EXCELerated Vision

Research finds office-based vision therapy cures convergence insufficiency

Last month I had the pleasure of listening to Dr. Mitch Scheiman, lead researcher of the Convergence Insufficiency Treatment Trial (CITT) present to a jam packed audience at the COVD Annual Meeting in Denver.  He brought to this meeting the results of the one-year follow up to the land mark CITT research. His new research,  which was published in Optometry and Vision Science, the Journal of the American Academy of Optometry, Vol. 86, No. 9, pp 1096-1103., entitled: Long-Term Effectiveness of Treatments for Symptomatic Convergence Insufficiency in Chidren, documents long term efficacy of office-based vision therapy.

What the research shows is that the results of office-based vision therapy for convergence insufficiency results in successful ellimination of symptoms even 1-year after treatment in children.

This concurs with what I have found with my patients for 3 decades. Once the patient has developed their binocular vision to automaticity they in fact "own it". This means no additional treatment is normally required.

The research also indicated that pencil push-up activities and other home oriented procedures as well as Base-In prism glasses do no better than a placebo in the treatment of convergence insufficiency.

Dan L. Fortenbacher, O.D., FCOVD

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

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

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