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

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

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

Vision Therapy IS NOT Eye Exercises

For the patient who suffers from the symptoms of double vision, headaches, fatigue and poor reading performance due to a binocular vision problem like convergence insufficiency, now there is scientific proof that office-based vision therapy is the only viable and effective treatment. When compared to all of the other commonly prescribed treatments recommended by doctors in the past, research has now proven that office-based therapy is effective but, pencil push-up eye exercises or computer based home therapy (used alone) are no better than a placebo.

Yes, office-based vision therapyis effective because IT IS NOT eye exercises. Why?

To understand the difference, one must understand that vision problems such as poor binocular control (like convergence insufficiency), accommodation problems (poor eye focusing), oculomotor dysfunction (poor eye tracking), problems in visual processing or visual motor integration (eye-hand coordination) are not typically problems with muscle weakness. 

A child that has double vision when reading is not having that problem because their eye muscles are too weak to turn their eyes in the orbit. If you think of any person with double vision like a "computer", the problem is not with the "hardware" (eye muscles), the problem exists in the "software" (the brain). The visual problem is a "brain coordination problem" not an eye muscle weakness problem.

Thus exercising eyes or eye muscles is no more effective in learning binocular "two-eyed" vision skill than exercising ones fingers in an attempt to learn how to play the piano. Doing finger exercises will not result in becoming a piano virtuoso. The same is true with eye exercises and vision.

Office-based vision therapy is effective because it IS NOT eye exercises. Office-based vision therapy is a process of helping the patient to develop the "brain skills" for proper binocular vision (and much more). This brain skill is a learned ability that, once learned, is like riding a bike...it is not forgotten.

The results of a successful office-based vision therapy treatment programis that the patient will learn proper vision skills and enjoy the lifelong benefit of good binocular vision, symptom free and more productive and competent in the rigorous visual demands of school and work.

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.

Convergence Insufficiency Symptoms...How you help recognize children with the CI Symptom Survey

Convergence Insufficiency (CI) is a vision problem that can dramatically affect a child's ability's in reading. It is a condition that affects millions of children. Research shows that CI can occur as often as 5-15% of children in a general pediatric population. Even more important, children who exhibit reading problems have a much higher frequency of CI.

A common symptom in patients with CI is double vision when reading. However, a child with CI will not usually come to their parents and say, "Mom, I have double vision when I try to read!" The reason is they usually assume everyone sees that way.

What can parents do? What can teachers do? What can doctors do?

The important thing to do is to ask the right questions. One of the most useful ways to identify a symptomatic child with CI is to ask questions that are common difficulties experienced by a person with CI.

Researchers in the Convergence Insufficiency Treatment Trial (CITT) created a handy symptom checklist. This checklist asks the right questions plus asks for a "grade" on each symptom from 0-4. It is called the CI Symptom Survey (CISS). In the CITT Research project those patients who had a total score of 16 or greater on the CISS where those who were chosen to participate in the study.

You can download the same symptom survey right here on the EXCELerated Vision Blog. Download Convergence Insufficiency Symptom Survey

Parents, teachers and doctors can use this CI Symptom Survey (CISS) to help recognize the child who may have the symptoms of CI that would warrant a comprehensive binocular vision examination. Simply answer the survey and tally up the score. Take action to find a doctor if the symptom score is greater than 20.

To find a doctor nearest you who understands CI and how to treat this condition, go the Doctor Locator at the College of Optometrists in Vision Development.

If you are in Southwest Michigan or Northern Indiana/Illinois contact WoW Vision Therapy Center.

Dan L. Fortenbacher, O.D.,FCOVD

Latest Research Proves Office-based Vision Therapy is Effective

The United States Department of Health and Human Services, National Eye Institute just released the results of the landmark $6.1 million multicenter Convergence Insufficiency Treatment Trial (CITT) on October 13, 2008. According to the National Institute of Health, scientists have now proven that office-based vision therapy is the only effective treatment for convergence insufficiency (CI) compared to the other common methods used by doctors to treat CI.

