One of the more memorable patients for Dr. Samuel C. Oliphant, OD, of Advanced Family Eyecare in Oklahoma City was a seven-year-old boy known to ride his bicycle into walls and garage doors.
His parents had his eyes checked, only to reveal that his eyesight was perfect—even if his aim was not. It was a puzzling situation until Dr. Oliphant discovered that his eye alignment was poor, so his eyes were literally not pointing to where they were supposed to point, wreaking havoc on his gross motor control (and garage doors everywhere.) After receiving treatment and prescription glasses, the boy told his mother one day in the car that the “road in front of us really goes somewhere,” revealing to Dr. Oliphant that it was the first time the boy had ever seen depth. Before vision therapy, the world had literally looked flat. “His motor skills are great and he can now read for hours and hours without getting tired,” Dr. Oliphant shared. “Treating his vision issue has made a profound impact on his life.”
How Important Are the Eyes?
Dr. Carolanne Roach, OD, of the Brain & Eye Connection Vision Clinic in Oklahoma City can give others firsthand experience into what it is like to have a visual system problem. By using a special set of lenses, Dr. Roach can make the words on a page become blurry with each blink of the eye—replicating what it is like for a student with focusing problems to function in the classroom. She can also demonstrate what convergence insufficiency is like for children whose eyes do not work well together. By presenting a paragraph typed in an unusual alignment on the page (such as the example on the next page), she gives firsthand experience with how reading speed and comprehension are compromised by many of the vision problems experienced by children in the classroom every day. “If the words swim on the page, waver or double every time you read, would you struggle for hours every day for a low grade? “ Roach asks. “Or, would you do everything you could to avoid school work?”
Dr. Troy Flax, OD, of Norman Vision Source also sees the impact that vision problems have in the classroom. “I can spot those kids a mile away. They are bright kids who can hold a great conversation. But they almost always have trouble with reading,” Flax explains. “They are fine with math, but poor in other subjects. And, more often than not, it is a visual processing issue.”
“Teachers give students instructions to sit quietly and read, or copy from the chalkboard. If the visual system breaks down, it is not easily done or done comfortably,” Flax continues. “When students have trouble doing it, they lose attention quickly and their classroom performance suffers.” According to Flax, one in four children have some sort of vision-related problem and Roach says one out of three students struggle in school because of vision problems. “For parents, it’s really about connecting the dots,” Flax says. “Does the child have no interest in school? Can it be connected to the eyes? If they are not working properly, it can cause all kinds of problems.”
What is Vision Therapy?
“Vision therapy is like physical therapy for the eyes,” Oliphant says. “Just like how a child is supposed to sit up at a certain age and crawl at a certain age, there are developmental milestones for vision.” Oliphant explains that sometimes, children don’t develop visually as they should, but parents may not notice right away. “All of a sudden, a child starts school and the parents realize there is a problem.”
“Let’s say that a kid can only focus effectively for two minutes, and the teacher says to read for 10 minutes,” Flax explains. “Forcing themselves to do that can cause headaches and muscle fatigue. Your eye muscles are not any different than any other muscle in your body. Through vision therapy, we can work with the strength and stamina of eye muscles. “
According to the American Optometric Association, 80 percent of all learning is acquired through vision. The act of sight not only includes one’s eyes, but also the neurological activity that processes visual information. Vision therapy helps individuals learn how to process this information and develop better coordination skills. “I teach the brain how to use vision,” Roach explains. “Just like reading and speaking, vision is a learned process. In the same way that you can learn a new language, you can learn to use vision better. It’s not automatic. You learn to understand what you see.”
“From a vision therapy perspective, it is not as much an issue of clarity, or the ability to see clearly,’ Roach says. “It’s how comfortably a child can see and how the eyes move.” Before referring a child for vision therapy, Flax examines three aspects of a child’s visual system: eye sight (how clearly a child sees), eye performance (focus and depth perception) and eye health. “A lot of times it is an eye performance issue,” Flax says. “It’s a problem of how information gets from the eyes to the brain. Sometimes eye performance issues can’t be fixed immediately. It’s a coordination thing. You can’t just put on a pair of glasses and fix it.”
By working with the eye muscles and the child’s prescription, vision therapists can train the visual system towards more efficient and effective eye performance.
