20-20 Eyesight is Not Enough
What the Doctor had to say about Mary, his young patient:
Mary was an excellent student prior to third grade. Then the teacher began calling home to report Mary's struggles in math, spelling, handwriting and reading. She would reverse letters and numbers and make up words while she was reading. Her mother noticed that Mary was always exhausted after a day in school and didn't want to play any sports or even play with friends. Homework was a constant battle.
Mary visited the school nurse many times with complaints of blurry, watery eyes, and head and stomach aches. Neither the school vision screening nor the yearly pediatric physicals uncovered any vision problems. Mary read the eye chart and her vision was reported to be OK [20/20].
Mary's mom saw Dr. X speaking on television and says, "I couldn't believe the description of a 'vision-based learning problem' - it was Mary!"
Dr. X's examination revealed visual-motor problems, double vision, and a condition called convergence insufficiency. Convergence Insufficiency is a condition where both eyes do not aim at the same spot at close range, such as for reading. This causes double vision and great fatigue when trying to focus on printed material at reading distance. The strain of trying to focus causes headaches, stomachaches, and an inability to concentrate on and comprehend what is being read. Because third grade is the time when textbook print becomes smaller and children are required to read much more than in previous grades, Mary's symptoms did not appear earlier.
The visual motor problems (how we coordinate our movements) would explain why Mary didn't want to participate in sports: the eyes control and direct many of the body's movements and her eyes were unable to do that effectively.
In the fall of 2001, Mary entered a program of Vision Therapy; as a result, her life is now very different. By the end of third grade, she was excelling once again in all subject areas. Mary's teacher noticed a dramatic improvement in her daily performance and attitude, and reading had become a "pleasure" instead of a chore. Mary now went off to school willingly. There were no more daily battles to send her off, and she was not exhausted after school.
Mary's mom wrote, "there has been a dramatic change in Mary's daily performance and attitude. Reading has become a pleasure instead of an unavoidable chore! Mary is excelling in all subject areas, including spelling (one of her worst!). I love Mary's new self-confidence and positive attitude - she no longer calls herself or thinks of herself as 'stupid' and 'the slowest in class'."
At the beginning of my daughter Holly's first grade school year, she complained of not being able to see the chalkboard. I knew she loved glasses and really wanted a pair, but, thought it wouldn't hurt to have her eyes checked. I took her to an Optometrist and was told she had better than 20/20 vision. I was happy and bought her a cute pair of sunglasses.
Throughout the rest of the year, her reading progressed a little slower than I had expected. We have always read a lot and I was sure she was prepared to learn to read and that she really saw herself as a reader. It just didn't seem like reading was clicking. Her teacher and I had some discussions about this too. I assured her [the teacher] that her vision had tested "better than 20/20."
She remained with the same teacher as a second grader in a multi-age class. We both noticed odd little things in her reading. She missed simple words that I knew she knew. She skipped words and added words. Her teacher had discussed her with the reading specialist who didn't feel that she had a "learning" problem. Near the end of second grade, I heard about an eye doctor who specialized in kids with reading problems and made an appointment right away.
Dr. X diagnosed Holly with Convergence Insufficiency. He arranged for Holly to do Vision Therapy at home on the computer. She worked really hard at home during the summer, and at times she literally looked sick after a session. But just before school started, she finished her therapy.
I could not believe the difference in my child! She just finished third grade and is proficient in all areas. She is so very confident and is doing just great in school. I don't think she could have kept up this year if we hadn't discovered her vision problem and corrected it.
I wish I had known you could have "better than 20/20" vision and not be able to unscramble the words on a page. I wonder how many kids struggle through school with a vision problem that could be corrected and no one even knows.
Mary Augustine, parent
As a first grader, my son Mikey was reading at the third grade level, he was a prolific writer and had very little trouble with academics. However, by the time he reached third grade, nearly every aspect of school was a struggle. Reading was no longer enjoyable, and writing, once approached with the most enthusiasm, was avoided at all costs. Homework assignments that should have taken no more than 15 minutes to complete would take up to two hours to do, and many times went unfinished.
