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Dear
Abby
School
woes caused by vision disorder
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Dear
Abby:
Please
help me get the word out about a common condition that severely affects
children's ability to succeed in school because it inhibits reading, spelling
and concentration.
My
daughter, who was obviously bright, tested at first-grade reading level in fifth
grade. She had undergone all the school testing for learning disabilities, plus
two days of testing at a respected university hospital. None of these tests or
specialists revealed what could be wrong with her.
My
child's self-esteem suffered. Her confidence faltered; she began acting out in
school. At home she was a great kid, until it came time for schoolwork. Then the
battles began. She thought she was dumb. When studying, she could read for only
a very short time. She often begged me to read things to her. When working on
spelling and assigned to rewrite the words she missed five times, she often
recopied them wrong. We thought she just wasn't trying.
After
much research on the Internet, I came across a disorder called "convergence
insufficiency disorder." This visual condition is the leading cause of
eyestrain. Fortunately, we had the opportunity to have her tested at the Mayo
Clinic, where her condition was confirmed, and she was successfully treated with
vision therapy.
It
was as though a miracle had occurred. After six months of treatment, my daughter
is almost at her age-appropriate reading level. Her comprehension and retention
have markedly increased, and her self-esteem and attitude about reading are much
better.
Children
with this condition will not benefit from tutoring, special education or extra
help from teachers until the condition is diagnosed and treated. My child had
20/20 vision and still had this disorder. It's not routinely checked with eye
exams, and schools don't test for it.
I
suspect that many children out there are undiagnosed or misdiagnosed and going
untreated. The treatment for convergence insufficiency disorder is noninvasive,
effective, and much of it can be done at home. Please help me get the word out
so other families won't have to go through what we experienced. -- Angie W. in
Minnesota
Dear
Angie:
I
am pleased to help you get the word out to other families whose children are
struggling to learn. After reading your letter, I contacted my experts at the
Mayo Clinic in Rochester, Minn., and was informed that this problem, where the
eyes drift too much inward (or outward) in attempting to focus, can also be
present in adults.
The
symptoms can include eyestrain, headaches, blurred vision, sleepiness and
trouble retaining information when reading. Other symptoms associated with
convergence insufficiency include a "pulling" sensation around the
eyes, the rubbing or closing of one eye when reading, words seeming to
"jump" or "float" across the page, needing to reread the
same line of words, frequent loss of place, general inability to concentrate and
short attention span.
The
good news is: Vision exercises can fix the problem in most cases, some done at
home and some performed in-office with a vision therapist. Prism glasses are
another option; however, they are more often prescribed for adults with this
disorder than for children.
 Going Binocular: Susan's First
Snowfall
National Public Radio, Morning
Edition, June 26, 2006
This
story begins with a chance conversation. Susan Barry, professor of
neuroscience at Mount Holyoke College, was at a party when she happened to
bump into Dr. Oliver Sacks. Sacks is a polymath. He's a physician and an
author (The Man Who Mistook His Wife for a Hat, and Awakenings).
His work has been turned into plays (one by Harold Pinter), short stories and
movies (Robin Williams played him). He is also a marathon swimmer, a lover of
ferns — and, as it happens, he is fascinated by stereoscopy.
Stereopsis
is the ability to perceive depth and space. So instead of seeing something as
flat, in two dimensions, when you see in stereo you see it in three
dimensions. Some people find stereovision completely fascinating. So
because Dr. Sacks has this enthusiasm, he was intrigued at the party when
Susan Barry mentioned that she had been born cross-eyed. The problem
wasn't surgically treated until she was past her second birthday.
Apparently,
that two-year pause was crucial, because when she got to college, Barry
learned that if baby cats or baby monkeys are cross-eyed during infancy, their
eyes don't learn to work together and therefore their binocular brain cells
don't develop and they lose the chance to see in stereo. The loss is
forever, and what happens to baby cats, the professor said, happens to baby
humans.
"Like
me?" Barry wondered. She never imagined that she saw differently
from other kids. But after the professor raised the question, Barry got
herself tested and discovered she was indeed monocular. She could not
see depth or space the way the rest of us do.
All this
she told Oliver Sacks. She also told Sacks that she didn't think she was
missing very much, not seeing in stereo. And that's when Sacks leaned in
really close and said, "Do you think you can imagine what it's like to
see the world with two eyes?"
Well,
miracles do happen. Barry found out what it's like. And she wasn't imagining.
