ALS and Vision Problems

When the eyes become the primary tool for communication and daily interaction, the visual system is asked to work harder and longer than it was designed to. People with ALS who use eye-tracking devices, gaze-controlled computers, or communication boards depend on sustained, precise eye movements for hours each day. This intensive visual demand can create significant fatigue that reduces the quality and speed of communication. Visual fatigue symptoms include:

• Eyes that feel tired, heavy, or strained after periods of sustained use
• Decreasing accuracy of eye-tracking technology as the day progresses
• Blurred vision that worsens with extended visual tasks
• Headaches or discomfort behind the eyes during or after using communication devices
• Needing longer breaks between sessions of visual communication

While eye movements in ALS are typically preserved better than other motor functions, subtle changes can develop over time. Saccadic eye movements, the quick jumps the eyes make when shifting between targets, may become slightly less accurate or slower. Smooth pursuit tracking, the ability to follow a moving object, may require more effort. Convergence, the ability to turn both eyes inward for near tasks, can become less reliable. These changes may seem minor in isolation, but when the person depends on precise eye movements for communication, even small changes can significantly affect function. Eye movement symptoms include:

• Slight difficulty targeting specific letters or icons on a communication screen
• Reduced speed when using eye-tracking technology
• Difficulty sustaining focus on near targets during extended use
• Occasional double vision or blurred images during visual communication tasks
• Decreased accuracy of eye-controlled devices later in the day

Communication devices, screens, and reading materials are all near-distance visual tasks. The focusing system, also called accommodation, must work continuously to keep these near targets clear. When visual demands increase dramatically because the eyes are the primary means of interaction, the focusing system can become strained. Accommodative dysfunction, the inability to shift focus efficiently or sustain near focus comfortably, can develop or worsen under these conditions. Focusing symptoms include:

• Text or images on screens becoming blurry during sustained use
• Difficulty shifting focus between a communication device and a person's face
• Vision that takes longer to clear when looking from near to far
• Increased effort needed to keep near targets in focus

ALS can affect the muscles involved in blinking and eyelid closure, leading to reduced blink rate, incomplete blinks, or difficulty closing the eyes fully. When blinking is impaired, the tear film that keeps the eyes moist and comfortable breaks down more quickly. Dry, irritated eyes create visual discomfort that compounds the fatigue from intensive eye use. Maintaining eye comfort is essential for sustaining the visual function that people with ALS depend on. Dry eye and comfort symptoms include:

• Eyes that feel dry, gritty, or burning, especially during prolonged use
• Blurred vision that temporarily improves after blinking or using eye drops
• Redness and irritation that worsens throughout the day
• Sensitivity to air movement, fans, or air conditioning

Some people with ALS develop increased sensitivity to light that makes certain environments uncomfortable. Screen glare, fluorescent lighting, and bright sunlight can cause discomfort, headaches, and increased visual fatigue. When the person relies on screens and visual technology for communication, managing light sensitivity becomes especially important for maintaining function throughout the day. Light sensitivity symptoms include:

• Discomfort when using screens in brightly lit rooms
• Difficulty with glare from windows or overhead lighting
• Preferring dimmer environments for visual comfort
• Squinting or turning away from bright light sources

The visual challenges of ALS involve multiple interconnected systems. Eye movement precision, focusing stamina, visual processing efficiency, tear film stability, and light sensitivity management all affect how well the person can use their eyes for communication and daily function. Addressing one area while ignoring others may bring limited improvement. An integrated approach supports the visual system comprehensively, ensuring that improvements in one area reinforce rather than strain another. For people with ALS, this means building the most efficient and sustainable visual performance possible.

The foundation of our Neuro-Visual Performance Training program is built on four core treatments. These work together to support and optimize the visual function that people with ALS depend on. Each targets a different dimension of the eye-brain connection, and together they build a stronger visual foundation.

