It's Developmental

Eye movements, eye teaming, visual perceptual skills, and eye-hand coordination are all developmental skills. This means that they typically emerge given the right opportunities and experiences like learning to walk, ride a bicycle, or swim. There is a range of normal vision development which can be tested and measured against standard age/grade norms. This is how developmental optometrists determine and diagnose any delays or deficits of normal visual development. What we do in vision therapy is help trigger a child to acquire and maximize their visual developmental skills. I can't tell you the number of times a parent has asked me whether their child will need to return to vision therapy in the future. My usual answer is that it is very like learning to swim but then not swimming all winter. Can you still swim when the pool opens in the spring? Yes, and what good swimmer hesitates to dive into the pool's deep end even if they haven't been swimming in ages? Unless the visual problem involves a diagnosis of amblyopia, or some other non-developmental condition or brain injury, once a child's visual skills have developed, they tend to keep improving.

After six years as a vision therapist....

It has been about six years since Dr. Doell recruited me to become a vision therapist in her optometry practice. At the time, I was a classroom teacher with a master's degree and I was also her patient - we had met when one of my own children suffered from a convergence insufficiency close to 20 years ago. She did about six weeks of vision therapy on Nancy and treated the whole family happily ever after.

We clicked - come from the same area of New York City and find the same things funny so we laughed through each appointment and even went out to lunch for fun a time or two. So, when she told me she was looking for people with masters degrees in education or OT to train herself, I was interested - besides single parenting (not by design) six minor children on a teacher salary was not cutting it so the few extra bucks looked good.

I observed the VT room in action and started working after school a couple of evenings each week. I already knew how to read a child's personality and make them feel at ease. It was easy for me to set up an activity and make it meaningful but it took a lot of practice to learn how to observe the eyes at work, how to match the right therapeutic activity to the diagnoses, how to decode the medical notes in the patient's file, and how to record and then apply what I observed.

Reading optometry books and articles made me feel illiterate at first - a whole new vocabulary had to be grasped - and I felt really slow at the task in spite of being an insatiable very competent reader. But I persevered, attended workshops and optometry conferences and asked the same questions a million different ways not realizing that it was the same question sometimes.

Now I find myself watching the eyes of people being interviewed on television and wondering if there is a strabismus or some other problem to explain anything other than aligned normal looking eye contact or eye movements. I find myself wishing I could do some simple activities with random colleagues and relatives because they display familiar ocular behaviors or postures that I know I could perhaps address and provide the means to greater visual efficiency.

I wish I could interest every classroom teacher in my e-books because a few carefully chosen lessons using the activities I present might just make a few more kids into more adequate readers who could do better on the dreaded standardized tests. Why don't the graduate level reading classes incorporate basic visual efficiencies or present the list of classroom behaviors that signal probable learning-related vision challenges which proper optometric attention could resolve?

I don't know how many more years I will be doing vision therapy a couple of days each week but I do know that my life and outlook has been forever changed because I have been introduced to the profession.

For Teachers About Learning & Vision

Teachers should be the first line of intervention when one of their students has a learning-related vision problem since they get to see the children at work every day. When a student covers one eye or puts their head down so that only one eye points towards the text or paper, the teacher should recognize that this child needs to see an eye doctor to rule out amblyopia, or problems teaming the eyes to keep a word or other image single. When a student squints or complains of having a headache often during school - especially when asked to copy work from the board or smart-board to a piece of paper on their desk, the teacher should suggest that the student's parent make an eye appointment to make sure that the child knows how to accommodate i.e. switch their focus from near to far and back again efficiently. When a student cannot line up the digits in a math problem or appropriately space words on their paper, the teacher should first offer some practical hints but if these do not seem to help, it is time for a referral to an eye doctor to make sure that the child's eye movements and visual perceptual skills are developing on schedule. When a student makes frequent reversals when reading or writing - especially after the second grade, this may be a visual spatial delay in the skills of laterality and directionality. Finally, when a student has trouble in PE or on the playground catching or aiming balls or, in general, has under-performing gross motor skills, the root of the problem could the visual-motor-integration. While each of these symptoms can make success in school very difficult, all of them can be addressed by a few weeks or months of in-office vision therapy under the supervision of a developmental optometrist. No child should be left behind in school because of addressable learning-related vision problems.

