developmental optometrists

Two issues:

First: Sounding out words is a *good* thing. Guessing at whole words is a dead end and usually has to be untaught later. Don’t push him to hurry up and guess!
At five years old, if he knows the alphabet and can sound out, he’s doing well. Yes, some kids go faster. Well, over the next year or two things will change. Some of those kids who are working on pure visual memory will stall out — some of them may even have to be taught to read all over again — yes really, I work with this all the time. Your son will start putting words together faster and faster and will catch up and quite possibly pull ahead.
Keep working on single letters and words and wait until he shows interest in putting them together. Have you taught him to print? Please, lower-case and correct directionality — this is one of the best things you can do for him. Once he can print smoothly, then he will want to write things, labels and messages and shopping lists and recipes, and this is a way to work into sentences. Another very old suggestion is to give him (short) written messages from friends and family, phone messages, meeting times etc., and then he will be motivated to read them.

Second: I am not sure why you think he may have a vision problem. Are there any symptoms *other* than working on or above age and grade level? Working on grade level rather than two years ahead is not usually considered to be a problem, after all.
Vision therapy and developmental optometry are highly controversial and as yet there is no solid scientific data proving its success. There is a lot of anecdotal evidence and I believe there is something there, but it’s still a field in early development. If I had a child who did show vision problems that wouldn’t stop me looking into it, but it is not a cure-all.
Apparently from what I read here, VT is still more an art than a science (so is teaching and so is much medical diagnosis, so that isn’t a condemnation) and if you do find a need for it, it is important to get a good provider with a good track record. Rod, who posts on this board now and then, knows a lot about the field and can direct you to people with many past successes.

Thank you, Victoria. I was worried about the visual stuff since he has astigmatism, and I was thinking maybe he couldn’t hold onto the whole words—he’s known the same whole words for about a year. But when he learned to blend words (courtesy of a video, believe it or not) he really got into it, and can decode even nonsense words like “plog” and “flim” Still, he’s not using that to try to read in context. I know he’s completely average for his age now, but I just really really thought he’d pick up the reading thing by now.

A lot of the opposition comes because optometrists, not medical doctors, developed the field. Ironically, independent research has verified the effectiveness of vision therapy — so much so that the American Association of Opthalmologists has created a sub-specialty called “orthoptics” to provide it. They do not call it vision therapy, however. They call it “muscle retraining”. They never mention optometrists, and they limit orthoptics to convergence and accommodation problems — because those are the areas with the most rigorous independent research so far. (Developmental optometrists treat additional problems, such as tracking and saccades, which have not been researched in great depth yet.)

Astigmatism, as you may know, involves distortion of the shape of the eyeball. This distortion can require the muscles needed for accommodation and convergence to work much harder than normal. It can be like lifting a brick at a very awkward angle rather than head-on. Because of this, the muscles may find the tasks too challenging. A developmental vision evaluation can determine if convergence and accommodation are at age-appropriate levels in your son. If they are not, then specific exercises can strengthen the muscles to the point where they can perform these tasks easily and automatically. The exercises also train the brain to handle the new sensory inputs efficiently. It’s a lot like a physical training program that develops skills.

Anyway, it’s reasonable to assume that astigmatism can be a contributing factor in developmental vision delays. Unfortunately, your opthalmologist is behind the times, because at the very least he should have referred you to a pediatric opthalmologist who employs an orthoptician for evaluation of convergence and accommodation. Regular physicians are even further behind the research. Many are just spouting an old political line and are unaware of the status of current independent research in the field.

If you haven’t seen this already, http://www.childrensvision.com has a link to a list of research studies on vision therapy — including studies by opthalmologists! It’s a shame, but professionals often cling to what they were taught in school, especially when they emerge with a medical degree.

Nancy

Hannah — I happen to have severe astigmatism myself, along with farsightedness, a convergence problem, and badly, stupidly mistreated amblyopia that caused me to lose most of the vision in one eye. So yes, there is definitely something here to watch out for.

