Hope Clinic, Specializing in Vision Therapy, Bellevue, WA, Silverdale, WA and Tacoma, WA

Hope Clinic Works with Educators

20/20 Sight Does Not Always Equal Good Vision

Lisa Knopp, COVD, Educator and Lead Vision Therapist

Throughout my experience as a K-6 elementary school teacher, a Director of Education at a learning center, and a parent of two very different teenage boys, it saddens me how many children “fall through the cracks” without substantive solutions found to address their learning challenges. They seemingly have the ability to perform at a higher level than they do, no matter what help we put into place.

“To Test or Not to Test?”

When they are in the early grades, teachers or parents are often reluctant to assess them for Special Education services because there is such variation in academic performance of young children due to developmental differences that are considered “within the norm”. At around third grade, we are more concerned if kids are not reading at grade level, if their math facts are not being memorized, or if writing/spelling is not up to par. Sometimes you even hear the comment, “Well, he is a boy” implying that the development of boys is often slow.

If there is a decision to administer the school districts’ Special Education testing, in order to qualify for Special Needs Assistance in the schools, the student must have a large discrepancy in abilities and performance in order to qualify (often two years or more). Many children do not qualify and continue to struggle, and by third grade or even earlier, self-esteem has already suffered and associations with school are often negative. Even worse, these students make it to fifth or sixth grade and basically are flunking school.

Often “the homework war” takes place at home.

The child has worked so hard all day in school, and by the time (s)he arrives home (s)he simply cannot willingly complete more hard work. Parents and kids face off, and frustration persists. Most parents do the best they can to have patience in between stirring dinner on the stove and doing the dishes, wishing their child could work more independently. Tears and crumpled papers later, the homework often gets into the backpack with little or no time left before bedtime. Not only has it been a hard day at school for the child, being home with family did not offer respite.

Well-intentioned educators often have a hard time until we ascribe a reason to match the behavior.

As teachers, we have a responsibility to successfully educate the child, and if the child fits into a certain category…..well, hopefully we will be able to provide a solution. We know that ADD/ADHD and Dyslexia are real syndromes or conditions, and require specific types of help to address the issues. Oftentimes these labels are tossed around with the family. If ADD is suspected, a parent may get the feeling that the school wants her child on drugs. (I speak from personal experience…… this is what happened to me in parent-teacher conferences about my son when he was in 4th and 5th grade….and I do not fault the teachers!) The labels are often used without an assessment process to identify the child as having the syndrome of Dyslexia or ADD. Furthermore, these conditions can not be medically diagnosed; they are not found in the ICD-9 medical coding system. Teachers play an important part in obtaining as much information as they can to help identify issues and help parents "bridge the gap" to find real solutions.

Identifying the Issues

Here are just some of the symptoms of ADD/ADHD and Dyslexia that are also symptoms of a Vision Disoder:

• Displays short attention span in reading or copying
• Avoids all possible near-centered tasks
• Shows gross postural deviations at all desk activities
• Complaints of headaches, other aches, and 'excuses' seemingly to avoid academic work
• Comprehension reduces as reading continued: loses interest too quickly
• Frequently omits words, repeatedly omits 'small' words
• Omits letter, numbers or phrases when reading
• Repeats letters within words
• Misaligns both horizontal and vertical series of numbers
• Repeatedly confuses left-right directions
• Mistakes words with same or similar beginnings
• Reverses letters and/or words in writing and copying
• Confuses same word in same sentence
• Repeatedly confuses similar beginnings and endings of words
• Makes errors in copying from reference book to notebook

These very behaviors, which often lead us to conclude that the child has ADD/ADHD or Dyslexia, are mimicked in the behaviors or symptoms of a Binocular Vision dysfunction. (Read on for a link to Educator's Guide to Classroom Vision Problems for a more complete list of symptoms that mimic the symtoms of ADD/ADHD or Dyslexia.)

