If your child has reading problems, treatable vision and eye movement disorders may be the reason

The evidence on eye problems associated with reading difficulties and learning problems continues to accumulate.  At our Vancouver eye and vision clinic, we treat many students with eye movement and vision problems who are struggling in school and who read below grade lever.

We use ocular motor therapy, vision therapy and eye-brain rehabilitation to get both eyes working together properly.  Often the students who we treat experience a huge jump in their reading abilities, improving by 4 or five reading levels following therapy.

A new study entitled Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls published in the May 2012 issue of the journal Graefes Archives of Clinical Experimental Ophthalmology adds to the evidence of the connection between eye and vision problems and learning.

The researchers were struck by the fact that in Ontario, Canada, approximately one in ten students aged 6 to 16 in Ontario have an individual education plan (IEP) in place because of various learning disabilities.  May of those learning problems were specific to reading.   They wanted to investigate the relationship between reading vision problems and binocular vision problems.

The researchers measured the visual acuity and eye movement measurements of students that had an IEP and compared those results with students in a regular education program.

The researchers found that the IEP group had significantly greater hyperopia, compared to the control group on cycloplegic examination. Vergence facility was significantly correlated to (i) reading
speed, (ii) number of eye movements made when reading, and (iii) a standardized symptom scoring system. Vergence facility was also significantly reduced in the IEP group versus controls. Significant differences in several other binocular vision related scores were also found.

Here is the study's conclusion:

This research indicates there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination (including cycloplegia), in addition to a comprehensive binocular vision evaluation.

Developmental optometrists find problems that other doctors don't look for

One special service that we offer patients at our Vancouver optometry clinic is developmental optometry.  Developmental optometrists find problems that other eye doctors are not trained to look for and treat.

For example, see this 1996 study from the field of rehabilitation medicine published in the journal NeuroRehabilitation by Raymond et al., where the authors advise that patients with potential visual information processing deficits should be referred to a behavioral or neuro-optometrist" and noted that "referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only."

Another word of advice comes from a recent family advice column from the Washington Post, where the writer said:

how well your son can see, it usually takes a developmental or behavioral optometrist to tell you how well his eyes are working when he reads or when he looks back and forth from the blackboard to the printed page. Some children get headaches because they can’t focus well or their vision is blurry, but they don’t complain because they think that heads are supposed to hurt or that the world is a blur for everyone.

If your son has these or other vision problems, don’t despair. Vision therapy is to the eyes what physical therapy is to the body, and it’s effective 90 percent of the time. He’ll just have to wear special glasses for a little while every day, do some eye exercises every day and maybe play a couple of video games. To learn more, go towww.covd.org, the Web site for the College of Optometrists in Vision Development.

Unfortunately, that incorrect approach has denied many patients treatment and diagnoses that would have improved their lives.

Visual processing and learning disorders

A recent study published in the journal Current Opinion in Ophthalmology called "Visual processing and learning disorders" came as a surprise to developmental optometrists who have been diagnosing and treating visual information processing disorders for decades.  The main treatment modality is vision therapy, which is neuro-ocular rehabilitation or rehabilitation for the eyes and brain working together.   

The study confirmed what has always been obvious to optometrists - that if the brain cannot properly process visual information, a child will have trouble reading and learning - even if he has 20/20 visual acuity.  The surprise was that the study was  published by ophthalmologists, who for too long have denied that vision had anything to do with learning.  For example, see this 1996 study from the field of rehabilitation medicine published in the journal NeuroRehabilitation by Raymond et al., where the authors advise that patients with potential visual information processing deficits should be referred to a behavioral or neuro-optometrist" and noted that "referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only."

Another word of advice comes from a recent family advice column from the Washington Post, where the writer said:

how well your son can see, it usually takes a developmental or behavioral optometrist to tell you how well his eyes are working when he reads or when he looks back and forth from the blackboard to the printed page. Some children get headaches because they can’t focus well or their vision is blurry, but they don’t complain because they think that heads are supposed to hurt or that the world is a blur for everyone.

