The importance of finding the hidden link between vision and reading to help the struggling child

Parents of school-age children who have struggled in reading and learning are often looking for answers to many questions. A common concern might be, “Why did my bright child continue to have difficulty with reading fluency and/or paying attention in the classroom this year, even with extra help?”

To provide some direction, two years ago the VisionHelp Group interviewed educational specialist, Wendy Rosen, author of the book, The Hidden Link Between Vision and Learning, Why Millions of Learning Disabled Children are Misdiagnosed and produced videos. Here is one example entitled: Misdiagnosing Learning Disabilities

In the video, Wendy mentions the diagnosis, “Convergence Insufficiency”, a binocular vision dysfunction usually associated with a reduced convergence ability and commonly identified with the Red/Green Penlight Near Point of Convergence (NPC) test. This test which can be done in about 30 seconds is one tool in the eye care provider’s binocular vision assessment tool kit.

But not so fast,  as outlined in my recent VisionHelp Blog post and also featured as the Elsevier’s Practice Update Story of the Week, there is new Harvard Medical School research published in the American Journal of Ophthalmology entitled: Receded Near Point of Convergence is Not Diagnostic of Convergence Insufficiency. What they found was that while the majority of  post-concussed patients (89%) had a reduced near point of convergence, what they also found was these patients had a high incidence of poor visual tracking (oculomotor dysfunction), eye focusing problems (accommodative dysfunction) and poor eye teaming and focusing flexibility (binocular vergence/accommodative dysfunction)

The conclusions by the JAO Harvard researchers was that, “Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.” In other words, these complex visual problems should be addressed with a comprehensive evaluation process followed by a comprehensive model of treatment to meet the patient’s individual visual needs.

So why bother doing a Near Point of Convergence Test on school-age children, especially those who have not  been concussed? Because a reduced NPC is one important measure found with Convergence Insufficiency. Furthermore,  research shows that those children with vision-based reading and learning problems also have a high frequency of oculomotor, accommodative and binocular vergence/accommodative problems!

Therefore, the importance of assessing binocular vision, plus additional sensorimotor areas, is critical to assessing those children with reading and learning problems. When the initial testing  diagnosis identifies a reduced near point of convergence, it is essential to have a comprehensive sensorimotor and visual perceptual evaluation so that an accurate diagnosis can be made.

Once identified, as outlined by the American Optometric Association CPG-18,  the best approach to treatment involves as comprehensive model of office-based vision therapy working one-on-one with a skilled vision therapist (typically 45-60 minutes 1-2 times per week in-office with assigned home support activities) in conjunction with lenses, prisms, and/or therapeutic tints prescribed and supervised  by an experienced Doctor of Optometry in developmental vision and rehabilitation. Furthermore, it’s important to clarify that home-based models of treatment with periodic office-monitoring visits have been found by clinical trial research to be no better than a placebo in treating these conditions.

For more information check out the VisionHelp Vision and Learning Project.

Dan L. Fortenbacher, O.D., FCOVD

Finding the vision connection to childhood reading problems and unhappiness begins with a simple question

Once upon a time there was a young boy who loved to read. He even hid books beneath his bed at night and would sneak them out to read with a flashlight under the covers. That young boy was me! To be sure, reading gave me happiness!

There are several things in life that we hope for our children. Certainly a couple of those top things are for them to have confidence and happiness. This is especially true when it comes to the school environment. After all, this can set the stage for the future success of that child including an enjoyment for reading which is not only important for a child’s academic success but research shows reading is linked with happiness. Conducted in 2016,  the University of Liverpool’s Centre for Research into Reading, Literature and Society (CRILS), found that those who read report better connections with others and greater feelings of happiness overall. 

Yet, given the potential for positivity of reading, we know there are many children who dislike reading. Parents are aware of their child who struggles with reading and often the assumption is that the child is either “not trying hard enough” or has a form of dyslexia (reading disability). These two explanations are usually frustrating for both the child and the parent. On one hand, it implies the child needs more parental controls for the perceived behavioral problems for lack of effort, which adds to more unhappiness. On the other hand, when a type of reading disability exists, then a combination of compensatory strategies or accommodations and educational tutoring is needed to help develop the reading performance. However, even with all the extra parental attention and academic help, there often exists an unaddressed effort to the task of reading which makes it a struggle and unenjoyable. 

