EXCELerated Vision: The Wow Vision Therapy Blog

Research shows link...eye movement predictor of academic success

"Eye movement is a predictor of academic success". This month marks the 10 year anniversary when the Harvard University Graduate School of Education made this announcement. The research clearly shows that there is important association between effective eye movement control and academic success.

Ever since this breaking news a decade ago, further evidence of the association between eye movement and academic success continues to be recognized. For example, in Volume 27 Issue 8 of the Journal of Brain Development in 2005 the titled research is, the Voluntary Control of Saccadic and Smooth-Pursuit Eye Movement in Children with Learning Disorders.

While the testing of eye movement is relatively easy, the clinical presentation of poor eye movement control can often be missed and misunderstood. For example the testing of smooth-pursuit  eye movement control can be easily performed with a bead on a stick or the tip of a pencil or pen. The examiner simply asks the child to look at the target (held about 10 inches from the nose) and follow it with their eyes as the target is slowly moved horizontally, vertically (on the midline) and in a rotation. The child should be able watch the moving target with minimal head movement. Furthermore, the child who is years and older, should be able to "visually track" the target with a minimal amount of distraction such as asking simple questions (cognitive loading).

With the advent of web-based professional networking sites, like Sovoto, a platform now exists to help doctors and other professionals who work with children to see an example of a child with oculomotor dysfunction. To see an example of a child with oculomotor difficulty that was associated with his reading difficulty click here.

The American Optometric Association has published the symptoms of eye movement disorders in the Optometric Clinical Practice Guideline (CPG) Care of the Patient with Learning Related Vision Problems. They are:

• Moving head excessively when reading
• Skipping lines when reading
• Omitting words and transposing when reading
• Losing place easily when reading
• Requiring a finger or marker to keep place when reading
• Experiencing confusion on return sweep phase when reading
• Experiencing illusionary text movement
• Having deficient ball playing skills

More importantly, once identified, the child who is diagnosed with a problem in eye movement, such as smooth-pursuits, can be treated with vision therapy. Specifically office-based optometric vision therapy provided by a vision therapist (supervised by the doctor), can effectively treat disorders of voluntary eye movement. The results can often be a dramatic improvement in the child's reading efficiency.

To see the same patient after 24 sessions of office-based vision therapy click here. His reading efficiency and fluency has improved and he is enjoying reading!

To learn more about optometric vision therapy  and find a doctor who provides office-based vision therapy visit the COVD website at www.covd.org

Dan L. Fortenbacher, O.D.,FCOVD

 

 

 

Home schooling mom learns impact of vision problems on her struggling 17 yr old daughter

Last week I saw a 17 year old girl for a new patient comprehensive vision evaluation. While most patients find their way to our practice as a referral from an eye doctor or an occupational therapist, this patient landed in my exam chair due to the determination of her mother to find an answer.

You see, our patient - lets call her Mary, is a  bright, articulate high school senior who wants to go to college next year, but due to her difficulty reading, she and her family are concerned that she will be unable to handle the college work load. What's more, her avoidance behaviors and mannerisms started to make her mother suspect something was "a miss" with Mary's eyes, even though she had had previous eye exams and was fit with contact lenses for nearsightedness. Mary complained of words overlapping and would turn her head or cover an eye when trying to read.

Thanks to the persistence of her mother through her own personal research,  she began to find the answers to her troubling questions.  Why was her bright daughter complaining of words moving on the page when reading? Why did she turn her head or furrow her brow when doing her paper pencil tasks? What she learned was that there exists specific types of vision problems that can cause bright kids to demonstrate reading and learning performance problems. One thing led to another and the family found our specialty practice; dedicated to the diagnosis and treatment of the vision related learning problems.

My examination revealed that Mary's eyes were healthy and her existing contacts properly corrected her eyes for a mild condition of nearsightedness. But, in spite of her 20/20 corrected eye sight, Mary was unable to coordinate her two eyes at near. She in fact had double vision for objects within 18-20 inches from her face! To further complicate this, Mary demonstrated poor eye tracking, eye focusing and poor visual processing skills. The diagnosis for Mary was convergence insufficiency, accommodative dysfunction,oculomotor dysfunction plus delays in visual information processing.

In spite of having the diagnosis, which explained why Mary struggled with reading and learning, it was painful for Mary's mother when she realized that Mary had been struggling with these symptoms since she was in 3rd grade.  Thanks  only to the determination of her mother through home schooling, Mary received the individual attention which enabled her to progress academically, albeit in spite of many compensatory strategies.

To restate the case, Mary's vision problems are not eye sight problems or eye health problems. Her eye muscles are normal and strong. Her neurology is normal. Instead, her vision problems are developmental. That means at age 17, Mary had simply not acquired the expected eye coordination and visual processing abilities that most us gain naturally through a process of normal childhood experiences.

The treatment required for Mary is  office-based optometric vision therapy (VT). VT is scientifically validated and proven safe and effective. Once Mary receives this treatment protocol, research has shown that she will not require any further treatment for these problems of eye coordination. Yes, there actually is a cure!

What makes Mary's case disheartening is that her visual issues could have been recognized early on. Mary should never have had to struggle for years with this binocular vision problem - convergence insufficiency. As a consequence of her binocular vision problem, Mary and her family have unnecessarily gone through years of frustration. They had to adjust their family around a home school model to support Mary's needs for individual attention primarily because she could not use her vision to apply herself academically.

On a positive note, Mary will soon be starting treatment...office-based vision therapy. And while she has had to tolerate her symptoms associated with these vision problems for years, within 4-5 months of treatment, I'm confident that Mary's binocular and other related "eye-coordination problems" will be resolved. What's more because she is bright and capable, once Mary no longer has near point double vision, she will be better prepared for the visual demands of college!

