Herald and Journal, July 17, 2000

Vision therapy helps develop visual skills

By Jane Otto

When my daughter, Jenny, was five, her kindergarten teacher remarked that she wasn't sure why, but Jenny didn't quite seem to grasp reading.

In first and second grade, though behind her peers, she always made some progress. Reading problems became more evident in third grade. She only did well in tests when they were read to her.

She was learning by memorization.

She faced a battery of tests to see if she qualified for special education during fourth grade. No, she didn't. They were as baffled as my husband and I were. The special education teacher said she was neither a visual nor an auditory learner.

What were we to do?

The answer came via a leaflet her Chapter One teacher sent home with Jenny.

"Learning to see," it read. Some symptoms were listed such as, poor spelling; letter, number, or word reversal; poor reading comprehension; skips, rereads or omits words; motion sickness, and so on. This was Jenny.

After some research, we found the Minnesota Vision Therapy Center.

A visit to the clinic's Web site taught me the difference between sight and vision.

Sight is how clearly we can see small objects. The eye chart dates back to the Civil War. 20/20 vision is the ability to read 20-point size letters at 20 feet.

Vision, however, is how the brain interprets, identifies, and processes what the eye sees. Vision is learned.

Testing at the clinic showed Jenny had poor eye tracking. This is the ability to track a moving object. Inadequate eye movement can cause loss of place while reading.

She had also difficulty focusing This is the ability to shift rapidly from one distance to another and still see clearly.

Double vision, a result of poor eye teaming, was another problem. The two eyes need to work together in a precise and coordinated fashion. One common form of poor eye teaming is when one eye turns in or out intermittently or even all of the time.

After testing and an extensive interview to explain the therapy, we set out on a 35-week journey to train Jenny to develop some underdeveloped visual skills.

Once a week, we traveled to Edina for an hour-session with a vision therapist. And then, there was the homework ­ four to five times a week.

Therapy isn't successful without completing the homework.

Eight-year Josie Bull of Lester Prairie can attest to that.

Josie and her dad, Brian, attended more than 40 weeks of therapy. The travel time and daily routine of homework is a huge commitment.

The homework was boring, said Josie, but she really liked her therapist.

Josie wasn't reading at all and her eyes would wander intermittently, said Josie's mother, Joanie Bull. Josie's depth perception was minimal. Josie said she often tripped over rugs or bumped into walls.

"If I would put my hand over one eye, everything would look fine," said Josie.

Behavioral optometrist Dr. Lori Mowbray of Minnesota Vision Therapy Clinic, said that the brain learns how to shut down one eye to compensate for this imbalance.

There are many adults who interpret what they see with just one eye, though they may have good eyesight. Adults such as those usually don't enjoy reading or have intense headaches after visual activities.

It was Josie's optometrist who recommended vision therapy. Brian Bull said that the success rate for surgery to correct wandering eyes was not very good. He looked into other options on the Internet and decided vision therapy was the way to go.

"Progress was slow," said Brian Bull. "It was in stages. The first six weeks showed no change. Then, you could see a big change."

In the beginning months, the Bulls often wondered if vision therapy was worth all their time and money.

"If it was anything else, ­ speech, hearing ­ it would be covered by the school district," said Joanie Bull.

Two obstacles to vision therapy are money and time.

Unfortunately, vision therapy is not cheap, and few insurance companies will cover the treatment.

Mowbray sees the need for vision therapy to be in the schools. However, one fear is not having trained therapists in the schools.

"If not done correctly, results will be minimal at best. Vision therapy can do more damage than good, and if that happens, they'll toss it out the window," said Mowbray.

Regardless, Mowbray said schools can play an important role in vision therapy.

"If insurance totally covered therapy, there are always those parents who wouldn't get their child here. Those kids are never treated, if it isn't done in school," she said.

Getting the word out to schools was not an easy feat. Mowbray attended numerous educational conferences and sent mailers to teachers with little response.

She now has a staffer, once a former teacher, attend the conferences and workshops.

"I found educators are more open to another educator sharing new information," Mowbra said.

Vision therapy, itself, is a very unorganized field at present, Mowbray said, and it is only taught in a few schools in the country. It's better known in Oregon and California. Mowbray spent five years in Oregon studying with different doctors and training in clinics.

Ophthalmologists have a lot of misconceptions about vision therapy, Mowbray said. It's only on the fringe of ophthalmologist circles.

The word is getting out there, she said, but primarily by word of mouth ­ from one patient to another.

Since opening, though, the clinic has doubled its staff, opened another clinic in Mankato, and is looking to open a clinic in Apple Valley.

The root of it all

How some persons have better vision than others is somewhat of an enigma.

Mowbray said infants or toddlers that have been seriously ill or suffered some trauma are often at risk for vision problems. During those developmental stages, the brain may prioritize what it needs to take care of first.

"Even though all the hardware may be hooked up, there are too many things that can throw things off kilter," Mowbray said.

As a baby, Josie had numerous ear infections and eventually had tubes inserted into her ears. Shortly after her fifth birthday, she had a severe bout with meningitis and was hospitalized for three weeks.

"You don't know what to blame," said Joanie Bull.

Does it work?

Success rate is good, but so much of that is dependent on patients complying. Mowbray stressed the importance of attending the weekly sessions and doing the homework for the program to be successful.

"We have very low non-compliance here," she said.

Jenny, who has now completed vision therapy, has seen the dividends. The most noticeable difference is her ability to copy without reversing letters or omitting words.

Though her reading has improved, she needs to work on phonics to be on par with her peers. Hindsight tells me that she was concentrating so hard on seeing what she was reading, she lost out on phonics.

Josie, who is home-schooled, has been doing a lot of work on her reading. Without the therapy, it would have been difficult.

Now, that Josie has completed her vision therapy, her parents said they would do it again regardless of the time and cost.

"There is a definitely a huge difference," said Brian Bull. "She's reading."

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