Screening Test & Questionnaire

This screening grid and questionnaire may be used together to help uncover possible visual issues and eye-teaming instability. They allow allied professionals to quickly determine, with reasonable accuracy, whether individuals would likely benefit from a therapeutic glasses prescription and/or Vision Therapy.

Screening Test

Procedure

Look directly at the X​ in the middle of the grid (do not move your eyes). Does this pattern seem to move, shake, change colour or cause negative symptoms for you?

Common Responses

  1. Yes, very uncomfortable
  2. Not uncomfortable, but unstable
  3. No, it looks fine

If you are an allied professional and have been provided with the screening glasses from our office, put them on your client, and gauge reaction again. View both the grid provided and look around the room you are in.

Common Responses With Screening Glasses

  1. This is amazing, much more comfortable
  2. It’s better, but still somewhat unstable or uncomfortable
  3. No real difference in symptoms or comfort level

A negative or uncomfortable reaction to viewing the grid, or a positive reaction to the use of the therapeutic screening glasses is a strong indicator that an individual would benefit from referral and further assessment. This test requires minimal vestibular, cervical or cognitive input – making the findings primarily visual. This test does not indicate that these screening glasses alone are in any way a long-term viable solution for the visual issues. Use of these glasses in isolation can prolong visual recovery.

Credit: Dr. Merrill D. Bowan, OD

To refer yourself or a client to our office, or to purchase a pair of the described screening glasses from our office, please contact us.

Convergence Insufficiency Symptom Survey

A total score of 22 points or higher is a strong indicator that referral is prudent. Pressing submit at the bottom of the questionnaire will automatically tally your score.

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