Hi,
As many of you know there’s been an ongoing discussion in here over the last few weeks about vision therapy and the research behind it, or the lack of such research.
Go to www.childrensvision.com and then from there to their link titled “Documentation of the Effectiveness of Vision Therapy.” You will end up on a page listing what I believe is the full 1988 journal article “The Effectiveness of Vision Therapy in Improving Visual Function” published in the Journal of the American Optometric Association. (This citation may be wrong, as the website unfortunately fails to list the date and place of publication, but such a report was written and I am almost certain that this is it.)
The report is a survey of the vision research, primarily directed at the issues of visual skills, that is, accomodation (ability to adjust focus,) binocularity (ability of both eyes to work together simultaneously) and oculomotor skills (ability to move one or both eyes efficiently from point to point.) It cites 238 references and refers to each of them in the report so that one can go to the research that most interests them.
I’m going to pick out just a few passages from the report for you to focus on.
Under the section “Can eye movement skills be modified?” paragraph 3:
“Heath (ref #80) discussed the influence of ocular-motor proficiency on reading. Sixy third and fourth graders who scored below the 40th percentile on the Metropolitan Reading Test and failed the ocular pursuit subtest of the Purdue Perceptual Motor Survey were divided into control and experimental groups. Results of the study showed significant improvement in ocular pursuit ability for the experimental compared to the control group. In addition, those children receiving therapy were found to score significantly better on a post-test of the Metropolitan Reading Test.”
(Incidentally, according to the report, every reference cited was from a “refereed journal.”)
Language: “Pursuit” is the ability to follow a moving object with the eyes. A “saccade” occurs when the eyes “jump” to a new point and refocus, as they do when reading. A saccade is not a pursuit.
Under “What are accomdative dysfunctions and their remdiation? [Focusing],” paragraph 2:
“The literature discusses many symptoms common to accomodative dysfunctions as a group. These have been described as reduced nearpoint acuity, a general inability to sustain nearpoint activity, asthenopia, excessive rubbing of the eyes, headaches, periodic blurring of distance vision after prolonged near activities at near, and excessive fatigue at the end of the day (152, 154, 156-160).”
and at paragraph 5:
“Wold (78) reported on 100 children who had undergone accomodative vision therapy procedures. These clinically selected cases showed an 80 percent rate of improvement in accommodative amplitude and 76% in accomodative facility using a pre- and post-treatment ordinal criterion referenced scaling method.”
and at paragraph 6:
“Liu et al (169) investigated accomodative facility disorders by objective laboratory methods using a dynamic optometer with an infrared photomultiplier. They objectively identifed the dynamic aspects of the accommodative response that were improved by vision therapy. Young adults with symptoms related to focussing difficulties were treated by procedures commonly used in orthoptic or vision therapy practice. Significant improvement in their focus flexibility occurred and these changes correlated with marked reduction or elimination of symptoms.”
Language: “Accomodation” is simply the ability to focus at a particular distance. “Asthenopia” is general visual discomfort. “Nearpoint” just means up close, i.e., reading distance. “Accommodative Amplitude” is how close you can focus. The number is higher if you can focus closer. “Accommodative Facility” refers to how easy or difficult it is for one to change focus, say, from near to far or far to near. “Orthoptic” just means vision therapy techniques.
One more and I’ll leave it at that.
Under “What are binocular vision disorders and their remediation? [Eye coordingation and alignment]” paragraphs 3 and 4:
“Patients exhibiting non-strabismic anomalies of binocular vision quite often report feeling ocular discomfort and astenopia (186). Some of the patient complaints include eyestrain, soreness of the eyes, frontal and occipital headaches, and ocular fatigue which result in an aversion to reading and studying (187, 187a).”
“Vision therapy has long been advocated as a primary intervention technique for the amelioration of non-strabismic anamolies of binocular vision (188-194).”
Language: “Strabismus” is an overt misalignment of the eyes, that is, you can usually see one eye is not working with the other. “Non-Strabismic Anomalies” involve situations where the eyes are not really focused on exactly the same point at the same time, but the deviation is so minor that it is not possible to see it, i.e., it is not strabismus.