Before you Medicate, Investigate- ADHD & Vision

Clinical research has established that there is a link between a diagnosis of ADHD and certain vision deficits or delays in children. Many children with ADHD also test positive for a saccadic eye movement deficit. This means that they have difficulty moving their eyes efficiently and accurately from one fixed visual target to another as in going from one word or line to the next on a page of text. Many children with ADHD also test positive for a convergence insufficiency (CI). This means that they are unable to cross their eyes or team them appropriately and may experience words moving, blurring, or doubling on a page. They may get headaches when reading or they may, without ever being aware of it, suppress the vision in one eye. Many children with ADHD also test positive for accommodative infacility (AI) which means that they have trouble adjusting their focus when looking from a near image to a different image in the distance.

The good news is that all three of these visual diagnoses can be addressed with a program of in-office vision therapy under the supervision of a developmental optometrist. So, if your child has been diagnosed or if you are being encouraged to obtain a diagnosis of ADHD, don't stop there. Arrange an appointment for your child to receive a comprehensive eye exam by a developmental optometrist who incorporates vision therapy into their practice. If the eye doctor finds that your child has any of these visual problems, follow through with the program of vision therapy. To find a developmental optometrist in your area, plug your zip code into the search box at www.covd.org.

You can read more about this in: Borsting, Eric; Michael Rouse, and Ray Chu. Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study. "Optometry", Volume 76. Number 10. October 2005

Learn to Be the Boss of Your Own Eyes

A first grader came to his 15th in-office session of vision therapy today. His parents brought him to the developmental optometrist in the first place because they noticed one eye shifting in whenever he got tired. They feared he would be teased for having crossed eyes and wanted to try to avoid surgery. Not only did the doctor concur that he has a strabismus- an eye turn, she discovered that he did not use both eyes as a team. Like many other children, he suppressed the vision in one eye to avoid seeing two images when his eyes were not aligned at the same time on the same visual image in space. This unconscious strategy made him unaware of any visual problem. He had good grades, was a good athlete, and had no intrinsic use for coming to see me every week. It has taken all sorts of monocular, and binocular activities disguised as games to coax him to begin to experience binocularity. Last week it started to make sense TO HIM. I asked him to watch a bead approaching his nose on a long string (the Brock String - magic to many patients but key to learning to use two eyes together). Whenever the bead got within about six inches of his nose, his left eye swooped in towards his nose and he reported seeing two balls. Had his eyes continued to be teamed on the in-coming bead it would have remained single. Finally he was able to connect the feeling of that eye moving in with the sensation of double vision. "You need to be the boss of your own eye," I suggested, "but it keeps saying: 'I don't have to obey you - I can do anything I want.'" That apparently was enough motivation to make the child take charge. Today I could push the bead within two inches of his nose without the eye wigging out and he could switch between that bead and another bead about eight feet away on the same string without any problems at all except that it made him very tired. By next week he should be able to do more repetitions without fatiguing. As long as he is the boss of his own eyes, he will make them mind. Of course, this activity correlates with the ability to read for extended periods of time without fatigue, double vision, headaches, or the words wiggling on the page. It also solves the cosmetic problem that his parents were so (justifiably) worried about.  I can't wait for his re-evaluation appointment with the doctor who will be thrilled at the emerging binocularity and independent control of his eye movements both when using one eye and two.

3-D Vision Therapy

Some people whose eyes do not team properly don't see in three dimensions. In other words, they may lack stereo vision (stereopsis). The cause may be an eye turn (strabismus), the suppression of one eye, or some other condition to be identified by an optometrist. Until recently the experts believed that unless the condition was addressed in a young person, either by vision therapy and/or surgery, it would become "hard-wired" in the brain. In other words, no one even held out hope for an adult to obtain stereopsis. That began to change with the experience of psychologist, Dr. Sue Barry, now nicknamed "Stereo Sue." Check out how she explains what happened to her on her website, www.fixingmygaze.com, or in her book by the same title. You can also watch her on You Tube:

http://www.youtube.com/watch?v=m2YqVLARZOM

http://www.youtube.com/watch?v=P9afrMMsh2w

http://www.youtube.com/watch?v=aUzJogvB0Hc

http://www.youtube.com/watch?v=CP8SsUl5wb0

http://www.youtube.com/watch?v=_c010cP8sKo

In the vision therapy context, I have worked with quite a few adults who had never experienced seeing in 3-D. When it begins to emerge, the delight they express is amazing- in spite of the headache that seems to accompany the adjustment to true binocularity. It takes time but to enrich the way the world looks is a reward that is truly worth the investment of time, money, and discomfort.