As outlined in numerous VisionHelp Blog posts, the visual system plays a foundational role in a child’s ability to successfully read. What’s more, we have evidence based clinical practice guidelines by the American Optometric Association (AOA) that outline what tests all optometrists should be performing on school-age children with reading and/or learning problems. But, too often these important visual tests are overlooked if the doctor is not aware of any parent concerns regarding a child’s reading. And, to be sure, most school-age children will not simply volunteer this information.

Therefore, the solution to this disconnect could be solved by the answer to a simple question which should be a part of every school-age child’s comprehensive eye health and vision examination.  The question for the doctor is easy. Every child should be asked, “Do you like to read?

If the answer is, “No”, then a few more questions are in order to learn if a child is experiencing any academic difficulties. The next step for the doctor should be to include additional testing to identify if there are sensorimotor conditions in binocular vision (eye teaming), accommodation (eye focusing) and oculomotor (eye movement) abilities. 

In fact, the American Optometric Association (AOA) Evidence-Based Clinical Practice Guideline, The Comprehensive Pediatric Eye and Vision Examination (CPG-2), gives a detailed and thorough overview. It is an excellent paper and one that all eye care providers should study. However, it’s 65 pages long and while an excellent resource for the doctor’s personal library, it’s sheer length could lead to possible procrastination for the reader.  But, thanks to the work of Dr. Carole Hong of the VisionHelp Group, you can access an excellent summary of the AOA CPG 2 in an easy to read, concise 2 page downloaded PDF available on the VisionHelp Vision and Learning Project, entitled, AOA Evidence-Based Clinical Practice Guidelines: Comprehensive Pediatric Eye and Vision Examination 2017 – Clinical Pearls

Here are three examples:

  • When a child’s history or initial testing indicates a possible developmental lag or learning disorder, additional testing should be performed to rule out a learning-related vision disorder.
  • Vision problems such as accommodative, binocular vision, eye movement, and visual information processing disorders can interfere with academic performance.
  • Vision disorders that occur in childhood may manifest as problems well into adulthood, affecting an individual’s level of education, employment opportunities, and social interactions. 

The Comprehensive Pediatric Eye and Vision Examination 2017 – Clinical Pearls can be helpful for doctors, teachers, occupational therapists, psychologists, educational therapists and other professionals who work with children who struggle with reading. When a vision-based problem exists, proper lenses and vision therapy can bring happiness to a child’s life by developing excellence in visual readiness skills to help facilitate making reading easier, more enjoyable and setting the path for academic success.

But, first it begins with the question…”Do you like to read?”

Dan L. Fortenbacher, O.D., FCOVD

 

Vision problems impact reading and learning…a focus for optometry’s next generation of doctors

The research is abundant and the evidence is clear…visual efficiency problems impact reading and learning. In addition to good visual acuity (eye sight), the American Optometric Association (AOA) defines visual efficiency problems as dysfunctions of visual skills involving binocular vision (eye teaming), accommodation (eye focusing) and/or oculomotor (eye tracking) abilities as well as eye hand coordination and visual perception. The AOA defines these visual skills needed for school success. Problems associated with these areas are usually developmental delays or associated with a neurological event, such as a concussion or traumatic brain injury and can be effectively treated with office-based vision therapy.

For over 10 years it has been my honor and privilege, as an Adjunct Clinical Professor at Michigan’s College of Optometry at Ferris State University (MCO),  to present to the 3rd year optometry students on developmental vision and rehabilitation. With the gracious permission of Dr. Mark Swan, Professor of Pediatrics and Developmental Vision at MCO, on October 26, 2018, it was my pleasure to lecture along with my 2 residents, Dr. Jamie Jacobs and Dr. Kelsey Starman in Dr. Swan’s Developmental Vision Course.

