Through these brief pages and by introducing you to a few patients out of the thousands I've treated in over thirty five years of specialty in Vision Therapy, I hope to convey some basic ideas about Behavioral Vision and Behavioral Optometry.
Behavioral Optometrists, through Vision Therapy:
I hope you will find our journey together pleasant and enlightening.
- improve school performance and achievement;
- help children and adults read better and remember more;
- improve visual and overall efficiency;
- treat visual disabilities that lower performance in students diagnosed with Dyslexia, ADHD, and Learning Disabilities;
- treat nearsightedness without eyeglasses;
- and much, much more.
The Power of Vision Therapy
When we think of the word "behavior", we often return to our own school experiences as very young children. Behavior means "being good or bad" and good and bad were defined for us by teachers or parents. But behavior has a different meaning here; we will discuss a particular type of behavior -- visual behavior.
An individual demonstrates visual behavior when he hits a baseball or reads and understands a book. The way he balances himself when he walks, how he drives a car or navigates through a doorway; these are examples of visual behavior.
Vision directs his visual behavior; it controls and monitors movement, posture, how he understands the world around him and how he achieves in school; it helps determine a great many important factors of his life.
Our concern is Vision -- not the limited notion of "clarity" as determined by the line of letters recognized at twenty feet, but rather the processing of information, the understanding of visual space, visual relationships, visual direction, visual memory, visually directed movement, thought, and much, much more.
When educators and psychologists evaluate inadequate classroom performance, they first observe and measure aspects of visual behavior -- really deficiencies in visual/motor/perceptual abilities -- but often do not realize it. Yet, how a student is treated and labeled in schools is determined by those incomplete evaluations.
The sad fact is that undetected visual/motor/perceptual deficiencies contribute greatly to a child's classification as Learning Disabled, ADHD, Dyslexic or Underachiever -- all this without awareness that a vision problem exists.
What can be done for those unfortunate children? The articles that follow may suggest a plan of action. I urge you to read them in the sequence in which they are presented.
The Student Who Hated School
I've encountered many patients with a great variety of visual problems. Some of them stand out in my mind for one reason or another. I want to briefly introduce you to "Carl".
Carl was a really nice kid. At seven and a half, he was easy to like, friendly, outgoing and smart, with a great sense of humor for his age. But he hated school with a passion. He had good reason for his dislike: he failed at everything, and no one knew why.
During examination, I discovered that many of his visual skills, particularly those concerned with reading, learning "sight" words and writing, were deficient. He couldn't remember what he read, so he was a failure at the age of seven and a half. Sadder still was his comment to me when we first met: "You know," he said, "I'm retarded."
But he wasn't.
Because he had not learned some basic visual/motor/perceptual skills when he was younger, whenever he was given a book to read, unless he worked at it, he would see a double, blurred image in front of his eyes. When he attempted to follow the line of printed letters, he lost his place. And there were other problems as well.
The good news was that Vision Therapy would help. But try to tell that to a kid like Carl who had lost all hope.
I want to share with you his teacher's report after six months of Vision Therapy.
...We have seen improvement this year in these areas:
- Carl can now identify all letters upper and lower case.
- He has begun using word attack/decoding skills.
- Carl can now read simple books.
- He now has an understanding of simple word problems.
- He can now accurately copy...information from the board.
- When working at a task in school he approaches it with the confidence that, "I can do this."
We're very pleased with what Carl has achieved so far this year. I also feel that he is pleased with himself. He has a good rapport with peers and he certainly gives the impression that he is happy in school.
Pretty neat. Carl began to like himself.
ADHD? Dyslexia? ... Or Something Else?
As an infant develops, he reaches out into space with his eyes and hands and matches what he feels with what he sees: textures, forms, shapes, weights. He explores the world beyond his fingertips with his vision; and, as he moves across space by creeping and walking, he learns visual perception through other bodily senses, to be stored in a memory bank, reinvoked and recalled when needed. Through repeated patterns of movements, he corrects and modifies his perception of the world by learning about his own body -- its composition, its dimensions. He creates an internal map which he projects out into space. Moving through that space develops visual concepts of "far/near," "up/down."
By touching and tasting, by hearing and smelling, he further refines his perception about the "outside," and, if all goes well, he begins to use his vision as a shortcut in place of those other body senses to gather information. He soon is able to process information about the outside world using visual clues alone. What he sees triggers what he knows, what he has learned.