Convergence Insufficiency (CI) is a public health concern due to the relative high incidence among children. Studys have shown that CI occurs as often as 5-18% within children of elementary school age in the US.

The CITT research investigators tested the efficicacy of 4 approaches to treatment of Convergence Insufficiency.

1. Pencil Push-ups Therapy (PPT). This form of treatment has been a commonly prescribed by eye doctors to parents for their children with CI and involves looking at the letters on a pencil while the pencil is brought closer to the end of the child's nose. The goal is for the patient to try to maintain convergence on the pencil while the target is progressively brought closer to the eyes. PPT is a home based eye-exercise approach to treating CI.
2. Home-based computer programs along with pencil push-up therapy (HBCVAT+). This approach uses computer based programs to help with convergence and eye focusing along with pencil push-ups.
3. Office-based Placebo Therapy (OBPT). This treatment was the placebo group in the research project who "thought" they were receiving regular vision therapy along with home reenforcement activities. In this case while the patient thought they were getting vision therapy, instead they were being provided a series of drills that mimicked vision therapy and therefore served as the "control group".
4. Office-based Vision Therapy (OBVT). This treatment group received weekly sessions of 60 minute in-office therapy (following a standardized approach) along with home reenforcement activities.

The research was conducted by a team of investigators at the following sites:

• Bascom Palmer Eye Institute - Miami Florida
• Mayo Clinic - Rochester, Minnesota
• University of California - San Diego Ratner Children's Eye Center
• State University of New York College of Optometry
• University of Alabama at Birmingham School of Optometry
• NOVA Southeastern University - Fort Lauderdale, Florida
• Pennsylvania College of Optometry - Philadelphia, Pennsylvania
• The Ohio State University- Columbus, Ohio
• Southern California College of Optometry - Fullerton, California

The results found that only Office-based Vision Therapy (OBVT) was effective in treating convergence insufficiency in children and that "pencil push-up" therapy, as well as the home based computer programs plus pencil push-up therapy, was no more effective than placebo therapy.

The public health conclusion from this research is that children who have been diagnosed with Convergence Insufficiency should be sure to work with a doctor who provides or will refer to a doctor who provides office based vision therapy. To find a doctor who provides vision therapy, be sure to contact the doctor locator at the College of Optometrists in Vision Development (COVD). Those who are Fellows are Board Certified in Vision Therapy.

Dan L. Fortenbacher, O.D., FCOVD

Joey's story - Success overcoming Convergence Insufficiency

My husband and I realized about half way through first grade that our son Joey wasn't reading like he should be.  He did well with spelling and math but he struggled in reading.  He was also reversing his letters quite frequently and we thought is was possible that he was dyslexic and started investigating the process for a diagnosis.

One day I was having a conversation with a collegue at work about my concern for Joey. She listened to my story and told me about her son who had similar problems until he had vision therapy. She recommended that we go to WoW Vision Therapy in Saint Joseph, Mi to have Joey tested because her son had gone through the program and had great results.

Joey's examination with Dr. Dan Fortenbacher revealed that he had problems with his eye coordination and focusing skills - a condition called convergence insufficiency and accommodative disorder.

After Joey had a diagnosis we were relieved that we had something tangible we could understand and work toward a goal.  Before vision therapy Joey was seeing double and the letters were moving off the page when he tried to read.  So, prior to vision therapy Joey tested at school below a first grade reading level. Now after he has completed vision therapy Joey is reading at third grade level and he continues to improve. 

Joey is much more confident about his abilities!  In baseball now and he is able to hit the ball more consistently and better than before.  We've also noticed that his balance and the way his body moves are better.  He is smooth and natural in his motions.  We are so pleased with where Joey is now because we believe he will continue to improve in his reading and even more, he can realize his potential in everything he does.

Thank you to his vision therapists, Monica and Jackie, for all of your efforts to bring Joey to this level!

Deanna Schmidt, mother