EXCELerated Vision

New England Journal of Medicine ringing endorsement of Sue Barry's book and vision therapy

From the latest issue of the New England Journal of Medicine (7-2-09) - Book Review- provides an unqualified and ringing endorsement of Dr. Sue Barry's book (Fixing My Gaze), and of the specially trained and imaginative optometrists who provide vision therapy, in part:

"Capitalizing probably more on latent neuronal connections than on the creation of new ones, Barry benefited from orthoptics — a hidden corner of restorative medicine. With contrived ocular exercises, specially trained and imaginative optometrists treat patients whose eyes are cosmetically aligned but imperfectly foveated.  The simplicity of the exercises and of the apparatus (such as beads on a string, papers taped to walls, and strips of film) is bracing for a profession enamored with technology.

The book’s main contribution, however, is exposing the wrong-headed dogma that acuity and binocular vision can be restored only during a critical developmental period. Surgical correction of strabismus is dominated by this notion, first posited by Claud Worth in his landmark 1903 book, Squint: Its Causes, Pathology, and Treatment, and set at a hard stop at 2 years of age by his student Francis Chavasse. The experiments of Hubel and Wiesel are often cited as confirming the lost malleability of the adult brain, but Barry points out that they did no such thing because there was no attempt at restoration of fusion. Her experiences and those she recounts from others belie the “nothing else can be done” message that ophthalmologists gave to her and to her mother throughout her childhood.

Several visual scientists have now demonstrated the reversibility of infantile loss of vision and stereopsis, but blindness to these findings and under appreciation of the solutions offered by orthoptics still persist."

 

This is one more example of the growing scientific and medical support for office-based vision therapy in the treatment of binocular vision problems like strabismus.

 

Dan L. Fortenbacher, O.D., FCOVD

A Neuroscientist's Personal Story in "Fixing My Gaze"

The bloggers are buzzing with praise for Dr. Susan Barry's personal account of her experience in obtaining binocular vision and the ability to see in 3-D.

Dr. Barry has done what no one in the scientific community has done before. She beautifully writes her own story. This is a must read for all parents who have a child with vision related learning problems or strabismus (crossed eyes).

You can also hear Dr. Barry on this NPR podcast.Click here to listen to a facinating interview.


Dan L. Fortenbacher, O.D.,FCOVD

Struggling in Reading, Frustration with Homework...Using this Summer to Prepare for Future Success!

Does your student miss-call easy words? Does he or she lose their place on the page, often re-reading the same row or skipping rows of text all together? Does your student find it difficult to concentrate while reading and thus avoids reading? When an otherwise bright child struggles, this surely raises a "red flag" in the minds of concerned parents and teachers.

At the time of this post we have completed the first week in May 2009. The school year is winding down to an end. This is the time of the year when the assessment process begins for those children who have struggled in school. Concerned parents and teachers want to know...why is my child having trouble and what should we do to help him or her catch up for next year? Parents often wonder, do we pursue summer school? Do we hire a private tutor? In some extreme cases, do we consider having my child repeat the same grade next year?

These are all valid questions, but speaking as a doctor specializing in vision development for 30 years, it is critically important to ensure that the struggling child does not have a "fixable" vision problem that is holding them back from reaching their potential. In my experience, if a child has a vision problem involving proper eye coordination skill, visual processing or visual-motor integration, it is imperative to address the underlying developmental vision problem as part of the solution to helping that child get back on track academically.

Since the majority of children with developmental vision problems can be corrected in 3-4 months, the timing to obtain help is critical. If a problem is suspected, the child should have a comprehensive vision evaluation. If the child is identified with a problem in binocular vision (eye teaming skill), accommodation ( eye focusing skill), oculomotor skill (visual tracking), visual perception or visual motor integration (eye-hand coordination) it is preferable for the child to obtain treatment during the "summer vacation". This will prepare him or her for a successful school year in the fall.

Unfortunately, when parents "let it ride" to see how their child handles it in the fall, they may be facing an emotional "roller coaster" (for everyone in the family) as the child tries but is unable to meet the visual demands of the next grade level. Too often we see children late in the school year after they have had weeks of frustration. This could have been avoided by being proactive during the summer. The summer is also ideal because treatment can be easier to plug-in to the summer activity schedule. 

