Eye Movements & a Struggling Adult Reader Who Has an MBA

I recently did a very simple eye movement activity with a friend who reads very slowly. It has always been a problem for her from the time she was in elementary school. In fact, she chose her high school and college courses to avoid reading so she became good at math and ended up with an MBA in finance. It remains agonizingly difficult for her to find the energy to tackle reading even a few pages. When she reads aloud, she lacks fluency, obviously struggling to keep her place while decoding the words and trying to process their meaning. So, I suggested that she might have some basic eye movement deficits. Now, I am not an eye doctor. Nor do I play one on TV but I am a skilled observer of a person's eye movements because of the work I do as a vision therapist. I asked my friend to cover one eye and to follow my pen as it moved in a slow arc in front of her eyes, up, down, across, and circling in toward her face. Then she covered the other eye and we repeated the activity. She had no problem making smooth eye movements to track the moving pen so her ocular pursuits look fine. She could even maintain a conversation while doing this activity. Next, one eye at a time again, I asked my friend to look at one pen and then, on my signal, jump her eye to another. She could not keep her fixation on the first object, nor could she accurately locate the second. When she visits a developmental optometrist for a thorough eye exam, I predict that she will receive a diagnosis of saccadic deficits. This is the result of poor control of the six muscles in each eye and can be addressed through a program of vision therapy. (In fact, just as a side note, the Purple Book of the Eye Can Too! Read series of e-books that I wrote has a lot of activities that rely on and can improve these eye movement skills). Next I asked my friend to use two eyes and focus on the #2 written on the side of a pencil that I was holding about a yard away from her face so that the eraser was facing up. I asked her to keep the #2 single and clear and to tell me if it got blurry or doubled. Slowly I pushed the pencil towards her face watching her eyes to make sure that they were converging. They did get closer and closer to her nose which is appropriate. However, when the pencil was about a foot away, my friend said, "That hurts!" She did not look away right then but I could see the stress that she was under. I repeated the activity and she repeated her report of discomfort at about the same place. So, when she visits the developmental optometrist she will likely receive another diagnosis related to her eye teaming skills.She should have been able to track that pencil in to three inches or nearer to her nose without pain, blur, or double vision. No wonder reading has been so difficult in spite of her willingness to tolerate significant discomfort in order to succeed. No matter your age, if you have difficulty reading, see whether there is a visual issue that can be resolved with a few eye exercises. Locate a developmental optometrist by going to www.covd.org and plugging in your zip code. Make an appointment and see what the doctor discovers.

Peripheral Awareness & Autism Spectrum Disorders

If you stare in front of you at a small visual target like a sticker or a spot on the wall you are using your central vision. The longer you maintain that fixation, the more you should become aware that you can also see objects in your peripheral field of vision. The ability to coordinate between your central and peripheral visual systems is very important. Athletes depend on it to sense when an opponent is approaching from behind. Everyone relies on it to remain aware of cars or other potentially dangerous obstacles that should be avoided. Peripheral awareness can actually be improved with practice and certain activities.

For individuals on the Autism Spectrum, however, coordinating and transitioning between the central and peripheral visual fields may be their most significant visual challenge. Many people on the Autism Spectrum repeatedly focus on spinning objects, or on moving lights and shadows. These are enjoyed via the peripheral system. Other people on the spectrum fixate on a pen or pencil that they hold and rotate right in front of their eyes or they cannot be pulled away from small objects or details. These are enjoyed via the central visual system.

As Patricia S. Lemer explains in her helpful book, Envisioning a Bright Future: Interventions that Work for Children and Adults with Autism Spectrum Disorders, learning to coordinate central and peripheral vision may improve a child's attention, focusing, and visual perceptual skills. It may even reduce toe walking and the need to hold onto a wall when walking. Dr. Melvin Kaplan (www.autisticvision.com) wrote a book, Seeing with New Eyes, that explains how these issues can be addressed using therapeutic prisms.

Children who are on the Autism Spectrum may have other visual challenges that can be addressed with the help of a developmental optometrist and a program of in-office vision therapy. They may need glasses to see clearly. You can easily locate an experienced developmental optometrist in your area by plugging your zip code into the search box at www.covd.org. Even if your child is not on the Autism Spectrum, it is important to schedule an annual eye exam with a developmental optometrist and to follow up with the treatment, prescriptions, or therapy that the doctor advises.

Find out why a child is a struggling reader by asking the right question

In my opinion, one of the most common reasons that parents and teachers don't bring their children to the optometrist when they first start having trouble learning to read is that the grown-ups don't ask the children the right questions. So, they never hear what the child is really experiencing.

The adults who probably learned to read early and always performed at the top of the top reading group when they were in grade school often declare that the reason a child is struggling to read is that they are just lazy, do not want to work, don't pay attention, or don't want to learn.

