Friday, February 27, 2009

"I like the eyes are not in pain anymore"

Let me tell you about a fourth grade home-schooled boy. We'll call him Charlie (not his real name but he is a real boy). When Charlie's mother first called me she was really concerned about the fact that despite her background and advanced degrees in teaching, Charlie could not read with any fluency. He took forever to do his assignments, made very frequent reversals in reading and writing, and was not advancing at a pace that should have been possible given his obvious intelligence and ability to handle advanced concepts whenever they were presented orally. Charlie's mother agreed to help review the material which would soon become the Eye Can Too! Read series of books because she was ready to try anything. After having Charlie attempt to do some of the activities, she realized that his visual skills were very poor indeed. We helped her to locate a developmental optometrist in her area who concurred, gave appropriate diagnoses, and began to supervise a program of vision therapy to address the various layers of Charlie's difficulties. These included eye movement deficits, convergence insufficiency, and visual spatial as well as visual perceptual developmental delays. Did I mention that Charlie HATED to read? Well, he, like many children with learning related visual deficits, hated to read.

So, here's the good news. Six months later, this week, Charlie's mother told me that she couldn't find him when she wanted him to do something last week until she looked in the living room. Charlie was curled up in a chair reading a Hardy Boy mystery book all by himself. It was the first time that his mother had ever seen him choose to read and also continue to read for an extended period so she left him alone. 40 minutes later she asked him why he was reading.

"I like the book," he answered. "The words do not disappear at the end of the lines [like they used to]. My eyes are not in pain anymore. It doesn't hurt. It's easier."

Once again I conclude that children who resist reading or who seem to find it excessively difficult may have learning related visual issues which can be addressed through a program of optometric vision therapy under the supervision of a developmental optometrist.

Wednesday, February 18, 2009

Does your student make frequent reversals when reading or writing? Here's help!

If your student makes frequent reversals when reading or writing or gets confused about left and right, the second book, The Yellow Book, in my three book series: Eye Can Too! Read ...Better, Faster, Without Making Reversals or Getting Confused may help. These behaviors are often due to a delay in a student's development of the visual spatial skills of laterality and directionality. Sometimes students who make frequent reversals when reading or writing are labeled dyslexic even though there is no consensus among the various disciplines on a definition for dyslexia. However, many of these students who receive vision therapy designed to address the visual spatial developmental issues overcome them. They often make significant gains in their academic performance as a result. The Yellow Book contains a series of activities like the ones we use in the vision therapy context which are designed to help students improve both of these visual spatial skills. Created with home-school families in mind, each activity identifies the visual skills used, the academic objectives and appropriate grade or ability level, a list of materials needed, clear instructions, and a set of observation guidelines to help you to understand what your student's performance may indicate. The book is available at as a pdf download or as a printed spiral bound text. The Purple Book (the first in the series) is also available online at Home School Inc- it gives similar activities designed to help students improve the eye movement skills that must be in place for a student to be able to read efficiently without skipping words, lines, or losing their place. In a few weeks, the third book in the series, The Green Book, will also be available. That book provides academic activities designed to improve a student's visual perceptual skills. Each book contains graded activities for Pre-K through 8th graders. While they are all written for a home school audience, classroom teachers will find the activities easy to adapt for their class either as whole group or learning center activities.

Tuesday, February 17, 2009

Do words on the pages you read seem to wiggle, double, or blur?

If you can easily coordinate both of your eyes to point to the same place at the same time, you are unlikely to have this problem. However, if you can't, you may find reading very frustrating because the words may appear to wiggle or double up on the page so that it is very difficult to decode them. When this happens to beginning readers, the situation is more difficult because these very young children do not usually have the experience of normal single vision so they don't know that what they are seeing when they read is abnormal. They also don't have the language to explain what is happening. It is especially difficult for very bright, obviously articulate children who cannot counter the grown-ups' assertions that they are not trying hard enough.

Here is a simple test that anyone can do at home to check how well their eyes can team. It is called a pencil push-up. Hold a pencil in front of your face about arm's length away and slightly below your nose. Try to focus both eyes on the writing on the pencil keeping it clear. Slowly pull the pencil towards your nose, keeping the letters clear. Can you pull the pencil to within an inch of your nose without it becoming blurred or doubled? That is normal. If the pencil doubles or gets so blurry that you cannot see the writing, you should go to a developmental optometrist who specializes in binocular vision and who incorporates vision therapy into their practice.

If you sit opposite the person who is doing the pencil push-up, watch their eyes. You should see them move closer and closer towards the nose as if they are becoming "crossed." You may notice that one or both eyes suddenly stop crossing and bleep out towards the ears. When this happens, the person will probably report that they see two pencils. That is because the eyes stopped teaming to point to the same place in space at the same time so the brain received two separate visual images instead of one fused image with depth and detail.

This could be due to a condition called convergence insufficiency. Recent research demonstrates that it takes an average of 12 in-office sessions of vision therapy to address a convergence insufficiency. There are even some computer programs that can be purchased to address eye teaming problems at home which can be used in conjunction with in-office vision therapy with some patients who have adequate stereo vision.