What can you do right now? To help parents and teachers recognize some of the signs and symptoms associated with a developmental vision problem Click the following to download an easy to use "Symptom Checklist": Download Developmental Vision Symptom Checklist

Print out the "Checklist" and answer the questions. If your child has a significant number of symptoms graded in the "3" or "4" category, then you should have them tested immediately by a doctor of Optometry who is experienced in children' s vision. If a diagnosis identifies a vision problem that could be corrected with office-based vision therapy, then do not hesitate. Get help for the child over the summer so that when the fall arrives, your child will have the visual readiness skills to meet the demands of the next grade level.

Success in school is dependent on visual readiness!

Dan L. Fortenbacher, O.D.,FCOVD

Is it dyslexia, reading problems, letter reversals...or all of the above?

Visual-spatial integration is the ability of the brain to process visual input to develop an awareness of the body in space and its relationship to other objects. Children who have problems in this area often have trouble with reversals of letters or words, and may be quick to be labeled as "dyslexic." While dyslexia is a general term for a reading disability, spatial processing disorders are specific to problems with laterality and directionality. Laterality is an internal awareness and control of the body, for instance, knowing the difference between left and right. Directionality is the ability to project that awareness into space, for instance, being able to tell someone else to turn left or right to get to a destination. For a young child, laterality and directionality are important in developing balance, coordination, gross motor skills, and awareness of a midline. At a young age, awareness begins to take place through the help of the vestibular system. If gross motor skills such as crawling, walking, and hopping are delayed, fine motor skills become even more difficult to learn.

    As a child grows, spatial skills become increasingly important and essential for tasks such as navigation and understanding and orienting symbols such as letters and numbers. If the child has a spatial processing delay, academic tasks such as reading and math become frustrating, especially when demands are increased from the second grade to third grade, third to fourth, and so on. If a good sense of individual symbol orientation is never learned, there may also be problems with orienting letters within a word. The child who has problems doing this may read the sentence "the dog saw a cat" as "the dog was a cat." Clearly, reading comprehension will become increasingly difficult with demands as well.

    What does this have to do with vision? Although a child may have good eyesight and healthy eyes, his or her brain may have trouble interpreting what is seen by the eyes. These children may struggle in school, especially with visually demanding activities such as reading and math, even though they have no problems with blurry or double vision. In addition to interpretation of symbols, eye movement and alignment requires very fine motor skills. Testing by a developmental optometrist can check visual-spatial integration abilities, as well as other areas of visual processing. Vision therapy for this area includes working with children individually to develop an awareness of laterality and directionality, and fine-tuning fine motor movements to make these skills automatic. For more information on this topic, go to the College of Optometrists in Vision Development website to learn more about vision and learning problems.

Paula Smith, Intern

Michigan College of Optometry

Vision Therapy for Convergence Insufficiency Eliminates Daily Headaches!

Emily was having headaches almost daily, especially in the afternoons at school.  We were very concerned about the headaches and also about her taking so much aspirin.  We had taken her to the eye doctor a year or two ago and she had 20/20 vision.  We decided to take her back to the eye doctor and discovered that she still had 20/20 vision, however her eyes were not adequately working together (convergence insufficiency) or focusing correctly (accommodative disorder).  Dr. Montgomery recommended eye therapy so we made an appointment immediately and began eye therapy with Emily at WoW Vision Therapy.  The headaches stopped after the first week!  We also noticed that she was beginning to read more and for a longer period of time.  In fact, she is now finishing chapter books where as before eye therapy she would read a few chapters and she was done with the book.  Emily is less frustrated with homework, enjoys school more and her reading level has increased.  We are extremely happy with the outcome that eye therapy has had on Emily.  We are also glad that we chose to have her vision checked prior to taking her to a medical doctor for the headaches.  Emily would have probably had unnecessary tests and would still be fighting the daily headaches.  Thank you Jackie and Dr. Fortenbacher!                

Stacy Ritchie, mother

Good Vision as a Set of Skills...Tools in the Classroom Learning Readiness Toolbox

Imagine a situation where an elementary school child, who is a bright little girl and should have no problem with school, avoids reading and struggles to do simple homework assignments. Even worse, she has trouble with "letter reversals" such as "b's" for "d's" or "p's" for "q's" when that type of letter confusion should have ended by age 7. Compounding these problems, copying from board to paper or book to paper takes her 2-3 times longer than other children the same age. This child is becoming frustrated and emotional side effects  are beginning to affect her self esteem.