Why don't the well-meaning but demotivating dissing grown-ups ask the child a simple question like: what makes reading hard or frustrating?

Instead of trying to put words in the child's mouth, the next thing to do is wait quietly until the child answers.

Perhaps the child will say that they can't tell where the letters are because the lines are always moving or they are on top of each other or look too blurry to read. Maybe the child will say that reading always gives them a headache. Any of these answers should send you to the optometrist immediately. They are classic symptoms of a binocular dysfunction like a convergence insufficiency. Research indicates that most patients diagnosed with convergence insufficiency resolve the problem after an average of twelve weeks of in-office vision therapy.

Other children may say that they keep losing their place when trying to read which may indicate a deficit of their eye movement skills. This condition, which is often accompanied and/or masked by a diagnosis of AD(H)D, can also be addressed by some guided vision therapy activities (And, if I do say so myself, by the activities in The Purple Book of the Eye Can Too! Read Series that I wrote- but that is shameless self-promotion, after all, so hurry and click on the link to that sale page.) Seriously, not being able to control their own eye movements is a common reason that otherwise healthy, obviously intelligent and articulate children do poorly in school.

Finally, the child may say that reading is confusing or they can't remember how to figure out the words. These answers should prompt you to have your optometrist schedule a developmental evaluation of the child's visual perceptual skills (And check out the other two books in the Eye Can Too! Read Series. The Yellow Book provides activities to improve dyslexia-like symptoms and The Green Book provides activities that rely on visual perceptual or processing skills.)

But, whether you buy my books or never look at them ever, take the advice of this mother of seven, grandmother, master teacher, and optometric vision therapist, please.

Children want to please there parents and teachers for the most part but when they don't know how to tell you why they are struggling and when you don't ask the right questions, they can only respond by resisting, refusing to cooperate, getting angry, or passively avoiding the dreaded school work.

Ask what makes it hard.

Don't put words in their mouth.

Respect their answers.

Believe what they say.

Be their best advocate.

Find real help and keep hunting if the first helper turns out not to work after all.

If you still don't know how to help your child or student, why not post your question or tweet it or Facebook it to the Eye Can Too! Read page's wall - I'll try to put in my two cents but I'll bet that the optometrists, vision therapists, parents, and educators among us will weigh in.

On behalf of all the children who went to bed tonight angry and confused about why reading is hard for them, thank you for reading this.

Does your student move their head across the page when reading?

Do you notice that one of your students moves their head across the page when reading? The same student probably also struggles with losing their place, skipping lines and little words, and finishing worksheets arranged in rows and columns. Someone who habitually moves their head when reading may be compensating for inadequately developed eye muscle movement skills. However, this strategy ends up hurting their reading speed, efficiency, accuracy, and comprehension. In fact, they are using their neck muscles to point their eyes to the text when each eye has a total of six muscles specifically designed to work together to make very specific, accurately focused eye movements.

Developmental optometrists whose practices include vision therapy have lots of activities that serve to address poorly developed ocular motilities. They usually start as monocular activities so that the student wears a patch over one eye to do the task, switching the patch to the other eye to repeat it. Once a student demonstrates equivalent accurate and efficient eye movement skills with each eye by itself, the therapy advances to binocular tasks. Not only does each eye need to move appropriately to gather visual information, the eyes together have to coordinate to point at the same time to the same point in space. Otherwise the image will wiggle, appear blurred, or seem to be double.

If you have a student who moves their head back and forth when reading, recommend that they see a developmental optometrist for a comprehensive eye exam. They may have a deficit of their ocular motilities which is easily diagnosed by a Developmental Eye Movement Test (DEM). The earlier in a student's academic career that these deficits are identified and addressed, the better that student will do overall in school.

The Purple Book in my Eye Can Too! Read series provides lots of academic activities for the home school classroom which can also be adapted for the regular classroom. Each activity provides review in language arts or math skills for Pre-K through eighth grade. I also included helpful observation questions to assist the teacher or parent to evaluate a student's performance. The activities in The Purple Book will help you identify if your child's eye movement skills are under-developed. They can also be used even by people who do not have eye movement deficits to increase their reading speed and efficiency.

Oddly spaced handwriting could indicate a visual perceptual developmental delay

When a student has a delay in the developmental visual perceptual skill of visual figure ground, they may not be able to space the letters within words adequately. First graders whose letters vary widely in size may not be aware of how their work differs from the model because of delays in the development of their visual processing skills. Students who put extra wide gaps between letters within words or between words within a line may also be attempting to cope with an underdeveloped set of visual perceptual skills.

Vision is much more than the ability to see clearly at near and in the distance. It involves gathering visual information, intake skills; interpreting visual information, processing skills; and responding to visual information, visual motor integration skills.

