Accommodation
Bulls Eye Rock
Letter Focus Chart

Oculomotilities
Continuous Motion Eye-Hand
Flashlight Tag
Marsden Ball

LETTER FOCUS CHART

Equipment: Letter Chart, large and small, tape.

Purpose:

1. Increase accommodative flexibility.

2. Saccadic training

Procedure:

1. Procedure for #1: Patient is seated or standing six to eight feet from the wall. Tape the large chart to the wall at eye level. Patient holds the small chart in his hand at 16 inches at eye level, so the top line of the distance chart is just visible over the top edge of the near card. Patient then shifts focus from near to far repeating each letter, which should be clear before moving on. This is usually done monocularly, unless specifically indicated by the doctor.

2. Procedure for #2: Place large chart at eye level with patient seated or standing. Look at the first letter while being aware of the last letter. Shift the eyes directly to the last letter. While looking at the last letter, be aware peripherally of the next letter down on the first row, and then shift. Continue shifting first to last working your way down the column, always maintaining peripheral awareness before you shift. When you get to the bottom, begin again this time with the second letter in on each side. Continue then with the third and eighth, then fourth and seventh then fifth and sixth.

Central vision is directed by peripheral cues. By being consciously aware of the periphery, the goal is to have the eye movements become more direct and efficient. Vestibular stimulation should be added to this exercise as soon as the patient is able to tolerate it.

Gradations for #1:

1. Increase the distance to the far chart.

2. Decrease the distance of the near chart to the patient's eyes

3. Increase the speed

4. Add rhythm

Gradations for #2:

1. Increase the speed of shifting from side to side, allowing the peripheral expanded awareness to become more automatic.

2. Change your distance from the chart, in some cases further away will be more difficult, in others closer will. Try both.