Season 2 Episode 3, 19 January 2024 (Duration: 0:37:09)

Host: Paul Burns

Paul is back for a second season, this time talking to health professionals and industry leaders. Paul and his guests dive into current thinking on stroke recovery within their respective fields, what’s out there for those with invisible injuries and as usual, he picks up some tips and tricks along the way.

In episode three, Paul talks to senior optometrist Melanie Imlach. Melanie has spent a large part of her career working with people who have neurological conditions that impact vision.

Paul seeks to uncover the ins and outs and what people can expect from behavioural optometry, which looks at how a person processes visual information in their daily life. They talk about how vision therapy can help stroke survivors who have experienced vision changes after stroke, and cover topics from peripheral vision loss to pattern glare.


Announcer: The information provided in this podcast is general in nature and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified medical professional. Hi there.

Paul: My name is Paul Burns and I'm a young stroke survivor. On this season of Smashing it after stroke, I'm chatting with health professionals and industry leaders.

We dive into current thinking on stroke recovery within their respective fields. What's out there for those with invisible injuries and as usual, pick up some tips and tricks along the way.

My guest on the podcast today is Melanie Imlach from Vision One Eyecare. Melanie is a senior optometrist with over 15 years experience and she has an absolute passion for helping people with special needs, such as acquired brain injuries, sensory processing disorders and other developmental conditions.

Today we discuss what behavioural optometry is, how vision therapy can help people in stroke recovery and I learn about pattern glare, which is something I've had post injury but could never articulate it. So please enjoy this chat I had with Melanie. Thank you very much for agreeing to come on and have a chat to me. I really appreciate it.

Melanie: My pleasure, Paul.

Paul: Yeah. So the first question I usually start with is what is vision therapy? And I know it has another name too, doesn't it? And how is it sort of different to optometry?

Melanie: I guess I could say that all optometrists trained together at university and get a bachelor's degree.

Paul: Okay.

Melanie: And from there we all kind of develop our own areas of interest in. And then that guides our choices with our continuing education in the future.

Paul: Okay.

Melanie: So vision therapy was an area that really interested me, and that is generally done by behavioural optometry, although all of optometrists are capable of doing vision therapy. Behavioural optometry will often do a little bit more education in that area out of choice.

So in a normal eye exam, frequently sight is measured on the chart. How many letters can you see on the chart? And then we look at eye health. But vision is actually a very complex process and a large proportion of it happens in the brain. So it involves focusing, aiming and moving the eyes and understanding what we see.

So in addition to carrying out a comprehensive vision eye exam, like all optometrists, we will also evaluate visual efficiency and how visual efficiency function can affect your activities of daily living and performance in life. So we can actually assess how well visual system is integrating with or interfering with other systems such as balance.

Vision therapy is actually learning to control those functions and reprograming those functions so that you can be efficient in the way that you use your vision to do those activities of daily living.

Paul: Is that because, for example, again, speaking from my lived experience, a lot of what used to be on autopilot for me becomes very intentional, I have to think hard about it, which takes my mental energy. So you're basically retraining (I’m paraphrasing here) to make that automatic, as automatic as possible again.

Melanie: That's right. We call that “automaticity”. So converting something from a conscious task to a subconscious task so it can be done automatically and efficiently, leaving your brainpower to get on with the content of what you're actually trying to absorb or perform.

Paul: So vision therapy, is that like a subset of behavioural optometry, or is it the exact same thing? Or how does it..

Melanie: Yeah, it's a subset, that’s a good way of looking at it. So it's a treatment tool. So in our in our toolkit of treatments and ways to help our patients, we have, like all optometrists, glasses and lenses and we can use filters and prisms and we can prescribe vision therapy.

Paul: Oh, okay, cool. It's quite a specific thing, and it's something that I found out by pure accident. How did you sort of develop that interest? What was it about it, that sort of a attracted you to it?

Melanie: As soon as I learned that it existed, I was fascinated by it.

It's a really, really rewarding area for us because we're able to empower our patients to take control over their visual function.

So we don't just fix things that are going on with sight. We actually help patients to learn to control their vision themselves in the way that they use their eyes and use it to direct their movement through the world.