Our lecture was entitled: Vision Problems that Impact Reading and Learning. The emphasis in our lecture was to go beyond the academics of these complex issues and  provide a level of appreciation for the important role the doctor has of integrating the science and art of vision therapy/rehabilitation in a private practice to obtain the best outcomes for patients.

Our lecture  involved 3 cases reports of patients treated by the doctors and vision therapists in our practices. Included were the “before” and “after” visual clinical findings as well as reading performance on a variety of standardized reading tests. In addition, each case report included three separate published papers in peer reviewed journals citing the connection between visual efficiency problems and/or the proven results of office-based vision therapy on treating visual efficiency problems involving binocular vision dysfunction, accommodative dysfunction and/or oculomotor dysfunction.

Therefore, in this lecture we presented not just 1 research paper but 9 research papers from around the world that shows the connection between visual efficiency problems and reading/learning problems.

Click here to download a pdf copy of our lecture.Vision problems that impact reading and learning

For addition information, including videos, books, white papers, research and more check out the VisionHelp Vision and Learning Project

Dan L. Fortenbacher, O.D., FCOVD

New Initiative -The VisionHelp Vision and Learning Project collaborative solutions to reading and learning problems

As parents we all want the best for our children and when they struggle to read, learn or grow academically there can be frustration and worry about what to do to find help.

Since vision is the dominant sensory system through which we read, learn and grow academically, vision care professionals need to be involved to identify any problems involving the eyes and vision and remediate and prevent the struggle that occurs when poorly developed vision or a neurological event, such as a concussion, interferes with learning.

However, reading and learning problems can be multifactorial and therefore, when a child is having academic struggles it is important to consider that for many, a professional “team approach,” working together for the common good of the patient, will help ensure the best opportunity for learning. A partnership is developed between the parents and these professionals.

To help parents and professionals, the VisionHelp Group is pleased to announce the release of the latest VisionHelp Initiative, the VisionHelp Vision and Learning Project which provides:

  • Help for parents to learn more about the symptoms and behaviors that may indicate a learning related visual problems…and what can be done
  • Help for professional partners to learn more about well-designed screening protocols and research studies that will help integrate children with learning related visual problems into their clinical practice
  • Help for vision care providers to gain immediate access to the evidence based, best practice protocols for evaluating children and adults to ensure that they are prepared for optimal learning

Dan L. Fortenbacher, O.D., FCOVD

The Olympic games connection to vision-based reading and learning research

What do the Winter Olympic Games have in common with vision-based reading and learning research?

The Winter Olympics brings together the finest athletes from around the globe to compete and show the world how there can be a universal interest in Winter sports and desire to be the best. While you may never have tried to do figure skating or snowboarding the half pipe, when you watch the performance of the these premier athletes in the Winter Games you begin to appreciate the magnitude and complexity of what they are doing, and it touches your mind and heart.

The visual system plays a direct role in the magnitude and complexity of individual performance abilities in every aspect of life. For the Olympic athlete, having good visual efficiency, using both eyes to team, good depth perception, tracking, focus, visual processing and visual motor integration skills are all needed to have peak performance.

But, what about when it comes to the proficiency of a child’s abilities in the day-to-day act of reading and learning? Indeed clarity of sight is important, but there are many visual problems that affects a child’s ability in reading and learning that may not be easily recognizable by just correcting a refractive condition with glasses. For example, vision problems that affect binocular vision (eye teaming) and accommodation (eye focusing) are critical to reading and learning even with 20/20 eye sight. But, some may ask, “Where is the research?”

Awareness for visual efficiency problems, such as Convergence Insufficiency (CI) and its impact on reading and learning, has been reaching the research international stage coming in from around the globe including Canada, India and South Korea, to name a few.

Here are a few examples of the latest in the “Research Olympics” on Vision and Learning:

From India:

Published in the Journal of Optometry, January 2018, entitled: Efficacy of vision therapy in children with learning disability and associated binocular vision anomalies, concluded: “Children with specific learning disorders have a high frequency of binocular vision (BV) disorders and vision therapy plays a significant role in improving the BV parameters.”

