A turning point – how correcting common binocular vision problems resets a child’s reading future

In this post, Developmental Optometrist, Dr. Alyssa Bartolini writes about about the impact that vision therapy has on the lives of children through the story of one of her patients. Dr. Bartolini specializes in developmental vision and rehabilitation and practices in Grand Rapids, Michigan at Wow Vision Therapy and new member of the VisionHelp Group.

One of my favorite parts of vision therapy is graduation day! It is an exciting event when our patients often invite their whole family to see all of the progress they have made throughout vision therapy. While the changes that occur after vision therapy vary with each patient, for the child who had a vision-related reading or learning problem prior to treatment,  the transformations we often witness in their abilities and confidence from their first exam to graduation day can be dramatic.

Recently, I was particularly touched by the graduation of an 8-year-old boy. On the surface this patient’s case seemed fairly simple. He was diagnosed with some of our most common diagnoses: convergence insufficiency, accommodative dysfunction, oculomotor dysfunction, and visual perceptual delays. However, I very clearly remember his first exam because he was extremely impulsive and struggled to stay on task. His mother was a teacher and informed me that he was recently diagnosed with ADHD. Despite being on ADHD medication, he was still falling behind in school (especially with reading) and his parents were struggling to figure out a way to effectively help him in the classroom. During the exam, I quickly realized that this patient was overloaded because his visual system was not providing him with accurate information.

After his first exam we performed an assessment of visual processing to further understand what was contributing to his struggles in the classroom. During the testing he relied heavily on his auditory system and was very fidgety.  We found that in the areas of visual discrimination, visual memory, visual directionality, and visual motor integration he performed at a 4-5 year old age equivalent. His Visagraph eye movement recording was at a 1st grade level and he scored at a <6 year old level on the King Devick saccadic eye movement test. This significant delay in visual perception and saccadic eye movement was a major factor in his struggles in the classroom.

Over the course of this patient’s vision therapy treatment plan his eye teaming, focusing and tracking all greatly improved. All areas of visual perception also improved to above his age and grade level. His mother reported that he went up 15 points on the reading section of his most recent MAP testing. An even bigger change for this patient was that his personality transformed. As his visual system became more stable and he could interpret what he was seeing more accurately, he became much more focused, had less anxiety, and we saw a huge increase in his confidence.

The AOA’s Clinical Practice Guideline Care of the patient with Learning related vision problems describes how important it is to thoroughly assess the binocular system and visual perceptual abilities in patients that are struggling in school. It states, “Visual efficiency comprises the basic visual physiological processes of visual acuity (and refractive error), accommodation, vergence, and ocular motility. Visual information processing involves higher brain functions including the non-motor aspects of visual perception and cognition, and their integration with motor, auditory, language, and attention systems.” 

This is also supported in a recent paper published in the Journal of Optometry, November 2017 entitled: Visual and binocular status in elementary school children with a reading problem. The Faculty of Science researchers at University of Waterloo found that children between the ages of 6 and 14 who all had an Individual Education Plan specifically for reading, more than three quarters of the students had good eyesight, but when they were tested for binocular vision, more than a third of the group scored below published norms. They concluded that it is very important to do tests of accommodation, binocular vision, and oculomotor function on all children, especially those with identified reading problems.

The Vision and Learning Checklist created by the VisionHelp Group is also a helpful tool that healthcare professionals, and teachers can use to identify patients that may have vision related learning challenges.

Once these patients are identified, it is important to educate families that an in depth binocular vision assessment, as well as visual perceptual testing, may be able to determine the root cause of their struggle in the classroom. Effective vision therapy can greatly help these patients, just like it did with the sweet 8-year-old boy who recently graduated with a huge smile on his face, and newfound confidence.

Alyssa Bartolini, O.D.




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