If your son has these or other vision problems, don’t despair. Vision therapy is to the eyes what physical therapy is to the body, and it’s effective 90 percent of the time. He’ll just have to wear special glasses for a little while every day, do some eye exercises every day and maybe play a couple of video games. To learn more, go towww.covd.org, the Web site for the College of Optometrists in Vision Development.

Unfortunately, that incorrect approach has denied many patients treatment and diagnoses that would have improved their lives. Thankfully, ophthalmologists have now come around to common sense. The study encourages ophthalmologists to take visual information processing seriously:

Visual processing is the main brain function allowing normal perception of what is being viewed. Ophthalmologists as well as patients must realize that with normal 20/20 eyesight interpretation of what is seen may be dysfunctional because of faulty brain processing of that which is seen by normal eyes. Abnormal Visual Processing as well as auditory processing disorders eventually lead directly to learning disorders in children and young adults.

The study also emphasizes and important point.  Just because a child can see clearly or has 20/20 vision, does not mean that her entire visual system (including the brain) is functioning properly.  For eye doctors to say that nothing is wrong with a child just because she does not need glasses, gives the child and her parents a false and dangerous sense of security.  Moreover, it is irresponsible for a professional to say that there is nothing wrong with a patient when all tests have not been performed.    For that reason, we advocate that only a comprehensive eye examination with a full developmental vision investigation should be performed on a child and "quick-and-dirty" school screenings are not much help and may even be harmful for what they miss. 

 For more information on visual information processing, visit our visual information processing page where you can download our Fast Fact Sheet.

At Vision Source Vancouver, our eye and vision clinic we successfully treat dozens of patients every year for visual information processing disorders.  

Related articles on vision and learning

More visual symptoms means lower academic performance ... - See For Life
Feb 29, 2012

Vision therapy for convergence insufficiency improves academic performance ...
Jan 16, 2012

82% of teachers report an improvement in students after vision therapy - See For Life
Jun 16, 2012

Binocular vision dysfunctions ate my homework - See For Life
Mar 31, 2012

Study proves that vision problems interfere with learning - See For Life
Apr 25, 2012

Visual function development: behaviors to watch out for in your children

Developmental optometry and ophthalmology

Dr. Lea Hyvarinen is one of the worlds few developmental ophthalmologists.  Usually, if you or your child has a developmental vision problem you will see a developmental optometrist like Dr. Randhawa  who is a member of the College of Optometrists in Vision Development (COVD).  Dr. Lea has just commenced a blog on children's vision development, which you can visit here and was a well-received speaker at the COVD annual meeting last weekend.

Dr. Lea Hyvarinen

In a recent post about infants with normal visual development, she provided the following table, which summarizes the development of visual functions that are easy to for parents and teachers to observe.  The table and the related post give an excellent indication of the quality of her new book called "What and how does this child see?" 

Visual information processing

The book covers many of the topics discussed on this blog, including as visual information processing, a topic that North American ophthalmologists tend not to be familiar with.  For example, see this 1996 study from the field of rehabilitation medicine published in the journal NeuroRehabilitation by Raymond et al., where the authors say that patients with potential visual information processing deficits "should be referred to a behavioral or neuro-optometrist" and noted that  "referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only."  Of course, Dr. Lea is an exception to this and would likely provide excellent assessments of her patient's visual information processing skills.

Visual development behaviors to watch for

Parents can refer to this table when trying to assess their child's visual development.  But understand that trained professionals should be consulted for reliable assessments and diagnoses.  As noted by Dr. Lea, the table "summarizes the main steps of the visual development. These milestones are used in many countries in the follow-up of normal development of visual functions and in detecting symptoms and signs of deviations from the norm."