On the other hand, none of this interfered with my reading, quite the opposite, I’ve been a bookworm since I first learned to sound out at age four, and I come out high on all reading tests.
The astigmatism and amblyopia and refusal of treatment made it impossible for me to play any team sport (thus driving me back to the books even more).

So I would say yes, treat the astigmatism — does he have glasses? Watch out for signs of amblyopia (“lazy eye” — the good one does all the work and the nerves to the weak one atrophy).
Vision therapy may indeed help him converge better and develop other strengths, but unless you see any real problems there is no need to spend a fortune on it yet. The homevision site and/or book might be helpful

On the reading, do everything you can to make reading and writing interesting and a part of his life. Find library books on topics that fascinate him, read part, and then tell him you have some work to do and let him see if he can puzzle out a bit on his own. Sound out street signs and help him find out where you are going. Write messages down for him.
And definitely extend the sounding-out to the next level, digraphs (sh, ch, the, wh, ng) long vowels (a_e, ai, ay etc.) and diphthongs (oo, ou, ow) and r’s ( ar, or, er=ir=ur) so that he can really sound out environmental words — a lot of phonics programs stop one step too soon, just doing short vowels and single consonants which are too limited to be practically useful.

I feel the need to chime in here. I, too, wondered about the need for vision therapy and was told point blank by her opthalmologist, 2 reading specialists, that VT was a load of hooey. I waited over a year. However, after making great gains in sounding out words and blending sounds, etc, my child was not able to read more than a few words. I finally made an appointment with a development optometrist. I was lucky, he was great. It was clear my child had accomodation and tracking issues. her reading took off-she is still a terrible speller but just won the summer reading prize in grade 8. I can VERY clearly recall the summers of tears after 10 minutes of reading; the summers of PAYING her to read, etc. She has found some authors and a genre she can’t get enough of and now is reading under the covers at night.

At 5 you may not be able to say your child has trouble reading. Does he have trouble catching a ball. Does he complain about sore eyes? If you really want to see an developmental opt. shop around, ask other parents, check www.covd.com (or .org, can’t remember). A check up is usually covered by insurance. Our VT was done at home and was the cost of 3 visits for montlhy checks. We did it as an acclerated program over the summer.

As with all services for our children, you must really check that you have found the knowledgeable and legitimate-whether it be a pediatrican, psychologist, neurologist, reading teacher, occupational therapist, or optometrist. Unfortunately, it is difficult to ascertain who is who.

I think the some of the response to your question was related to age of your son. Many, many 5 year olds do not read spontaneously. Nor should they be pushed to. But if you feel that something is seriously out of line with his abilities/interests then do investigate. I, too, felt the way you do. I had a very, very verbal and high IQ child and was surprised at her difficulties.

Good luck, keep us informed.

I am a great believer in vision therapy. However I also know that the visual skills for reading take time to development. I believe that age 7 is the age by which most children have the convergence, tracking, and accomodative skills needed for reading.

I don’t think it would be a bad thing to go to a developmental optometrist but I also don’t think there is cause for alarm.

The vestibular system (inner ear) is the system that needs to be strengthened to make the visual system work efficiently. I also suggest that you check out a web site called www.balametrics.com. They sell balance boards and kits with activities to do with your child. This could go a long way in preparing your child for reading.

Thanks so much, everyone!! This is a great board. I know it seems odd to be complaining about a nonreader at 5, but he’s got the phonological awareness, the sound-symbol thing, the blending concept—and has for a while. I will check the d.o. thing out, and the balametrics is interesting, too. He definitely has trouble balancing on one foot, I noticed once when he was among his friends in a Simon Says game. I check every once in a while and he still really can’t do it. I’m thinking of getting the preschool version of balametrics. Any input on that would be great, but maybe I’ll just do another post.