 

From Canada:

Published in the Journal of Optometry, September 2017, entitled: Visual and binocular status in elementary school children with a reading problem, concluded: The results in this study show that children with an IEP for reading also present with abnormal binocular and/or accommodative test results. To thoroughly investigate the binocular vision system, we recommend that tests of accommodation, binocular vision, and oculomotor function should be performed on all children, especially those with identified reading problems.”

From South Korea:

Published in the Journal of Ophthalmic and Vision Research, Volume 12, 2017 entitled: Effectiveness of Vision Therapy in School Children with Symptomatic Convergence Insufficiency, concluded: These findings suggest that vision therapy is very effective to recover from symptomatic convergence insufficiency.”

The United States has been the leader in vision therapy research for vision and learning problems thanks to the tireless efforts by the Convergence Insufficiency Treatment Trial (CITT)“Olympic Team”. Over the last 2 decades the US (CITT) Team has lead this research and published papers that have been voluminous showing that accommodative vergence problems, such as Convergence Insufficiency and Accommodative Disorder can have a major impact on near visual performance such as reading and attention.

From USA:

Published in Archives of Ophthalmology, October 2008 entitled: Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children, the most notable “Gold Medal” US research project by the CITT Team was a multi-center randomized double blind prospective study concluded: “Office-based vergence accommodative therapy is an effective treatment for children with symptomatic convergence insufficiency.”

Additional “Gold Medal” performances by the CITT Team over the last decade has been published in the following papers:

Published in the Journal of Optometry and Vision Science in October 2009: Academic behaviors in children with convergence insufficiency with and without parent-reported ADHD, concluded: “Children with parent report of ADHD or related learning problems may benefit from comprehensive vision evaluation to assess for the presence of convergence insufficiency.”

Published in the Journal of Optometry and Vision Science in January 2012: Improvement in academic behaviors after successful treatment of convergence insufficiency, concluded: “These data suggest that parents may report a reduction in the frequency of specific adverse school and may have less overall worry about academic performance after children with symptomatic CI show improvement or are successfully treated.”

While, like the Olympics, research is complicated and technical, thanks to the dedication of these  “Olympic Research Teams” from around the world, what we know now should touch our minds and our hearts. Vision related reading and learning problems do exist in every country and there is effective treatment with vision therapy.  No longer should children who struggle with reading and learning problems be overlooked from having a binocular/accommodative or other visual problems.The research is clear, but the bigger question is how will we respond to end this senseless struggle for those with vision-based reading and learning problems?

Wouldn’t it only make sense for any child who struggles in reading or learning to have of a comprehensive eye and vision evaluation because, if a visual problem exists, effective vision therapy treatment could be a game changer in that child’s life!

Dan L. Fortenbacher, O.D.,FCOVD

 

How vision impacts reading, learning and attention through the eyes of an educational specialist

When a child struggles to read it can be very frustrating, not just for the child but for the parents and the teachers.  No parent wants to see their child having trouble with something as important as reading. The same is true for teachers. In many school systems, teachers are now expected to have their students reach certain reading standards and if they don’t, that child may be faced with repeating a grade level.

Meet Wendy Rosen,  a former classroom teacher and educational consultant and author of the new book: The Hidden Link Between Vision and Learning, Why Millions of Learning Disabled Children are MisdiagnosedIn this 6 minute VisionHelp interview, which premiered at the 2017 COVD Annual Meeting, Wendy gives an explanation for why so many children struggle with vision-based learning problems and how to find help they need.

Dan L. Fortenbacher, O.D., FCOVD

Another Look at Reading and Vision

We sometimes tend to overlook or forget valuable online resources that have been created for parents, teachers and other professionals.  Here is one of them, in the form of a link from the American Optometric Association, on reading and vision.  Take another look at how good this is:

AOA_horiz

A LOOK AT READING AND VISION

Getting at the Root of Reading Problems

When Michael or Jennifer has trouble reading, parents and teachers need to investigate many different possible causes.

Because a combination of problems, rather than just one, is usually at the root of a reading difficulty, all possible causes should be explored.