Paul: And I guess it's one of those things, like in my experience, so for those that can't see me on a video, I'm a glasses wearer now and I’ve never had that issue before. And it was one of those sorts of things that you sort of think “oh optometry is slap some glasses on and off you go”.

But it is quite a lot more involved in that, in the vision therapy sphere, and it does give you that sense of, I guess empowerment is a good word. You take ownership of being able to get better.

Do you get a lot of responses like that from your patients? It's like they really enjoy that sort of ownership that they can take?

Melanie: The sense of achievement that we see them experience through the process and at the end of it to see where they've come from. That's what gets me out of bed in the morning. I just love to see that joy that they experience, that they can do this for themselves.

Paul: And what sort of mix of patients do you have? I mean, I know you guys deal a lot with children, but do you find you have a fair mix with children and adults?

Melanie: Sure do, Yeah. So, look, I started off my journey being really interested in paediatrics and children's vision care, and in doing so, you kind of learn a lot about how vision develops in a human being, and it develops with building blocks. So when somebody has something like a stroke, it's like those building block towers get pushed over.

Paul: That's a really good way of describing it.

Melanie: So I've gone from really well understanding a children's vision development and realising that actually this is relevant through all of our lives, not just when we're children, because we all experience things that push that tower over. And so then my patients move from just being children, and also children with special needs such as autism spectrum and ADHD, to patients that generally have had conditions that have impacted the stability of their visual structure.

And it really started for me that that shift when I wanted to try and explore migraine more because I'm a migraine sufferer and I have a lot of visual effects from migraine. So in educating myself through that, I realised the link between vision that was out there. So then I started to move my career towards looking at patients who have had neurological conditions that have vision symptoms associated with them.

Paul: I know we will talk about stroke. But you did mention - it seems like vision therapy can help a lot of different people both adults and children. And you do mention ADHD and autism, you know, so I guess what sort of issues and types of patients do you sort of encounter and how?

Melanie: Often patients are brought in to see me when they've got impacts on their vision from those sorts of conditions. So autism can impact things like sensory integration and vision is the dominant sense.

Paul: Sorry, when you say sensory integration, what do you mean by that?

Melanie: Putting together in the brain the information we receive from each of the senses. So patients that have autism will often have difficulty with that.

Paul: Yes. Yes.

Melanie: We can’t help them with all of those senses, obviously. We only look after vision. But I think it's really important and this is something that I'm very proactive about, and that is every patient that we see that have these special needs, needs to have a multidisciplinary approach to their treatment.

And Paul, I'm sure you would agree with me with your experiences.

Paul: Absolutely. And it's a common thread with what everybody I'm speaking to on this season of the podcast is saying - you cannot treat people in isolation. It needs to be that team approach.

Melanie: That's right. So you will involve GPs, neurologists, physiotherapists, psychologists, occupational therapists, speechies and understanding that vision is a piece in a puzzle. So I'm helping these patients to put a large piece in their puzzle, but I'm not filling the whole puzzle.

Paul: No. You see people with ADHD and I've found in my personal experience, in my unique set of post-stroke souvenirs, I have a little bit in common with some ADHD sufferers, as in my ability to hold attention on anything is a real challenge. And that must be quite a challenge as a therapist to try and get somebody to sit down with ADHD like so how do you overcome that?

Like how do you how do you manage that? Because that must be part of the puzzle as well from a therapist perspective, to get somebody to be able to focus on what it is that you need to focus on in order to get them a good outcome.

Melanie: Well, when we do a vision therapy session Paul, we break it into a handful of activities or exercises that we're teaching our patients to take home and practice. Okay, so let's say that we're giving this child with ADHD four activities and they've got to learn that during their vision therapy session.

And so rather than just running through each of those consecutively without any breaks, we give them time out sessions between each time. So they're allowed to kind of get that out of their system before we draw their attention back to go on with the next activity. So different people have different strategies. So, you know, a stroke patient might need to ground themselves between each activity. So they can calm the system because they become very elevated by the activities that we're giving them.