Vision becomes more than simply eyesight. It directs and modifies everything that his body is doing. It, in turn, is constantly monitored by every bodily change that occurs. Vision is a product, a result of interactions with all the senses and it affects and influences behavior, response, psychology, even the physiology of the entire person.
But some individuals need help to fit the pieces together. They malfunction at various levels of performance -- visual, motor and perceptual -- all interconnected, all related, and eventually even labeled and defined by symptoms of such malfunctions as ADHD, Learning Disability, and Dyslexia.
Developmental relationships are quickly forgotten, but the truth is that human beings are biologically "wired" so that most behavior is monitored, guided, and directed by vision. The overwhelming presence of visual and sensorimotor nerve fiber connections in the brain guarantee the importance and primacy of visual function in the body and so, when vision is affected, the rest of the body is affected as well. That is why Vision Therapy often is so helpful in these conditions.
During Vision Therapy, the patient modifies and improves his visual performance with lenses, prisms and instruments through a variety of techniques that enhance the availability of information to him and enable him to use it more effectively.
Vision Therapy allows him to process information from the outside world more accurately, more efficiently and more completely, in a shorter space of time, and respond more effectively, resulting in a more effective human being no matter what his "label."
Letter From Home
In May, I received the following letter from parents of a nine-year-old child in Vision Therapy. Because it describes some very typical patient changes, I want to share a portion with you. Of course, I've changed the names to preserve privacy.
Dr. Richard Fischer
28 Riverside Drive
Binghamton, NY 13905
May 26, 2000
Dear Dr. Fischer:
The following is a brief summary of changes we have seen in Jody's vision for which we credit his vision training:
Jody has commented on how much he believes he is improving.
- Jody has improved in his ability on all at home exercises. We have noted that he seems to be more aware of himself in relation to his surroundings, and appears to be more physically coordinated than prior to his vision training;
- Jody is more interested in reading books himself and is able to read 5 to 7 pages at a time. Prior to his vision training, he could barely maintain his focus for 1 paragraph. We have also noted that he does not rub or cover one eye as frequently as he used to do and that he does not suppress one eye as often as he used to;
- We have noted that his right eye does not seem to wander to the right as often although it still sometimes occurs when he is very tired. He is able to recognize when his eyes are not working binocularly.
Carrie Foster/Jerry Foster
He began failing at two but no one noticed. His parents wondered at his "slowness," at his fear of heights, why he wouldn't sit still . . . but surely he would outgrow it.
A little later he scribbled instead of drawing, but it was his clumsiness that irritated mother most . . . all those dishes to be replaced. Even his friends laughed when he stumbled. But . . . he'd outgrow it.
Yet, when he began learning to read . . . he didn't . . . not well . . . and he forever stared out the window and didn't "pay attention." He still stumbled and his friends laughed when he missed the ball. He was boisterous and always moving, but now his actions seemed to cover an elusive shyness, and adults began to notice a despair that surrounded him.
And his parents, who loved him, took notice and found after much searching not a pair of eyes that did not see, but confusion between the seeing and the doing. Not a damaged brain nor lack of basic equipment but an inability to use it effectively.
Visual/Motor/Perception (VMP) is a name we use to describe interconnected, related sensorimotor involvement at different levels of performance. Often, children with VMP disabilities have problems in reading, writing, movement coordination, even speech articulation. Often, such children are distractable and cannot sit still. They appear immature, "hyper", lazy, uncooperative, and sometimes they make unsatisfactory adaptations that lower their general performance and achievement in the classroom.
We call groups of symptoms that often occur together a syndrome. The Visual/Motor/Perceptual Disability Syndrome mimics behavior noticed in children classified as Learning Disabled, Dyslexic, ADHD and even Autistic.
Indeed, VMP Disability Syndrome could be associated with or even be another name for similar conditions. Doctors have observed a relationship because more often than not, when these symptoms are treated with Vision Therapy, patient overall function improves, sometimes to such a degree as to raise questions about the validity of the original diagnosis.
A Child with PDD
Pervasive Development Delay (PDD) is a term used to describe a child who can neither be diagnosed with Asperger's Syndrome nor Autism, but who lies somewhere within the boundaries of the developmental scale that ends with Autism. Children so afflicted are often very bright but have many problems.