 Near
the approach of Barry's 50th birthday, Barry met Dr. Theresa Ruggiero, an
optometrist who specializes in vision therapy. Barry started a vision
therapy program and will never forget the astonishing moment some months later
when against all expectations, her vision suddenly — after a half century
— popped into 3-D. You can hear her amazing account of this moment on
National Public Radio Morning Edition website by clicking
here. Barry's vision is also the subject of an Oliver Sacks essay in
the New Yorker magazine. For an abstract, click
here.
Barry's
experience, it turns out, is not unique. Apparently other people have spent
their lives with visual deficits expected to last forever and, through vision
therapies suggested by their eye doctors, they say they have gotten back some
of the sense they had lost.
What is
especially fascinating about all these stories is they suggest that brains are
more "plastic" — more changeable and repairable in adulthood —
than many scientists and doctors had thought.
For a
long time, leading neuroscientists taught that there is a brief "critical
period" in infancy when a baby brain can rewire itself and change; when
that period ends, change stops.
It would
follow that if you are born cross-eyed and do nothing about it until you are 2
years old, you can never learn to see in stereo. Barry's story (and the others
if they prove to be true) suggest that while baby brains are more malleable
than adult brains, adult brains are not frozen in place.
They can
change. Barry's did.
Miller: a vision for improving education
By Emily Sapienza
VillageSoup/Knox County Times Reporter
Debbie Miller is a woman with a
vision. And she is willing to take big risks to see it realized.
Miller has a vision of a world with fewer children in special
education and more in advanced placement; with fewer young people in juvenile
detention, and more in higher education.
In her words, it's a vision of how to "save the
world."
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| Debbie
Miller |
A cure for these social ills is more simple and more easily
attained than people realize, said Miller. For the last 13 years Miller,
55, has dedicated all of her free time and much of her financial resources to
alerting school systems and parents to a problem she has termed "functional
vision issues."
Functional vision issues are problems in the synchronized
movement of the eyes. People with functional vision issues have trouble moving
their eyes in unison. Functional vision issues are not caused by medical
problems such as nearsighted or farsighted vision, said Miller. But the issues
often result in difficulties reading and therefore in learning and paying
attention in school.
Children with functional vision issues are frequently
misdiagnosed as learning disabled, said Miller, and are then treated through
placement in special education programs that fail to address the issue and cost
school systems a lot of money. She believes as much as 20 percent of the
population could suffer from functional vision problems.
There are 21 different issues with functional vision that have
been identified, though the most common are convergence excess, when the eyes
aim closer than the object a person is trying to see; convergence insufficiency,
when the eyes aim farther away than the object they are supposed to be pointing
to; accommodative infacility, when the eyes do not focus on a visual space at
the same distance; oculomotor dysfunction, when one eye produces a jerking
motion during reading; and suppression, in which children shut out sight in one
eye to enable them to see better, according to Miller's book "Imagine
Seeing Thru My Eyes!"
Miller believes the answer to this problem is to screen
elementary school students for functional vision issues. Working with
optometrists, she designed a screening test and then an exercise program for the
eyes that treats functional vision issues, making it possible for students to
read. Treating these vision issues will keep children succeeding in school,
which will in turn have a positive impact on many of the social problems the
United States faces, said Miller.
Miller's journey to raise awareness about functional vision
issues began when her own daughter Kim had trouble reading in the second grade.
They were living in Florida at the time. Up until then, Kim had always been a
good student who enjoyed school, said Miller. But in second grade, Miller said,
Kim's teacher said Kim should be put to bed earlier because she constantly had
her head down on the desk.
"Kim wasn't tired," said Miller. "She had
convergence excess."
Convergence excess is one issue in functional vision that
causes the eyes to converge when tracking words across a page. By putting her
head down, Kim was actually attempting to cover one eye so she could read
comfortably, said Miller. It took three years and countless visits to
specialists before Kim was diagnosed, however. In that time she was placed in
special education classes, developed behavior issues in school and became a
pretty unhappy child, said Miller.
Miller had suspected that Kim's eyes might have been part of
the problem. But she couldn't prove it, she said. "She had medically
healthy eyes," said Miller. "She passed all the school eye
screens."
Eventually, an acquaintance recommended that Miller take Kim to
see an optometrist named Dr. Steven Franzblau. Franzblau identified the problem
and provided exercises that trained Kim's eyes to work in unison again.
After Kim's convergence excess was treated, her behavior
issues disappeared, said Miller, and by the end of the school year she was
reading at grade level again.
