Vision Therapy Information Kit

About COVD----------------------------------------------------------------------------------------The College of Optometrists in Vision Development (COVD) is an international membership association of eye care professionals including optometrists, vision therapists, and optometry students. The guiding principle of vision care provided by all members of COVD is that vision can be developed and improved. For example, we know that infants are not born with fully developed visual abilities and that good vision is developed through a learned process. The mission of COVD is improving lives by advancing excellence in optometric vision therapy through education and board certification. COVD seeks the active support of parents, teachers and the public health community in this endeavor. Established in 1971, COVD provides board certification for optometrists and vision therapists who are prepared to offer state-of-the-art services in: ¾ Developmental and behavioral vision care ¾ Vision therapy ¾ Visual rehabilitation These specialized vision care services develop and enhance visual abilities and correct many vision problems in infants, children, and adults. COVD board certification process includes a rigorous evaluation of the eye care professional's knowledge and abilities in providing developmental and behavioral vision care for patients. Optometrists who successfully complete the certification process are Board Certified in Vision Development and Vision Therapy and are designated Fellows of COVD (FCOVD). Vision therapists are certified to work with COVD Fellows as Certified Optometric Vision Therapists (COVT). Parents and teachers are encouraged to contact: ¾ COVD Hotline (888) 268-3770 or www.covd.org for information on learning-related vision problems, vision therapy or to locate a developmental optometrist in their community. ¾ Partner organizations such as Parents Active for Vision Education (PAVE) at www.pavevision.org which can also provide information and assistance in finding a local source for vision care. For more information, contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

Revised May 2009

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Vision Therapy Case Studies-----------------------------------------------------------------Children throughout the country struggle with undetected vision problems that prevent them from reaching their full potential. In many cases, these children are labeled “dumb,” misdiagnosed as ADD/ADHD, or placed in special education resource rooms. Learning-related vision problems can often be treated with a program of vision therapy – but too many teachers and parents do not consider seeking a vision evaluation or know about vision therapy. Each year, developmental optometrists are able to help thousands of children who struggle in school due to undetected and untreated learning-related vision problems. The following case studies illustrate some of the vision problems children experience and how they can be helped through the use of vision therapy. Kaitlyn, 5th Grade Problem: Kaitlyn struggled with schoolwork and began to think she just wasn’t smart enough to do well in school. She complained of headaches when reading and often covered one eye. She frequently lost her place when reading and comprehended things much better when being read to by someone else. Evaluation: An initial eye examination found that she had 20/20 visual acuity. Specialized vision testing revealed that Kaitlyn’s eye tracking skills and focusing ability became unstable when she was reading. Solution: She began a program of vision therapy to help her better control her eye movements and improve eye-focusing abilities. At the conclusion of therapy, Kaitlyn’s mother reported: “Kaitlyn has improved two grade levels in reading and math. She has not had a headache in two months and no longer suffers from frustration due to slow learning. Kaitlyn has improved much faster than we thought possible.” Brandon, Age 16 Problem: Brandon started struggling with reading when he was 9 years old. His mother had taken her son for eye exams on a regular basis and had been told everything was fine, aside from the need for glasses for his nearsightedness. As a result, she had never even considered the possibility that vision was playing a role in her child’s difficulties. Brandon had been diagnosed with ADD, CAPD, was in Learning Disabilities classes in school, and was even seen by a neurologist. His mother ended up homeschooling Brandon because he was so depressed about his reading problems and nothing else seemed to be working. Evaluation: Sylvan Learning center referred Brandon for a developmental vision evaluation which revealed that he had convergence insufficiency in addition to accommodative and tracking problems along with myopia.

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Solution: “I was miserable before I came to vision therapy and depressed. Vision therapy gave me my life back,” he said. According to his mother, “Since vision therapy, he has begun to dream of a future he thought he would never have. His self-esteem has improved. He no longer thinks of himself as stupid. His vision skills have improved. He no longer sees blurred images on the page and now he is ready to go to Sylvan and catch up on all the learning he missed out on because of his visual problems. The doctor says he is ready, but more importantly, he says he is ready. This is a wonderful program that can be life-changing for a child. It was for my son.”

