Vectograms – A Clear and Single World – Part 1

If we were to ask 100 therapists which activity gives them the greatest amount of trouble, my bet is the vast majority of them would name the vectograms. While I don’t pretend to be an expert, I certainly have been forced to think and re-think them on enough occasions, that I’m comfortable offering my opinion. The main item to keep in mind is the goal the activity. This is true for all activities, really, but especially with vectograms. Remember, when working vectograms, the main objective for your patient is a clear and single target. Period. While there are several other benefits and complications beneath the surface, I’m often reminding my cohorts to keep things simple – or better yet, keep them clear and single. The rest of it, if your patient can get there, is just gravy.

The first piece to consider in a successful experience with a vectogram is the setup. No matter which target you choose or have assigned, your setup will dictate your level of success.  The cards are designed to be viewed at 16 inches (aka – Harmon Distance) and assuming our patient does not have strabismus (we’ll get there in a future post) should be in a relative primary gaze. Of course, there will always be exceptions which are patient specific, but by and large, primary gaze is a safe place to start. The next piece you’ll want to consider is correction. Was your patient prescribed corrective lenses and are they wearing them? Learn from my mistakes. Many of times I’ve been completely stuck on why this vectogram at a minimal level of demand is constantly blurry, only to realize several minutes in we’ve missed one crucial element.  Those glasses aren’t doing us much good in mom’s purse, are they?

As an aside, a reminder for all therapists that the decision to have a patient wear their glasses on a particular activity, or even full-time, belongs to the doctor.  My doctor and I have known each other a long time and she rolls her eyes at me every time I ask if a patient should wear their glasses, but I still ask, just to be sure.  For my money, it’s not an area which permits guessing and I don’t enjoy making careless mistakes.  Sure, your patient’s glasses may appear to be just a simple plus at near, but it’s always possible the lenses were intentionally de-centered to induce prismatic effect and you don’t know it. Agreed, the chances are slim, but my point stands. Better to be safe than sorry.

The final piece in the setup equation is probably the most important for me, and that is the background. Although the vectograms are designed to be placed in a nice holder, like the one pictured above, many of us get creative in how we present the targets.  They can be projected, held in front of a patient as they walk around the office, taped to a window or clear piece of plexiglass, even taped to the ceiling while the patient lays on the floor. Yes, I’ve done it. None of these answers are wrong, per se, but they do create challenges.

Consider this…

An office I used to work in had these great bay style windows overlooking the street below. We were two floors up and the building was positioned just so that the sun never shone directly into the room. It was like a Vision Therapist’s dream location, at least for those who enjoy working vectograms on a window as much as me. The one challenge was the building across the street, which was painted a dark grey, even pewter color. The building was not in a direct line of sight when the vectograms were taped on the window; however, if my patient began to lean ever so slightly to their right, the balcony of the building came into play.  It took about four patients reporting the divergent target, which a moment ago was floating outside, had suddenly flattened out before I decided to stand behind one of them during the activity. When my line of sight lined up with theirs, the issue was obvious. It was difficult to decipher the target from the balcony. Any patient with Visual Discrimination or Contrast Sensitivity challenges will almost certainly struggle as well.

The second reason I’m always aware of the background is simply to open the door for the transfer of skills. Asking someone (who, by the way, is in our office because they lack efficient visual skills) to position their eyes through, past, beyond, or even into a stationary object seems a bit unreasonable, at least right off the bat.  Yes, feeling tone is important and understanding how to control our eyes is part of the process, and we will get there when it’s time. At the start, my preference is to perform divergent vectograms (Base in Only) on a holder which does not have a solid plastic background. This may mean taping them to a window or piece of plexiglass, it may mean disassembling one of the stands in the office and removing the background plastic, or even having a patient hold the cards in the clear plastic slider.  My logic for this, be it right or wrong, is in making the experience more real.  It seems much easier to gauge the appearance of divergence with a target when there’s objects in real space to work with, and in doing so, opens up the opportunity for a patient to transfer their new found skill into their real life visual world.  Asking them to diverge through a solid object doesn’t seem to offer the same opportunity.

So once we’ve thought this through and set up our patients for success, the first words out of our mouths should be…

Stay tuned…

%d bloggers like this: