Vision…academic problems and the emotional fallout

When a child struggles in school it is not only an academic problem. That’s just the tip of the iceberg. When a child struggles to keep up with their peers, it affects them emotionally, socially and physically. What is particularly troubling is how children with vision related learning problems often have emotional fallout that affects their self-esteem and can cause a spiralling of problems to cascade. Anxiety, worry and fear often can be rooted emotions within the child who has to deal with the side effects of a binocular vision problem.  Social difficulty can emerge making it difficult to make friends. This can lead to more withdrawn behavior, sedentary activities (video games, TV and computers)  and a general disinterest in three-dimensional play which in turn leads to a lack of physical development.

A greater number of media reports have been helping to provide vision education for the public. In this Fox News story you will learn about  a child, Isaac, who had a common binocular vision problem, Convergence Insufficiency. What is particularly interesting is to hear Isaac tell the reporter what it was like to have a vision problem that caused him to struggle in his reading. You might even think, “Hey, this kid seems pretty confident. After all, he actually stands up before a reporter and does a good job of answering questions.”  But, the viewer should also bear in mind that Isaac was properly diagnosed and treated. He had  office-based optometric vision therapy. He can muse about what it used to be like now that  his reading, sports and  performance overall is comparable or better than his peers. He is now confident!  

What is particularly troubling is, Isaac had to struggle needlessly. His parents thought his vision was ok because he passed all of the vision screening tests. Whether it be by the pediatrician or the school, routine vision screenings only determined that  his eye sight was fine. Therefore, sight-based vision screenings routinely miss patients who have binocular vision problems. Yet, binocular vision problems, like convergence insufficiency occur in nearly 1 in 12 children. In this story, if not for the persistence of his mother who found a doctor who could properly identify this condition, Isaac would have likely continued in a downward spiral of vision difficultly causing reading difficulty causing stress and emotional fallout.

Dr. Andrea Thau of the American Optometric Association helps to explain how this condition can affect a child in more ways than just the mere symptoms of a vision problem.

Let’s now look at another child,  in this case our patient  Zach whose parents gave us permission to share his exam video.  Zach, who completed his treatment for convergence insufficiency (office-based optometric vision therapy) returned to the office after 3 months for his progress evaluation.  He followed the protocol of NO home reenforcement for over 12 weeks to verify that he had maintained his abilities. Prior to treatment, Zach’s binocular vision problem caused headaches, eye fatigue, overlapping (double) words and reading was a lot of work. While Zach did not have a reading disability, he just found reading to be very stressful. It was described that Zach would have emotional “meltdowns” when required to read for any length of time. Look and listen to this chairside assessment of his oculomotor function you will see and hear a  child with a whole new emotional disposition.

The question for the reader is,  if so many children are affected with this condition,  why is there not a more coherent public health effort promoting vision education and advocacy for children with binocular vision problems, like convergence insufficiency?

Dan L. Fortenbacher, O.D., FCOVD

11 thoughts on “Vision…academic problems and the emotional fallout

  1. Very good post. Some thoughts regarding the commentary and videos are the following

    In Dr Thau video, I am amazed that we are focused on eye health and tonometry rather than functional testing. It is time for us to stress our uniqueness in this field.

    Another comment is to integrate vision therapy techniques into the presentations. Parents need to SEE these techniques to better understand the concept of vision therapy.

    And finally, interdisciplinary involvement is important in addressing all of the needs of children with learning problems.

    Keep up the good work


  2. Thank you Richard for your thoughtful comments. All are very good points and important ways for us to continue to improve upon our communication and education of the public. Hopefully, our collective voice will facilitate these important points so that the kids (and adults) with binocular vision (and related developmental vision) problems, will no longer have to struggle with undetected vision problems. We can only hope that those patients who need care can find access to care and not be disuaded by misinformaton.