So, don't accuse your child of being lazy if they report that the words wiggle or look double or blurry. Take them to a developmental optometrist who will be able to provide therapeutic interventions to address the problem in a few short months afterwhich reading should become much more efficient and enjoyable.

Saturday, February 14, 2009

Tossing Bean Bags Can Improve A Child's Reading

Children who struggle with reading because they keep losing their place, skip little words, or miss entire lines may have deficits of their eye movement skills. Since there are three pairs of muscles connected to each eyeball, (that's 12 muscles in all), the eye can be accurately pointed towards an exact point in space often without the need for the head to move at all. Of course, if a child's eye movements have not developed to a place where she can control them automatically and efficiently, she will find reading difficult or frustrating. Tossing bean bags can help her control her eye movements. Here's how to give directions for the activity for which you need nothing more than two bean bags:
  • Hold a bean bag at waist level, palm up in one hand
  • Hold the other hand also at waist level, palm up
  • Toss the bean bag from one hand to the other in a large soft arc
  • Watch the bean bag from the time it leaves the first hand, following it constantly until it lands in the second hand
  • Toss the bean bag back and forth without taking your eyes off the bean bag

If it is difficult for your child to catch the bean bag, suggest that he make sure to look at the hand with which he needs to catch the bean bag right before the bean bag lands there. You may need to issue the same cue with every new toss at first.

When this becomes easy for your child, make the activity more difficult.

  • Hold one bean bag in one hand as before with the other hand at the waist, palm-up, in order to catch it
  • Toss the bean bag as before
  • When the bean bag is flying, clap one time. Then, catch the bean bag
  • Toss it back, clapping and catching with the other hand

When this becomes easy, make the activity even more difficult.

  • Hold two bean bags, one in each hand at waist level, palms up
  • Toss one bean bag in an arc
  • Watch the bean bag that is flying
  • When the bean bag is in the air, mid-flight, clap the other bean bag into the hand that threw the first bean bag (DO NOT Throw the second bean bag - CLAP It!)
  • Catch the first bean bag with the now empty hand
  • Continue for as many repetitions as possible

As your child masters these simple and quite entertaining activities, she will become more aware of how to direct her eyes. The longer she can sustain the activity, the more she will exercise her eye muscles. While this activity alone will not remediate a severe eye movement deficit, it will begin to give your child experience using and developing their ocular motilities.

If your child has difficulty reading because he loses his place, skips words or misses whole lines you should not assume that he will grow out of it. Instead, schedule your child for a complete eye exam at a developmental optometrist who has experience with binocular vision and who incorporates vision therapy into his practice. Click on the link (at the top right of this blog) to the College of Optometrists in Vision Development to find a member eye doctor in your area.

You may also be interested in purchasing the first book (the Purple Book) in my Eye Can Too! Read series because it provides a series of academic activities for elementary school students which rely on the eye movement skills of saccades and pursuits. All of these activities are designed to be done at home facilitated by a parent. Every child can improve their eye movement skills just like every athlete can improve their strength and dexterity. To purchase your copy of this book, just click on the link at the top right corner of this blog.

Monday, February 2, 2009

What if your 3-D glasses didn't work?

Did you put on a pair of 3-D glasses to watch the special Super Bowl commercials yesterday? At least 4% of you probably did not notice any difference in the picture after you put on the glasses. This is the percentage of the American population that has a strabismus or an eye-turn. Even more people have difficulty teaming their eyes together whose conditions may involve a convergence insufficiency, convergency excess, or other problem that involves binocular function and would also have found the commercials less impressive than they had been led to believe. Other people probably were able to appreciate the added depth and detail in the commercials with the 3-D glasses at first, but then their eyes began to hurt or the special effects seemed to fade away. Still others, who have amblyopia, commonly called a lazy eye, tend to suppress the information gathered by the weaker eye, so they would also have had difficulty using the 3-D glasses.

3-D glasses work by providing the right eye with different visual information than the left eye so that a more complex image will be perceived when the two pictures are combined in the retina. ( See for a discussion of how 3-D glasses work.) For them to work requires that the individual has good binocular vision. Strabismus, eye teaming disorders, and amblyopia all correlate with reduced or absent binocularity. People who have these conditions usually have difficulty with depth perception. Some of these conditions also impair the individual's ability to read efficiently because, with a convergence insufficiency, for instance, the words may seem to be unstable on the page. They may also get headaches or report seeing double when they read.

Fortunately, with appropriate diagosis and vision therapy, these conditions can be helped. New research demonstrates that convergence insufficiencies can be addressed with a program of in-office vision therapy. Children who have been diagnosed with other binocular disfunctions have the best prognoses but even adults can be assisted to gain ground as has been demonstrated by the experience of Sue Barry, dubbed "Stereo Sue". (See ttp:// for her story.)

What is my point? If you or someone at your Super Bowl party was unimpressed by the 3-D glasses because they didn't seem to change anything about the picture, or if anyone found wearing the glasses uncomfortable or intolerable, it probably means that they need to schedule a comprehensive eye exam with a developmental optometrist who specializes in binocular vision and who also is a vision therapy provider. Then, if there is a diagnosis that can be helped by vision therapy, know that the benefit of seeing in stereo is worth the investment of time, money, frustration, and effort.