Why don't more people know about vision therapy?

I just had a long conversation with the publisher of my Eye Can Too! Read series about why people don't know about vision therapy as a way to improve a child's reading among other things. She commented on the interest the books receive at the various home school curriculum fairs (there's one this weekend in Schaumberg, IL, by the way- my books will be at the Home School Inc booth). She said that when the sign offers "help for struggling readers," parents are not as attracted as when it says "vision therapy workbooks." By the way, Lottie, your eyeball painting attracts A LOT of interest! Here's some of what I said.

1. Education generally does not consider that other than for low vision issues, vision could be the root of a child's difficulty in learning to read. It isn't profiled in the graduate school reading courses. (I would love to offer such a course at the graduate school level here in St. Louis- I even have a course proposal written!) Vision therapy and binocular vision evaluations are not typically included in an IEP (of course not because then the budget-strapped public school districts might have to pay for the services). The school nurse's vision screening doesn't usually deal with anything other than acuity and obvious ocular health issues. So when a child has received all the reading interventions at school, gets read to at home regularly, is otherwise intelligent, articulate, and healthy, but still cannot read on grade level, he gets labeled learning disabled in reading, given a diagnosis of dyslexia, or placed in still more sedentary tutorials. If these children were to be sent to a developmental optometrist for a binocular vision evaluation and, if indicated, a developmental evaluation of their visual-perceptual skills, and again if indicated, enrolled in a program of in-office vision therapy, many of them would gain the skills they need within 12 to 48 weeks.
   
2. Home schooling parents frequently choose to home school because their struggling readers are not well served in a traditional school setting. Then, in their frustrated search for interventions, they end up spending too much money without achieving the result they hoped for. Since vision therapy providers are hard to find, are usually very expensive, and their services tend not to be covered by health or vision insurance, these parents suspect that the prescribing doctor may just be another person looking to separate them from their money without bringing any real change.
3. Optometry and ophthalmology are not always friends. Optometrists are the eye doctors who generally provide vision therapy services as well as binocular vision evaluations. Ophthalmologists are the medical doctors who specialize in the treatment of eyes. They also do eye surgeries. While there is more than 40 years of documented optometric research to prove that vision therapy works, there is limited awareness about it partly because of the disconnect between optometry and ophthalmology. Since 2008, though, both professions agree that in-office vision therapy is effective to treat convergence insufficiencies. This is real progress. Ophthalmology also agrees that vision therapy is helpful in the treatment of amblyopia.

So much for the big issues that may be slowing down the sale of my "vision therapy workbooks" as the publisher nicknamed them. Really, they are graded academic activities for home-school students in language arts and math that also help parents identify, begin to address, and certainly improve a students efficiency, comprehension, fluency, and speed when reading. In no way do these books attempt to diagnose or prescribe anything for anyone. Rather, they connect the dots I hold because of my background in education, home-education, and as an optometric vision therapist.

One reason that I started blogging about these issues (other than as a marketing strategy for the books, of course) is that I know that a lot of children who don't like to read and who are not "living up to their potential in school" change after their unaddressed learning-related visual challenges get fixed. I see it every day when I work in the vision therapy context. I'd love to be considered a resource for parents and teachers around the issues of vision and learning so please, post your questions as blog comments or on the wall of the FaceBook page. Or email me at asklesley@teamlesley.com. I'll answer what I know- probably I'll suggest you schedule an appointment with a developmental optometrist too.

For optometrists, the Eye Can Too! Read series of e-books is a great resource for your home-schooling families. The books work as stand-alone solutions or as resources for home therapy in connection with a program of in-office vision therapy for saccadic deficits, laterality & directionality delays, and visual perceptual delays. Let me know if you are interested in receiving preview copies or in having them available on CD for sale at your office.

Do You Have Good Eye Movement Skills?

A very common learning related visual problem is poor eye movements. The six eye muscles in each eye should work together to point the eye to a visual target such as a word on a page or a baseball coming towards a bat or glove. There are actually two types of eye movements facilitated by these muscles. Pursuits are the movements the eyes make to follow a moving visual target smoothly. When I am helping a patient develop good pursuits, I often characterize this skill as "ice skating for your eyes." The other type of eye movement is called saccades. Saccades are the short hops the eyes make between two fixed visual targets such as when going from the end of one line of text to the beginning of the next line.