Age (months)	Behavior
0–1	•       turns eyes and head to look at light   sources  •       horizontal eye tracking, tonic focusing
2–3	•       intense eye contact at 6-8 weeks  •       vertical and circular tracking •       interested in mobiles •       interested in lip movements
3–6	•       watches own hands  •       reaches toward, later grasps hanging objects •       observes toys falling and rolling away •       shifts fixation across mid-line •       visual sphere of attention widens gradually •       very active in visual interaction
7–10	•       notices small bread crumbs, touches them  •       adjusts the grasp to the size of the objects •       interested in pictures, also stereo images •       recognizes partially hidden objects •       recognizes family members by facial features
11–12	•       knows places at home  •       looks through window and recognizes people •       recognizes pictures, plays hide-and-seek •       can predict adult’s goals of motor actions

For more information of children's vision, eye care, and children's optometry, please visit www.kidsvision.ca.

Related articles:

Study proves that vision problems - visual information processing deficits -  interfere with learning to read and cause dyslexia

The former First Lady of the United States on her daughter's developmental vision problem and how vision therapy worked for her

Mom of struggling reader speaks out

Vision problems can have drastic effects on brain development and learning

How to choose a children's (pediatric) optometrist

Binocular vision dysfunctions ate my homework 

TED: ideas worth spreading - Dr. Susan Barry on vision therapy and depth perception

Patient story - Five year old girl sees her mom's face for the first time in our Vancouver eye clinic

Mom of Struggling Reader Finds Help and Speaks Out for College of Optometrists in Vision Development's National Children's Vision and Learning Month

This blog post reproduces the content of a press release issued by the College of Optometrists in Vision Development to commemorate National Children's Vision Learning Month. It is a story that is familiar in my office and the office of every developmental optometrist. Patients are told by doctor after doctor that their child's vision is fine so long as the child can read the letters on the chart and there is nothing wrong with the physiology of the eye. However,visual acuity the the health of the structures that make up the eye are only part of an eye examination.

Developmental optometrists also assess the functioning and movement of the eye, the ocular muscles and the workings of the visual system. The latter assessments can uncover binocular vision problems or deficiencies in visual informaiton processing, which have been shown to adversely impact learning and academic performance.

Here is the press release:

Despite being told by five different eye doctors that her 8-year-old daughter Shelby's vision was fine, Lynn DeVore of Yakima, Washington continued to search for reasons why her daughter continued to struggle with reading. The pediatrician said that since the eye doctors said Shelby's vision was fine that Lynn "was just being paranoid and that maybe Shelby was simply not very smart." She continued to search until she found the answer and now DeVore is stepping forward to help other parents by sharing their story for National Children's Vision and Learning Month.

"We knew there was a problem early on, but we were told she would read soon. We struggled and struggled and still reading was a fight. Shelby was very frustrated with reading and had very little confidence in all areas of her life," shares DeVore. Fortunately she saw an ad in a local magazine that listed all the things Shelby struggled with. The ad was for a developmental optometrist who provides an in-office program of optometric vision therapy.

The evaluation confirmed that Shelby did in fact have a vision problem. It was convergence insufficiency, an eye coordination problem that can make reading very difficult. After completing the prescribed program of vision therapy, Shelby went from reading at 1st grade level to reading on grade level.

How could so many eye doctors have missed this? A very good question! When parents suspect their children have a vision problem that is contributing to their learning difficulties they often go to the pediatrician or the pediatric ophthalmologist only to be told their child's vision is fine and they can see 20/20. States Dr. David Damari, President of the College of Optometrists in Vision Development, "It is important for parents to know that when it comes to the diagnosis and treatment of vision problems which interfere with reading and learning, a comprehensive vision exam is needed. These children need to see an optometrist who provides an in-office program of vision therapy and performsthe in-depth testing required to determine if the child has all the visual skills required for academic success,".

Despite volumes of evidence-based optometric research, many pediatricians and ophthalmologists continue to state that vision has nothing to do with learning, referring parents to psychologists, learning specialists, etc. However, the limitations caused by convergence insufficiency and similar visual disorders can be disabling during reading and computer use according to the definitions of disability in the Americans with Disability Act, but these disorders are all easily treatable with optometric vision therapy.

The five most common signs that a vision problem may be interfering with your student'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" into "d" 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 symptoms checklist is available on COVD's website.