What is the cause of these problems and what should her parents or teachers do? Does this child have a learning disability that prevents her from learning and needs special services at school?  Maybe she is just not trying hard enough or acting lazy and better discipline will get her on track. Maybe she has ADHD? Perhaps it Is just a problem with her teacher? (After all, this little girl is smart!) Or could there be another cause? Could this little girl have a vision problem?

A vision problem? This seems like a reasonable question to ask. However, in this case the little girl shows no signs of having problems "seeing". She can see a small bird across the playground as well as any other child. This same child loves to play soccer and softball and doesn't seem to have any trouble finding the ball on the field. When asked, she says she has no problem with "blurry" vision.

But, to be on the safe side, the little girl is taken to have her "eyes tested" by the school vision screening and comes back from the test with a "PASS" - 20/20 in each eye. Now what?!

Well, just because this little girl has "detail vision" can we assume that she has the visual readiness skills for the demands of the classroom, reading, paper pencil tasks and effective learning? If a child's eyes are healthy and she (or he) has 20/20 eye sight is anything more required? YES, much more than good eye sight is required for effective learning in the classroom?

Parents and teachers must know that good vision is much like the tools in a toolbox of classroom learning readiness abilities. These are often referred to as vision skills. These skills are developmental and therefore are usually acquired normally as a part of the natural childhood experiences. However, as many as 1 in 4 children in the classroom can have deficiencies in some (or all) of these vision skills placing them at risk of experience learning difficulty.

They are:

• eye tracking skills - eyes following a line of print
• eye teaming skills - two eyes working together as a synchronized team
• binocular vision - simultaneously blending the images from both eyes into one image
• accommodation - eye focusing
• visual-motor integration - eye-hand coordination
• visual perception - visual memory, visual form perception, and visualization

It is important for parents and teachers to not rely on vision screenings that are based simply on testing eye sight alone. 20/20 eye sight (with or without glasses) is not a measure of a child's "learning readiness" vision skills.

The moral to this story is, when ever a child is performing below expected, don't assume that their vision is adequate just because they pass the eye sight vision screening. It is critical that they be seen by a doctor who is trained to evaluate all of the above vision skills and if a problem is identified, will offer office-based vision therapy for the child or refer the child to a doctor will provide office-based vision therapy. This will help a child who needs help acquiring all of their vision skills for effective learning!

For more helpful information click here to go to the College of Optometrists in Vision Development website to learn more about Vision and Learning Problems.

Dan L. Fortenbacher, O.D.,FCOVD

Convergence Insufficiency a Vision Problem that can Look Like ADHD

 Convergence Insufficiency (CI) is a vision problem that affects many children in the classroom. Instead of an eyesight problem, CI is called a binocular vision problem because it affects a child's ability to coordinate their eyes together while attempting to do near oriented vision activities...such as reading! Typically children with CI will see 20/20 and therefore glasses alone will not correct the problem.

While CI has been successfully treated by developmental optometrists for decades with office-based vision therapy, this eye coordination problem that affects as many as 1 in 7 children in the classroom,  has recently been gaining a lot of national media attention. On February 27, 2009 the CBS Baltimore WJZ-TV News reported the story of 9 year old Jana Jones, a bright little girl, yet struggling with CI.

Another common behavior exhibited by children like Jana with CI is difficulty with attention and concentration in the classroom. These children often appear as though they have attention deficit syndrome (ADHD). With appropriate office-based vision therapy, children with CI will gain the proper eye-coordination skills needed for sustained near oriented visual tasks such as reading, computers and homework. This typically results in better attention and concentration as well as reading performance can dramatically improve.

Office-based vision therapy has been proven with scientific studies to be the only effective treatment for CI when compared to all other treatment modalities.

Click here to go to Jana's WJZ-TV story and video segment.

Click here to read the most current research.

Dan L. Fortenbacher, O.D.,FCOVD

How Sports Vision Therapy Can Transform You To An Elite Athlete!

With one of the biggest sports events happening today, Superbowl weekend may have you questioning what you can do to bring your sports performance to the next level of competition.  Arizona Cardinal’s wideout, Larry Fitzgerald has been having quite a successful season and defensive coordinator Dick LeBeau says,” I’ve never seen anybody catching the ball any better than Larry Fitzgerald," It has recently been brought to sports fan's attention that some of the credit goes to his optometrist grandfather who had him doing sports vision therapy when he was younger.