The interesting thing about references 188-194 is that they are from the 1950’s to the 1970’s in line with the “Vision therapy has long been advocated…” comment.
Anyway, that’s it. And no, I haven’t read all the research, or even most of it…just some of it. What I have done is accumulate personal experience, most of which seems to support what the research on vision therapy has been saying for years and years.
Incidentally, with the type of research now being done, as indicated in the article Shay posted a bit below this thread, the answers to all of these issues are likely to be made much clearer in the next five to ten years. All it will take is for an enterprising researcher to apply the same research methods to vision therapy as is being done regarding the multi-sensory phonics training methods. I have little doubt what they will find. Vision therapy, too, will be shown to literally rewire the brain.
Enough. Check out the website if you’re interested. As I said, the entire report is there. It’s a very good site….Rod
Re: Vision Therapy Research
This is very interesting and clarified something for me. There is significant strabismus in both my husband and my families. My son was diagnosed with binocular difficulties which I just learned from your post seems like a sort of mild strabismus. I had always wondered if there was a relationship between the two disorders.
This makes absolute sense.
That really clarified a few things for me. Thanks.
Rod, I would like some advice about vision therapy.
I posted awhile back about my dd’s trouble with her faulty saccadic eye movements. This is definitely interfering with her reading.
My dd has been through vision therapy as well as audio processing therapy. She has concluded her therapy with her SLP and this is the recommendation of SLP:
“Work on __’s visual processing skills. ___ still struggles with faulty saccadic eye movements. She often scans from right to left then left to right and will frequently lose her place when reading. The traditional procedures to remediate this saccadic eye movement weakness have been somewhat beneficial, but it is time for ___ to use compensatory techniques. A simple index card under slid from line to line as she reads should help her keep track of each line. It might also be beneficial to draw a simple yellow arrow from left to right on the card to reinforce the message ‘left to right.’ “
I would like to continue helping my dd with this problem. I hate to give up and just have her use a card under the line she is reading. I don’t mind her doing it, but I would like to somehow help her to remediate this problem.
Any suggestions would be helpful.
Thanks,
Jan P.
Re: Rod, I would like some advice about vision therapy.
Hi Jan,
First, remember this isn’t my area, so some of this is speculation on my part.
A saccade consists of the picking up one’s eyes from one spot and locking them together on the next spot on the page. While it sounds simple, there’s a lot going on. Yet, for most of us it becomes an automated skill that we hardly realize we are performing.
Since it’s a skill, the way to improve it is to practice it, and as with most practicing, it only pays to practice it correctly. Practicing the wrong way only reinforces the wrong approach to a skill….make sense?
So, I would take this up with the vision therapist, and if you don’t get a reasonable response or an explanation as to why your daughter’s saccades will not improve further, then try to find another vision therapist. As I said, it’s a skill, and you’re job is to find a therapist competent to work on that skill with your daughter, i.e., to get her practicing the proper movements, rather than the wrong movements.
Part of the problem with VT is that, while it is in reality a relatively old field of work, it has been ignored by the mainstream reading researchers for so long that there is a general ignorance as to what it is, what it does and how to find it.
The unfortunate result of all this has been to limit the number of practicing vision therapists out there. Also, due to the reduced numbers, you will find a broad range of different approaches to developing the same skill, some extremely expensive, and others quite reasonable…..some good, some not-so-good, etc.
Because of the variation in techniques, costs and results, I always advise people to get the names of some satisfied parents before spending much money on VT. A good vision therapist should easily be able to supply you with such references.
Nevertheless, your instincts are, I think, correct. You should be seeking remediation of the skill deficit, not a compensatory technique that simply accepts the skill deficit as something that can not be changed.
Hope this is of some help….Rod
Jan
A few people on these boards have found the circle ‘e’s have helped this problem. I read about them here and have been doing them with my son. It is pretty simple.
