Good sight and bad vision…recognizing the difference and how to explain it to parents

Just like other doctors specializing in the field of developmental and rehabilitative optometry recognize, many patients find their way to our practices through a referral by a primary care optometrist who enjoys working with children as well as understands the role of vision in child development. Another equally strong ally is the professional who works with children with developmental and/or rehabilitation issues, specifically the occupational therapist (OT), speech language pathologist (SLP) or physical therapist (PT) who recognizes the children with visual problems that involve poor eye coordination, visual processing or visual integrative skills. These may be children with developmental delays, sensory processing disorder, autism or other medical problems that contribute to delayed development such as cerebral palsy.

Last week it was my pleasure to lead our team of doctors from Wow Vision Therapy to a Lunch and Learn  presentation to the professional team of therapists at the Memorial Children’s Hospital, Children’s Therapy Center in South Bend, Indiana. Here we were able to present case studies. One was a child in vision therapy with a binocular vision dysfunction called intermittent exotropia, another child with cerebral palsy suffering from oculomotor dysfunction and a host of others developmental vision delays. Our third patient had a complex array of vision problems associated with autism.

One common theme among all of these patients was the fact that within one year prior to seeing me, they all had received an eye examination and all of them had been found to have normal eyes…normal eye health, normal eye sight and no need for eye glasses. But, all 3 children had serious vision problems that significantly impaired their ability to effective progress in their other therapies (OT, SLP, PT) due to the serious nature of the delays in their visual development.

In response to this apparent failure for some eye doctors to recognize the obvious, a  question was posed to me by one of the attending Occupational Therapists. With a sigh of frustration, she noted that too often her patients with developmental delays and apparent visual problems involving poor eye coordination, such as binocular vision problems or oculomotor problems or visual processing problems have been told by a previous family eye doctor that this child’s eyes are normal. So, with that in mind she wanted to know how to explain to a parent that, “Yes your child may have good eyesight, but from what I can see, he has poor vision skills and that it is important that they make an appointment with a doctor who specializes in developmental vision for an examination?”

While the question may look complex, the answer is not. Simply put, Vision occurs not in the eyes but in the brain. The eyes are the sensory receptors. Yes, it is absolutely essential to examine a child’s eye health, eye sight and to determine whether there is a need for corrective eye glasses, even as an infant. But, when a child has developmental delays, those delays will often effect the dominant sensory system of the brain…vision.  Therefore a child may have good eyesight and still have bad vision…that is to say, delays in vision development.   These conditions are diagnosed by a doctor of optometry who specializes in developmental vision and vision therapy.”

To support this, an excellent resource for parents is the Parent Resource Center on the COVD Website

Another approach is to give the parent resources like the VisionHelp Blog that are linked to Developmental Delays and  Vision Therapy Best Practices

An additional important resource that I recommend to parents are these two books:


Another resource are videos from the VisionHelp YouTube Channel. Here are a couple selected videos:

And one final suggestion for the primary care optometrists, ophthalmologists, occupational therapists, speech language therapist, physical therapists and other professionals in the rehabilitative community to consult with a doctor Board Certified in Developmental Vision and Vision Therapy. To find one in your area go to the College of Optometrists in Vision Development… and click on the Doctor Locator and look for the initials FCOVD.

Dan L. Fortenbacher, O.D., FCOVD

7 thoughts on “Good sight and bad vision…recognizing the difference and how to explain it to parents

  1. RE: Branding. Dr. Fortenbacher, from your article: “To find one in your area go to the College of Optometrists in Vision Development… and click on the Doctor Locator and look for the initials FCOVD.” Just a note that there are many VTODs out there without the FCOVD designation. In the Calgary area, for example, there is only one FCOVD certified VTOD, while there are a number of VTODs practicing, including myself. Those VTODs/therapists in this area who do the highest volume and have, anecdotally, the best reputations are not FCOVD certified. Are you suggesting PTs, OTs, primary practice ODs, et al. should avoid using non-FCOVD ODs? If so, VT in this area crumbles.

