EXCELerated Vision

Signs and Symptoms of a vision-related learning problem...Teachers need to be on the look-out!

In Michigan, school officially begins the first day after Labor Day. Students are eagerly coming into the classroom and teachers are ready with their lesson plans. The parents have high hopes for their children.

However, some children will be entering the classroom with a hidden vision disability. These are bright children who are smart enough to catch on quickly particularly with verbal teaching presentation yet when given visually demanding reading or written tasks they will begin to have problems. Yes, studies show that about 5-15% of children in the classroom will have performance problems caused by an underlying vision-related learning problem. Teachers need to be on the look out for these signs and symptoms.

What does it mean when a child has a vision-related learning problem?

A vision-related learning problem describes the signs, symptoms and behaviors of a bright child who under-performs in reading and learning due to one or more deficiencies in vision development. These deficiencies in vision development have a medical diagnosis and are treatable with office-based vision therapy.

Even though a child may have normal eye sight (20/20 visual acuity), to be visually ready, a child must enter the classroom with over 15 visual skills essential for reading and learning. These visual skills encompass eye-coordination, visual perception and visual-motor integration (eye hand coordination).

Below are examples of the essential “eye-coordination” visual skills necessary for reading and learning:

Eye teaming skill – the ability to coordinate the two eyes together is called Binocular Vision. A child who lacks Binocular Vision skill will often experience eye strain, fatigue, poor attention and avoidance of reading activities. The child will often experience words over lapping with extended reading, yet will rarely tell their parents that they are seeing double. Imagine how strenuous is would be if while reading you were seeing double.

A common medical diagnosis is Convergence Insufficiency.

 

Eye focusing skill – the ability to focus our eyes for sustained reading as well as shift focus from near to far when copying from the chalkboard requires good eye focusing known as Accommodation. A child who lacks Accommodation skill will often miscall easy words, complain of headaches with reading, tire easily and have poor attention and concentration for reading. The child may complain of blurred vision while reading or will just give up quickly when reading.

A common medical diagnosis is Accommodative Dysfunction.

 

Eye tracking skill – the ability to “point” our eyes on the printed material as well as skillfully move our eyes from word to word and through rows of sentences is known as Oculomotor function. A child who lacks Oculomotor function will typically lose their place easily when reading. They often require the use of their finger to keep their place on the page. The child with poor eye tracking will be much slower in their reading and have poor fluency and comprehension. They will lose attention easily and have difficulty coping from book to paper. It is hard to pay attention what the meaning is when words seem to jump around on the page.

A common medical diagnosis is Oculomotor Dysfunction.

 

When a child has a medical diagnosis in one or more these essential "eye coordination" vision skills, your doctor may prescribe treatment involving office-based vision therapy which may also include prescription reading glasses. With treatment a child can acquire the necessary “eye coordination” visual skills essential for better performance in reading, learning and attention in the classroom.

 

It is important for teachers to be on the look-out for these signs and symptoms. It is equally important, however to be sure to recommend a doctor in your area who looks for these problems in children and will prescribe office-based vision therapy (if necessary) or refer to a doctor who provides office-based vision therapy. One good source to find a doctor is the College of Optometrists in Vision Development. Click on Doctor locator.

 

Dan L. Fortenbacher, O.D., FCOVD

 

Vision-related Learning Problems...parents be aware, 20/20 sight is not enough!

Your child may not be visually ready for school due to a vision-related learning problem even though they have excellent eye sight (20/20 or better). How can that be? Your child's visual "readiness" for learning involves over 15 visual skills. It is very important for parents to have their children's vision evaluated before school to make sure that they have good eye health, eye sight AND to see if they have the essential visual skills that are critical for reading, learning and attention and concentration.

Public awareness is growing for children's vision-related learning problems. August is the National Children's Vision and Learning Month.

Helping to spread the word about vision-related learning problems,  two of the nations top doctors in developmental vision and vision therapy have been interviewed by TV News stations. The following news segments provides vital information to parents.

First, lecturer, private practitioner and recipient of the prestigious the COVD 2008 GN Getman Award, Dr. Carl Hillier from San Diego: Click here to view Dr. Hillier.

Second, private practitioner and Vice President of the College of Optometrists in Vision Development Dr. Carole Hong from San Francisco: Click here to view Dr. Hong.

It is important that your child be tested prior to school by a primary care optometrist who is experienced with children's vision problems. An important question to ask your doctor is, "If my child has a vision related learning problem do you either provide or will you refer me to a doctor who provides office-based vision therapy?"

Dan L. Fortenbacher, O.D., FCOVD

Reading and Attention Problems Found with Common Eye Condition in Children ...A Proven Treatment for Convergence Insufficiency

Parents, teachers and health care professionals should see this video by the National Eye Institute. Too often children with reading and attention problems are overlooked in the healthcare delivery system, labeled with ADHD, learning disabilities and/or behavior problems when instead they have a common undiagnosed eye condition known as convergence insufficiency (CI).

Watch this video and see what the director of the National Eye Institute (NEI), researchers as well as a mother of a child who had CI, have to say. The results of the National Institute of Health (NIH) "double blind" multicenter research project completed in 2008 found that the only proven treatment for CI is office-based vision therapy. Other approaches such as home based remedies or prism glasses are not effective.

Children with CI often have symptoms that can impact reading, learning and attention. After treatment the patient will often show dramatic improvement in reading, learning and attention and concentration for near vision visual tasks.

At Wow Vision Therapy, office-based vision therapy is provided by a Doctor supervised Board Certified Vision Therapist along with vision therapy assistants.  Once successfully treated, the results are life long without the need for further maintenance treatment.