Marien, Age 12 Problem: Marien was a bright twelve-year-old who struggled to read. A neuropsychologist had evaluated her and suspected the root of her academic problems was an emotional disorder and possibly dyslexia. This diagnosis perplexed Marien’s parents because it seemed to only partially identify Marien’s struggles. Evaluation: A comprehensive vision examination determined that Marien had a significant tendency for one eye or the other to drift outward. As a result, every time she sat down to read or write, Marien had to work very hard to keep from seeing double. Solution: A five-month program of vision therapy resulted in significant improvement in Marien’s visual abilities and school performance. Her eye teaming greatly improved and she was more confident and became more responsible with her schoolwork. Her mother reported that following therapy her grades improved considerably. In math, where she had found word problems very difficult, she went from a grade of “D” to an “A.” “Marien now believes in herself and that is the greatest gift we or her family could ever give her,” her mother said. Dustin, Age 7 Problem: At the beginning of first grade Dustin tested at the fourth grade level in science and social studies, but was on a preschool level in math and reading. He also hated any activity that dealt with a ball of any sort. If a ball was thrown to him, nine times out of ten he was unable to catch it. A school psychologist assessed him to be five points above functionally retarded. He withdrew from all activities that made him feel challenged. Evaluation: Frustrated by the school system’s inability to determine why Dustin was unable to succeed, his parents sought a comprehensive vision evaluation. Solution: Testing determined the need for vision therapy to help him learn to more effectively process visual information. Dustin’s parents noticed improvements in his school performance in less than a month. “When Dustin started vision therapy he could not recognize any letters of the alphabet, nor copy anything written down in front of him. Today he can copy sentences with proper spacing and read a beginner’s book with assistance,” his parents reported. “Dustin shows a noticeable improvement in self-esteem and is beginning to flourish in all avenues.”

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Rebecca, Age 17 Problem: Rebecca puzzled her parents and teachers. Seemingly bright, she had inordinate difficulty reading. She read very slowly and her comprehension was much better when listening. Evaluation: A comprehensive vision examination detected a learning-related vision problem. Solution: A program of vision therapy soon improved her reading skills. “Not only am I a faster and more accurate reader, but I can enjoy it more and read for longer periods of time,” she said. “This program has made school easier and homework time shorter. My only regret is not doing this earlier in my life so that I would be more confident and would have done better. Vision therapy makes me feel like a better person.” For more information, contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

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How “sight” is NOT “vision”----------------------------------------------------------------Sight is not the same as vision. “Eyesight” is a physical process of focusing light within our eyes, whereas “vision” involves our ability to understand what is seen. It is estimated that as much as 80 percent of all learning during a child’s first 12 years comes through vision. Because a child has 20/20 visual acuity according to the Snellen Test (eye chart) does NOT mean he or she has good vision. The eye chart used by most schools for visual screening assesses if a child is able to identify letters at a distance that a normal child would be expected to see—20 feet. The Snellen Test does not identify the following problems: ¾ Near focusing (Most learning is done within an arm’s length; such as reading from a book or working at a desk.) ¾ Eye coordination (binocularity) and focusing ¾ Convergence (a visual skill required for reading) ¾ Eye movement and tracking ¾ Depth perception and peripheral vision ¾ Visualization ¾ Strabismus (crossed or wandering eye) While statistics show vision disorders are the number one handicapping condition for children, the Snellen Test typically identifies only five percent of children having problems seeing clearly in the distance.

For Further Information, Contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

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Learning-Related Vision Problems—Q & A----------------------------------------------Q1: What are “Learning-Related Vision Problems?” A: Learning-Related Vision Problems affect the way a child’s eyes work with each other and the brain to collect and interpret visual information. They can be as simple as an inability to see close-up (eye focusing problem) or as complex as a cognitive inability to “visualize” or interpret what their eyes are seeing or a problem with how the eyes converge (convergence insufficiency). In many cases, a child’s visual abilities aren’t sufficiently developed for him/her to be able to read – or learn to read – effectively. Unfortunately, children with learning-related problems usually don’t tell a parent or teacher they have a problem. They don’t realize they are supposed to see letters, numbers, objects – the world – in a different way.