One that is sometimes overlooked is the child’s vision. This may happen because the child appears to be able to see, does not complain about his or her eyes, has passed a school vision screening or has not had a comprehensive eye examination.

To See to Read

Reading requires the integration of a number of different vision skills: visual acuity, visual fixation, accommodation, binocular fusion, convergence, field of vision, and form perception. Of these, only one is checked by the typical school eye chart test.

Limited eye examinations may cover only one or two. And symptoms of reading related vision problems are often not noticeable to parent, teacher or child.

A comprehensive optometric examination, however, does cover these vision skills. It is a must for every child who is having trouble reading.

Visual Acuity

Visual acuity is the ability to see objects clearly. It is usually the only skill assessed in a school vision screening. The typical school eye chart is designed to be seen at 20 feet and measures how well or poorly the child sees at that distance.

If a problem is discovered in the screening, the child should be referred for a thorough optometric examination.

Visual Fixation

Fixation is the skill utilized to aim the eyes accurately. Static fixation is the ability to focus on a stationary object when reading a word or working a math problem. Saccadic fixation is the ability to move the eyes quickly and accurately across a page to read a line of print.

Pursuit fixation is the ability to follow a moving object with the eyes.

These complex operations require split second timing for the brain to process the information received and to track the path of the moving object.

Accommodation

Accommodation is the ability to adjust the focus of the eyes as the distance between the individual and the object changes. Children frequently use this vision skill in the classroom as they shift their attention (and focus) between their book and the chalkboard for sustained periods of time. Being able to maintain focus at near for sustained periods of time is important for reading, writing and also taking tests.

Binocular Fusion

Binocular fusion refers to the brain’s ability to gather information received from each eye separately and form a single, unified image. A child’s eyes must be precisely aligned or blurred or double vision, discomfort, confusion or avoidance may result.

If that occurs, the brain often subconsciously suppresses or inhibits the vision in one eye to avoid confusion. That eye may then develop poorer visual acuity (amblyopia or lazy eye).

Convergence

Convergence is the ability to turn the two eyes toward each other to look at a close object. School desk work is one instance in which a child depends on this vision skill.

Field of Vision

Field of vision is the wide area over which vision is possible. It is important that a child be aware of objects in the periphery (left and right sides and up and down) as well as in the center of the field of vision. Near central or Para-central vision is important for reading ability.

Perception

Visual perception is the total process responsible for the reception and understanding of what is seen. Good visual perception is necessary for successful school achievement.

Form perception is the ability to organize and recognize visual images as specific shapes. The shapes the child encounters are remembered, defined and recalled when development of reading skills begin.

Regular optometric care can help assure that a child will have the visual skills necessary for successful classroom performance.

Treating reading-related vision problems

The optometrist examines these vision skills and determines how well the child is using them together. When a vision problem is diagnosed, he or she can prescribe glasses, vision therapy or both.

Vision therapy has proved quite effective in treating reading-related vision problems. It involves an individualized program of training procedures designed to help a child acquire or sharpen vision skills that are necessary for reading.

Treating reading problems

Because reading problems usually have multiple causes, treatment must often be multidisciplinary. Educators, psychologists, optometrists and other professionals must confer and work together to meet each child’s needs.

The optometrist’s role is to help the child overcome the vision problems interfering with the ability to read.

Once this is accomplished, the child is then more capable of responding to special education efforts aimed at treating the reading problem itself.

Music Reading and Developmental Vision

Yellow Cat

The Yellow Cat is back!  It’s been two years since I blogged about the Cat.  If you’re really into music education, you can see some nice proprietary videos from the Yellow Cat here.  Our colleague Dr. Paul Harris wrote one of the few articles in the literature about visual profiles of musicians.  What excited me this morning was the Cat’s latest piece entitled: “Quick Vision Check”.  Here are some great potential signs she suggests that music teachers observe:

1. Is there a relationship between how many times a student moves his eyes and how well that student reads his music?

2. Do students who read well move their eyes more or less than students who don’t?

3. Do you have students who don’t look at the music at all?

4. Do you have students who tilt their heads to the side when reading?

5. Do you have students who move their heads from side to side when moving their eyes across the page?

6. Do your students’ eyes track in the right place in the music?

CatCat proceeds to advise that piano teachers are in a great position to inform parents when they suspect a vision problem and when doing so, should recommend a good Developmental Optometrist or an Ophthalmologist who specializes in vision and how children learn.  The latter may seem peculiar until you remind yourself that Cat is an acquaintance of our visionhelp colleague, Dr. Nancy Torgerson, who enjoys a collaborative relationship with a pediatric ophthalmologist who “gets it”.

The key to making sure that parents grasp this, Cat notes, is to direct them to www.covd.org or www.pavevision.org.

Take a close look at the Cat’s three page masterpiece, and share it with piano teachers and parents of children taking lessons for any instrument involving music reading.  It’s an instant classic!

Yellow Cat Banner

A Parent’s reality…Regardless of 20/20 eye sight, remaining vision problems cause reading and learning problems

Dad frustratedLast week I witnessed  the astonished look on a father’s face when his  7 year old little girl (we’ll call Jenny) struggled with some routine chair-side vision tests. His surprise was not during the measurement of her ability to read the eye chart. She read the 20/20 line of letters like a pro. But, when I asked Jenny to visually look at and follow a moving bead on a stick, Jenny responded as if she couldn’t or wouldn’t do it. Observing his daughter’s seeming lack of compliance, Dad began to go into a coaching mode. “Jenny, look at the bead!” , he repeated as I moved it very slowly in front of her face. Then in almost a sense of exasperation he said, “Come on, Jenny, you have to do your best for the doctor”, as if this was a routine personal frustration he had for his 7 year old daughter. Jenny’s face just grimaced as if this was almost a painful process.

So I stopped the visual tracking test and gave Jenny a break. Then I asked her to put on some red/green anaglyph glasses. Sometimes kids call them the 3-D glasses. I asked her to look at a penlight that I positioned about 3 feet in front of her face. Then I brought the light in toward her nose and asked her to tell me when she saw it go double. Jenny reported double at about 14 inches. I repeated the test  2 more times and she consistently reported the light separating into 2 lights further and further away from her face. When her Dad saw this, he thought Jenny was simply “playing around” and said, “Jenny, this is important, you have to try harder!” So, I removed the red/green glasses from Jenny and asked  Dad to put them on. I did the same test on him, except he saw the light remain single up to about 2-3 inches from his nose. Now he was starting to get it!

Girl struggels in readingJenny’s parents situation is not unusual because every family has their own unique side to the story when unaddressed vision problems cause reading and learning problems. It usually begins with a child who is bright and yet struggles in school. In this case their almost 8 yr old daughter, Jenny was  having a difficult time reading. She even had extra tutorial support and attention at school. But, her parents were prepared to retain her in the first grade, even though her teachers said Jenny was capable of “just barely” reading 2nd grade material and suggested that she be promoted to 2nd grade. However, while Jenny could read single words at a time, what she struggled with was reading them in a sentence, losing her place and  slow to do her work. Her parents felt a bit remorseful of having to make a decision to retain her in 1st grade because Jenny was good in math and was mature enough to handle the transition to 2nd grade. But, because of the reading discrepancy Jenny’s parents thought  they should retain her in 1st grade, while on the other hand they were worried that she would get bored and grow to dislike school and feel the emotional sense of failing when her peers were moving forward. They were visibly torn!

Fortunately for Jenny, one of the teachers helping to tutor her, spotted some of the hallmark signs of a visual tracking problem and made the referral to our office. At first, Jenny’s dad was convinced that his daughter couldn’t  have a vision problem because she had passed the school eye sight test and the pediatricians vision screening. But, he and his wife wanted to make sure so they made the appointment.

What did I find? Yes, little Jenny had normal eyes, good eye sight (20/20) and no need for corrective lenses. But, she had severe delays in her Oculomotor (visual tracking)abilities causing her to lose her place when reading, a binocular vision dysfunction (Convergence Insufficiency) causing her to experience intermittent double vision and fatigue when reading and Accommodative (eye focusing) Dysfunction that resulted in loss of visual attention for reading.

