrome, attention-deficit/ hyperactivity disorder, and postural tachycardia Pre-treatment findings Post-treatment findings Right eye Left eye Right eye Left eye First visit since the last concussion 2 years (2021) Previous treatment glasses, PT, CT, medical treatment Uncorrected VA LogMAR 0.52-2 0.4-2 0.5- 0.10 Habitual prescription (D) -1.00 -0.50x170 -1.00 -0.25x010 -0.25 -0.75x175 -0.25 -0.50x010 Cycloplegic refraction (D) pl-0.75x175 -0.25 -0.50x030 Corrected VA 0.00 0.00 0.00 0.00 New Rx for distance (D) -0.50 -0.25x165 -0.25 -0.50x010 CT (dist, Δ) ortho ortho CT (near, Δ) 2 esophoria 2 exophoria Associated phoria (distance, Δ) No prism Associated phoria (near, Δ) No prism AC/A 4/1 NPC (cm) TTN TTN AOA (D) 8 8 8 8 BAF (cycles/ minute) failed + 11 MAF (cycles/ minute) failed + failed + 15 14 MEM (D) plano plano +0.25 +0.25 NRA (D) +1.00 +2.25 PRA (D) -2.75 -2.50 Vergences (distance, Δ) BI: x/8/6 BO: x/20/18 BI: x/8/6 BO: x/20/18 Vergences (near, Δ) BI: x/10/8 BO: x/35/30 BI: x/10/8 BO: x/35/30 VF (cycles/ minute) 13 13 KD (years of age) 10 14 BIVSS 75 31 VOMS increase in symptoms VOR & visual motion No increase in symptoms reported Saccades (Maples) Head movement: 3 Ability: 4 Accuracy: 2 Head movement: 5 Ability: 5 Accuracy: 4 Pursuits (Maples) Head movement: 2 Ability: 4 Accuracy: 2 Head movement: 5 Ability:5 Accuracy: 5 OVT sessions 12 recommended 10 sessions completed Table 2. Summary of the Visual Evaluation Findings Before and After Vision Therapy (Case 1)
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