Q2: What causes Learning-Related Vision Problems? A: Research indicates the problem can be due to a difficulty in either acquiring or processing the information we receive through our eyes. The visual skills needed to see effectively may be lacking or the brain may not be sufficiently trained to interpret what the eyes see. Without these abilities, the child or adult spends so much energy just “looking at” and “decoding” the written word, there is little mental energy left to comprehend and remember the word’s meaning.

Q3: What specific visual dysfunctions contribute to Learning-Related Vision Problems? A: Inadequately developed or ineffective visual abilities in the following areas can lead to Learning-Related Vision Disorders: ¾ eye tracking skills (eyes staying on target) ¾ eye teaming skills (eyes working in synchronized fashion) ¾ binocular vision (blending images from both eyes together at the same time) ¾ accommodation (eye focusing) ¾ visual-motor integration (eye-hand coordination) ¾ visual perception (visual memory, visual form perception, directionality)

Q4: Can vision therapy really help children with ADD? A: Many children diagnosed with Attention Deficit Disorder (and labeled as candidates for drug treatment) have not been properly evaluated for visual problems. What may be thought to be a lack of interest in reading and schoolwork by these children may actually be an inability to keep their eyes properly focused on their books or other deskwork. These children become easily distracted and may appear to be hyperactive.

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Q5: What evidence is there that supports the use of vision therapy? A: Vision therapy has been successfully used in the treatment of vision problems for more than 70 years. The College of Optometrists in Vision Development maintains an archive of published research articles and clinical studies on the effectiveness of vision therapy. In addition, thousands of patients each year who experience the benefits of vision therapy can attest to its positive impact on their lives.

In 2008, the National Institute of Health published a study in the Archives of Ophthalmology which demonstrated that in office vision therapy is the most effective treatment for convergence insufficiency, a vision problem which impacts children and adults. Q6: Why is vision therapy provided mostly by optometrists rather than ophthalmologists ? A: Traditionally, optometrists have concentrated upon the functional and mental processes involved in good vision (eye tracking, eye teaming, binocular vision, visual-motor integration, visual perception), while ophthalmologists have concentrated on the physical nature of the eye (eye disease and surgical treatment). Although vision therapy has its early roots in ophthalmological procedures for the treatment of crossed-eyes (strabismus) and lazy eye (amblyopia) called orthoptics, its use for the treatment of other forms of binocular vision disorders and visual perceptual problems has largely been developed and provided by optometrists.

Q7: What is COVD and its mission for children? A: The College of Optometrists in Vision Development (COVD) is the organization that educates, evaluates and board certifies optometrists in the practice of comprehensive developmental and functional vision evaluation and vision therapy. Members of COVD consist of developmental optometrists who’ve undergone additional specialized education after completing their graduate level professional training in optometry. The mission of COVD is to serve as an advocate for comprehensive vision care emphasizing a developmental and behavioral approach. Our goals are to ensure that children receive the comprehensive vision care needed to evaluate and diagnose Learning-Related Vision Problems and to provide the necessary treatment with vision therapy to help them achieve their full potential. We believe that no child should be left behind because of a vision problem that interferes with his or her ability to learn.

For Further Information, Contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

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Learning-Related Vision Problems and Vision Therapy—Myth vs. Reality---Several misconceptions surround public knowledge of vision-related learning problems and vision therapy. The following chart presents frequently assumed myths: Myth

Reality

There’s no difference between sight and vision.

Sight and vision are actually two very different things. While seeing is the physical process of focusing light within our eyes, vision involves the ability to understand what is seen.

If you have 20/20 eyesight, you have perfect vision.