I met with Jenny’s parents outlined a treatment plan of twice a week office-based optometric vision therapy and within 4-5 months I expect Jenny will be visually fully functional and able to apply herself in the classroom. Jenny got started last week in treatment, and because we were able to clearly identify a discernible visual problem that can be completely remediated with the proper evidenced-based treatment in a relatively short period of time, Jenny’s parents decided to place her forward into 2nd grade.

If you are like so many who are searching for answers, this story about Jenny helps to give some insight. However, it is probably safe to say that you have questions about how a child, possibly your own child can pass the school or pediatrician vision screening,  reportably have normal sight (20/20) and yet have vision problems that cause significant problems in school, such as reading!? Yes, while Dr. Press and I have written about this extensively on the VisionHelp Blog, sometimes it’s better to hear about it from a parent who has been through it before.

With that thought in mind, here is a video of a mother, Michelle, whose son Dimitre had his crossed-eye surgically aligned, did occlusion therapy and had 20/20 visual acuity, but still had  serious vision problems that blocked his abilities to read, learn, ride his bike and even make friends.  Take a look and see if this helps explain why 20/20 sight is simply not good enough to define vision readiness for reading and learning in the classroom…

For more Facts about vision problems that affect reading and learning, here are some helpful sources:

OSU researchers find conclusive link between vision problems and children with IEPs

Accommodative function in school children with reading difficulties

A summary of research on vision problems associated with reading and learning

To find a doctor nearest you go to www.covd.org and click on the Doctor Locator.

Dan L. Fortenbacher, O.D., FCOVD

Vision, Attention and Reading

This is Laurie Cestnick, Ph.D., a clinical neuropsychologist who practices in Massachusetts.  She has impressive credentials, having taught at Harvard and MIT, and being on the staff of the Hallowell Center in Sudbury, Mass.    Dr. Cestnick has published some interesting research relating to visual processes and dyslexia, and in particular is very interested in visual attention.  Her work is a nice example of the potential synergy between clinical neuropsychologists and developmental/rehabilitative optometrists.  You may recall that a couple of months ago I did a six part series on our patient, Ruth, who is experiencing alexia sine agraphia.  As Ruth recovered in therapy and in time, she progressed from alexia to dyslexia, and she exhibits features of hemispatial neglect layered on top of her right homonymous field loss.  The last part of the series discussed optometric approaches to visual attention and temporal order challenges in patients with acquired dyslexia that can also be seen in children with developmental dyslexia.  For that reason I found this YouTube video presentation by Dr. Cestnick of particular interest.

At the end of Dr. Cestnick’s video, at the 1:09:10 mark, a woman asks her if she has any advice for optometrists or ophthalmologists evaluating a child for these types of problems.  Dr. Cestnick notes that you want to rule out a vision problem.  Reading issues aren’t always brain based.  She mentions that a “stereoptic vision problem can look like neglect”.  She goes on to explain a stereoptic vision problem, which sounds like she’s describing either a shifting due to unstable phoria (she describes a phi phenomenon), or a type of midline shift one might notice in suppression.  Dr. Cestnick opines that “when you send these kids to get their vision tested, they come back saying they have ocular motor dysfunction – which basically means they think their muscles are weak, which they can never test for, which is the same as saying they have a brain based problem.  You can’t tell sometimes if it’s eye based or brain based, you can only tell if it’s something strong like stereoptic.”

Dr. Cestnick is on the right track, noting that patients with these issues need help not only in improving spatial awareness in the field in which they have inattention, and that neglect can occur in the right field which is more disruptive when reading English (witness our patient, Ruth) – but that timing or speed is a crucial factor.  Many individuals with neglect will do well if they have time to scan, but will get tripped up otherwise.  There is much in her presentation that is insightful, and her approach would be that much more powerful if combined with knowledge of what developmental/rehabilitative assessment and therapy has to offer.