Both pursuits and saccades are developmental eye movements. Like learning to swim or ride a bicycle, once a person knows how to do them, they continue to improve. With experience, the person can coordinate the movement automatically and fluently enough to do other things at the same time like carry on a conversation, for example. However, for patients whose developmental eye movements are delayed, basic tasks like reading, lining up digits in a math problem, or hitting a baseball can be very difficult.

There is a simple test that optometrists use to test a child's eye movements called the Developmental Eye Movement Test (DEM). It is available exclusively from the Bernell company (www.bernell.com). Bernell provides an assortment of tools for optometrists and vision therapists. The DEM can be used for children as young as first grade. First the child is asked to read a column of 80 single-digit numbers arranged vertically. The examiner times the child with a stop watch. Then the child must read the same 80 numbers arranged in rows horizontally with random gaps in the rows. By the time a child is twelve years old, the speed with which they read the vertical numbers should match their speed reading the horizontal numbers. The test has been validated over a period of years so norms for a child's performance scores have been established according to both age and grade. Besides comparing the vertical and horizontal reading speeds, the DEM also measures the number of errors made by the child. It only takes about three minutes to complete the entire DEM but the results may explain why a child is having difficulty in school in spite of having 20-20 vision.

If your child scores poorly on the DEM, vision therapy may be indicated. Your child may also be helped by the activities in the Purple Book of the Eye Can Too! Read Series. While I wrote the series for home-schooling families, anyone can implement the activities which are similar to what we use in in-office vision therapy to address eye movement deficits.

Poor Reading Fluency May Indicate a Learning-related Visual Challenge

Efficient readers move their eyes quickly across a page of text decoding words and processing meaning. The most efficient readers even scan and recognize familiar words by their shapes. It takes more than good phonetic skills and a good visual memory to read fluently though. People who have deficits of their saccadic eye movement skills can't usually do it. Because their eye muscles are not developed well enough for them to control where to point their eyes, they may not be able to maintain a fixation long enough to process the word or its meaning. When they lose the fixation, they also lose their place in the text.

Fortunately, saccadic eye movement skills are fairly straight forward to improve. Starting with monocular activities that exercise each eye by itself, the eye muscles get strengthened enough to become much more reliable within a few weeks. Like I tell my younger vision therapy patients who are struggling with saccadic eye movement deficits, "You are supposed to be the boss of your eyes but they are mocking you and saying, 'We don't have to do what you say. We can do anything we want." After several weeks of consistent practice, most patients gain significantly better skills.

Until they can manage quick and accurate saccadic eye movements while also doing a cognitive task at the same time, though, the optometrist typically will not discharge a patient from vision therapy.

While there are other learning related visual issues which can result in poor reading fluency like a convergence insufficiency or a visual perceptual delay, improving your student's saccadic eye movement skills will usually result in an increase in reading speed, fluency, and comprehension.

The good news is that even if you do not have a diagnosed deficit of your saccadic eye movements, anyone can improve their reading speed, fluency, and comprehension using the activities in the Purple Book of the Eye Can Too! Read series. (Click on the links at the right of the blog to preview the series at Home School Incorporated.) While written with the home school context in mind, the activities are appropriate for anyone and can even be adapted for use in a classroom learning center. The book contains graded academic activities that all also rely on and build saccadic eye movements.

Of course, every child should be examined by a developmental optometrist or other eye doctor once each year to make sure that their vision is developing normally, the eyes are healthy, and if they need glasses, they have the correct prescription. If you are concerned about the possibility that your child has a learning related visual problem, be sure to let the doctor know.