Although Mikey maintained a healthy enthusiasm for school, probably because of the social aspects, his declining achievement in the classroom was wearing on both Mikey and the rest of the family. Because his test scores indicated that he was within norms, having him tested through the schools would be impossible until he was performing below grade level for two years. Not willing to allow him to slip that far, we tried to supplement his schoolwork with other work at home, with no results.
Then Mikey hit a wall-literally. While approaching a drinking fountain, he walked into the wall. He saw two fountains and had gone to the wrong one. After that incident, he revealed that he often saw double, whether he was reading, writing, or playing. Alarmed and desperate for an answer, we quickly connected his declining academics with the double vision and went looking for answers. His vision was tested at 20/20, so a vision problem was initially eliminated. He was referred to a neurologist, and thankfully, a brain tumor was ruled out after an MRI. We were at a loss-we had ruled out lots of conditions, but we still had no answers.
While trying to find even a direction to begin investigating, I happened upon an article on Visual Learning Difficulties that included a checklist of symptoms. Mikey demonstrated about 70% of them. After comprehensive testing to identify the gaps in his visual development, he began an individualized program of Vision Therapy that lasted nine months.
The approach to Vision Therapy was developmental and specific to his needs both in the classroom and in daily life. Most all of the activities were fun for him, and the most gratifying thing was that he felt that he was making progress almost immediately.
Mikey is now in 8th grade and performs at or above grade level in all subjects, and we attribute that to the skills and tools he learned in Vision Therapy. After watching Mikey's progress and discovering the applications of Vision Therapy, I have become a vision therapist myself, and have the opportunity to help others like Mikey fulfill their potential.
Alma Winn, Mikey's parent
Because of Vision Therapy, my daughter, Brooke, now reads with added enthusiasm and excitement. Both her school work and her attitude about school have improved and we couldn't be more pleased!
Brooke's vision problems remained undetected for nearly ten years because standard vision exams showed her to have 20/20 vision. She started developing headaches during school hours and upon examination by a local optometrist, it was determined that Brooke's headaches were being caused by her visual inability to remain focused while doing close work [accommodation], her inability to track moving objects [eye tracking], and an inability to use both eyes simultaneously [binocular vision, eye teaming]. Our optometrist noted that while eye glasses might relieve some of the tension and pressure on the eyes, it was not going to correct the problem. Vision Therapy was offered as a method of correcting Brooke's vision problems.
Since completing Vision Therapy to correct her vision problems, improvements in many aspects of school and social areas have been noted. Brooke now loves to read and would rather read a good book than watch television! The headaches have disappeared, as well as the blurred vision and physical fatigue she experienced while reading. Her reading speed and comprehension have improved. Brook's softball performance have improved drastically, she was one of two team pitchers this year.
My husband and I couldn't be happier with our daughter's success through Vision Therapy. I encourage parents to have their children's vision checked regularly by a licensed developmental optometrist. I also encourage and support Vision Therapy as an effective and successful method of correcting visual problems.
Kathy A. Marshall, Brooke's parent,
The Vision Therapy program is highly recommended. I was not aware of the differences in eyesight and vision until being introduced to this program. The problems my son Christopher was having were beyond my comprehension. I never imagined he was having a vision problem.
Since participating in the program, there has been a drastic and positive change in Christopher's attitude toward wanting to achieve success in his studies. He loves to read and write and is much more interested in stopping by a book store to purchase a book. I am very proud of his success.
He has shown progress in school and shows great signs of maturity and high self-esteem. Thank you for your service, care and concern. Keep up the great work!
Billie Jo Thomas, Christopher's parent
From kindergarten on, Evan showed signs of stress upon departing for school (crying, kicking the back of the car seats, irrationality). This behavior also occurred whenever we worked on homework together. Over time, we pulled him back a year thinking he was not quite ready for the demands of school. This helped, but not as much as we had expected. He was still shrinking away from school-related activities and certain sport activities (throwing/catching balls and handling small objects etc.).
We had numerous teacher conferences over these early years about these signs of stress. None of Evan's teachers had any insight into the things we saw. They continually said that he was doing fine and saw no signs of trouble/stress. I knew this couldn't be right. I worried about my son's future in school. The light bulb came on for me one day when I was visiting an eye care center and I happened upon the binder full of stories about children and vision problems. I followed up with an information session and vision assessment with Dr. X. We found that while Evan has 20/20 vision, he had disabling problems with eye focusing.