If a child has 20/20 visual acuity according to the Snellen Test, it does NOT mean he or she has good vision. The Snellen Test, or eye chart used by most schools for visual screening, assesses if a child is able to identify letters at a distance that a normal child would be expected to see—20 feet. This is what is called visual acuity and has nothing to do with how the child interprets or understands what he or she sees. In addition, the test does not assess visual skills such as seeing close-up, focusing, depth perception, peripheral vision or eye coordination.

If a child has a chronically short attention span and has frequent behavior problems, that child likely has ADD/ADHD.

Children with vision problems are unable to concentrate on their work and therefore often exhibit a short attention span. In addition, many children are embarrassed by their difficulty reading or performing other activities and act-out as a diversion. Before a drastic diagnosis of ADD/ADHD is made and medications prescribed, parents and teachers should first consider a comprehensive eye examination for their children. Much is at stake in the event of a misdiagnosis.

The effectiveness of vision therapy is not scientifically proven.

Numerous scientific studies published in Optometry and Vision Science, Optometry: Journal of the American Optometric Association, American Journal of Optometry and Physiological Optics, Documenta Ophthalmologica and American Journal of Ophthalmology show that vision therapy is an effective treatment for vision problems including eye focusing, eye coordination, amblyopia (lazy eye) and strabismus (crossed eyes).

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Myth

Reality

Those eye exercises I see marketed in magazines, on the radio or TV are the same thing as vision therapy.

Most of those programs offer eye relaxation procedures that do not correct specific vision problems. Vision therapy is performed by professionally trained optometrists who use proven methods and technology to customize effective treatments for each individual. Vision therapy programs are prescribed to treat specific diagnosed vision problems and can provide noticeable improvement in each patient within weeks of commencing treatment.

Kids who are already busy with homework and after-school programs don’t have time for vision therapy.

One of the goals of vision therapy is to make schoolwork and homework easier for students. Poor visual abilities are often a reason that completing assigned tasks takes so long. Following vision therapy, children are able to complete their assignments more efficiently and do not have to devote as much time to homework as before.

Adults cannot be treated with vision therapy.

It is never too late for adults to receive vision therapy. Numerous executives, office workers and administrators who spend a lot of time reading or in front of computers consistently suffer from headaches and eye fatigue. Thorough examination by a developmental optometrist often reveals these individuals have suffered from life-long errors in the way their eyes work. These people can usually be far more productive when they’ve been trained to use all their visual abilities more effectively through vision therapy.

Children with crossed eyes will eventually grow out of them.

Untreated, this condition (also known as strabismus) can lead to amblyopia (lazy eye). Unfortunately, amblyopia can lead to permanent vision loss if untreated. With amblyopia, one eye becomes stronger than the other, suppressing the image of the other eye until eventually the weaker eye becomes useless.

If a child has problems seeing, they’ll tell a parent or teacher.

Unfortunately, children with vision problems usually don’t tell a parent or teacher they have a problem. They don’t realize they are supposed to see letters, numbers, objects – the world – in a different way.

For Further Information, Contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

