COLLEGE OF OPTOMETRISTS IN VISION DEVELOPMENT
INTERNATIONAL OFFICE 243 N. LINDBERGH BLVD., STE. 310 ST. LOUIS, MO 63141-7851
(314)991-4007 (888) COVD770 FAX: (314) 991-1 167
VISION AND LEARNING
Research has demonstrated that vision is a contributing factor to an individual's ability to attend and respond to classroom instruction. A major portion of what we learn is taken in through the visual system.
There are many aspects of vision which might affect an individual's abilities to attend and respond to teacher instruction. It is well known that nearsightedness, farsightedness, and astigmatism, ail of which can result in blurred vision or eye strain, relate to performance in the classroom. However, individuals may have focusing problems which do not allow them to rapidly change focus from book to blackboard and vice versa. They may have difficulty using both eyes together. This dysfunction can require excess effort to overcome and may interfere with visual information processing. Also, an individual may have difficulty controlling eye movements. This could result in loss of place when reading, frequent guessing of words, need for the use of the finger to maintain one's place, or other more subtle difficulties.
Visual information processing problems may result in children being overwhelmed the day
they start school. The academic curriculum is designed on the assumption that children
possess certain visual information processing abilities, as well as other skills, at certain chronological ages. In other words, is the child visually ready for school? The child who has not developed the required level of skill may have difficulty from "day one". These difficulties might manifest themselves as problems in reading, writing, mathematics, spelling, thinking, sports endeavors, playground activities, and even the social relationships children have with their siblings and peers.
Individuals manifesting visual problems associated with learning problems may benefit from the use of lenses and prisms for both the prevention and remediation of these visual problems. Other visual problems might best be remediated by optometric vision therapy. This includes the application of lenses and prisms in conjunction with procedures to provide the individual with strategies which will aid in the development of adequate visual performance.
There are specific controlled studies in the literature demonstrating the effectiveness of optometric vision therapy for treating problems in the functioning of the visual system. There are also numerous case reports supporting specific diagnoses and treatment plans. Studies have also demonstrated visual deficiencies and visual information processing deficits in older individuals, supporting the fact that children do not simply outgrow these deficits.
Members of the College of Optometrists in Vision Development (COVD) have post graduate
education in vision and learning. Fellows of the College are certified in the diagnosis and treatment of learning related vision problems. For further information contact COVD or consult with your COVD optometrist.
III. At about 16 weeks of age, the child discovers that they have two hands which they can
"see in one look" as they move together, apart, closer, and further away. At this stage,
it is time to:
1. Play "patty cake". Make a big game of it with your baby. Say all the words to them as you
"pat 'em, roll 'em, and toss 'em". Each movement of the hands helps them learn the
many directions of movement which hands and eyes can take.
2. Provide plastic or wooden blocks of a size that they can hold in their hand. Help them to
put these blocks together so that they click and bang as they watch them.
3. If the child is a bottle baby, have them help you hold the bottle during feeding time. Place
their two hands on the bottle as it approaches their mouth, so they see and feel the
nearness of it as the nipple enters the mouth.
4. Arrange for several clean, smooth objects that they can put to their mouth. The sequence of
looking at a rattle, taking it in the hand, and putting it to the mouth is a very important
experience in learning about the many things surrounding them. In fact, this is the
practice for feeding themselves and is the eye-hand control necessary for use of their
own spoon.
5. Move the mobile closer to the baby. They will enjoy the opportunity to hit it so that it
swings and bounces. Previously, most of their movements have been random or steered
by you. Now they can create movements of the objects around them.
6. Play "Please" and "Thank You." Place a toy in the baby's hand and say "Thank You".
Gently remove it and say "Please". Wave the toy so they look at it when you place it in
their hand. This helps them learn to visually grasp and release objects as well as to
develop finger flexibility and dexterity.
7. Tie bells on the the baby's booties and help them learn to see their feet by hearing them
too. Help them learn to kick the mobile to make it move.
WHAT IS OPTOMETRIC VISION THERAPY?
Optometric vision therapy is an individualized treatment program designed to improve visual function and performance. It is an approved treatment modality for disorders including, but not limited to:
- ocular motility dysfunction/eye movement disorders
- vergence dysfunction/inefficiency in using both eyes together
- strabismus/misalignment of the eyes
- amblyopia/lazy eye
- accommodative disorders/focusing problems
- visual information processing disorders
- visual sensory and motor integration
- visual rehabilitation after traumatic brain injury or stroke
- all of which result in inefficient visual information processing.