    Following similar logic, I would suggest that ODs who have no formal training in education (i.e. a minimum of a BEd) avoid discussing classroom concerns as ‘experts’ when addressing other developmental professionals. Personally, I have continued to research, write, and study well beyond the excellent foundation in VT my training at Pacific provided (including a regular public education pieces in different online sources including In spite of my lack of FCOVD certification, I feel I have much to offer in the way of therapeutic alternatives to children struggling in school, as well as professional education opportunities for OTs in the area – as evidenced by a rapidly growing interest in the online and onsite training events I sponsor. I am also a very active advocate for VT and for mandatory pediatric vision assessment in the region. In addition, my background in public education, instructional design, and neural science all contribute to the therapeutic pictures I paint for clients. By your statement, given the lack of FCOVD beside my current three degrees, I should avoid contributing in these ways because, by implication, I am no ‘expert’. Likewise, as a non-expert, I should, by extension, cease researching and writing for public education.

    Branding is a difficult idea in the world of therapy. As it stands, there are no requirements for fellowship training to deliver vision-based therapies. Emphasizing exclusivity in accreditation over service sends the wrong message, and, I might suggest, works against the growth in acceptance of VT as a viable service and solution to reading/learning problems – cutting the nose to spite the face, one might say. Better wording might be to suggest people locate VTODs in their area. Period.

  2. Thank you for your comments Dr. Boulet.
    Board Certification is not a “branding issue”. Rather it is an attempt to provide the public with a mechanism to show that a doctor has pursued extra training and completed an accredited process that demonstrates that they meet a higher level of expertise than basic competence. In the late 60’s here in the US, there was a cadre of ODs who recognized that a problem existed when patients with VT related conditions needed to find a doctor who could deliver services that met an appropriate standard of care. These pioneers determined that in the area of developmental vision and vision therapy there should be a certification process that enables a more reliable referral process for doctors and the public. That was the impetus for the beginning of the College of Optometrists in Vision Development (COVD) in 1971 for which we now have Optometry’s Board Certification process in this specialty with the International Examination and Certification Board (IECB) of COVD. Those doctors who complete the extensive Board Certification process are bestowed with the title FCOVD.

    With that being said, this is not an attempt to discredit any doctor who, has through their own post graduate training and clinical experience clearly met a level of expertise that would demonstrate advanced competency, but not chosen to pursue the FCOVD. Just as you said, you have many strong qualities and from what I already know of you and your work, I would have no hesitation in referring a patient to you for care if they lived in Calgary. In addition in your own way, you have established a strong communication pattern to the professionals in your area and because of your strong track record they know you and appreciate the good work you do… so no need for them to look further when a patient needs care in developmental vision.

    However, let’s keep in mind the intent behind having a Board Certification process in any specialty of health care, whether it be optometry or medicine, is to serve as a mechanism to provide the public with a more reliable mechanism to find a qualified doctor than simply doing a Google Search, in this case of a “VT OD in your area”. The process of attaining Fellowship in COVD is a very involved process and positive experience for the doctor as it serves to push him/her to become better. But, it can have flaws because it is a voluntary process and therefore there are many doctors who may be very qualified, like you but have not chosen to pursue their Fellowship.

    Therefore, for the point of this article I chose to recommend the FCOVD because it is a proven system for showing the public that a doctor has pursued advanced competency. However, it is fair for you to comment that this process does not guarantee the doctor who is a FCOVD is always better. While it is a suggested starting point, it is still a good idea for those seeking help to contact the doctor’s office and ask questions about their experience as well and possibly even a visit to see the office, meet the doctor and his/her staff to see if it appears that they have the delivery system to do office-based optometric vision therapy.

    Again, thank you for taking the time to leave your thoughtful comment.

  3. Pingback: How Can My Child See Well and Still Have a Vision Problem? | Lynn Hellerstein, Author of See It Say It Do It

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