You may ask what sports vision therapy is, and who would be a candidate for such a program?  Sports vision therapy can really benefit any athlete looking to improve their visual skills to an above average level, but specifically those players who are inconsistent in their performance, have concentration issues and are affected by fatigue or game stress.  Although vision is only one of the many components of an elite athlete, one needs to ensure that any underlying visual deficits have been addressed, since they may be the reason a player is not performing to their full potential.  In any sport, an athlete is continually taking in visual information.  Whether it be in response to the ball or other players, the athlete must then process the information and move the body to make the appropriate reactions. The more efficient a player is with these skills, the more successful they will be.

Depth perception, or stereopsis, has also been in the news lately in regards to the 3-D commercials set to air during the Superbowl.  If you are unable to view the commercials with a sense of depth, you may have inadequate binocular vision skills and a decrease in your eye's ability to team together efficiently.  Being able to judge distances, how close you are to other players or how fast a ball is approaching is crucial to most sports.  Even a slight reduction in your depth perception could be the difference between being a good athlete and a great athlete.

Although the goal from sports vision therapy is highly individualized for each athlete, one common goal is to ensure that all the visual processes are making a positive contribution to the athlete’s performance and not creating a distraction.

Sports Vision Therapy may be your answer in transforming your sports performance to that of an elite athlete!

Lindsey Stull, OD

Better 3-D Vision and Vision Tracking..."Super Bowl" results for High School Student- U of M Baseball Scholarship

Better eye coordination and 3-D vision helps improve performance in many ways. Simply put, "track it better" hit it better in baseball and read it faster and easier in school and academics.

Read about one of our 17 year old patients and his success from vision therapy. His name is Cameron Luther. Cam's initial diagnosis before treatment was accommodative (eye focusing)and oculomotor (eye tracking) dysfunction . He presented for a vision evaluation because he and his parents were very concerned about his difficulty with reading efficiency. He was very frustrated keeping his place and concentrating on his reading material. Following 25 sessions of office-based vision therapy Cam has improved in many ways. Here is Cameron's story in his own words:

"Since beginning vision therapy, I have noticed improvements in nearly every aspect of my vision, but there are two improvements that have stood out amongst the rest. They are my reading speed and my ability to track a baseball when hitting.

At the start, my reading speed was not where it needed to be. In my preliminary test, as a seventeen year old, I was reading at around a sixth grade efficiency. This really took a toll on my ACT score, since the test is timed and requires a lot of reading. I knew I was bright and the potential to read faster and score better, but my eyes had trouble focusing. Throughout my vision therapy I noticed steady improvements and by the end, my reading speed and efficiency was at the level of a third year college student. Thanks to this improvement, I was able to reach my goal, and scored a 33 on the ACT.

Last spring (2008), I had had a mediocre baseball season, and I was getting worried. Having just finished my junior year of high school, that summer was going to be my last chance to be noticed by the colleges. As it turns out, the vision therapy which I had originally done to improve my reading, helped a great deal with baseball as well. I felt like I could track the ball out of the pitcher's hand and could read the spin on a curve-ball like never before. As it turns out, I led the Midwest region in home runs over the summer with nineteen, and was offered a baseball scholarship by the University of Michigan! I doubt any of this would have worked out had it not been for the vision therapy.

Lastly, I would like to thank my vision therapist, Dr. Lindsey, Dr. Fortenbacher and everyone at WoW Vision Therapy. You all really made a difference."

Cameron Luther

The Benefit of "Two-Eyed" Vision...The Ability to See 3-D!

A common question asked by parents of children with strabismus ("crossed-eyes") is, "What is my child seeing?"

My answer is, "It is not what they are seeing, it is what they are not seeing".

What the child with a crossed eye is not seeing is 3-D or stereo vision. In other words they are missing out on a quality of vision experience that is often difficult to put into words, but, in general means the ability to see the volume of space that exists between objects in our environment.

Surgery to correct crossed eyes may offer a cosmetic solution to crossed eyes, but surgery alone does not automatically provide the patient with stereo vision. However, office-based vision therapy is an effective treatment to not only help the patient acquire straight eyes, but also develop the brain's to gain the ability to see...3D!

Recently, Joe Palca (childhood photo above) columinist of National Public Radio, covered this in more detail with a personal perspective. Click here to read the article and even better to hear the audio story!

Dan L. Fortenbacher, O.D., FCOVD