Most people who visit an optometrist know that any eye health problems will be detected and managed and that glasses or contact lenses will be prescribed if indicated. That picture is incomplete because there are visual conditions that are best managed by optometric vision therapy. This therapy enables an individual to learn more efficient ways to perform visually. It is an art and science of vision care that complements the
prescription of eye glasses, contact lenses and the treatment of eye disease.
Optometric vision therapy, also referred to as visual training or orthoptics (CPT 92065), is an established, medically necessary therapy when prescribed by an optometrist. Optometric vision therapy can improve visual function much like physical therapy can improve general motor function. Clinical tests with associated normative values are administered by an optometrist to determine the presence of visual deficiencies. If
optometric vision therapy is indicated, the optometrist recommends a specific treatment plan.
Optometric vision therapy typically involves a programmed combination of office treatment and home therapy. Lenses, prisms, optical devices, and specially adapted computers are some of the devices through which one learns to use vision more effectively. The specific materials are less important than the feedback provided to the patient to enable change. Visual skills need to be developed until they become automatic and are subconsciously integrated with the other skills. The extent of success is also linked to patient
compliance.
The benefits of optometric vision therapy, which include improved visual information processing and the ability to sustain visual function over time, are as applicable to the child in the classroom as they are to the adult using a computer or reading a book. Without efficient visual skills the act of reading can be frustrating. Some of the common symptoms relieved through vision therapy include eye strain, visually induced headaches, inability to concentrate when doing visual tasks, and errors such as loss of place or
reversals. More often, individuals have no recognized symptoms due to their avoidance of visually demanding tasks or an adaptation that decreases their performance. Optometric vision therapy also facilitates appropriate visual development, and serves as a component of the multi-disciplinary effort following stroke or head injury.
Members of the College of Optometrists in Vision Development (COVD) have post-graduate education in the diagnosis and management of conditions for which optometric vision therapy is an appropriate treatment. Fellows of the College are certified in providing this vision care. For further information, contact COVD or consult with your COVD optometrist.
MULTI-DISCIPLINARY MANAGEMENT OF THE CHILD WITH LEARNING DIFFICULTIES: THE ROLE OF THE OPTOMETRIST
When a child is not achieving to his or her potential, concern is raised among parents and teachers. Action may follow any number of courses including parent conferences, private assessments, and tutoring. Ultimately, children having difficulty learning are evaluated by an inter-disciplinary team of school personnel. This team may have different names in different districts, but it is typically comprised of a school psychologist, a learning specialist, and a reading specialist. With the parents' consent, the outcome of these evaluations is an Individualized Education Plan (IEP). This sets the goals to be achieved by the child through special education. The child is most commonly identified as perceptually impaired, neurologically impaired, learning disabled or having attention deficit disorder.
The role of the optometrist in the multi-disciplinary approach is to assess the child's visual abilities. Attempting to function in the academic environment with poor visual abilities may result in fatigue, short attention span, avoidance of near work, slower performance, and reversals or transpositions. Deficient eye-hand coordination can result in sloppy or tedious handwriting which will interfere with a child's ability to express thoughts in writing.
Tests administered at school, or visual screenings conducted by school nurses, are useful in identifying the need for comprehensive visual evaluations. They are not intended to substitute for optometric assessment. The results of any prior assessments, together with the child's history and the results of the optometric evaluation, will be thoroughly considered when making recommendations for treatment.
Many children with learning difficulties do not have problems with eyesight, but do have
vision problems. Recommendations for treatment are more likely related to enabling the child to process visual information efficiently. This may be accomplished through the application of lenses, prisms or vision therapy. When visual function is improved, children are better able to benefit from classroom instruction or specialized resources.
The sequence of steps which bring a child to an optometrist skilled in learning-related visual difficulties may vary. Sometimes the parent approaches the optometrist directly because of positive experiences with a sibling or through another parent's recommendation. Referral may also occur through a professional treating or working with the child. In all instances, the optometrist's role is as one member of a multi-disciplinary or group effort to help the child achieve closer to his or her full potential. No single discipline or professional can supply all the answers.
Members of the College ofOptometrists in Vision Development (COVD) are optometristswho
have a special interest in the multi-disciplinary management of children with learning difficulties. Fellows of the College are certified in the diagnosis and management of learning related vision problems. For further information, contact COVD or consult with your COVD optometrist.