Paul: Yeah, totally.

Melanie: Whereas a child may actually do something like we have a little mini trampoline in the corner of the room and they might jump on the trampoline between the activities so they can get that out of their system. So it's really recognising what it is that helps the individual that's with us on the day to settle so that we can continue.

And the other thing with stroke and all of these neuro atypical situations, patients have a lot of difficulty sustaining visual attention.

Paul: Yeah. Yeah, totally.

Melanie: And part of the reason for that is because they've lost the connection between their peripheral vision and their central vision and being able to put them together and process them simultaneously.

Paul: Yeah, peripheral vision has kind of become a different experience post injury.

Melanie: Yes. So there’s kind of two categories to that, one is being able to integrate your central and peripheral vision so that you can sort of understand where you are in space, whilst you’re attending to something.

Because if you don't, you feel disorientated, dizzy and off balance. So that's the first area. But the second area that relates to visual field and peripheral vision is visual field. So and this is something that optometry and ophthalmology will always look at with a stroke survivor. And that is, what's happened with their peripheral vision?

So we do a thing called a visual field test, which is done usually at a subsequent visit, and you sit behind a little dish and lights flash up in different places and you have to press a button when you see them. Very commonly, there's a large proportion of the visual space that goes missing during a stroke, and that's called a visual field defect.

And it’s very important that that's tested after stroke and other types of acquired brain injury because it can have an impact on driving and also on many, many functions in life. So one particular patient of mine who had suffered with a stroke and he wasn't able to sit down on the chair. He’d turn around to sit down and he’d miss the chair and he'd fall beside it as he as he lowered his body.

So he didn't have a sense of where he was in space in relation to the things around him.

Paul: Yeah. Okay.

Melanie: So for him I was able to prescribe “prism”, which shifted his sense of centre. And then he immediately, in the consulting room when we practiced, sat straight squarely onto the chair and he was very excited. So, you know, it's such a simple thing for me, but it's life changing for him.

Paul: That's it.

Melanie: And another example I have for you is a lady who was missing the right-hand side of her vision. And she was always dizzy and disorientated. And we worked out that part of the reason for that was that she would always, having had spent her life right-hand dominant, she turned by her right shoulder to move through the world, to change direction.

And of course, that's turning into her blind side. She can't see where she's going, so she's disorientated. So we were able to train her to turn by her left shoulder. And just a simple thing like that changed how she felt on a day-to-day basis.

Paul: Small action, big reaction. And they're the ones you’re after, right?

Melanie: That's right.

Paul: So staying on the brain connection thing for a second. Is that one of the reasons why glary surfaces can be an issue?

Melanie: Pattern glare?

Paul: Oh so that’s a thing? What's pattern glare?

Melanie: Pattern glare is a type of light sensitivity, which can be quite disabling. It's triggered by artificial lights. So it's not so much when we're outside. People always think of glare as “the sun is glary”. It's not about that. It might be, fluorescent lights have a very, very fast flicker rate in them.

And that flickering can cause pattern glare and other things like the sun setting, dawn and dusk. It's flicking between the trees when you're driving. That creates that pattern glare as well.

Paul: I'm sorry, the look on my face because I try to describe this to people, what it's like when I'm out in dawn or walking through the bush or something and glare coming through the trees. It breaks me.

Melanie: Oh, awful. Yeah.

Paul: I didn't realise that was a thing.

Melanie: So some people, yes it's unpleasant, but they've fine. Others it triggers a cascade of their symptoms. So migraine sufferers often get triggered by that. And so do individuals with an acquired brain injury. So patterns of frequency in fluorescent lighting and with the sun between the trees, that's one area of pattern glare, another is with stripey patterns. So if you're going on an escalator in a shopping centre and you know those little silver gratings in the escalators?

Paul: yeah.

Melanie: That creates pattern glare.

Paul: This is ringing so many bells for me, particularly early on in my recovery. We've got boardwalks around where I live and I can't walk on boardwalks if I can see through the boardwalk because again, it breaks my brain.

