Vision Therapy

Factual Questions
1

We have twin sons, one is reading at grade level (they’ll be entering 2nd grade in a little over a month). The other son has always had a difficult time with reading. He’s been in additional reading classes and it’s just not something he’s picking up.

So we took him to an optometrist who’s determined (and demonstrated) that he’s got some problems with tracking. His Visual acuity is fine, it’s a cognitive thing. Losing his place when reading, some letter/word swapping (reading ‘saw’ instead of ‘was’), etc.

I’m wondering what the Dope’s experiences are with the therapy involved here. It’s frankly more money than we have at the moment, and I’d like some kind of feedback on the process. The internet seems REALLY vague with information on this, as if the only information available is enough to get you into an optometrists for evaluation. At the same time, the initial contact stated that they have a 100% success rate. This smells a little funny to me and makes me wonder if it’s a temporary issue that he’ll eventually work his way out of. (I’ve seen similar developmental things where the kids just CAN’T figure something out, then one morning the lightbulb comes on and they’ll never forget.)

2

Optometrist or ophthalmologist?

I’d see an ophthalmologist for a better opinion. Preferably, in your case, a pediatric ophthalmologist.

3

My bad, this Doctor is published in the field and deals with child vision issues as a specialty:

http://www.greatvisionperformance.com

4

Couple of thoughts:

  1. Second opinions are a good thing, even if the first doctor is a widely respected and published expert.

  2. Some vision problems can ONLY be correct when the child is young. If this is a visual processing problem in the brain then waiting until puberty may make it impossible to correct. I have no way of knowing if the problem your child has falls into this category, but it’s yet another reason for a second opinion.

  3. Ask about payment plans.

5

I, too, would move on to a pediatric opthamologist.

When my son was younger, I thought he had vision (and hearing) problems. He was really too young to tell us what was wrong, but he was ‘at risk’ for problems, had retinopathy of prematurity, and I thought he wasn’t quite right, but unsure. (He also had/has developmental delays and a diagnosis of Asperger’s type autism.)

The optometrist was the easiest to to see and sold us glasses.

The opthamologist was more difficult to get in to see, but gave my son a much more thorough exam with several follow up visits to follow the ROP. My son never like the glasses and the op said he didn’t need them.

I was always kinda pissed at the glasses guy and felt like he just took advantage of us.

6

Well, I should also describe the process, My son went in for an initial screening where it was determined that he was visually seeing everything but that there was a processing issue that required further testing. We came back for a very through series of tests and it was pretty obvious something was amiss. He scores VERY high in pattern and individual sight word recognition, but is having issues with words he doesn’t recognize, and losing place on the page when he’s reading.

Part of the concern is: We can dedicate tim for him to work on this stuff over the summer…when he returns to school, he’ll have homework, in addition to vision therapy. The kids were getting 30-45 minutes of homework a night, but it was pretty common for him to go over an hour and you could see him just shut down with work unfinished.

Mom and Dad are having issues with this because part of the work is left on our shoulders to cope with and frankly…we’re not qualified.

7

Vision therapy is great. Our 8-year old had trouble tracking, problems with convergence and flipping letters. He’s had about 4 months of vision therapy and his reading has greatly improved. His doc (pediatric optometrist) thinks he’ll be done in another month.

It’s important to get it done early before he get too far behind in his reading. Our son’s second grade teacher was worried early in the year, but was very pleased with his progress by the end. He will be getting reading tutoring this summer to help him catch up.

It’s also inportant to get a good doc–we lucked out. Another mom said she wasted months with a different doc before she switched to ours and her daughter was making major improvement.

8

He’s still only an optometrist. An ophthalmologist also has a medical degree, and with such can diagnose troubles deeper.

9

Ophthalmologists generally don’t practice vision therapy, although some do recommend it (and many do not.) Optometrists and occupational therapists are much, much more likely to practice vision therapy.

Full disclosure, i’m a fourth year optometry student. There is no problem with getting a second opinion, but you should keep in mind two things:

  1. there are some ophthalmologists who have a knee-jerk reaction against vision therapy, even in cases when the research is clear that it’s beneficial
  2. there are some optometrists who think vision therapy can cure a myriad of ills, and over-prescribe it, regardless of whether the evidence is there or not for the child’s particular condition.

Sorry if that’s confusing. The “vision therapy” thing has unfortunately become part of a professional turf war between optometrists vs. ophthalmologists, so you are probably going to find a ton of conflicting information.

And I wouldn’t say ophthalmologists “diagnose troubles deeper,” – of course it depends on the particular optometrist and ophthalmologist involved. The two professions have different tools in the toolbox for dealing with binocular vision issues. But I really, really don’t wish to derail this thread with that particular topic.

10

I’m still evaluating options (Nice that the A/C for the house went out last night…it never rains but it pours)

Come to find out the boy’s Godfather is a licensed literacy tutor and may be willing to help, so there’s a possible avenue there. Based on him retiring this month, his schedule may open up a bit.

11

FWIW, the AAP’s take:

An optometrist who specializes in this therapy and has published on it and who has not told you that the scientific consensus is that it is hokum and who would charge you more money than you have at the moment? Well …

12

And while we are at it Quackwatch

And the word from The American College of Pediatric Ophthalmology and Strabismus

13

So I guess Ceejaytee is just a liar.