    Thanks again,


  3. (Wasn’t sure where to post exactly…if anyone could forward the right location, would be great – would appreciate site recommendations as well, thank you 🙂

    Hello Everyone! My name is Ron, I’m a 25 Year Old Male, recently diagnosed with Convergence Insufficiency – First off, I’d like to express that I am very grateful to have found, there are so many great stories and so much Information, makes me feel very hopeful to know that there are other people out there giving and receiving this kind of support! Well Hopefully I’m posting in the right area!! Where to start – Guess this started during Childhood, I had always noticed that my right eye has alway been “weaker” than my left, significantly weaker, would sometimes have to cover one eye to read, there was also straining when it came to reading – Unfortunately, I didn’t receive much help for this as a kid, It wasn’t really taken seriously and I was only prescribed “reading glasses”, which I never ever wore, I unfortunately got away with not wearing them cause I was self-conscious about it. My problem wasn’t really severe enough to draw any kind of attention to My Parents or Doctors – I saw with binocular vision, never had problems with my eyes crossing or anything.. Well at about the age 21 I started noticing that my eyes would sometimes cross, and very slowly but progressively had gotten worse and worse….went for glasses at some point, tried contact lenses, of course, doctors would always say that they couldn’t find anything wrong with me, but I would insist that there was!!! So that seemed aimless, just going to get eye exams and being blurred for no reason at all. Anyway, as my problem got really bad not too long ago, within this past year, decided to go and see yet another eye doc..gave her a brief history on what had been going on, and told her that I think that I have a “lazy eye”, she only asked how long had it been going on, and proceeded to tell me that, unfortunately there is nothing that could be done, and that if there was any chance it would’ve been during childhood, I was too old to be treated, she said. This was devestating information for me, i didn’t know what to do, full of hopelessness, she made me feel.. Well, recently, this past year, my problem has gotten so much worse that it has really put a hold on my life, big depressing change for me – I’m no longer able to really make eye contact without my eye wandering, I’m able to kind of make “binocular” eye contact after a struggle of about 5 seconds, even then it sometimes hard to maintain, but I do…the funny thing is that, I am able to read, look at TV, Photos, animals, EVERYTHING, except for when it comes to actually making eye contact!! I struggle greatly, usually if it’s at a distance though – I’m still able to talk to someone face to face and maintain binocular vision, but can feel the strain from my weaker eye trying to stay in place.. Man it has been hell…the looks of sorrow from people sometimes, in public, or the look of surprise when my friends sometimes notcie it–I haven’t shared this with any of my friends yet, because for me it would feel as though I’ve allowed this thing to win, I won’t let it–can’t help buy cry now as I type this, has been taking such a toll on my mental well being, I’m even losing weight from the stress. There is currently a lighter side for me though…recently went to the New York Eye and Ear Infirmary In NY – There I was diagnose with “convergence Insufficency” – They’ve really helped me feel optimistic again by telling me all about what was going on, and Introducing me to a few Vision Strengthening exercises to help me develop Binocular Vision again, they say that since I still see with Binocular Vision most of the time that I still have a very good chance of Improvement!! I’ve been very hopeful with these exercises, have been doing them (at home exercises at the moment) about 7-10 times a day for 3 mins within each “Set”, I sometimes only have time to do them about 3-4 times a day.. Have been obsessed with the possibility of regaining binocular vision again. Have been doing pencil push-ups (wooden stick with a 5 at end), another one with three dots, large, medium, then small one at end of card. I’d really appreciate some help from anyone willing to offer it, and read all of this, I know its way too much.. What are the stages that I’ll be going through with these exercises? Why did they say that it’ll become worse before it gets better? How long will a person of my age (25) have to do these exercises before I can notice major Improvement? I’ve noticed some differences, like: Less eye strain, can read without closing my weaker eye now.. But could someone please tell me how long it will take to be able to make Eye Contact without as much effort as it takes now? Also, would it be wise for me to go and get “in-Office” Vision therapy, on top of my current exercises? Thanks again for whoever has taken the time to read this, I really even appreciate that, desperate for help, I’m so anxious and depressed about this whole thing. Also, would like to give all of you who are going through the same or even much worse than I am, much deserved credit – please stick in there and be strong, I know the pain..


    • Hi Ron,
      Thank you for your heartfelt comment. And, yes you found the correct location to post your note. I am happy that first you have received a diagnosis. That is essential to setting the stage for you to obtain the proper treatment. Your motovation to find the answer to your visual difficulty is very impressive and yes with your determination you will be able to obtain the help you need. But, it is so sad that you have had to suffer for years with a vision problem that has left you with many years of frustration and emotional fallout. This should not have happened when there is proven treatment for this condition. Yes, I would encourage you to find the help of a doctor in NYC who provides office based vision therapy. A good place to find a doctor who is qualified to offer office-based vision therapy is at the Doctor Locator on the COVD website at
      Best of luck Ron and thank you for sharing your story.