Evan showed signs of improvement one month after beginning Vision Therapy sessions 3 times a week. Now, after completion of Vision Therapy, Evan finishes his homework lickety-split, no complaints, picks up his favorite books to read (in bed, in the car, on the morning before school), and has improved in spelling and comprehension to a great degree. Additionally, his ability catching and throwing balls and small objects improved greatly. Most importantly, he is much more comfortable in an academic environment now. His interest and performance more closely match his level of intelligence.
During the course of Evan's therapy, I read quite a bit about these particular types of vision problems. I am a believer in the existence of these basic problems and that Vision Therapy is worth the time and expense. When relevant and possible, I bring these particular types of vision problems up to friends and family. Educators in the public schools seem very reluctant to give any credence to these issues and the validity of Vision Therapy. How very unfortunate and sad.
Bill Tanaka and Toni Fischer, Evan's parents,
Prior to Vision Therapy, Kimberly L.M. had complained of symptoms like headaches, eyestrain, and blurred vision. Previous eye exams had shown her to have perfect "20/20" vision, but her parents felt that something was wrong. Although she was very bright and hard working, Kimberly had difficulty with long reading assignments and tests. A Stanford Achievement Test in April '98 showed her to test in the 60-75% range.
She was found to have a visual-motor dysfunction and went through a program of Vision Therapy from October '98-February '99. Her symptoms were eliminated and she reported that she was able to read for prolonged periods of time without effort or eyestrain. She was re-tested with the Stanford Achievement Test in March '99, where she tested in the 90-98% range.
Report written by Dr. X on Kimberly L.M., young patient
I am a school board member in the Campbell Union School District (Santa Clara County). I have also served as the Governmental Relations Chair to Senator Byron Sher, as well as Treasurer to our Santa Clara County School Boards Association.
I am the mother of two sons who have had various visual processing problems and who have benefited immensely from Vision Therapy. I would like to share with you my perspective on the value of comprehensive eye exams and Vision Therapy as both a parent and as a board member.
My ten year old son, Scott, had always struggled with reading. He was enrolled in three different reading intervention programs at our local school, none of which provided sustained improvements. Participation in a child study team at his school did not reveal any causal reasons for the lack of correlation between his academic potential and his academic performance (his IQ level was high and his performance level was average). After school and during the summer, he participated in two different lengthy one'to-one private tutoring programs. Although we saw some improvement, again there was very little sustained improvement.
In third grade, Scott was tested for our gifted program, as are all third graders in our district, and he tested into the 98th percentile - and yet he could not read without a great deal of effort, he read far below grade level and was becoming increasingly frustrated about his inability to master a process that is fundamental to so many other areas of learning and achievement.
A developmental vision exam found that Scott had difficulties in eye movements, focusing, convergence, and visual information processing, as well as double vision - although his eye health and acuity levels were normal [20/20 distance vision]. There was never any indication throughout the child study team process, the on-site reading intervention programs, or the private tutoring programs that anything was wrong with Scott's vision.
Scott completed 40 half-hour sessions of Vision Therapy and now wears prism glasses to correct for the double vision, and, not surprisingly, his SAT/9 scores reflect the benefit Vision Therapy has had for him: from 2nd to 4th grade his reading level improved from the 30th to the 85th percentile, his math level jumped from the 60th to the 93rd, and his language from the 60th to the 81st. This year I am sure Scott's scores will reflect even greater gains and he has set a personal goal to read one million words of recreational reading during the course of the school year. I am confident he will meet that goal.