VISION SKILLS
Vision skills are a group of neuro-muscular activities which are learned and developed.
These skills involve moving, focusing and teaming the eyes so they may function efficiently. Vision skills include several components.
Fixation is the ability to direct and maintain steady, central visual attention on a target. This basic skill is developed in infancy and refined through the early years. Ocular motor skills are the neuro-muscular control skills developed to point the visual system on target and move it to either follow a moving target(pursuit eye movements), or jump from one object to another (saccadic eye movements). The infant reflexively turns the entire upper torso toward the direction of a noise, then gradually learns to turn only the head to guide the visual system. Through the toddler years the individual refines this movement system by learning to use eye muscles to replace head movement - an achievement important in visual readiness for school. Eventually vision becomes the dominate sense.
Accommodation is another component skill involving focusing the light entering the eyes. This combined lens neuro-muscular system is a network integrating the eyes and the brain. Accommodation is developed rather well by age three and further accuracy is achieved throughout the early years of development. This function deteriorates with age, causing the need for bifocals and/or reading glasses beginning at about age forty.
Additional skills are involved with teaming the two eyes together. These include convergence (the ability to direct and sustain one's eyes toward a near target) and other neuro-muscular ocular alignment activities to localize where the object is in relation to the observer.
Optometrists evaluate the development, function, and efficiency of these vision skills. Poorly developed or aberrant function of vision skills results in inefficient visual performance and/or symptoms of fatigue or discomfort. This may have a negative impact on performance in school, the job, sports, and activities of daily living. When properly diagnosed these visual inefficiencies can be effectively remediated with prescription lenses, prisms and/or vision therapy.
The symptoms typically caused by vision skill deficiencies include seeing double, losing one's place with reading, poor or slow reading ability, discomfort (eye strain or headaches) with sustained use of the eyes, clumsiness, and poor performance in sports. Difficulty processing visual information when reading, using computers or performing any sustained visual activity might also be attributable to vision skill problems.
Members of the College of Optometrists in Vision Development (COVD) are optometrists with a special interest in vision skills and the remediation of vision skill inefficiencies. Fellows of the College have certified their competency in this area. For more information contact COVD or consult with your COVD optometrist.
REVERSALS
Problems of letter and number reversals in children have concerned parents and educators for many years. Some have considered reversals as a symptom of dyslexia. More commonly reversals reflect a lag in spatial development. Most research has shown there is no structural or medical basis for these reversals. Although reversals are common and expected in five to six year old children, they may persist through childhood. Many adults continue to manifest these problems.
For many years, scientists have studied children with reversal problems, particularly
regarding orientation to right and left as related to their own bodies (laterality), and to objects around them (directionality). At three, or even younger, the child should have grasped the concept of top and bottom, and right side up or upside down (even though still looking at books upside down). The four year old is grappling with front and back, and may still put a shirt on backward. Many four year olds show reversals as they put on shoes by themselves. Some four to five year olds may start printing numbers and letters from right to left. At these ages, this is a normal stage of developing orientation in children.
Although most children master this concept of directionality by age seven, this confusion in orientation may continue, in some people, all their life. Reversals are a manifestation of a developmental lag in the process of orientation. They are indicative of an underlying problem in the integration of the vestibular and visual systems in the brain. Rote repetition of learning to write letters and numbers correctly or rotely learning right and left hands may help us pass a test, but it does not solve the problem of the underlying causative factor of orientation development.
The development of orientation starts in the prenatal period-with the attitudinal reflexes which help the fetus orient in utero. This development continues through varied learned experiences in our lives. Interferences in movement activities involving vision and neuromotor relationship limit the development of orientation. According to the neuroscientist J.D. French, orientation contributes in an important way to the highest mental processes-the focusing of attention, and the ability to think, to learn, and to act.
Specific vision therapy, including the unique application of lenses and prisms during visual-neuromotor activities (movement with awareness and feedback), provides learning experiences to improve the development of laterality, directionality and orientation, and the related problem of reversals. When a child learns to orient easily, the evidence points to a well integrated and effectively operating person.
Members of the College ofOptometrists in Vision Development (COVD) are optometrists who have demonstrated interest in the problems and remediation of reversals. Fellows of the College are certified in the diagnosis and treatment of learning related vision problems. For further information, contact COVD or consult with your COVD optometrist.
WHTPAPER
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