Friday, October 26, 2012

What MDs say about vision therapy

Vancouver's children's optometrist on vision therapy for kids
As a member of the College of Optometrists in Vision Development, I read the COVD blog which often has excellent and up to date information of developmental vision disorders and vision therapy.  Today, there was an excellent post on that blog on what MDs say about optometric vision therapy.  

That is an interesting topic because vision therapy is not taught in medical schools but is taught in every optometry school on the continent.  This fact is often at the root of a misunderstanding between some MDs and optometrists about what vision therapy is, what diseases it treats and why it works.  

The topic is a timely one for COVD to discuss because one of the most famous (and one of the only) developmental vision MDs - developmental ophthalmologist, Dr. Lea Hyvarinen, addressed the COVD at last weekend's annual meeting.  We wrote about her and her new book in a previous post.

Here is the COVD's collection of statements from MDs about vision therapy:
Pediatrician and Parent Advocate for the National Center for Learning Disabilities

Dr. Debra Walhof is a Pediatrician who specializes in Integrative Medicine.  During the past 20 years, she has practiced in hospital, academic and community-based clinical settings.  Her work has focused primarily on multi-cultural and under served populations who present as "at risk" across many developmental and behavioral domains.  According to Dr. Walhof:

“It is important to remember that normal sight may not necessarily be synonymous with normal vision... That being said, if there is a vision problem, it could be preventing the best tutoring and learning methods from working. Now that certainly doesn't mean every dyslexic child needs vision therapy, however in my opinion, skills such as focusing, tracking and others are essential foundational tools for reading. In general, if your child has trouble with reading or learning to read, getting a vision evaluation to assess these skills from a qualified Developmental Optometrist would be a smart move.”

Psychiatrist & Physician

Dr. Katherine Donovan, a Psychiatrist from Charleston, S.C., was one of those parents who didn’t give up, “It wasn’t until my own child had problems with reading that I discovered that my medical training was missing a very valuable piece of information which turned out to be the key to helping my daughter, Lily. While I had taken Lily to many ophthalmologists and learning specialists, desperate to understand why this very bright child still could not read well, or write legibly at age 12, I always got the same answers:  ‘her vision’s fine’ and ‘she’s dyslexic.’”

“As a physician, I had been taught that vision therapy was controversial and could not treat learning disabilities. However, my personal experience with my daughter proved to me that vision therapy worked, when nothing else did,” Dr. Donovan shares. “While vision therapy cannot treat learning disabilities, per se, it absolutely corrected a vision problem which was blocking Lily from being able to learn. After a visit with a developmental optometrist who tested over 15 visual skills critical to reading and learning, I was shocked to learn that Lily was seeing double out to three FEET—which meant that when she tried to read, the words were double. No wonder she hated to read!” Following optometric vision therapy, “Lily now reads 300 pages a day, in her free time; she puts down ‘reading’ as her favorite hobby; and she has a 95-average at Buist Academy with NO help from me on her homework! Prior to this, I’d been spending three to four hours each night, for many years, tutoring Lily,” Dr. Donovan shares with delight. 

 Physician and Medical Expert Witness for Medico-Legal Cases

Even though there is a wealth of optometric research which proves vision therapy works, as Dr. Donovan mentioned, there is false information in the medical community about vision therapy.  This can be confusing for parents, especially when it comes from their child’s pediatrician.  

Dr. Joseph Manley, a physician and medical expert witness for medico-legal cases, states, “The conclusions (particularly the failure to recommend vision therapy for children likely to benefit from it) of the American Academy of Pediatrics report on Learning Disabilities, Dyslexia and Vision are based on exclusion of the most relevant data and inconsistent application of the Academy's stated criteria for selecting evidence.  They fail to acknowledge abundant published and anecdotal evidence supporting the use of vision therapy.  This overlooked evidence includes controlled trials, observational studies, case reports and consensus of experts - the same kinds of data that underpin the daily practice of medical professionals.”
Neurologists & Leading Clinicians on Learning Disabilities

Brock Eide, M.D., M.A. and Fernette Eide, M.D., leading clinicians and writers on learning disabilities, state, “In spite of the very positive research findings validating the role vision plays in learning, some are still claiming visual dysfunction plays little or no role in the reading challenges that dyslexics face. This is a shame. When we look specifically at the results of studies performed to address specific visual issues, the evidence supporting visual therapy is quite strong.”