It is ironic that the year Scott showed the greatest performance growth was the year that the school did not provide any sort of intervention. His performance growth occurred during the time that he was provided with Vision Therapy. Therefore, I am asking that the reader consider the following:
the eye exams that are currently provided within the school system are incomplete and they provide students, parents and teachers a false sense of security regarding a child's ability to visually process information;
our teachers are not trained nor are they aware of the multiple indicators that might suggest that a visual processing problem exists;
I believe that the State of California is not making more effective use of intervention programs funding because an inaccurate assumption is made regarding a student's ability to visually process information. My son is an example of this. As a parent, I wish I could take back those hours of frustration. As a board member, I wish we could have used those reading intervention programs on a student who had the visual ability to benefit from them. Before we invest any resources in any remediation or intervention program we need to ensure, from the very start, that the student has the visual ability to process the information being presented. It is estimated that 20% of all school age children could benefit from some type of Vision Therapy and probably 70% of those in need of remediation and interventions could;
Vision Therapy is cost effective - our educational system realizes a return on that one-time investment for the entire time that the student remains in our system. Once a vision problem is corrected, it remains corrected. Vision Therapy is targeted and specific, and its impact on academic performance can easily be evaluated. Few other programs can offer such a valuable, immediate and direct link.
Susan H. Mayer, Scott's parent,
Before Vision Therapy, my son was insecure and moody. Other children in his private school classes teased him because he could not read or write. Although he scored at the gifted level on IQ tests, he'd say, "I'm too stupid" or "I can't do it" when asked to do reading, writing, or arithmetic. He had problems sleeping due to nightmares and night terrors. Our family spent a lot of time and money seeking help from at least eight medical "experts" (this included a three-hour visit to a pediatric ophthalmologist, who concluded that there was no vision problem). Finally, we were referred to Dr. X.
My son began wearing prism eyeglasses and started Vision Therapy. Immediately, he stopped rubbing his eyes and showing signs of fatigue when doing school work. Within three months, he was reading at second grade level! His sleeping problems disappeared.
Today, my son is a happy and confident six year old who is proud of his academic accomplishments. His social skills have improved along with his self-esteem.
Our family feels blessed to have found Dr. X and his caring, professional staff. Thank you all for providing an invaluable service!
Linda H., Parent,
I brought my daughter to Dr. X for a developmental vision evaluation. She had a short attention span, made errors when copying, had poor writing, spelling, and reading comprehension. Her reading was slow and she skipped words. She really didn't like to read.
Dr. X found what all the other doctors found when he tested her [same eye exam findings]. Her eyes were healthy and she was able to see the smallest letters on the eye chart. She had "20/20" eyesight. Dr. X further tested all her visual skills required for learning. He found that she could not follow along a line of print when she tried to read, she had difficulty keeping her vision in focus and could not shift her focus easily from the blackboard [distance] to her desk [near]. She also had trouble keeping her eyes focused at the same point [at near], while reading her eyes got tired.
[Editor's Comments: Dear Reader, This is a story we hear again and again. School eye exams and standard pediatric eye exams only test distance vision and do not test how a child's eyes are functioning at near or when shifting from near to far and back again. Many children who have 20/20 vision still have vision problems that make near work (reading, writing, etc.) difficult. To continue ... ]
I enrolled my daughter in a program of Vision Therapy. After a few short weeks, I noticed she picked up a book on her own and read it without anyone telling her to. Other changes included less fatigue and headaches, better comprehension and getting more organized. The most incredible change was that after four months of Vision Therapy, my daughter was retested at her school and her reading had improved three grade levels.
Bonnie S., patient's parent
For many years, we struggled with our son. We felt that he was not performing up to his academic ability in school. Personality wise, he was obstinate and hard to reach. At one point, he was even on medication, because the doctors and teachers felt he had ADHD.
In October 2001, we decided to have his eyes examined. He has 20/20 vision, so he was not in need of glasses. But after Dr. X read the questionnaire that I filled out, he suggested further testing to determine if there was another kind of vision problem. We were skeptical, but went ahead with the testing. Much to our dismay and relief, a problem was detected.
Now the hard part lay ahead: getting our son to come to the twice-weekly visits for 17 weeks. Remember, I said he was obstinate and hard to reach. It was a struggle to say the least, but we persevered and he has now finished his Vision Therapy. Through these last 17 weeks, we have seen his hard shell exterior slowly melt away and a level of confidence that we had never seen before emerge. Our son has even started reading for pleasure, something he never did before.
Our son's positive result from Vision Therapy brings to mind the TV commercial for MasterCard: "Having our son back as a confident, caring, READING individual ... Priceless!" Would we recommend Vision Therapy to others? Absolutely!