14

Or a subset of the therapy was what was helping Ceejaytee’s child.

15

We did this with our son. He was poor at tracking, and like you said, it was obvious. He went for six or eight months, IIRC (maybe less, I’m not sure any more). They had lots of different things they did involving focusing and tracking.

Before he started, he tested good at reading, but didn’t like it. Now he does like reading, and will read on his own, so from that point alone, I feel it was worthwhile. A lot of behavioral problems they described for kids with problems like his fit him very well, but those haven’t really improved. I was a little concerned going in that it might be a little quacky, but it did improve his actual observable problem.

As far as homework, I wouldn’t worry either way. The appointments and home work are very different from school and school work, and my son enjoyed the appointments, and some of the home work. He was in 5th grade at the time, I think.

Not all insurance covers it, so be prepared for that.

We went to Bennett Optometry, (which obviously you won’t, but in case you’re interested in comparing websites).

16

It is clear that the therapy has helped my son. He is tracking with his eyes instead of moving his head back and forth. He’s making the transition from the board (divergence) to his paper close up (convergence) better. He is much less fatigued when he reads. He will still need reading tutoring to catch up but his teacher, his reading teacher and we his parents all noticed a major change in his reading. He used to lose his place easily, skip lines and transpose words. He couldn’t cross his eyes at all but he can now.

The other parents at the office all see the same improvements in their kids too.

17

Some of the home work:
He had sets of four lenses on a stick, of e.g. +0.25 and -0.25 diopters. He’d read while using the plus side, then after a sentence or paragraph, flip to the minus side, and so forth for 20 minutes. I think he had 025 0.5, 1.0, 1.5, 2.0 and over the course of months worked up to the higher values.
He’d spend 10 minutes with a piece of newspaper, filling in letters like “e”,o", “b”, etc.
He had eye charts he’d have to read from a distance, first with one eye, then another. Sometimes (all the time?) he’d alternate focusing close in, then reading a line from the chart.
He had to follow with his eyes a pencil eraser as I moved it around his field of vision.
He had paragraphs of “words” of random letters, and in order he’d find the first “a”, then continuing find the first “b” that followed, and so forth to “z”. I’d record the time for this.
He’d have word searches.
He had red and green plastic lenses, like 3D glasses, and he’d flip which eye had which after each paragraph.
In the newspaper, draw a line over one letter, then under the next, etc. for two minutes.
I’d put some dry white rice on the table, and he pick up as many grains in three minutes as he could, and put them in a jar.
Watch TV for 30 minutes wearing the red/green glasses, and also use a red or green sheet, alternating every so often (so he’d only be using one eye at a time, I think).

18

I wonder how much of those mental gymnastics helped?

19

I think it should be said that, whether or not the specific treatment regimen being contemplated here works at all reliably, we are not deep in the land of woo here. There are good theoretical, and empirically backed reasons to think that it is likely to be possible to remediate and improve visual function through some form of eye exercise. There is a shitload of evidence that skillfully, cognitively controlled eye movements play a very large role in normal vision, and that the skills and useful habits in question are, at least partially, learned rather than innate. Generally speaking, sensori-motor skills can be much improved by appropriate practice, and there seems to be no good reason why that should not apply to visual skills just as much as to, say, catching a ball.

The problem here, however, is that we do not yet know enough in detail about the issues to be able to say reliably what sort of exercise regime will actually be helpful. At present, people can do little better than guess, and use a scattershot approach of exercising as many aspects of eye movement as you can think of an exercise for. It might well be, however, that quite different exercises might be appropriate for different individuals, depending on the detailed specifics of their visual problem. What works for one patient might be useless, or even, conceivably, actively harmful, for another. (This might explain why Ceejaytee’s and ZenBeam’s sons, and others, might truly have been helped, even though large scale studies apparently show little sign, on average, of any benefit.) Another possibility is that most people reach ceiling, get as good as they are going to get or need to get with the relevant skill, at a fairly early age, after which there is little room for further improvement. A few individuals with particular problems might benefit from appropriate eye exercises, but they are going to be a complete waste of time for most. Unfortunately, we do not yet understand the role of eye movements in vision anything like well enough for us to be able to say who might benefit from eye exercises, or what those exercises might be.

I must say, that the fact that the optometrist seen by Unintentionally Blank’s son has written a book called What Your Bright Child Can’t See does not fill me with confidence. That is just the sort of title that a con man might use to hook gullible parents with the hope that their underperforming child is in fact, underneath it all, the hidden genius they always hoped for, and that the genius will start to blossom forth as soon as they cough up the hefty treatment fees. On the other hand, as Broomstick mentions, for some visual problems there is a relatively short window of time during which they can be successfully amelioated, and if things truly are fixable, and you do not get them fixed soon, your kid may be out of luck. In practical terms, I can only give the advice that several others have: get a second (and maybe even a third) opinion from a real opthalmologist, and follow their advice.

By the way, this Wiki page might be helpful: http://en.wikipedia.org/wiki/Eye_exercises

20

Incidentally, one of my best friends was failing badly all through primary school and in the early years of secondary school, all because no-one had realized that he was badly short sighted. He has told me himself that his problem was that he simply could not see what was on the blackboard. In fact, he is extremely smart, and as soon as he got glasses, some time in his teens, he began to do very well academically. He is now professor of astrophysics at a prestigious British university.