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Undetected Learning-Related Vision Problems – Key Issues -------------------------¾ Vision disorders are the number one handicapping condition for children. Yet, 18 million children will not have an eye examination by an eye doctor by the time they enter school. (Only Kentucky has passed a law that requires every child to have a comprehensive eye examination before entering public school.) ¾ Children needlessly struggle for years in schools across the country because they have undetected, learning-related vision problems. ¾ Children are often misdiagnosed as having ADD/ADHD, labeled “dumb,” or misplaced in a resource room when their academic or behavior struggles actually stem from correctable vision problems. ¾ The Myth of 20/20 “Vision:” Vision problems most often go undetected when it is assumed a child has perfect eyesight because he/she passed a school screening eye chart test with “20/20 vision.” It is a little known fact that this test does not measure how well a child can see at near distances, nor does it evaluate other visual skills necessary for learning or sports such as eye focusing, depth perception, peripheral vision, eye coordination or eye teaming. ¾ When a child is struggling with academics, sports or behavior, parents and teachers should be encouraged to consider a vision problem. There are time-tested signs to look for that a child may have a vision problem (see “Signs of Learning-Related Vision Problems). ¾ Developmental optometrists provide specialized vision care called vision therapy that is proven to help correct many vision problems, improve visual skills needed for reading, and restore self-esteem. ¾ Statistics demonstrate the critical need for higher awareness of learning-related vision problems: • An estimated 10-million children suffer from vision problems, according to the National Parent Teacher Association. • One in four school-age children have vision problems according to statistics from Prevent Blindness America. • Sixty percent of students identified as problem learners have undetected vision problems, the American Optometric Association reports. • A study conducted by Roger A. Johnson, Ph.D. showed that 70 percent of juvenile offenders had undetected and untreated vision problems. • A recent study highlighted at a conference at the Harvard University Graduate School of Education shows that visual perception and eye movement abilities are strong predictors of academic scores. • In 1995, the economic impact of visual disorders and disabilities was estimated by the National Institutes of Health to be more than $38.4 billion. • In 2008, the National Institute of Health stated that 5 percent of school-age children are

affected by convergence insufficiency and it is the most common vision disorder in children other than the need for eye glasses. For Further Information, Contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected] Revised May 2009

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Glossary of Children’s Vision Terms

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Accommodation (eye focusing): The ability to focus the eyes to see clearly up close, to change focus from distance to near and back again, and to maintain clear focus for an extended period of time. Poor eye focusing ability can make it difficult to concentrate on reading from a book for a long period of time. Amblyopia (lazy eye): Reduced vision in an eye, not correctable with eye glasses, as a result of the eye not receiving adequate use during early childhood. Most often it results from either misalignment of a child’s eyes or a large difference in image quality seen with the two eyes. Over time the eye with the least clear image is ignored or suppressed making 3D/stereo vision impossible. Binocular vision (eye coordination): The ability of both eyes to work together as a team. Each eye sees a slightly different image and the brain, by a process called fusion, blends the images into one threedimensional picture. Good eye coordination, a skill that must be developed, keeps the eyes in alignment. Poor eye coordination comes from a lack of adequate vision development or improperly developed control of eye muscles.

Convergence insufficiency: a form of a binocular vision problem where the two eyes don’t turn in correctly. When we read our eyes have to turn in and they have to point to the same place on the page. If one eye doesn’t line up with the other it can cause problems with reading, such as loss of place, loss of concentration, reading slowly, eyestrain, headaches, blurry vision and double vision. Ocular motility (eye tracking): The ability to smoothly and accurately move the eyes along a line of print or follow a moving target with our eyes. Poor eye tracking can result in skipping words, losing one’s place on a page, having to re-read materials, or difficulty copying from the chalkboard. Strabismus (crossed eyes): An inability of the two eyes to aim at the same place at the same time. This can result in an eye turning in, out, up or down. A child with crossed eyes may experience periods of double vision and if untreated this condition can lead to amblyopia. Visual-motor integration (eye-hand-body coordination): The ability to integrate visual information with gross and fine motor movements. Inadequate visual motor integration can result in clumsiness and difficulty with handwriting. Visual perception (visual information processing): The process by which the brain interprets and understands the visual information received by the eyes. Aspects of visual perception include visual memory, size and form perception, directionality and color perception. Poor visual perception may contribute to letter reversals or difficulty with comprehension when reading.

For more information, contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected] Revised May 2009

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How Well Could You Read if Print Looked Like This?-----------------------------------------These are representations of what it might look like if you had a Learning-Related Vision Problem.

For more information, contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

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Signs of Learning-Related Vision Problems---------------------------------------------The College of Optometrists in Vision Development asks that parents and teachers look for the following signs FIRST when a child is struggling academically, behaviorally or in sports. If the response to one or more of the following is “yes,” the child may have a correctable vision problem.