It is vital that parents take the time to learn all of the signs that a vision problem may be interfering with academic performance. When a child has a vision problem, they do not outgrow it, and despite extensive tutoring or special services at school, very little improvement occurs.

Shelby was lucky that her mother didn't take no for an answer. Take 5 minutes in honor of August being National Children's Vision and Learning Month and visit the website for the College of Optometrists in Vision Development; then spread the word and share the information: www.covd.org .

What is 3D Vision Syndrome?

The proliferation of 3D media in movies, video games and in the classroom is bring a new vision disorder into focus: 3D Vision Syndrome, or 3DVS.  Here is a video produced by the American Optometric Association that does a good job of summing up lots of science and research into a short and easily understandable presentation:

3DVS  is comprised of a group of symptoms that, taken together, indicate a functional vision disorder while watching 3D content. Symptoms include but are not limited to visual discomfort and fatigue, headaches, blurred vision, eyestrain, diplopia (double vision), dizziness/nausea and vision induced motion sickness after watching a 3D movie, 3D television or atfer playing a 3D video game.

Most people with 3DVS have an problem with the the way their eyes work together or focus.  Eye movement problems like this are often classified as binocular vision problems, the most common of which is convergence insufficiency.  Binocular vision problems are effectively treated with vision therapy.  To read research studies on convergence insufficiency and binocular binocular vision, click here.

A famous case of a developmental optometrist using vision therapy to treat 3D vision problems was the subject of the book Fixing My Gaze as well as the New Yorker piece by Oliver Sacks titled "Stereo Sue".

Vision therapy for visual attention skills significantly improves reading comprehension

The connection between vision and reading is well known to optometrists, all of whom study visual information processing (sometimes called visual skills) in optometry school along with treatments like vision therapy for deficiencies in visual imformation processing skills.

That body of knowledge is often not taught to other health professionals.  This makes it important to frequently talk about studies that prove the connection between visual skills and reading so that patients get the information they need to get the right help for themselves or their children who, although intelligent, have difficualty learning, reading or doing schoolwork efficiently. Researchers have commented that patients should be referred to an optometrist for assessment of visual information processing deficits because other professionals are likely to not test for them (see page 234 of this article from the journal NeuroReahbilitation).

Many people may be mistakenly diagnosed for learning disabilities or ADHD when the problem is actually a visual one.  At the very least, people who are suspected of ADHD or learning disabilities should see a developmental optometrist to be tested for visual information processing deficits to ensure that they are being treated for the right disorder.

One study on the connection between visual attention skills and reading was conducted by Harold A. Sloan, John Shelley-Tremblay, Anthony Ficarra, Michael Silverman, and Steven Larson and published in the Journal of Learning Disabilities in 2003.

In the study 15 moderately disabled readers received 12 hours of vision attention therapy. Significant improvement in reading comprehension and attention scores were seen in the group who received therapy, but not in the control group who received no therapy.

Here is the abstract that was published the the study:

This study quantified the influence of visual attention therapy on the reading comprehension of Grade 6 children with moderate reading disabilities (RD) in the absence of specific reading remediation. Thirty students with below-average reading scores were identified using standardized reading comprehension tests. Fifteen children were placed randomly in the experimental group and 15 in the control group. The Attention Battery of the Cognitive Assessment System was administered to all participants. The experimental group received 12 one-hour sessions of individually monitored, computer-based attention therapy programs; the control group received no therapy during their 12-week period. Each group was retested on attention and reading comprehension measures. In order to stimulate selective and sustained visual attention, the vision therapy stressed various aspects of arousal, activation, and vigilance. At the completion of attention therapy, the mean standard attention and reading comprehension scores of the experimental group had improved significantly. The control group, however, showed no significant improvement in reading comprehension scores after 12 weeks. Although uncertainties still exist, this investigation supports the notion that visual attention is malleable and that attention therapy has a significant effect on reading comprehension in this often neglected population.

The study is evidence of the connection between visual attention skills and reading ability as well as the efficacy of vision therapy in treating visual attention deficits and achieving a corresponding improvement in reading ability.