Also, he is enrolled in a “sports-skills” class (he does have trouble catching), and yesterday he could NOT run after the ball in a mini soccer game. He just stood there and sucked his thumb. Maybe it was visually too confusing for him. It was his first time, though. He said he was afraid to bump into other kids. I’ll mention it to the d.o. we go to.

My son was found to have a visual motor deficit through testing done at school. I was told by an opthamologist that vision therapy was a waste.

I did not start vision therapy until third grade. I truely wished I had started sooner and would have except for the preponderance of bad advice from medical professionals.

I think the best way to explain it is the problems are brain based. It is not the eyes but the processing of the visual and motor information which is done in the brain.

The exercises stimulated the areas of the brain he had difficulty with. Visual skills that were once a struggle like focusing near to far (called accomodation) became automatic. Just think about constantly losing your place when you read because your eyes can’t remain focused or trying to copy from the board when focusing near to far is hard work.

He used to hate to read but scored 100% on the reading portion of the state tests last year after vision therapy. He now LOVES to read. (He also received very good phonemic awareness reading instruction which is essential but sometimes not enough)

It was one of the best things we ever did. Just realize you have to do the exercises every day. Just taking your child to therapy is not enough. I think that is why some find it not helpful. You need to work very hard to correct vision related difficulties.

My 5 year old was evaluated by the same optometrist and was found to not have any visual deficits.

thank you, Linda, and everyone. Linda, you’ve spoken to one of my big fears about this discipline—I’m afraid that I’ll take him to a d.o. and they’ll say “oh sure, he needs this…” whether he does or not. (I know that’s hugely unethical, but d.o.’s are not accorded much respect in the medical field, judging from the comments of my pediatrician and opthamologist.) I’m glad to hear that one told you your little guy was ok.

I will post again with the results, for anyone who is reading and considering this, too.

Honestly, I think a mother would know pretty quickly that their child did not need vision therapy.

I was amazed at how difficult the exercises were for my son. Things that seemed simple like reading text near and then far made him weak in the knees and sick to his stomach.

I think if things seem easy, then the child just doesn’t need it. My much younger son found the same exercises easy. I also tested every child I knew, my nephew, neighbors kids etc. It was interesting to see how kids who learned easily had no trouble with these exercises.

I think your idea of using the preschool version of Balametrics with your child is a great one. In my son’s case, the vestibular system has been intimately linked to his vision issues.

You may have some difficulty getting a definitive diagnosis from an optometrist. I was told it was developmental when my son was that age. But time alone did not do anything…we were in the same place two years later.

We did vision therapy with some results but nothing like what Linda found. This was partly at least due to the fact that the vision therapist used “flat” approaches. For some kids that is enough but your child doesn’t sound like one of them….I say that because of what you observe about sports. You ideally want someone who incorporates balance/motion into therapy. You may be able to “ready” your child by doing Balametrics first.

My son even after years of therapy and reading instruction still dislikes to read. He can read at grade level though.

Beth

After 6 weeks of vision therapy my son just started reading and wouldn’t put his book down. Then that seemed to wear off even though we continued with therapy.

It was only after therapy this past summer that he again developed his love of reading. He reads all the time now. I don’t know if it will wear off again.

The only thing I can point to is the fact that the first 6 weeks and again this summer we worked on focusing and tracking. After the initial 6 weeks (when I initially saw the reading enthusiasm wear off) we worked on a ton of different issues from visual spatial to bilateral exercises etc.

I learned that before doing VT my son would look at a word and it would split in half. This still happens to him very close up. We continue to work on strengthening the muscles in his eyes as well as improving the range of motion of these muscles. This is still a weakness for my son but it continues to improve.

I also think that reading itself is one of the best tracking exercises that you can do.

He also takes Chromium picolonate as my doctor told me a chromium deficiency can affect his specific problem. I wouldn’t recommend this for everyone but rather check with your doctor.

have been a wealth of information for me. I am going to try many of the same things on my daugher.

My daughter craves bread—not sugar—BREAD—which contains chromium, doesn’t it?