Melanie: That's right. So that's pattern glare. And it exists even with the right size font, black text on a white background. As your eyes move across it, that can trigger it in a very sensitive individual. So how do we manage it? We go through a special process of selecting a chromatic filter which reduces the intensity of that pattern glare, and then that's prescribed in a pair of glasses.

And often I'll have a patient with different densities of that chromatic filter in their lenses, so they might like a very faint colour through the lens in social situations. And when they're having a bad day, they might have a darker pair or, you know, when they're very symptomatic.

Paul: Okay, if you're wearing glasses with some of those sorts of filters on them, do you actually have to change glasses if you're getting around at nighttime, for example?

Melanie: It depends how dense that filter is in the lenses. So very, very faint filter through the lens is okay in the evenings and in fact can help with some of the house lighting that we’ll have that’s uncomfortable around the house. Yeah.

Paul: Pattern glare!

Melanie: Pattern glare.

Paul: I had no idea it was a thing. Although to be fair somebody may have mentioned that to me in the past and it's gone by the wayside. But thank you for the reminder. I think it's really useful to know for those out there that do suffer and again, it's quite a weird one to articulate to people like “I can't walk on boardwalks. Ah why?”

Melanie: Yes! So now you can explain it. It has to do with the contrast frequency of the grating that you're looking at. Oh that spacing. We did a fit out of our practice. So we've got wooden planks because, you know, it's very fashionable at the moment to have vertical, stacked pieces of wood.

And I was really fussy about the spacing between the planks because the last thing I wanted was pattern glare patients to come in and they’re looking straight at that wall! So yeah, it's very specific, but it is in lots of places in life.

Paul: Okay. I guess, and we probably touched on it a little bit already, but I mean, what's your approach for treatment and what sort of strategies can people expect? But I guess it's one of those questions that if someone walks into a room for vision therapy for their first time, what can they expect? You mentioned some tests and things that you do, or is it so different for everybody?

Melanie: We don't ever jump straight into vision therapy. That's the first thing.

So, so a patient that comes in to see us for the first time will come and have an initial eye examination, which I usually take about an hour in these sorts of cases to do my first test. And from that I’ve assessed eye health and vision and some introductory things into eye coordination and alignment. And I'm also assessing the light sensitivity because that's a very common problem.

Once I've worked out if there is those problems there, then I'm looking to initiate a pair of glasses that deals with those problems. So it may involve a chromatic filter to help with light sensitivity. It may involve prism to shift that sense of centre if they're not very well centred. And of course it incorporates whatever their normal prescription would be, which is I calculate on that day.

So I'm looking to alleviate the most acute, most disruptive symptoms that way. Then we bring them back. We do the visual field test, which I mentioned to you, and sometimes we'll put some drops in the eyes to have a better look at the retina at the back of the eye too. And then usually sort of eight weeks later or so, we reassess to see where their symptoms are at.

And we may consider doing a neuro optometric assessment where we do more tests for visual processing, eye tracking, eye jumping, eye coordination and we're looking to see whether vision therapy would help them. And if that comes back in, I guess the profiling of that assessment, then we would initiate vision therapy.

Paul: Gotcha.

Melanie: But typically, vision therapy takes a number of weeks to help a patient with. And it might be weekly, it might be fortnightly sessions, depending on how much a load the patient can tolerate.

Paul: And what sort of duration and what I mean, I guess, what sort of effort do people typically have to put into it? I guess, you know, there's some therapies out there. You know, I can just go once a week, but, you know, there's some therapies out there. You know, if you're going to do it, you really have to create space in your life to be able to commit to it.

Melanie: Vision therapy is absolutely one of those. It's not an easy undertaking and I never encourage someone to do it unless they feel that they can commit to it and that involves practicing the activities that are set in those vision therapy sessions that I mentioned earlier. So you might be given four activities to practice throughout that week and they might take a total of 10 minutes or 20 minutes depending on how slowly you need to pace yourself.

And I usually suggest that they're broken up throughout the day, rather than all done in one because it's quite taxing.

Paul: Yeah, totally.

Melanie: With children, it's always weekly sessions. That's where we see the best progress. But with acquired brain injury, sometimes we do it fortnightly just because it's tiring for our patients and so usually around 20 weeks is a good understanding of a minimum of what it might mean to help them or 20 sessions.