Physical Signs ¾ One eye turning in or out ¾ Squinting, eye rubbing or excessive blinking ¾ Blurred or double vision ¾ Headaches or dizziness after reading ¾ Head tilting, closing or blocking one eye when reading

Labeled ¾ Lazy ¾ Dyslexic ¾ Attention Deficit Disorder ¾ Slow learner ¾ Behavioral problem ¾ Working below potential

Performance Signs ¾ Avoids “near” work ¾ Frequent loss of place when reading ¾ Omits, inserts, or rereads letters/words ¾ Confuses similar looking words ¾ Failure to recognize the same word in the next sentence ¾ Poor reading comprehension ¾ Letter or word reversals after the first grade ¾ Difficulty copying from the chalkboard ¾ Poor handwriting; misaligns numbers ¾ Book held too close to the eyes

Secondary Symptoms ¾ Smart in everything but school ¾ Low self-esteem, poor self image ¾ Temper flare-ups, aggressiveness ¾ Short attention span ¾ Fatigue, frustration, stress ¾ Irritability

For more information, contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

Revised May 2009

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Vision Therapy-------------------------------------------------------------------------------------Vision Therapy (or Vision Training, Visual Therapy): A progressive program of prescribed vision "exercises" or procedures to help an individual’s eyes work together and with their brain to properly interpret visual information. Doctors of optometry who specialize in vision therapy are called developmental optometrists. Vision therapy is individualized to fit the needs of each patient and is usually performed under doctor supervision one to two times per week for several weeks. The program is sometimes supplemented with procedures the patient can do at home between office visits. The first step in any vision therapy program is a comprehensive eye health and vision examination. Following a thorough evaluation, a developmental optometrist will prescribe vision therapy if he/she feels it is appropriate in order to: ¾ help patients develop or improve fundamental visual skills and abilities ¾ improve visual comfort, ease and efficiency ¾ change how a patient processes or interprets visual information Specialized medical equipment and materials used in vision therapy may include therapeutic lenses, prisms, filters, occluders or patches, electronic targets with timing mechanisms, stereoscopic devices, rotating targets, and computer software. The National Institute of Health funded a study to determine the best treatment protocol for convergence insufficiency. The results of the study demonstrated that in-office vision therapy is the treatment of choice as it is the most effective treatment for convergence insufficiency. Research also supports the effectiveness of vision therapy for a variety of other vision problems including eye focusing, eye coordination, amblyopia and strabismus. Numerous scientific studies have been published in journals such as Optometry & Vision Development, Optometry and Vision Science, Optometry: Journal of the American Optometric Association, American Journal of Optometry and Physiological Optics, Documenta Ophthalmologica, and American Journal of Ophthalmology show that vision therapy is an effective treatment for vision problems. Please see the contacts below for study abstracts and/or full text of articles.

For Further Information, Contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

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3D / Stereo Vision--------------------------------------------------------------------------------Did you know that not being able to see a 3D image can affect much more than your ability to enjoy a three-dimensional movie? Did you know that you need for your eyes to work together as a team in order to see 3D? Did you know that you are never too old to treat stereo blindness? Stereo Vision or stereopsis is also referred to as 3D vision. Stereopsis, from stereo meaning solidity, and opsis meaning vision or sight, describes the sensation of depth attained from the successful merging of the two slightly different pictures seen in each eye into one 3D image. The condition of stereo blindness occurs when two eyes do not work together to create one 3D image. People often describe their world as looking flat when this occurs. This can be caused by an eye turn (strabismus) or a lazy eye (amblyopia). Depending on the severity of the vision problem, individuals with convergence insufficiency can also have problems with 3D vision. Treatment for Stereo Blindness Patients with stereo blindness require optometric vision therapy, including the use of prisms and 3D glasses. Treatment duration will depend upon the particular patient's condition and associated factors. If you would like to interview adults or children who have gone through vision therapy and gained stereo vision please contact us.

For Further Information, Contact: Pamela R. Happ, CAE, Executive Director College of Optometrists in Vision Development, Aurora, OH (330) 995-0718 or [email protected]

Revised May 2009

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