Your son and my daugher could be related. They sound so much alike. Would you grace me with a list of exactly what stuff you tried and at what age for what remediation, please. For example, your tried a developmental optometrist to work on spatial issues at what age? Did it improve reasoning, logic/math skills at all? The excercises that you did at home—where did you find them? Online or out of a book?

How expensive was the developmental optometrist? Is there a difference between Vision Therapy and Developmental Optometry?

We started vision therapy in third but I wish we started it much sooner. I was told by a pediatric opthalmologist that his eyes were fine this despite the diagnosis at school of a visual motor deficit. That is his primary learning deficit. The more I learned about vision therapy the more I realized it was exactly what he needed because an experienced developmental optometrist can address the specific visual deficits much in teh was an experienced audiologist can help you best understand auditory issues. My son’s doctor has been treating children for over 40 years. He literally wrote the book or wrote some of the books on the subject. He is Dr. Moskowitz in New Jersey.

We first addressed some of the tracking /focusing issues. These exercises worked on improving the range of motion of the tiny eye muscles that my son could not control on his own to focus and track effeciently. He could track his eyes but it was alot of work for him and the extra work stole his attention from the task at hand whether it was reading, writing or other close work.

After we addressed these issues we worked on visual spatial issues, memory issues, processing speed etc. Wherever the therapists so a deficiency they worked to improve those areas.

We did see and improvement in math.

We also did interactive metronome which helps with attention and sequencing as well as motor timing issues. My son had a severe sequencing issue, he had a very difficult time learning to skip count etc. I looked at IM as a program that addressed his more global motor needs. We did this in the beginning of third before vision therapy. I thought it was a good primer for vision therapy.

We also did audiblox off and on. I really think it helped but some of it was very similar to what we did at vision therapy and I thought the optometrist was able to give us a program that was more specific to his needs.

Not all optometrists address issues the way ours did. Some only deal with the focusing and tracking and are not as experienced with dealing with all the issues these kids face.

I forgot to add. I thought chromium was something found in green leafy vegetables. My son does not eat vegetables which is why I decided to give him a supplement.

I only give him 1/2 a pill every few days and on a full stomach. He felt nauseous when he got it on an empty stomach. I would check with a doctor first as this is a mineral and the body can store these over time so too much could lead to a problem especially in young children.

I wish he could swallow the Omega 3 pills but he just can’t. I try to give him eggs with omega 3 and that does seem to help.

I just took my 12 yer old son. We thought it was great. They found that his eyes tend to go apart after long periods of reading ( he does well on short comprehension tests but tires after reading for 15 min or more) and so his vision on the page gets blurry. Prism glasses have been great. Additionally they gave us exercises to do with his eyes. It certainly has helped and much of it is covered by insurance since it is medical (not much else for LD kids is). So my advice is your child is young but for those out there with an older child don’t hesitate since it certainly can’t hurt.

That is great news!

I actually will say that everything I read indicates it is easier to remediate these types of vision problems when you start when the child is younger.

One of my son’s problems (accomodation/focusing near to far) is considered more difficult to remediate as age advances.

Hi everyone,

I took my son yesterday for the second part of his developmental optometric screening. His tracking, etc. is fine; where she found some trouble was when my son (he’s 5) had to match shapes that were more abstract than circles, squares, etc. Interestingly, though, she said he could look at the shapes alone, remember them, and find the match that way, but not if they were on the same page. That would seem to indicate that he might have trouble recognizing word patterns on a page, as opposed to in isolation, right?

She also said that his skills were age-appropriate, but that he seemed bright and highly verbal, so it seemed almost like a relative deficit.

I have a book (Visual-Perceptual Skill Building) with exercises (match the shapes, etc.) that I’m going to try to use with him. Any other suggestions? The d/o wants to see him in 6 months and says “keep an eye on it.” She also noticed some gross-motor awkwardness. Any thoughts? Thanks in advance, once again.