Mr. and Mrs. Marshall, patient's parents,
Through our son's Vision therapy, we have seen improvements in reading, comprehension, reading for fun, less sleepy while reading, fewer headaches, improved self confidence, improved concentration, and improved self-esteem.
His history before Vision Therapy:
When we saw our sons low reading score on a standardized test, we literally freaked out. How could this be when his teachers had not said anything was unusual? I had noticed that his eyes watered and he rubbed them a lot when he read. He also had a tough time recognizing the same word in a sentence. When I took him for an eye exam and explained that he got headaches when he read, I thought for sure we had solved the problem. However, his report came back stating he had 20/20 vision. His 2nd grade teacher noticed that Caleb had trouble staying within a line when reading and recommended a visit with Dr. X. This proved to be what Caleb needed!
After Vision Therapy:
When Caleb was tested again in the spring after months of Vision Therapy, his scores jumped. He went from being in the first percentile to slightly above the average in a matter of six months! He still has work to do and practice in reading but we now understand his trouble and can work with him.
Caleb Schneider's parents,
I am writing my success story from a different perspective than that of a patient, or parent of a patient. I have been an educator for 45 years, functioning in such roles as a teacher, as principal and teacher simultaneously, as just a principal, and now as a director of a tutoring center.
About 20 years ago, an optometrist spoke at the Home/School association meeting. His topic was vision and reading. He spoke about how eye exercises could help some children to focus better and thus read better. He stressed the importance of teachers watching children's eyes to see what they were doing as the student read. His talk definitely inspired me. It changed the way I taught. I watched what was going on, and referred many students to the eye doctor, regardless of what school vision testing said. I saw changes in some students, and none in others. The search for effective learning solutions continued.
Eight years ago, as school principal, I insisted that a particular child had a vision problem and should see an eye doctor. The teacher disagreed, saying "He can see everything else that goes on in and out of the classroom, he could read if he would just settle down, pay attention, and learn." I finally called the student's home and requested that he be taken to the eye doctor. Results: the student had 20/20 vision, no glasses were needed, but he had a focusing problem. He was seeing double. We needed to do some Vision Therapy. The student had a couple of visits with the eye doctor, and was given a few different exercises to help him with his focusing. There was some improvement, but not all this young fellow needed. It was, at least, something.
As I began my work as director of the tutoring center, I became more and more convinced that some of our students were not progressing. They were intelligent children, but were not focusing on the printed material before them. Reading just wasn't working. That year, I had my own eye exam in a new town. After it was over, I asked the doctor if she, or if she knew of any other doctor in the area who offered Vision Therapy. She knew of the therapy, but did not practice it, and did not know of anyone in the area that did. The search continued.
The following year, a student from the previous summer returned for the summer session. In hand was Dr. X's report of his initial visit with her, and the suggested plan for Vision Therapy. I called Dr. X and asked many questions. I wanted more information. We had a long and informative talk. Within an hour of that conversation, I had another parent call and ask me about Vision Therapy. She had heard about a doctor (a different one) who did this and wondered what I thought of it. I got the name and telephone number, and was on the phone gathering more information. Both places sent me a lot of written information.
About the same time, I was looking for a program called the Controlled Reader at the exhibits at the International Reading Association Conference. To make a long story short, I ended up with a Visagraph program, which shows what the eyes do as a person reads. I began using it with students who were having extreme learning problems, and began referring them to the two Vision Therapy clinics I knew about.
The most exciting part of my whole teaching experience has been having students come to class week after week while participating in Vision Therapy and see the changes in them. These are the success stories that have made all of the above so very worth while:
Tyler had been with us for 3 sessions, and first and second grade. His reading has improved. In spelling, he couldn't pass a shortened modified list, now he keeps up with the rest of the class and passes. Next year he will do the challenge words. He's happy. School is an okay place to be, and he doesn't have to come to the learning center any more.
Tricia used to say "Do I have to read?" Now, she comes bouncing into the center and down the corridor to her classroom, because she can't wait to get started. One day she was "lost." When she was finally located, she was in her room, READING A BOOK. She would not participate in sport activities before. She now joins her family in shooting baskets.
Michael couldn't focus on anything on the written page. Now he comes to announce that he got to read to the kindergarten today.