But you know, I guess people often will go to the exercise physiologist or the physio for a year. You know, that often. So it's similar to other therapies in that way.

Paul: And I guess in the same way a good exercise physiologist or you know occupational therapist or what have you, if you enrolled in a large duration of work, you know, there's good check points throughout that to see how you're going, if it's successful, that sort of.. so I'm assuming it would be the same.

Melanie: So yes, so we conduct a progress evaluation every eight sessions and I’m retesting the things that they were deficient in in their initial assessment. And I'm looking for key indicators that there has been progress and change made.

Paul: And that must be that must be really fulfilling. I mean, as a stroke survivor too, where my memory you know, I often sort of talk about it, my lack of memory in my podcast. But it's... sometimes you forget just how far you've come.

Melanie: That's right.

Paul: You know, or if you need to tweak something in order to get some progress.

So to have those specific and measurable test points where you can go back throughout the journey of recovery therapy, you know, it must be a real, you must again, one of those things you mentioned before, but you must get a real buzz out of people being able to see the amount of progress because it's not always easy to tell how well you are recovering as a stroke survivor.

Melanie: Now, if we took you before you start vision therapy and treatment with your other multi disciplines and then we took you a year later after you've done all those, and if you could see yourself just from point A at the beginning and point Z at the end, and you didn't, you didn't have all the bit in the middle and they just went immediately following one another, you'd be like, “Wow, this is not the same person!”

Paul: Yeah, totally.

Melanie: But of course the progress is gradual, so you don't have that amazing, stunning awareness of how it's happened.

Paul: I always kind of compare it to, you know, grandma and grandpa. When they see the kids. We say the kids every day of the week and you don't notice them. And then, you know, grandma, grandpa might see them, you know, every six weeks. It is like, wow, you kids have grown. And we just as parents don't really quite understand.

But so do you see many clients with invisible injuries? And I might you know, I would classify myself as someone with an invisible injury, because if you see me down the street, you would not notice that I've had a stroke. But do you see many people, you know, stroke survivors or otherwise with these sorts of injuries?

Melanie: Oh, we sure do. In fact, I'm one with migraine because you can't see migraine either. But yes, absolutely. And when you do have these invisible injuries, sometimes you have days where you feel like am I imagining this?

Paul: I'll totally absolutely.

Melanie: And I think I see when I do the consultation that I do and I find the visual dysfunctions that I do. I'm able to validate to the patient this is real for you. And yes, these symptoms have a reason.

And just having that validated can be a great relief and it can be the beginning of starting to feel better.

Paul: It's key and it's really tough to sort of articulate to people. Again, I've used this example multiple times, but when the bit that's been injured is the bit that you use to interpret the world, you don't always know if you've got the correct bead on things.

Melanie: You can't actually measure your own self because the measuring device isn't working. So it's hard to measure yourself.

Paul: Yeah, and especially when it's the end of the day and you're completely fried from a million and one things anyone has to focus on during a day. And you're nodding, have you got something else to add here?

Melanie: I do.

Paul: Yeah, please.

Melanie: I'd really like to share something that's not from me. It's actually developed by a lady named Christine Miserandino. So she has developed something called the spoon theory.

Paul: I love spoon theory.

Melanie: Oh yes. So I don’t know how many of your listeners know about the spoon theory? But it's important to remember that you have a certain tank of energy which is spent on things that you find challenging. So following an acquired brain injury, things like going to the shopping centre, or out for dinner, or scrolling on your phone, or traveling in the car, they can be extremely taxing.

So it's important to pace yourself and you need to determine the energy expenditure quota that you can have in a day and allocate basic activities of living, basic things you need to do every day with a spend. So if you know that, for example driving, being passenger even in a car, is going to take, if I say to you you've got 12 spoons to spend today and you know, you have to go somewhere in the car, forget what you're actually doing at the place you going. The trip itself might take you four of your spoons. And maybe you had a meeting on Zoom, Paul. And that's going to take six spoons today.

Paul: Yes.