The Eides run the Eide Neurolearning Clinic in Edmonds, Washington, are authors of the popular book, The Mislabeled Child:  How Understanding Your Child’s Unique Learning Style Can Open the Door to Success, and lecture throughout the U.S. and Canada to parents, educators, therapists, and doctors. Drs.  Eides have published extensively in the fields of gifted education, learning disabilities, and twice exceptionalities such as giftedness and dyslexia, and served as consultants to the President's Council on Bioethics.
 “While not all children or adults with dyslexia have visual processing problems, many --at least two-thirds in some studies-- do. This makes sense from a neurological standpoint, because several of the structural neurological features associated with dyslexia appear to predispose to visual difficulties,” Dr. Brock Eide adds.

“Not surprisingly, several types of visual difficulties are more common in dyslexic than non-dyslexic children. In one study of dyslexic children, just one type of visual problem, near-point convergence insufficiency, was present in 30-40% of the dyslexic children, compared to just 20% of controls. As can be seen from this control figure, visual processing problems are also quite common in non-dyslexic school-age children,” Eide continues.

Dr. Fernette Eide explains, “The bottom line is that visual problems are common, though not universal, in children who struggle to read; and optometric vision therapy can help address visual problems in children with significant visual dysfunction. A good visual examination is an important part of the workup of every struggling reader.” 


Ophthalmologist, Dr. Bruce Sumlin, writes, “Optometric vision therapy makes sense.  It is very similar to other kinds of treatment and therapies we provide in the medical disciplines which help to develop neural connections in the brain.”John B. Ferguson III, MD, an ophthalmologist who has been in practice for over 34 years, was not always a strong believer in vision therapy.  When asked what made him change his mind, Dr. Ferguson shared, "Among ophthalmologists, vision therapy has been thought to be reserved for certain eye muscle disorders. I was unaware, and I believe many other ophthalmologists are also unaware, of the significant effects that these eye muscle disorders have on the attitude and behavior of some children. I thought that at the most these children, if left untreated, might experience headaches or read less efficiently. However, I had the opportunity to speak with children and the parents of children who went through vision therapy and I was very impressed by the dramatic and positive academic and behavioral changes they experienced."

According to ophthalmologist, Robert Abel, in his book The Eyecare Revolution: 
“Vision therapy is taught at optometry schools; ophthalmologists know very little about it … It can change people’s lives, as it has for President Lyndon Baines Johnson’s daughter, Lucy, whose dyslexia was helped greatly by vision therapy.”
In an editorial responding to an article, “Optometric Vision Therapy &Training for Learning Disabilities and Dyslexia,” Dr. Paul Romano, ophthalmologist and editor of the Binocular Vision & Strabismus Quarterly states:

“…why should I think that my fellow ophthalmologists are correct about dyslexia and learning disabilities virtually never being a real eye problem and amenable to some eye directed therapy? I must trust my own 30 years of personal experience.”
“There is no doubt in my mind that the exams most orthoptists, ophthalmic technicians and ophthalmologists, including pediatric ophthalmologists, perform for the learning disabled or the dyslexic child are too often inadequate or incomplete and are unable to find these ‘subtle abnormalities of monocular and binocular vision which may give rise to these problems...”

“Also I simply do not believe the current organized ophthalmology-pediatric ophthalmology mantra that virtually nothing with regard to binocular vision (except maybe convergence insufficiency) can be affected, altered or improved by anything other than surgery. There are too many other areas in medicine where change is achieved without drugs or surgery.”

How to Identify a Vision Problem
Children should be referred for a comprehensive eye exam whenever visual symptoms are noticed or if they are not achieving their potential. Many of these vision problems will not be detected during a school vision screening or limited vision assessment as part of a school physical or routine pediatric health evaluation. 
Locate a Doctor in your area who is experienced and knowledgeable in diagnosing and treating learning-related vision problems.

Related article:

What teachers say about vision therapy