Type up a page of nonsense text. Have the child underline all the letters stopping and circling the ‘e’s. We started with a font size of 12 and my son just couldn’t do it. He cried when he tried to do it. I moved to a size 20 font and have been gradually decreasing the size as he has improved. We are now down to size 10 after about 6 weeks. When we started he was doing a half a page twice a day. He is now doing a full page (smaller font so it takes longer) about 4 times per week.
I have noticed an improvement in his reading and an improvement in his enjoyment of reading. I don’t think he is fully remediated, yet. His phonemic awareness, segmenting and blending issues were previously remediated.
My son was diagnosed with saccadic eye movements and pursuit eye movements. He also failed a screening test for binocular vision.
Hope this helps.
Schools could do this
Hi Linda,
Thanks for posting the circle e information. I don’t have much exposure to specific activities done in vision therapy. I’ve just seen the results in a lot of kids.
However, it’s fairly obvious from your post that if school reading specialists, special ed teachers and even regular classroom teachers were to become familiar with these vision diagnoses, and with some of the recommended exercises, that much of the therapy could be done in schools.
Most of the people who have had direct experience with vision therapy also feel that this would be a good use of school resources which would, in the end, save them a lot of money (and then there’s the benefit to the kids themselves.)
Just a quick note on the language used: Everyone employs saccades and pursuits, that is, everyone has saccadic eye movement and pursuit eye movement. Your child was probably diagnosed as having poor saccadic eye movements and poor pursuit movement, in that he failed the saccade testing and the pursuit testing.
Rod
Re: Schools could do this
Therapy in general is pretty simple. The difficult part is usually what type of therapy for which problem.
When my son was faced with fine motor issues it was a no brainer for me. I knew exactly what exercises to do for him because of my work in rehab dealing with these particular issues. I think honestly the things I did were really just every day things that helped him to build this specific weakness. It had to be done every day.
The one problem I have with most therapies is that they lack the intensity required to have the needed effect. I spoke to one vision therapist that said they did therapy twice a week with no homework. I passed. It didn’t make any sense to me. I am going with someone who prescribes homework. I wish there was follow-up at the school as well. It should come from all sides.
I think many think these things are hard or difficult but they are actually quite easy and can get at the core deficit rather than constantly trying to get the child to circumvent something that is not firing in his brain. Children can learn to compensate but with all we know about the brains ability to change, why should they have to?
I really am doing all of this in the hopes that my son won’t need me to do that much for him later on.
My husband always says, “If you do it right, parenthood is planned obsolescance.”
Re: Jan
My son’s vision therapist hid the alphabet in order, amongst random letters which he had to scan and circle. If he found the whole alphabet he knew he got the paragraph all right. We also had to time him. As he gained speed he would be moved to smaller lettering. There was also a long string that had to be tied to a door knob, the other end you place at his nose. Two large colored beads on the string. One stayed near the door knob, the other is moved nearer and nearer and you have to refocus from one to the other.If you hold the string properly you will see the string form an X with the bead in the center. The object is to see how close you can get the moving bead before you see two of them.
Re: Jan
I also saw the bead exercise while at a friends house who had done VT with her son. I think this was a convergence exercise?
Re: Rod, I would like some advice about vision therapy.
Jan — I am very against the index card. In every case I have met, the student immediately read better when I took the card away, dyslexic or not, classroom or individual. The card is a prime distractor and excuse.
Try a simple pointer. I use a nice ballpoint pen. At first, you move the pen slowly left-to-right as she is reading, pointing always at the sound being worked on orally, and ALWAYS tracking in proper direction. The have her point with the pen herself. If she finds it difficult, well, that is the problem and the skill to be learned. It is definitely best to do this every day, and at a minimum three times a week. Don ‘t overdo it at forst, maybe twenty minutes at a time oral reading with a pointer, working for accuracy (NOT speed).
This is one of those old tried-and-true approaches that often helps and is very unlikely to hurt.
Give it a few weeks and see if she is tracking better at all. If there is any improvement, even if she is slower, keep it up. This isn’t a race and accuracy comes before speed.
Sorry, there’s a few errors….tried to catch them but….
The most confusing one is “sixy” should be “sixty third and fourth graders…”
Rod