Eye control

We want to enable the person to be able to move their eyes free of the rest of their body in the central zone, and to move the head appropriately when larger eye movements are required.

To reach this goal, we must make sure the person knows what it means to look and is able to easily look where and when desired.

This includes the binocular computing of space so in some cases of strabismus this activity will need to be revisited later during VT.

If the patient has maintained alignment, move as far to one side as possible for them to keep contact.

Hold the wand still and give the patient time for their system to balance. Ask the patient to describe their experience so far.

Move the wand as far to the opposite side as possible.

After their system has balanced, ask them if this is the same or different from the other side.

Remember during this process to be aware of overall posture, balance, breathing, etc. Help the patient to do likewise.

We will move the wand through eight fixed positions.

Continue to hold the wand in close to face & move wand every 4 clicks –up, down, in, and out at random centered in front of each eye.

UP is directly above the left or right eyebrow.
DOWN is directly below the left or right eye below the cheek bone.
IN is on near side of the nose where the other eye cannot see.
Out is as far to the side as it is possible to keep alignment.

The activity is begun standing with both eyes open.

This procedure is done without glasses in most cases.

In most cases use a Wolff wand, but other targets may be used., e.g.,

ET finger

Flashing Penlight with finger

Use what they can/will look at.

A younger or less able person may do better by placing a sticker on their thumbnail.

Metronome on—set at 120.

Begin with the wand held near the midline at about the Harmon distance—Ask the patient to look at the wand.

Look at their eyes and assure yourself there is reasonable alignment.

Bring the wand closer, to about 15 cm while watching alignment.

If the patient has lost alignment, ask if they are seeing double.

If yes, ask if they can change the way they look in order to see single.
If no, investigate why the patient is not seeing double and adjust therapy accordingly.

Make sure that both eyes are open and pointed at the wand, even when the wand can only be seen through one eye or the other.

If there is head movement, ask if they are aware of their head moving.

If so, Can you let your head be still?

If not, place gentle pressure on the crown of the head to increase proprioceptive feedback.

Some use a bean bag to add weight to the head, but this tends to add noise to the process.

If there is body sway, the patient seems unsteady, or they lose track of the wand, it is best to ask the patient to lay supine on the floor.

In that case, gravity is supporting the stability of the body and the patient is left free to look without the need to remain upright and stable against gravity.

Once the patient is successful with the 4 beat pattern, go to 2 beats per fixation.

Once the patient is able to maintain comfortable 2 beat fixations while standing relaxed, add in two more fixation points at about 25 cm directly in front of each eye.

Now we are working in a three-dimensional volume of space.

After the 2 beat pattern is mastered, go to a 1 beat pattern, and then to continuous movement passing through all of the points.

You may go to a circle passing through the fixation points in front of each eye, and then on to a figure eight pattern.

Do not neglect the two added points 25 cm front of each eye.

Home Practice

Hands clasped in the “steeple” position.

Hold hands clasped together, with forefingers extended to form a "steeple“.

Look at the top of the “steeple”.

Move to each of the same 8 positions

Up, Down, In and Out in front of each eye.

It can help to rub the fingertips together to increase tactile feedback at the point where the eyes are to be looking.

Push the boundary to where it seems the eyes are stretching to keep on the fingers, but the picture stays clear and single.

As in the office, begin with the metronome set at 120 and move every 4 beats.

Once 4 beats becomes effortless, go to 2 beats per position, and once successful, 1 beat, and then continuous movement through all 10 target positions.

Do not neglect the positions at 25 cm in front of each eye.

One fun variation is to look at one’s face in the mirror and keep one’s gaze steady, fixing on the eyes in the reflection.

The head is then moved while the eyes remain steady on the eyes in the mirror.

This homework can be done with polaroid feedback as the mirror reverses the polaroid effect so that a suppressed channel will disappear, and the lens will appear black.