With her daughter's issues taken care of, Miller was ready to
move on to other things, until she thought about the other children who might be
suffering in silence from similar vision issues. Working with Franzblau and two
other optometrists, Dr. Rick Morris and Dr. Lawrence Lampert, Miller founded
Future Vision Youth Development Inc., a nonprofit organization that aims to
identify and treat functional vision problems.
Functional vision issues often present themselves around third
grade, said Miller, because that is when most students begin to read books with
longer paragraphs that require the reader to track their eyes back and forth
across the page, she said. "If we can catch this in third grade, we've got
it," said Miller.
Future Vision Youth Development worked within the public school
system in Palm Beach County, Fla., running programs that screened students for
functional vision issues and then treated them with vision therapy administered
by optometrists certified as fellows of the "College of Optometrists in
Vision Development."
It was Miller's dream to expand the program across the Florida
public school system. She spent her free time and almost all of her money
working to that end. She applied for grants, she went before school committees,
she did everything she could to further her own vision of helping children by
addressing their vision issues.
When Miller moved to Maine with her family in 2000, she was out
of money but she was still dedicated to her goal, she said. Miller
recently published a book "Imagine Seeing Thru My Eyes," which details
functional vision and her experiences working in the field. It is her hope to
bring her programs to the Maine public school system, she said. "I want
Maine to do this," she said. "I want the industry built here. I want
to develop education in the nation, whatever I have to do."
Miller believes that addressing functional vision can
"effect change in the entire nation in the education system."
"That's what I want," she said. "I expect it to
happen. There's no doubt in my mind."
Miller holds a master's degree in human relations from the New
York Institute of Technology. While studying for her master's she did field work
in psychiatric wards, where she worked with teenagers. "Most of the
children in the psych ward had trouble in school," she said.
Catching vision problems and correcting them early will prevent
countless children from ending up in costly special education programs, Miller
said. "Instead of 'No child left behind' it will be 'catch me if you
can,' " Miller said.
"This is a story about changing the world … It's not
going to change the world overnight. It's going to be subtle. But it's such good
stuff."
Miller's book is available online and at area libraries.
No Need For Children With Lazy
Eye To Wear Patches All Day
ScienceDaily (Sep. 17, 2007) —
Children with amblyopia (commonly known as lazy eye) need only wear an eye
patch for three to four hours a day for 12 weeks to improve vision, say
researchers in a study recently published on the British Medical Journal
website.
 Patching
for all waking hours for up to several years, which is often recommended, is
almost certainly excessive, they argue.
Amblyopia results from a disturbance to the vision pathways between the
eyes and the brain, which is often associated with blurred vision or crossed
eyes (strabismus).
Studies have shown that occlusion therapy (patching) can improve vision,
but results suggest that "maximal" doses (12 hours a day) are no
more beneficial than "substantial" doses (six hours a day). Despite
this, many doctors still prescribe large doses, above six hours a day.
So researchers at City University in London and McGill University in
Montreal funded by Fight for Sight, London, set out to determine the amount of
occlusion treatment required in children with amblyopia to achieve the best
outcome.
The study involved 97 children aged 3-8 years with a confirmed diagnosis of
amblyopia. All children had a full ophthalmic assessment and were instructed
to wear glasses all the time for 18 weeks. On completion of this phase, 80
children who still met the study's definition of amblyopia were then told to
wear a patch for either six or 12 hours a day.
Two electrodes were attached to the under surface of each patch to monitor
the amount of occlusion each child actually received. Visual function was
recorded every two weeks.
There was no significant difference in visual acuity between the two
groups. However, the mean dose rates (hours a day with a patch) actually
achieved were also not significantly different (4.2 in the six hour group and
6.2 in the 12 hour group).
Visual improvement was similar for those children who received 3-6 hours a
day or 6-12 hours a day, but significantly worse for children who received
less than three hours a day.
Children under 4 years of age required significantly less occlusion (under
three hours a day) than older children to correct their vision.
This analysis suggests that achieving an initial dose rate of three to four
hours a day should be a clinical priority, say the authors. The response
depends on age, however, so for children under 4 years this could be reduced.
Patching beyond 12 weeks did not confer additional benefit.
Eye patching can cause considerable distress for both the child and family,
they add, so doctors should try to minimise the amounts necessary for the best
expected outcome.
If you would like more
information on learning-related vision problems, contact the national offices of
Parents Active for Vision Education (PAVE), a nonprofit organization whose
mission is to educate parents and teachers on the vital role vision plays in the
learning process. Their toll free number is 1-800-PAVE-988.
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