      • Hi Dr. Fortenbacher-

        Thank You so much for your response, I really do appreciate it…Could not have gotten better advice/support from an actual doctor In person, have not yet anyways…Thank You Very Much!! I needed a bit of a Charge, trying to stick with this, hard. I’ve already scheduled an appointment for Vision Therapy with State University of NY College of Optometry , just have to wait until Monday to pick up a copy of my Eye Chart – so until then, I’ll continue my exercises about 10 times a day (If I can, usually have time for about 6 rounds!!)and just wait for the extra help, see where it takes me.. Thanks for the website by the way, I will be using it to find another Doctor if this doesn’t go as I hope it will. Thank You Both for Listening and helping! 🙂


      • You’re welcome, Ron. Although this may sound obiovus, at your appointment at the SUNY College of Optometry let them know about your experiences with NY Eye and Ear Orthoptics, and what you’re working on. The key factor that you have going in your favor is that you’re willing to invest the time and effort to make change. Looking forward to seeing you get to the next level of care and sharing your experiences here (or perhaps following in the foot steps of Strabby, Squinty Eyes and Flatland with your own blog!).

      • Hi Dr. Fortenbacher-

        Yes, Thank You, I will be letting them know of the Exercises that I’m currently doing, for sure. I’ll definitely keep my updates going here – I was actually considering a Blog or something, because I’ve come to realise that this Information isn’t easy to come across, and that there are other people out there who desperately need help and have no Idea where to begin.. If It’s this difficult to even get a proper Diagnosis, how could someone possibly consider Vision Therapy as a treatment option.. It is frustrating to know that there are others out there going through what I have been through/going through, and who’re being told that there is nothing that can help…It’s just not right. I’ve gotten way more Information through searching the Internet than any Doctor or Health Care Professional has ever given me In my life…Including the Support that I’ve gotten from all of you, and all of the wonderful resources out there!! People should have this Information available to them. Sorry for going on and on again, and Thanks again for Listening guys!! Will def give an update after I’ve begun my Visual Therapy, hopefully by the end of next week, If all goes as planned.

        Have a great Night!! 🙂


    • Posting here is fine, Ron. All comments automatically go to Dr. Fortenbacher and to me. How unfortunate that it took all this time for you to get some help, but glad to see you’re going in the right direction. To address your queries:

      1) What you’re doing is “VT-Lite”. NY Eye and Ear does “orthoptics”, not optometric vision therapy. Take a look at the blog piece that Dr. Fortenbacher wrote on this here.

      2) What are the stages that I’ll be going through with these exercises? You’ll have to ask them, but chances are it will be more of the same, but perhaps at a bit more demanding level as you make progress.

      3) Why did they say that it’ll become worse before it gets better? When one takes an orthoptic approach (orthoptists aer the trained technicians who work with eye muscle surgeons) it is purely an eye muscle strengthening program you’re trying to undertake for your convergence insufficiency (CI). In that sense it’s like going to the gym, and experiencing no pain no gain. Optometric vision therapy is a more nuanced, balanced and scientifically supported approach. The CITT study that you will read about used more of this approach than a pure orthoptic approach.

      4) How long will a person of my age (25) have to do these exercises before I can notice major Improvement? With optometric vision therapy, patients with CI notice major improvement within 3 months, though full resolution takes longer. With orthoptics – who knows? There’s never been a scientifically controlled study that has established that.

      5) I’ve noticed some differences, like: Less eye strain, can read without closing my weaker eye now.. But could someone please tell me how long it will take to be able to make Eye Contact without as much effort as it takes now? That’s fantastic. It shows that what you’re currently doing through NY Ear and Ear is having some benefit, and we refer to that as “anecdotal evidence”. But to transfer this beyond the relative two dimensionality or your eye exercises, including eye contact, you’ll likely need optometric vision therapy.

      6) Also, would it be wise for me to go and get “in-Office” Vision therapy, on top of my current exercises?
      Yes, it would be wise. You can contact the State University of NY College of Optometry if you prefer a teaching clinic environment like NY Eye and Ear, or you can locate optometric vision therapy providers through resources such as

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