Fortunately, more eye doctors are becoming aware of the critical importance to recognize, diagnose and properly manage patients like Mary. For example, Dr. Dominick M. Maino, Editor of the journal Optometry and Vision Development and Professor of Pediatrics/Binocular Vision at the Illinois Eye Institute/Illinois College of Optometry has recently written a compelling journal editorial emphasizing this to the profession entitled, The Binocular Vision Pandemic.

Dr. Rochelle Mozlin, Associate Professor at State University of New York, State College of Optometry with a Masters Degree in Public Health also recently wrote on the COVD Blog, Vision Therapy — Where is the Evidence?, listing the evidence based Clinical Practice Guidelines, written by a team of optometric experts, and published by the American Optometric Association.

With greater professional and public awareness of the impact of binocular vision problems on reading performance, fewer children like Mary will have to struggle for years without getting the help that they truly need. For more information go to www.covd.org

Dan L. Fortenbacher, O.D.,FCOVD

Seeing is believing...vision is learned - A facinating lecture by Neuroscientist and Artist - Beau Lotto

As optometric clinicians who provide vision therapy, we find ourselves discussing the concept that vision is learned to patients and parents on a daily basis. Yet, when discussing to a parent, one of the goals of vision therapy is to develop proper binocular neuromuscular control, the parent may sometimes have the misconception that vision therapy is an eye muscle exercise process. This eye exercise myth can also be one of the reasons why educators could be confused about the "vision connection" to reading.

Sometimes others can say it better. In this case Neuroscientist Beau Lotto uses a variety of interesting demonstrations to show that vision is learned.

 

Dan L. Fortenbacher, O.D., FCOVD

From Temple Grandin to Moms Fighting Autism...seeing the vision connection

Statistics from the Autism Society shows that autism is the fastest growing developmental disability in the US. Current studies are suggesting that Autism is occurring in 1 in 110 children with nearly 1.5 million living with this condition. Autism is a spectrum disorder that typically includes pervasive developmental delays in sensory processing. One critical area to a child with Autism can be vision development.

One of the most famous adults with autism is Temple Grandin, PhD., who has been able to rise above the challenges associated with autism. Her story is now being told in the HBO full length feature film entitled  Temple Grandin, staring critically acclaimed actor, Claire Danes. As a testament to her ability to apply herself, Dr. Grandin describes the impact of her vision in her book, Thinking in Pictures, and Other Reports of My Life with Autism.

Expanding this awareness is a new group, Moms Fighting Autism. Moms Fighting Autism is a monthly webinar service dedicated to helping moms who have children with autism. And this month the Moms Fighting Autism Webinar is featuring one of Optometry's leading lecturers, writers and clinicians in the area of Developmental Vision...Dr. Carl Hillier.

Dr. Hillier's webinar is occurring on February 16, 2010 at 6:PM PT. Dr. Hillier will be discussing “Vision and Living Within the Autistic Spectrum,” including Vision Therapy.  To register for this FREE webinar click here.

Dr. Hillier was also recently featured on San Diego 6 News. Click here to see Dr. Hillier's interview with reporter Greg Phillips. The topic was how hidden vision problems can be the cause of your child's reading disabilities.

With greater public awareness of the vision problems associated with autism, more children (and adults) can find the developmental vision care that will help those with autism to lead a more happy and productive life. A good way to find a doctor who specializes in developmental vision care is to go to the College of Optometrists in Vision Development website and search for a Board Certified Fellow in your area.

Dan L. Fortenbacher, O.D.,FCOVD

Vision Therapy Isn’t Just About Eyes

As a 4th year Optometry student at Michigan College of Optometry, I had assumed that the goal of vision therapy was only to target the eye coordination skills that our patients have trouble with in the clinic and improve on them to eliminate symptoms or prevent symptoms from arising in the future.  After my rotation here at Wow Vision Therapy, I have learned that vision therapy is about so much more than just the eyes.

 

There is a phrase that I heard when I first started here, and I’ve never forgotten it.  “If you can’t coordinate your body movements, you can’t coordinate your eye movements.”  I have found this to be so true.  When a patient doesn’t have good control over simple body movements, then it is difficult to control the eyes in a coordinated fashion because all of the mind’s attention is on controlling the body, not the eyes.

 

Here at Wow Vision Therapy, we work on not only eye movements but body movements as well.  We do something called “Chapters” which is a series of coordinated body movements that focus on being able to make the upper half of the body move in sync with the lower half of the body.  As the difficulty increases with each Chapter, vision plays a more significant role in the successful completion of them by requiring balance or noticing simultaneous movements between the arms and legs.  Just in the short amount of time I have been here I have seen many children graduate from the program that are less clumsy and are able to ride a 2-wheel bike now when they never could before.  The coordination learned through the combination of vision and movement during the Chapters plays a significant role in this successful outcome.

 

Also during my time here at Wow Vision Therapy, I discovered that vision therapy can also help eliminate motion sickness!  Motion sickness and how to cope with it is not only related to movement, but it also has a visual aspect to it.  During our “see-sick protocol”, patients are taught how to cope with motion by using their vision to help stabilize and balance themselves to eliminate the woozy feeling that excessive motion can cause.  I have suffered from getting car-sick my whole life, and after doing our “see-sick protocol”, I was able to study in the car all the way to Pennsylvania and back without even a hint of car-sickness!  I have also had many of my own patients experience a huge improvement in their motion sickness after completing this protocol.

 

If you or your child is experiencing trouble with coordination, balance or motion sickness, give Wow Vision Therapy a call (if you are in South West Michigan) or contact the College of Optometrists in Vision Development at www.covd.org for a doctor near you.  You may be surprised at how many issues can be corrected and improved with vision therapy!

Erica Oosting

Michigan College of Optometry 4th Year Intern

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