Dan L. Fortenbacher, O.D., FCOVD

David's Story...Binocular Vision Problems can Cause Reading and Learning Problems

When a child struggles in reading and learning it is critically important to have their vision evaluated for not only eye health and eye sight, but also binocular vision. A child who has a binocular vision problem, such as convergence insufficiency(CI) or intermittent exotropia will typically experience reading and learning problems. Study's show that approximately 5% of children in the classroom have CI.

 

Parents should rely only on the advise of  eye doctors who are experienced in working with children. Too often a child with a binocular vision problem will needlessly struggle because of misinformation or lack of a proper diagnosis.  David's story is a good example of a child who struggled for 4 years before his mother found help.

Dan L. Fortenbacher, O.D., FCOVD

 

               David's Story

David was identified with a vision problem by the county vision screening in kindergarten (he failed the depth perception or ball in the box test).  He was referred to see an eye doctor.  David was originally seen by an ophthalmologist and diagnosed with intermittent exotropia in his left eye.  He had 20/20 vision and seemed to have excellent control of his exotropia.  The doctors believed that David would compensate for his vision problems and these problems were believed not to have any effect on his tracking abilities or learning skills.

 

David seemed to be fine in his developing skill set, however, by the end of first grade, he began to struggle.  He started to have headaches and tummy aches before school, when doing homework, and while riding in the car.

 

 David’s struggle continued into second grade causing him to fall further behind in reading and develop a strong dislike for school.  Soon we attended and consulted another veteran ophthalmologist for a second opinion.  Tutoring seemed to help, but still did not seem to solve the problem completely.  The second ophthalmologist again stated that vision was not the cause of learning difficulty.

 

In third grade we were referred to Dr. Seim’s office at Mattawan Family Eye care who suggested that David’s vision was causing possible double & unclear vision affecting not only his reading, but all facets of learning.  She suggested that David see Dr. Fortenbacher at Wow Vision Therapy in St. Joseph for further testing and treatment.

 

THANK YOU … Debra (his vision therapist), Dr. Fortenbacher, and all vision therapy staff at Wow Vision Therapy.  David has now completed vision therapy. He has gained confidence in himself, and no longer dislikes school.  David no longer gets headaches when he reads, plays video games, does homework, or concentrates in the car.  ** David is now a successful 4th grade student currently pulling an "A" in Mathematics, a "B" in Language Arts, and an "A-" in Reading! (Not bad after the public school recommended he not move forward to 4th grade.)

-Terry Elenga, David's mother

Does your child need vision therapy?

Arizona Cardinals' Wide-Receiver and Pro Bowl MVP Larry Fitzgerald Encourages Parents to Take Action TODAY

"The public doesn't realize that you need over 15 visual skills to succeed in reading, learning, sports, and in life. Seeing 20/20 is just one of those visual skills," says Larry Fitzgerald, acclaimed Arizona Cardinals 2008 NFC West Champions' wide-receiver.

During the many pre and post Superbowl press interviews, Fitzgerald, explained that one of the keys to his success was having vision therapy as a child. He had a vision problem that was making it difficult to pay attention in school and his grandfather, Dr. Robert Johnson, a developmental optometrist in Chicago, Illinois, diagnosed the vision problem and the appropriate treatment.

Fitzgerald went through vision therapy under his aunt's guidance, Dr. Stephanie Johnson-Brown, who is currently the executive director of the Plano Child Development Center, a not-for-profit vision care service corporation which was co-founded by her father, Dr. Johnson in 1959, which specializes in vision education and the identification and remediation of vision development problems in children and adults.

According to a report from the New Jersey Commission on Business Efficiency of the Public School, "Undiagnosed and untreated vision related learning problems are significant contributors to early reading difficulties and ultimately to special education classification."

"Vision problems can have a serious impact on a child's education. Don't wait to see if this next school year will be better, take action today!" Fitzgerald encourages parents.

One of the most common vision disorders that interferes with reading was recently the focus of a national study funded by the National Institutes of Health and the National Eye Institute, on convergence insufficiency. This is a vision problem where the two eyes don't work together in unison the way they are supposed to when one is reading. The result can make reading very difficult.

While at least one out of every 20 school-age children is impacted by convergence insufficiency, there are other visual abnormalities to be considered. It is estimated that over 60% of problem learners have undiagnosed vision problems contributing to their difficulties.

The good news is the majority of these vision problems can be treated with a program of office-based optometric vision therapy. The study by the NEI found that in-office vision therapy was the best treatment for convergence insufficiency.

The five most common signs that a vision problem may be interfering with your child's ability to read and learn are:

1. Skips lines, rereads lines
2. Poor reading comprehension
3. Takes much longer doing homework than it should take
4. Reverses letters like b's into d's when reading
5. Has a short attention span with reading and schoolwork

Any one of these symptoms is a sign of a possible vision problem. A more in-depth symptom checklist is available on College of Optometrists in Vision Development (COVD) website.

If your child has symptoms, do not delay. If you are in the region of Southwest Michigan contact Wow Vision Therapy, or to find a doctor in your area who specializes in vision development and optometric vision therapy go the COVD website,www.covd.org, and click on the doctor locator to find a developmental optometrist near you, preferably a Board Certified Fellow. Look for the initials FCOVD after the doctors name.

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

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

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

Convergence Insufficiency impact on Children- In the News

Five to fifteen percent of children sufffer from the symptoms of convergence insufficiency, however many people have not heard about it's impact on children or the parents of these children.

ABC12 News interviewed patients and parents of children with CI in the practice of Dr. Bradley Habermehl, Flnt Michigan. Click here to see this breaking news story about convergence insufficiency.