Learning-related Visual Challenges Can Effect Behavior

Students who get very agitated about doing homework, who do not like reading, or who are having serious challenges learning to read may be responding to an undiagnosed visual problem. I see this in the vision therapy context all the time. Children resist doing certain activities by engaging in all types of behaviors that they hope will distract me from continuing to insist on the task. Some children express anger or frustration, even becoming oppositional or somewhat combative. Other children say that they can't do the activity because it is too hard, too tiring, or too confusing. Still others goof around to avoid actually doing the work. These same strategies happen in the classroom and at home over homework. It can be enlightening for the therapist, teacher, or parent to have a calm conversation with the child. Ask whether the activity is difficult. Then ask why. If the child says that the words move on the page, they can't keep their place, the task is just confusing, or it gives them a headache respect the answer. See if the child can make a distinction between doing the assignment and understanding the material. Don't lead the conversation, though. Just give the child the opportunity to explain the basis for the behavior. Then, instead of making the child push through a task that is overly challenging, give an alternate activity that is more achievable. Talk about better ways to tell the adult that a task is too difficult instead of continuing to utilize the bad behavior as an avoidance strategy. Of course, if your child gives you any indication that their resistance to visual tasks is because of how difficult it is for them to cope with the visual information, make an appointment with a developmental optometrist in your area. First, rule out any need for corrective glasses. Then, rule out any eye movement deficits, eye teaming problems, visual processing delays, and visual motor integration deficits or delays. All of these issues can make school very overwhelming to an otherwise bright child. All of them can be addressed using a specific program of vision therapy under the supervision of a developmental optometrist who incorporates vision therapy in their practice setting.

Does Your Child Have a Head Tilt?

This could be a sign that your child favors one eye over the other. She may tilt her head because each eye may have a different visual acuity at near or in the distance. Perhaps she sees better and clearer with one of her eyes.

Another cause of your child's head tilt could be the result of a convergence insufficiency or a convergence excess. These conditions may indicate that she is having difficulty teaming both eyes together without experiencing blur or double vision. Her coping strategy could be to suppress the visual information received by one eye, shutting it off, in effect, by tilting her head.

If your child has always experienced these visual conditions, she may not even realize that it is abnormal.

So, if your child has a head tilt, don't scold her about her posture until after you take her to a developmental optometrist for a comprehensive eye exam. She may need glasses or a program of professionally supervised in-office vision therapy. You can find a developmental optometrist in your area at www.covd.org by plugging in your zip code.

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 http://www.3dglassesonline.com/how-do-3d-glasses-work/ 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://www.newyorker.com/archive/2006/06/19/060619fa_fact_sacks 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.

What Do Children Say When They Have Learning-Related Visual Challenges?

"I shut one eye when I read because it is easier," one second grade boy admitted to me at a recent in-office vision therapy session. His diagnosis includes saccadic deficits and convergence insufficiency. He hates to read. No wonder! The words don't stay put on the page when he attempts to read and he can't keep them single unless he closes one eye. However, that strategy deprives him of some detail and appreciation for depth. Within the next 6-12 weeks, though, he should notice a significant difference. The vision therapy activities that we do together and that he does between the weekly sessions at home are research-based and proven to strengthen the eye muscles as well as to help him realize how to coordinate and team both eyes to point to the same location at the same time, thus keeping the image single as well as 3-dimensional.

The next patient, a first grade girl who is in her eighth week of in-office vision therapy, surprised both her mother and me. Her diagnosis is saccadic deficits. This means that she has difficulty moving her eyes quickly and efficiently from one stationary visual target to another- like what the eyes do when moving from a word or a line of text to the next without loss of place, or skipping. I asked her if she has noticed any changes when she reads since she started coming to vision therapy. She said, "Yes, there aren't two words anymore." While this correlates with some of the anecdotal findings I have recorded about her progress, since she did not have a diagnosis related to eye teaming such as convergence insufficiency or convergence excess, we did not realize that she was suffering from dyplopia, double vision. Children have no other visual experience than their own so frequently they do not identify their visual challenges in language that tips off the adults that they need some interventions. This child has more vision therapy work to do to resolve the saccadic deficits but imagine how much more comfortably and successfully her school days must be now that the letters and words on a page look clear, stable, and single.

Vision therapy is an intervention that works to address quite a few learning-related visual issues. If your child is struggling at school, let me encourage you to schedule a comprehensive binocular vision exam with a developmental optometrist who is experienced with pediatric patients and who also incorporates vision therapy into their optometry practice.

Even Adults Can Gain Better Learning-Related Visual Skills

Yesterday my editor for the Eye Can Too! Read series of books emailed this: "Today I was reading something and suddenly realized. . . I’d been reading!! I had been reading for a quite a while (5 minutes) without a break-off, and yet also unselfconsciously. After those five minutes I started my breaks again—but I believe I am seeing that your activities are working!! “Break” is my word for my kind of stop-start reading, going back and forth because I’m not comprehending—jumping all over. I think that before doing these activities I could only read for one minute before I started breaking. Maybe less than that."

By "your activities", she meant the activities in the first book in the Eye Can Too! Read series which give graded academic activities designed to give home school students experiences using saccadic eye movements and pursuits- the skills that help people move from word to word and line to line on a page of text without losing their place, skipping words, or getting lost...