Melanie: Right. So you've got two spoons left over today. What are you going to spend them on? Well, you probably can't go out again and do something that's going to take a big spend. So really understanding, pace the week out, plan your high spends on different days so they're not all on one day so that you don't end up in a deficit because a deficit can mean you're whacked for a week and you can't do anything.

So I think the spoon theory by Christine is an amazing metaphor that can help very many people with these conditions.

Paul: Yeah, I agree. And we use spoon theory here at our house a lot. My kids refer to spoons. We always talk about how many spoons Dad's got left and Dad is still learning, even though he's five years post, to really need to keep a spoon or two in his back pocket because you never know when you're going to need one.

Melanie: Especially as a parent, Paul! Kids take unexpected spoons.

Paul: They do, they do! And it is a great metaphor and there's a lot out there written about spoon theory. So I think if anyone is listening and has curiosity around spoon theory, give it a Google. It's a well.. it's a good use of spoons!

Melanie: Yeah, that's fantastic.

Paul: So how does vision therapy, and we touched on this before, like specifically help stroke survivors improve their functions?

Melanie: So I think rebuilding the tower that I mentioned at the beginning, so that is the goals of vision therapy. So that will start with movement-based things where we integrate visual cues with the way that we move, integrating that peripheral and central vision. So the specific activities we can do that simulate life experience that the child will have to develop those skills.

And we use a lot of lenses. 3D eye activities, filters, prisms, balance beams, visual targets, to start to develop those skills again so they can be relearned.

Paul: So I guess, those skills and those equipment that you need. Like you mentioned, balance beams. So is it a case that sometimes some folks that need, you know, vision therapy might have to go out and procure, you know, some small items, or is that provided as part of it?

Melanie: When we do vision therapy, we do provide a small equipment pack. It's not a huge amount of money. It's a few key items that we would like them to have when they're finished vision therapy for maintenance activities. But the majority of what our patients use, we loan to them. So and for example, with a balance board activity, we would loan that balance board for that to be taken home.

And then we have adaptations. So in our room we might use the balance beam, but at home you might use a piece of masking tape on the carpet as a line to follow while you are doing a special visually guided movement along the line.

Paul: How old is behaviour optometry, vision therapy, as a discipline? Is it relatively new, or has it been around a long time?

Melanie: A long time. A really long time. The grandfather of behavioural optometry, Dr. [Arthur Marten] Skeffington, I think there was articles from him back in the forties and fifties, you know, so this is not new. Definitely not.

Paul: Wow, okay.

Melanie: But what is new, I think, is the research and evidence base behind it that's coming through now. So, it wasn't considered to be an evidence-based therapy until very recently. And we're still catching up and getting the awareness out there of the research that there is.

In the medical fields we have evidence-based guidelines for guiding practice and vision therapy for certain eye conditions has actually got the level one top tier gold standard evidence base behind it, because there's been a meta-analysis of research papers to confirm that it does have an effect.

Paul: Fantastic. So, who does refer to optometrists, you know, that specialise in behaviour optometry, vision therapy?

Melanie: There's no referral required Paul, because in our country optometry is accessible and there's Medicare rebates available to it and no referrals required.

Having said that, we do receive referrals and it's lovely when somebody is given us some background information for our patients. So, the frequent places I get referrals from is GPs, occupational therapists, and teachers, they are the most common sources of referrals.

Paul: So basically, when a teacher notices, is something going on in class where a child, for example, may not be able to see - I almost said, see the blackboard and showed my age then. But see the whiteboard.


Melanie: Do you know what? It’s not even a whiteboard Paul, it’s an interactive board these days. There's a computerised thing.

Paul: I’m an IT guy and that still terrifies me, but it's very cool.

Melanie: Yeah, but there's a number of symptoms and behaviours that a child will exhibit with vision difficulties in a classroom.

Paul: Okay. And this is one of my favourite parts of the questions that I often ask, because I did just mention that I am an old IT guy. But so I guess what does the future look like for vision therapies for stroke survivors? You know, is there technology out there.

I know that you've just returned from a conference for a bit of thought leadership. So what's happening in the space? What can people look forward to? What's exciting at the moment?