Warning Signs of Visual Problems
“School screenings miss an estimated two-thirds of vision problems,” Roach explains. “And they rarely catch children who have near-vision problems. A child can have good eyesight and still have vision problems, so you can’t just rely on vision testing at schools as your only indicator.” There are many red flags that might indicate a child might have a vision problem that could affect his learning, including: car sickness and headaches, poor handwriting and/or poor eye-hand coordination, and poor spelling ability. Find red flags and warning signs here. Some of the most common problems that can interfere with learning include eye alignment (poor binocularity), control (eye movement), focusing (accommodation), lazy eye (amblyopia) and eye turn (strabismus).
Can Visual Problems Be Confused with Other Issues?
Dr. Roach points out that vision problems share many of the same characteristics that often lead to a diagnosis of Attention Deficit Disorder (ADD) or Attention Deficity Hyperactity Disorder (ADHD). “Sometimes with kids, it’s not so much an attention issue—it’s a visual problem,” Roach explains. “There is a lot of guessing with the diagnosis of ADD and ADHD and there is no proven test to absolutely diagnose it. Doctors are just working from symptoms. ADD and ADHD are a diagnosis of exclusion, meaning you have to exclude everything else. This can include motor skill issues, hearing problems and vision problems.”
Similar characteristics between ADD/ADHD and learning-related visual problems include failure to pay attention to details, difficulty sustaining attention, inability to follow through, difficulty organizing tasks and difficulty taking turns. “ADD & ADHD are thrown around pretty liberally,” Flax adds. “From the eye perspective, the problem can be visually-related.” Roach says that part of the complication is that many children do not know how to adequately express their vision complications or may not even be aware that they have one. “Children don’t know that what they see isn’t what everyone else sees,” Roach explains. “They don’t know that’s not normal, so they don’t know to tell their parents or a doctor.”
What To Do If You Suspect Your Child Has a Visual Problem
“I most commonly see kids beginning in third grade,” Oliphant says. “In first and second grade, most of the classroom information is still presented audibly. By third grade, kids are expected to read for knowledge and learning. With many schools pushing for faster achievement for students, these problems are starting to come to light earlier.”
“We have the tools to figure out eyesight issues,” Flax encourages. “What we want to know from parents is ‘here is what my kid is doing…’ with information about things they’ve noticed about their children, especially in regard to their school performance.” Flax recommends eye exams beginning at age three, or younger if you have if you have reason to believe there are any issues. “Bad visual habits start early and can be hard to break,” he says. “Kids don’t know any different than how they are used to seeing, so a huge red flag is if a kid complains about their vision.”
If vision therapy is thought to be beneficial for your child, the therapist will use a standardized test for diagnosing vision problems, and compare your child’s results to other age-based norms. Most vision therapists will also look for neurological problems before recommending a course of treatment.
Benefits of Vision Therapy
“The thing about visual issues is that you don’t grow out of them,” Roach says. “But there is also no age at which the brain cannot learn to use the visual system properly. Because of the brain’s ability to learn, vision therapy works on young children, older children, teens and adults.” “With poor visual perception, a child loses comprehension, reading speed and cadence. They are often poor spellers. They do great verbally and can memorize letter order for a spelling or vocabulary test and do fine. But, if you ask them to write a paragraph, the spelling is bad,” Oliphant says. “These frustrations definitely affect their self-esteem and can lead to them using words like ‘stupid’ to describe themselves.”
With proper vision therapy, a child’s coordination often improves, leading to improved self-confidence and sports performance, reading skills improve, homework battles decrease, and self-confidence and esteem are positively impacted. “I’m at retirement age, but I’ll work forever because this is such a rewarding job,” Dr. Oliphant says. “Kids who struggle to learn can achieve far below what they are capable of. With vision therapy, I’ve seen these same kids excel and do well in both sports and school.”
“Vision therapy can give students the tools they need to become whatever they want,” Roach concludes. “But it is not necessarily a quick fix and can take six months to a year. It’s a commitment, but one with great benefits.”
If you think your child might have a vision-related learning problem or could benefit from vision therapy, consult your optometrist or ophthalmologist for more information.
Brooke Barnett is the assistant editor of MetroFamily Magazine.