Ophthalmology Poised to Discover Vision and Learning!


find_the_target_15311 It was bound to happen.  For many years, optometrists have been intimately involved in helping children develop improved visual capabitlies which in turn has enabled them to respond more fully to educational interventions.  The most recent example of this is a position statement issued last year by the American Academy of Optometry on Optometric Care of the Struggling Student.  Yet it seemed that no matter what evidence Optometry put forth, Ophthalmology continually put forth statements to the public that, in essence, vision had little if anything to do with learning.  Regarding reading in particular, the party line was that reading problems belong in the camp of dyslexia which was a phonemic/decoding/language-based problem, with vision being close to irrelevant. Let me share a specific instance with you of Ophthalmology trying to move the bullseye every time we were about to hit the target.  In 2006 the New Jersey Commission on Business Efficiency of the Public Schools on the topic of Special Education Reform issued a report entitled: “Individual Supportive Education Reform Agenda for New Jersey Reading”.  It is a marvelous report that you can read here, which essentially points out how much money was being wasted on special education services for reading, while underlying vision problems went undected or untreated.  This is not to say that all reading problems are attributable to vision problems, but that the issue of vision was being marginalized if not ignored in actual practice. This led to the passage of a bill in 2007 for a Pilot Project in New Jersey to study the effects of comprehensive eye exams and follow-up care on special education services that made the front page of the AOA News.  Despite the bill’s passage, the Project never got off the ground.  Ophthalmology thwarted its implementation because they were not prepared to deal with the outcome. With that background, take a look at pages 8 – 11 of the Annual Report from Wilmer Eye Institute that I received in the mail today (entitled Focus: Changing the Way the World Sees) and let me know what you think about the article entitled Classroom Insight: http://www.hopkinsmedicine.org/wilmer/news/sightline/Sightline_Special_Edition_Annual_Report_2014.pdf

16 thoughts on “Ophthalmology Poised to Discover Vision and Learning!

  1. Encouraging. I am an optimist. However, the devil is still in the details. What are the parameters of the study? What questions will be asked? What is the hypothesis to be proven or disproven?

    Separate question: Is Robert Slavin related to the late Sid Slavin?

  2. Robert Slavin is not related to Sid Slavin and did not know him. I met with the Slavins a few years ago, and he contacted me again a few months ago about this project. I do have some details about it. Basically, they are funded in such a way that they are required to use the JHU ophthalmology residents to do the vision screenings for the project. All children will have a cycloplegic eye exam. I tried to get them to do more with functional testing, and even offered to train the residents, but this is what they have. I don’t think this project will be as effective as it should be but it will probably demonstrate that uncorrected refractive disorders can impact near vision.

    • Thanks for the information, Marsha. Not totally surprising that they would eschew input from Optometry, but between CITT and PEDIG one never knows! As hard as it is to avoid cynicism for this particular project, I am hopeful that one of these days someone like you offering the assistance you did would be welcomed with open arms rather than “thanks but no thanks”. It’s an interesting aside that Paul Harris did his Baltimore Inner City Project in the ‘9i0s, and I suspect this group – working with the same population – probably has no awareness of the work done before them.

  3. From what I read, to them the world is still either blurry or clear; and if it is clear, they conclude meaning will be derived, and if its blurry, it won’t. If someone speaks to me in German LOUDER, I still can’t understand it.

  4. Right you are, Carl. It is ironic that the article that preceeds this one in the newsletter is entitled “Think Small”. The approach that glasses derived from cycloplegic refraction is the full monty regarding reading visual problems related to reading is a shallow one, but at least as Marhsa noted it’s a first step to recognize that for at least some children, some of the measures they take will be relevant.

  5. “WE KNOW THAT KIDS WHO FALL BEHIND
    IN READING ARE LESS LIKELY TO SUCCEED
    IN LIFE, BUT THERE HAS NEVER BEEN A
    STUDY THAT SEPARATES THE KIDS WHO
    CAN’T READ FROM THE KIDS WHO ARE
    STRUGGLING TO SEE CLEARLY.”
    DAVID FRIEDMAN, M.D., PH.D., M.P .H.
    What is also noteworthy is that all these projects seem sponsored by deep pocketed philanthropists. While NEI grants are great it is also good to get alternative funding. Once the parameters are announced it would be interesting to publish an op ed in a journal predicting likely results and discussing the Harris study and NJ failed pilot project so there is a record of optometric precedence.

    • Excellent point, Ed. You’re not likely to see that in an Ophthalmology journal, and you can bet that this won’t be submitted to an Optometry journal. In fact, if the results are positive, I would envision two possible scenarios: 1) There is an op ed accompanying the article, much as the 2008 CITT study, that qualifies the positive association and cautions against the “overprescribing of glasses” or other ophthalmic interventions as opposed to simply more reading tutoring or 2) Ophthalmology takes credit for “discovering” this association, with no retraction of the policy statements they’ve wielded to try and discredit Optometry in the past, but certainly scant if any mention of optometric references to the positive association between lenses and reading, the Harris study, NJ pilot project, etc.

  6. Len, I would still like to see that study. I recently shared with Andrea that I think that group is much more important than all children entering school. Gary

    • I would still like to see that study too! In fact, why not contrast the impact of earlier intervention with intervention in 2nd or 3rd grade? Once we get the blinders off the educational and medical systems combating the importance of vision beyond the “eyesight issues”, we can move on to the more (or at least other) educationally relevant visual abilities.

  7. Interesting comments, and thx for posting Len. Repka is somewhat more open minded than many OMD’s, I can’t imagine there won’t be some measures of accommodation and convergence. But if you go back to the Helveston paper in the 80’s where they did include measures of accommodation and convergence (and chose norms that were ridiculously low), they concluded of course that only color vision (!!) and a visual motor test they made up had any relationship to learning. Guyton was known to read our literature, maybe Repka will follow suit. The influence of CITT may make them more careful if they measure accommodation and convergence. But we won’t hold our collective breath.

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