The report that follows is from a Physical Therapist who has been working with one of my 12-year-old patients. As always, the names and location have been changed for confidentiality.
|Student: Charles Lamb
||Review Date: 08/11/00
|Home District: Deposit
|Service Provider: Margaret Ayres, PT
|Running Speed & Agility
||6 yr. 8 mos.
||3 yr. 6 mos.
||10 yr. 11 mos.
||8 yr. 11 mos.
||1 yr. 2 mos.
||11 yr. 5 mos.
||10 yr. 5 mos.
||11 yr. 11 mos.
||8 yr. 11 mos.
||1 yr. 3 mos.
||10 yr. 5 mos.
|Upper Limb Coordination
||7 yr. 8 mos.
||2 yr. 6 mos.
||10 yr. 5 mos.
A delay of less than one year is insignificant. Charles has no significant delays. He has made remarkable progress this year. Charles has made great gains in every skill area, particularly in his upper limb coordination and his running speed and agility. Physical therapy alone cannot account for his remarkable change. I feel that a major reason for this improvement is that Charles is now receiving Vision Therapy. Visual and gross motor skills are an integral part of one another.
Charles' academics are getting more intense each year and his present motor skill delays are not substantial. Therefore, I am recommending that Charles be discharged from physical therapy at the end of this school year. It has been a pleasure working with Charles.
Margaret Ayres, PT
You'd never guess by looking at this strapping, good-looking 40-year-old that twenty-two years ago, "Ralph" could not join the Marines because he was unable to read well enough. Yet that is exactly what happened.
When I met him, he had just turned 18 and graduated from a rural high school. He was also reading at only a third-grade level. It seemed that school policy at the time was to "promote" students when they could no longer fit under the desk. District officials called it a "social" promotion and seemed to feel that it would help the psychological adjustment of the student.
School policy on eye testing was another example of this "Stone Aged" thinking. They used the old Snellen chart to determine whether a child could see 20/20 at a distance. And guess what? Ralph passed with flying colors.
We knew even then, of course, that seeing a sign 20 feet away had nothing to do with reading ability at arm's length. But that fact did not disturb the school nurse in the slightest. Ralph saw 20/20. His vision was perfect!
He eventually wound up in my office where I discovered that deficient visual skills had caused the reading problem. Fortunately, Vision Therapy corrected that in short order.
He's quite the reader now. When I recently saw him at his annual checkup a few months ago, he proudly mentioned that he had just finished one of the longest and most complicated books ever written, War and Peace. He was very surprised and disillusioned when I confessed that I had never read it.
I hope he returns next year.
The Nearsighted Computer Operator Who Ran
A favorite patient of mine is a 35-year-old woman who is employed by a large local computer firm.
When I first her, she was terribly myopic. "Elaine" told me she needed stronger and stronger eyeglasses each year for distance seeing, and she really hated the way they looked. Could Vision Therapy help?
Contact lenses were not an option; they were uncomfortable on her eyes; also, Elaine had a friend who had experienced severe complications when he had opted for laser surgery. My patient wanted to try nonsurgical methods to reduce her myopia.
Before Vision Therapy began, she needed to move very close to the eye chart without lenses -- within three feet -- to be able to identify the largest letter.
Eyeglasses? Elaine had one of the largest collections I'd ever seen. "I'm really dependent on them," she explained, "and the first thing that I do every morning before I get out of bed is to put them on. I really can't do anything without them."
As Vision Therapy proceeded, she began to see more clearly than before; she noticed that she was becoming less dependent upon those thick lenses and didn't seem to need them quite as much. She was amazed that she could more around her apartment without any glasses at all and, most surprising, could avoid crashing into the furniture.
One day, Elaine came into the office smiling broadly and looking like the proverbial cat with a great secret. During her daily jog near her house, she discovered that she had left her glasses on the dresser at home, and never even noticed!
That was six years ago. When I examined her last, her myopic progression had been contained. No, she could not throw away her glasses; she was not 20/20. But she now required lenses that were considerably weaker than the ones she had worn when I first saw her. And she could remove her glasses more often than before, and live a more normal existence without her extreme dependency upon them. And she had avoided surgery.
Elaine also had gotten married and had a baby in the interim, but, though Vision Therapy is truly wonderful, there is probably no connection. Still, you never know.
There's more to healthy vision than 20/20 eyesight!
Learn more about symptoms
of visual problems which
school and sports success.