Richard can read now, and is so excited about being able to do what the rest of the class is doing.
Mothers call to thank me for recognizing their child's problem and referring them to the right help. Mothers are so happy about their child's progress that they cry as they tell me about the successes.
I could go on and on. I have referred many students to Vision Therapy. Not one person who followed through on the suggestion has told me that they are sorry for accepting the suggestion, or doing the therapy, or that they begrudge the cost.
Josh would tell me every week his eyes would hurt and he complained of headaches if he was watching TV or reading and when doing homework. Teachers at school told me that Josh would have to repeat Kindergarten because he was so behind on everything in school. I took him to the eye doctor for a check up. She said he could do without glasses. Six months later I met Dr. X. Since starting Vision Therapy, he is doing better in school with his reading and writing. He's no longer reversing his letters and numbers.
Nancy, mother of Josh, 7
Nathan would tire easily, and would be very frustrated that the words moved on the page. He would try to cover one eye to compensate, and he would see double and that freaked him out at times. He felt left out because other kids were reading and he could not. He had a bad attitude about reading. I was angry and frustrated too, and thought it was me doing something wrong, or me being too hard on him.
Since Vision Therapy, Nathan has gained self confidence, he has a desire to read, and he knows he has better control of his eyes. I feel that if you see signs of a reading problem you should get tested as early as possible. Even if you don't see any signs of a vision problem, you should have your child's vision checked before starting school. Don't just check for 20/20, go to a developmental optometrist to check if tracking, eye teaming, and focusing are working before you start to have problems with reading.
Now Nathan is aware of his eyes more and is able to stay focused. He can read faster and smoother and has a good attitude about reading
Laurie, mother of Nathan,
His first grade teacher thought there was something wrong. "He's obviously intelligent," she said. "He tries very hard, but he's not getting the results he should be getting. I think you should get his eyes checked again."
The optometrist was all smiles and very reassuring. He'd used the standard tests for 20/20 vision and color perception. "No problems," he said. "His eyes are fine."
Great! His eyes weren't the problem. We worked extra hard at home, but the gap between his effort and results continued into second grade. His teacher recommended that he be tested for learning disabilities. He did very poorly on those tests and was admitted to the Resource program. He was evidently learning disabled, but what? How? One Resource teacher got quite depressed. "So much effort here and so little progress," she said.
A friend once told me: "You only know what you know."
During this period my son's mother and I were going through the process of a divorce, and a psychologist was appointed by the court to help with the children's transition. After the very first session she said of my son, "I don't think his eyes are working properly. Have you heard of Vision Therapy?" No, but this was our lucky day. The psychologist put us in touch with Dr. X, a development optometrist and vision therapist.
Dr. X tested our son. He found that his eyes were incapable of focusing far and then re-focusing near with any kind of speed, making copying from board to paper a very difficult task. He found that his eyes could not track evenly, causing him to skip lines and words. Reading was tough, and tests where questions were answered by filling in spaces or circles were like trying to catch soap bubbles for him. He could miss long columns of answers, unable to line them up properly.
Twenty-two weeks of Vision Therapy later, he began doing much better in school. He is now a fifth grader reading at a seventh grade level. He still has some spelling problems, but he's much improved; and, significantly, his self-esteem is still intact, thanks to the wonderful, caring teachers at his elementary school.
If only the tests for eye teaming, focusing, and tracking had been added to the usual eye tests that's given, what a bright world this could have been much earlier. The teachers did their job, but you only know what you know. This additional information must be provided to teachers, children, and parents. There are kids that pass the current 20/20 eye exam in schools, and these children can't "see."
John, father of Rik, 11,
Rylie would mainly complain about constant headaches and how sore her eyes would feel. The more she read the worse the symptoms would become. Before we realized what the problem was, we thought it could just be fixed with glasses. After meeting with Dr. X, we realized that the glasses were not enough to fix her problem. Vision Therapy was needed and a short time later Rylie was cured of her vision condition that caused her headaches.
Dana, mother of Rylie, 12
Source: 20-20 Eyesight is Not Enough
Please note: In-office therapy under the direction of a behavioral optometrist using prisms, filters and lenses, as used with our patients, is far more effective than home-based therapy.