Vision Therapy

Often described as physical therapy for the eyes, vision therapy retrains eye teaming, focusing, and vergence skills. Vergence is the ability of the eyes to turn inward or outward together to maintain single vision. For people with ALS, vision therapy strengthens the oculomotor skills needed for precise eye-tracking, sustained near focus, and efficient communication through gaze-controlled technology. Activities are adapted to the person's physical abilities and energy levels.

Perceptual Training

Perceptual training targets how the brain interprets what the eyes send it. It develops skills including visual memory, visualization, spatial awareness, contrast sensitivity, and speed of recognition. For people with ALS, perceptual training helps the brain process visual information more efficiently, reducing the cognitive effort required for visual communication and freeing resources for sustained engagement throughout the day.

Optometric Multi-Sensory Training (OMST)

OMST is a passive rehabilitation protocol that combines light, sound, motion, and touch. It helps the brain relearn how to filter and process sensory information. OMST works while the person rests in a low-demand setting. It allows the brain to recalibrate how it receives and organizes input from multiple senses at once. For people with ALS, OMST is especially valuable because it supports visual processing improvement without requiring physical effort, making it accessible regardless of the person's motor limitations.

Optometric Phototherapy (Syntonics)

Syntonics uses carefully selected wavelengths of light to stimulate and balance the visual system. It helps regulate the autonomic nervous system and reduce light sensitivity. By targeting specific neural pathways, syntonics supports overall visual processing and can improve peripheral vision awareness. For people with ALS, syntonics helps create more comfortable visual conditions that support sustained use of eye-tracking and communication technology.

In addition to our core treatments, we draw from a range of advanced tools to build a program tailored to the specific visual needs. No two patients are alike, and the combination of visual challenges varies based on the stage of the disease and individual factors. We access every tool in the toolbox to address the unique combination of needs. The combination depends on the evaluation results and the visual demands most critical to the person's daily life.

• Prism lenses to shift images and reduce strain while the brain retrains, like training wheels that support progress toward independent function
• Moisture chamber glasses or targeted dry eye management to maintain tear film stability and visual comfort
• Red light therapy to reduce neuroinflammation and support cellular recovery in brain tissue
• Screen and lighting optimization recommendations to reduce glare and visual fatigue during communication device use
• A large interactive screen system that trains eyes, hands, brain, and body together in real time
• Guided light-and-sound relaxation to calm the brain and support neural balance
• Vagus nerve stimulation to help shift the body from a stressed state into calm, focused function
• Home-based software to reinforce perceptual and focusing skills between office visits

Treatment involves regular in-office sessions along with home-based activities adapted to the person's abilities. Sessions are guided by a trained therapist and designed to work within the person's physical limitations and energy levels. The combination of treatments is tailored to the specific visual skills that evaluation identified as most important for the person's communication and daily function. Many patients and families begin to notice improvements within the first several weeks, often starting with reduced visual fatigue, more comfortable screen use, and longer periods of effective communication. Progress is measured through objective testing so the care team and family can track the changes taking place.

We understand that not every family lives close enough to attend weekly appointments. For families traveling from out of state or internationally, we offer an intensive 12-day in-office program. This delivers concentrated treatment over a short period. The process begins with a remote consultation and review of the person's history so the care team can plan before you arrive. During the intensive, the patient receives multiple sessions per day combining vision therapy, OMST, syntonics, and other modalities. After the intensive, the family continues through a structured remote program. This includes guided exercises, virtual check-ins, and home-based tools to reinforce the gains. This approach allows families from anywhere in the world to access our full integrated program.

The reason this integrated approach works is neuroplasticity, the brain's ability to form new neural pathways through targeted practice. Think of it like learning to ride a bike. Once the brain builds a new pathway, that skill becomes automatic and enduring. The same principle applies to the visual skills that people with ALS depend on for communication. Through consistent, guided training, the brain creates more efficient routes for processing visual information and controlling eye movements. These are not temporary fixes. They are structural changes built to support the highest possible level of visual function for as long as possible.