80% of learning at school is through vision. While seeing 20/20 is very important in maintaining good vision, good vision is not limited to only seeing 20/20 clearly.

Visual efficiency skills are visual habits that allow one to maintain single, clear and comfortable vision at all distances. Usually they develop in childhood. They can also be trained with Vision Therapy even in adults.

Visual skills include but are not limited to eye teaming and focusing abilities; visual tracking skills, necessary for reading and writing, as well as eye-hand coordination. Fine and gross motor coordination also contributes to the development of visual skills.

Visual efficiency skills can be divided into three main groups.

1. Accommodation or visual focusing ability allows us to see clearly at all distances. It allows one to increase and relax their eye focusing ability at different distances, as well as maintain visual focus for longer periods; necessary for reading, writing, or viewing smaller objects at near.

2. Binocular function or eye teaming allows us to comfortably bring our eyes in and out to maintain single vision at all distances. It is also responsible for eye alignment.

3. Oculomotor skills or eye tracking allows us to read and write comfortably and follow the text without missing our place when reading.

A person can have clear 20/20 vision at distance and near but still experience symptoms that can be explained only by deficient visual skills.

Usually visual skills are interconnected; so often one has deficiency in more than one skill. Rarely, we can see difficulty with only one isolated skill.

Children who have difficulties with one or more skills may have symptoms ranging from difficulty maintaining clear visual focus and attention, losing their place or skipping lines when reading/writing up to headaches; dizziness, double vision, blurry vision and eye turn.

Improving visual efficiency skills can be as simple as prescribing glasses to correct a patient's refractive error (nearsightedness: farsightedness or astigmatism), or more complex, using Vision Therapy Training (VTT).

Vision Therapy is a complex progressive program of vision procedures.

- It is performed under doctor's supervision,

- The program is individualized to meet each patient's needs,

- It is conducted in-office, consisting of 30 to 60 minutes sessions once or twice weekly. Often additional vision therapy exercises are given as homework to perform 2-4 times a week lasting 15 mins on average.

The number of in-office sessions is estimated in the beginning of Vision Therapy with special tests. It is called Visual Skills or Efficiency Evaluation NEE). It lasts from 60-90 minutes.

The doctor estimates the number of in-office sessions based on VEE findings. It can vary from 8-12 sessions and to as many as 24-36 sessions but the number can be changed during the therapy depending on the patient's motivation and their progress during therapy.

Sometimes patients may require booster VT sessions once a year or once every two years to boost their skills until they are stabilized. Usually patients require fewer number of booster sessions compared to initial length of VT.

Vision therapy consists of many types of activities that use:

- Special therapeutic lenses, prisms,

- Game activities,

- Computer programs,

- Balance boards,

- Other specific tools designed for unique VT activities

Vision therapy purpose is to develop patients visual skills to help maintain comfortable, clear and single vision. It also improves visual efficiency and ease.

Overall, Vision Therapy changes how a patient processes and interprets visual information. It makes it easier to adapt to changing visual demands.