Treating patients who have been suspected to have Dyslexia or ADD/ADHD

At Hope Clinic, in addition to hundreds of Developmental Optometry practices in the world, we treat patients who have been suspected to have Dyslexia or ADD/ADHD or who have been "diagnosed", even though there is no clear diagnosis for Dyslexia or ADD/ADHD, and are identified as having underlying Vision Issues by our doctor's 21-Point Vision Evaluation. The vast majority of our patients have 20/20 vision or are corrected with lenses to 20/20. Their vision issues in most cases are not picked up by a typical Optometrist, nor are they discovered in a School Vision Screening. It is not until they are evaluated by a Developmental OD that it is discovered that they have a binocularity issue, in other words a difficulty teaming the eyes.

Vision Dysfunctions

Many of these children and adults struggle when working at near point activities because they have eye tracking problems or Oculomotor Dysfunction - they have trouble with eye movements that allow efficient readers to move smoothly across a page, read in ‘chunks’, keep their place, and process what they read for good comprehension.

Others have eye focusing or Accommodation problems - the lenses in our eyes have to physically adjust to see things clearly and singly when we view things at different distances, for example when we look at a distant whiteboard and then copy information to a piece of paper in front of us, going from near to far, back and forth.

Eye alignment problems

Many of our patients have eye alignment or Convergence/Divergence disorders. Our eyes need to converge or diverge together as a team in order for us to see singly, allowing processing of words/sentences/math problems correctly. Research shows that 1 in 12 children are affected by this type of vision problem. For people with this type of challenge, seeing things clearly and singly at near point is physically very stressful and often impossible. The National Institute of Health (NIH) recently funded a major study on Convergence Insufficiency, a major convergence disorder affecting reading and academic performance. Visit covd.org for an Abstract of this Study.

When children have one or more of these issues, they most often don’t know to tell their parents or teachers because they think that what they see is what everybody sees. They may not report that they see double, or that there are no spaces between words, or that the beginnings and endings of words switch places. In some cases, students are doing very well academically because they have learned coping mechanisms - yet they are exhibiting discomfort/headaches, double vision, blurred vision or other symptoms. It stands to reason that, since they are working so hard on the physical aspects of “seeing correctly”, many of these students’ Visual Information Processing Skills (including but not limited to Visual Memory and Visualization Skills involved in spelling, reading charts/graphs/maps, studying and retaining information) are compromised.

Learning problems and underlying vision issues?

We know that students who have learning problems often have more than one issue that needs addressing in order for them to learn to their optimal potential. We need to consider and investigate all the contributing factors, and ask the question... Is there a contributing underlying Vision Issue? In contrast to the lack of testing that leads to the syndromes of Dyslexia or ADD/ADHD, the thorough tests for Binocular Vision Issues by a Developmental OD result in clear medical diagnoses and insurance codes for medical insurance coverage.

As vision specialists we feel it is important to bring awareness to these issues to, offering workshops/talks to educators and families about the common signs and symptoms to look for with a possible vision issue, and Free Screenings in each of our three clinics to gain valuable information about how a person "sees".

We offer parents of our young patients the option of sharing the doctor's findings report with the child's education team to help us get on the same page in order to help the child optimally. We offer talks and workshops for educators (teachers and para-educators, administrators, OTs, PTs, Psychologists) to educate them about Vision Issues which often result in academic challenges, and to offer help in identification and prevention of vision issues. We also offer power point presentations for PTA families to help them maintain stress-free healthy vision in school, work and play, full of simple yet often overlooked daily practices to help us prevent future vision issues......beyond "20/20".

Let's identify possible vision issues

We invite you to share what you are reading here with your colleagues, and consider further education on this topic. To help you identify possible vision issues of students in your classroom, please download this form to view and print copies of the Educator’s Guide to Classroom Vision Problems. Using this checklist with individual students can help you encourage their parents to consider scheduling a Free Screening to gain valuable information about their child’s functional vision.

To read about my own son’s Vision Issues and how Vision Therapy helped him, you are welcome to read about him in our newsletter.