The root of a student's difficulty, frustration, dislike of, and inaccuracy with reading or writing could be their visual skills. In fact, even when a student passes a vision screening, they could still have undetected learning-related visual challenges.

If they do not have independent, automatic, voluntary control of their eye muscles, they will have difficulty with gathering visual information. This aspect of vision can also be impacted by poor eye teaming skills.

If they do not have effective strategies for processing the visual information that the eyes send to the retina, they will have difficulty recognizing, remembering, or manipulating it.

If either the visual intake skills or the visual processing skills are under-developed, they will have difficulty with the motor response such as writing a word neatly, or finding the beginning of the next line, or hitting a baseball.

Teachers and parents are the first line of intervention when a student has a learning-related visual issue. If you notice that a student has a consistent problem with a certain type of assignment, ask the student what they think is going on before you tell them how to fix it. Then make sure to arrange a comprehensive vision examination with a developmental optometrist who is experienced with children and binocular vision. The doctor will be able to recommend an assortment of options for how to address any learning-related visual diagnosis with glasses, in-office vision therapy, or by suggesting activities for you to do with the student at home or in the classroom.

When otherwise healthy, intelligent, articulate, and curious children experience difficulty in academics, suspect that the problem has a visual root. At least, rule out any learning-related visual problem by taking them to a developmental optometrist for a thorough check-up.

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.

"I like the book...my 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.

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.

Why Can't My Student Remember How to Read Simple Words After Lots of Review?

As frustrating as it can be for the teacher when a child seems unable to recognize the same easy word in the next sentence, it may be even more difficult for the student. Imagine knowing that you are a very smart person before being confronted with the need to learn to read, and then finding yourself stuck in the lowest performing reading group. How boring! How demeaning! The child cannot figure out how the other students can make the letters stand still on the page, or which of the double lines go with which letter, or which side of the page or word is the beginning, or why the letters and words seem to disappear - that is, if he has learning-related visual challenges. What is even worse, since he has never had any experience of normal vision with which to contrast his own, he cannot explain why he is having trouble. When teachers or parents decide that somehow the problem is related to his behavior or that he is just not trying hard enough or that he is being lazy, the student often responds with even less effort, overt anger, or becomes withdrawn and depressed.

Before assessing that your student is guilty of any of those things, consider that all of these symptoms correspond to a visual condition that can be addressed with simple activities during in-office or home-based vision therapy. Get your child tested by a developmental optometrist who is familiar with vision therapy. Then, follow through on the recommendations that the doctor suggests.

What? Your child passed the vision screening at the nurse's office at school, at the pediatrician's, and, besides, the local eye doctor says he does not need glasses. As the developmental optometrists are fond of saying, "vision is a lot more than 20-20 eyesight." There are ocular motility skills - how the eye muscles work together to point the eyes to a point in space; eye teaming skills - that keep the words single on a page and contribute to an appreciation of depth; accommodation skills - the ability to easily and comfortably change the focus from near to far and back again; a whole cluster of visual perceptual skills - how to interpret the information gathered by the eyes; and visual motor integration - how to use visual information to direct motion. Students can have difficulty with any of these skill sets without needing glasses.

If your student is having difficulty learning to read, if her academic performance does not "match" her expected potential, if school just seems too hard, get a thorough eye examination that considers more than just whether your child needs glasses.

What's So Important About How A Student Holds A Pencil?

Many of the patients that I see in my work as an optometric vision therapist do not have good pencil posture. Instead of the relaxed, efficient grip that should be required of each kindergarten student who is learning to write, many students who struggle with learning related vision problems use a fist grip or hold the pencil very close to the tip or do not secure the paper with their free hand. The issue is not limited to poor or illegible handwriting. In an article in the OEP Vision Therapist, Volume 33, Number 1, 1991, therapist Denis Hoover reported on the observations of Dr. Ernest J. Kahn. This optometrist administered the Sentence Copy test (probably by Wold) to his patients and noticed the following three associations.

1. Most near-sighted children hold their pencil 1/4 inch or closer to the tip.
2. Most children who also have been diagnosed with a learning disability utilize "bizarre" pencil grips and also exhibit poor coordination in general.
3. All the children who used nonstandard pencil postures blocked their line of sight with their fingers so they had to adopt an improper reading distance or head tilt.

So, if your student or child does not use a standard pencil grip, first try to retrain the skill. Many teacher supply stores carry soft grip guides that help a child remember where to hold the pencil. These are inexpensive and very helpful. Then, because this behavior may indicate that the child may be struggling with a learning-related visual challenge or may even need glasses, make sure to schedule a routine eye examination with a developmental optometrist who is experienced in working with children.