Melanie: Oh, look, there's lots of research in the field of neuroplasticity. In the past, doctors used to think that after childhood the brain wasn't capable of regenerating and healing its neural networks. But now we know that new neural networks do develop. And this process is called neuroplasticity. So, it's really exciting to think that the brain can heal itself and it can make changes at any age.

There's some great books on the topic written for the public by Dr. Norman Doidge. So, there's a book called The Brain’s Way of Healing, and another one, The Brain that Changes Itself.

Paul: Oh, I think I've heard of that actually.

Melanie: Yes. In any case, it's an amazing amount of work being done to improve the future outlook for patients who survive stroke. And in terms of optometry and what we can contribute, in the past, optometrists would have to get this kind of training on neuro optometric rehab from overseas. But the Australasian College of Behavioural Optometrists is now training, in Australia, optometrists and accrediting for that treatment.

So, it's going to be and is already much more accessible to patients than it used to be. So, it's really exciting I think in general what the future holds.

Paul: Is there any technology coming down the line that is starting to help in your space?

Melanie: In terms of adaptive technologies to help patients deal with some of the deficits that they've experienced with their vision. Yes, a good example is a patient, again, that I was seeing that was missing the right-hand side of her vision. She was, she lost the ability to read because if you think about when you read, you move your eyes towards the right-hand side.

And your peripheral vision of what's on the right guides where you move your eyes. So, if you're not seeing that, you can't direct your eyes along the line of text because it's missing.

One patient of mine had some adaptive technology that she could use. We got for her, which was an assisted e-reader type tag reader pen. So, we rotated the page vertically so we could shift it over into her seeing field.

And then she would run this pen along the lines of text and it would read out loud to her. So she could still remain independent, receive mail, read documents, you know, involved in her medical care. It was really great.

Paul: That is so cool.

Melanie: Yeah. So there are absolutely new technologies coming out to help us with these things.

Paul: How would somebody find a vision therapist? You know, is there a database?

Melanie: There is a database. First of all, there's two sources out there.

We've got Optometry Australia. You can go on there and search for a particular area of expertise where an optometrist can help you and it will give you that option. And the other area which is the Australasian College of Behavioural Optometrists, so very geared up for helping patients with these sorts of difficulties and they're the ones that have run this accreditation process and training.

So you can go on that website as well. So that's ACBO for short, And they will have a list of optometrists that have done this further training.

Paul: This is always the final question I ask. If you had one tip, one take away, one juicy nugget of wisdom that someone, you know, perhaps someone who has had a stroke, that you could offer to them that they can take away and sort of implement maybe and, you know, really sort of get good benefit out of. What could you leave someone with?

Melanie: I would like them to remember that they are not alone. They don't have to give up. There are services available to help them. And once you start with one service, as I said to you, we're building a picture, we're putting pieces of the puzzle back in. Usually a good practitioner in their service will identify that they need another service and they will help.

So it's just a matter of going, reaching out the first time. And from there, if you haven't got help, find someone who will help you and they will be able to guide you to the different disciplines to get the puzzle pieces put in. So you are not alone. You can get some control back.

Paul: Yeah, that's fantastic. And I've found that in my experience sometimes too, is when you do find other practitioners, if you've got, you know, a trusted person you've been working with for a long time, you guys in your sphere of, you know, allied health, optometry, everybody knows everybody. So being able to sort of, you know, maybe it's not an official referral, but just “hey give Joe Bloggs at such and such a call, they’re good operators and they’ll help you out” is worth its weight in gold – or it has been for me.

Melanie: That's right. Absolutely Paul.

Paul: Oh fantastic. I think that's probably a good place to finish. So again, thank you very much for your time. It's been an amazing chat and I think there's a lot of value in it for other people out there. Please, if you feel the need for vision therapy, speak to those that are currently helping you and have a look up at those websites that Melanie has suggested in the podcast.

And yeah, you'll be able to get some additional insight, help. So thanks so much again, Melanie, I appreciate your time.

Melanie: I've really enjoyed talking to you today, Paul. It was great.