When we began working on the book project neither one of us suspected that she had any learning-related vision challenges. She wears glasses- but lots of people do. Glasses correct a person's ability to see clearly at near or in the distance. However, when I took her to see the vision therapy practice in which I work under the supervision of a team of developmental optometrists, she had a huge amount of difficulty doing the most basic eye movement and eye teaming activities. Now, I am not qualified to diagnose anyone about anything, but I could suggest that if she did some of the basic activities in the Purple Book of the series, which became available in September 2008, she would gain ground. And I absolutely recommended that she locate a developmental optometrist in her local area who would be able to give her a comprehensive eye exam and follow up with a customized program of vision therapy.

As we have continued to talk about how she is doing, she has realized that she has never actually read an entire book straight through. Instead, she has developed all kinds of strategies to help her process the book's information - like note-taking and re-reading each paragraph three or four times- habits that make her a very excellent editor. The effort that she must have needed to earn a college degree and an MBA had to be huge. Now she can begin to envision a day when reading will be fun. I am so pleased to have been placed in association with her and I trust that many others who have a life-time of reading difficulties will find the same encouragement to have a comprehensive vision examination by a developmental optometrist no matter how old they are.

Even this morning on National Public Radio's "Morning Edition", Joe Palca reported about his difficulties with 3-d vision because of amblyopia. Amblyopia, or lazy eye, is another condition that responds to vision therapy activities especially when the patient is young. However, new research is demonstrating that even adults can be trained to achieve stereo vision. Palca's report gives a great example of what happens in a vision evaluation and at vision therapy sessions.(http://www.npr.org/templates/story/story.php?storyId=99083752).

Seeing Through New Eyes, By Melvin Kaplan

This book that promises to be able to "change the lives of children with autism, Asperger syndrome, and other developmental disabilities through vision therapy" intrigued me from a number of perspectives. I am an optometric vision therapist so I work with this patient population on a regular basis. I found Kaplan's clinical notes and case studies to be rich with insight as well as technique that I can adopt with some of my patients immediately. I am the aunt of 3 children whose symptoms fall along the autism spectrum so I was interested in whether Kaplan's material would be presented in layman's language. It is. Recently I wrote a series of three books about learning-related visual skills for home schooling families, the Eye Can Too! Read series and have been asked to consider writing a book in the same series to give the home schooling parents of special needs children a series of visually reliant academic activities that they can use. Kaplan's book would definitely be included on my resource list should I end up writing the fourth book. Kaplan's vision therapy evaluation tools for non-verbal patients are great and his explanation of the therapeutic use of yoked prism glasses (while sounding quite mysterious to the uninitiated) is well documented and easy to understand. My only negative comment is that the book takes a long time to read even knowing the terms and activities as I do. However, anyone who wants to understand why some children rock, flap the air, or utilize other stimming behaviors to make sense of their world will gain both empathy and hope that these socially challenging habits can be adjusted by reading Kaplan's book. Well done.

Kaplan, Melvin. Seeing Through New Eyes. Jessica Kingsley Publishers. Philadelphia, London. 2006

Does Vision Therapy Do Any Good?

The link between learning-related visual skills and juvenile delinquency has been explored in article after article by the American Optometric Association and the Optometric Extension Program since the sixties. In 2000, Stan Kaseno, OD., reported on the results of the San Bernadino Juvenile Hall Vision Clinic after it had been involved in providing vision care and vision therapy to juvenile delinquents for twelve years.* 93% of the juvenile deliquents initially were unable to pass a developmental test of their visual skills. The average recidivism rate for these offenders is 70% but the ones who received 24 sessions of vision therapy had a recidivism rate of just 15%. The youth also made measurable gains in their reading levels and IQ scores. In addition, they began to set goals for their lives. Unfortunately, the San Bernadino Juvenile Hall Vision Clinic closed in 2000 due to a lack of state funds. However, if this is the potential for improvement after just three months of vision therapy, doesn't it make sense to get every struggling student evaluated to see if their academic challenges could be rooted in a learning-related visual issue? Use the links on the blog to locate a developmental optometrist in your area and schedule your child's eye exam today.

*Dr. Kaseno's article is in Volume 41/Number 3 of Behavioral Aspects of Vision Care, c. 2000. Optometric Extension Program Foundation Inc., Santa Ana, CA.