With nearly 2.9 million school-age children in the United States classified as learning disabled, new research suggests that up to 60 percent of these students may have undetected, correctable vision problems that could play a significant role in their disability, according to the College of Optometrists in Vision Development (COVD). In fact, results of study published recently in the Journal of Learning Disabilities revealed that participant sixth-graders with below average reading skills improved reading comprehension and test scores by up to two grade levels through visual attention therapy. This research confirms prior studies. “This most recent study is confirming what developmental optometrists have known for years,” says Manhattan-based Henry Ettinger, O.D., who offers specialty vision services, and has been treating children with learning disabilities for the last 18 years. “It’s been my experience that in most cases of learning disabilities, the underlying causes are due to poor visual abilities. Research shows that one in every four children have vision impairments that are interfering with learning ability. Sadly enough, only a small percentage get diagnosed.” When a vision problem goes undiagnosed for several years, it becomes harder to address the problem once a child becomes a teenager. “Unfortunately, I see a large number of kids whose parents have pursued every avenue under the sun, and they are only finding out the child’s problems are vision-related when the child is 14 or 15 years old,” says Stacy Friedman, O.D., an optometrist and assistant clinical professor of optometry at SUNY College of Optometry in Manhattan, who treats children with learning disabilities. “It’s a lot harder to fix the problem when a child is 14. It’s much easier to help them when they are 5 or 6.” One of the reasons many of these children “fall through the cracks” is because visual attention deficiencies can’t be diagnosed through traditional eye exams. In addition, these visual problems can’t be treated with eyeglasses alone. So this is why, sadly, the underlying causes are not addressed in these children,” Dr. Ettinger says.
Visual Attention Therapies Visual attention is the ability of the visual system to focus long enough to accurately perceive information and send it to the brain for interpretation. Visual disorders can divert attention and slow visual processing, resulting in poor reading comprehension. According to the COVD, many students are unnecessarily prescribed drugs for attention problems or placed in resource rooms where they continue to have trouble learning. Vision therapy offered by developmental optometrists trains the participants' eyes and brains to coordinate, improve concentration and filter out distractions. They also sharpen the student's ability to shift attention efficiently and sustain that attention for longer periods of time. “We work with children who have learning problems, and analyze the visual component. In terms of the therapy, we work on trying to remediate various vision problems like eye-coordination and focusing problems. We work with techniques that enhance visual attention,” says Queens-based Steven Lieberman, O.D., who specializes in both adult and pediatric optometry, and treats children with vision-related learning problems. Meanwhile, there are several signs that a child with a learning disability may have a contributing vision problem. “For example, they may have an eye tracking problem, where they skip lines, reread lines, lose their place easily, or always need to use their finger to keep their place when they are reading,” says Dr. Friedman. Other signs parents and teachers should look for to determine if a vision problem may be playing a role in a learning disability are: confusion of similar looking words, visual stress when the child reads, double vision, poor reading comprehension, sloppy handwriting, failure to recognize the same word in the next sentence, or complaints of eyes hurting or headaches after reading.
Diagnosing The Problem One way to help diagnose vision problems in children with learning disabilities is through form perception tests, “one’s ability to differentiate and understand similarities and differences among shapes and forms,” Dr. Ettinger explains. “For example, form perception is the ability to determine a B instead of a D.” In addition, optometrists can diagnose a vision problem through the testing of binocularity skills or eye coordination functions. “We can test for eye coordination functions with the use of prisms,” Dr. Ettinger explains. “We would insert a standard prism before the child’s eyes, and we would see how quickly the child can fuse two images together into one.” In addition, a developmental optometrist can also test a child’s eyes for the ability to scan from one point to another, says Dr. Ettinger, who uses these techniques in his 10-week intense, one-on-one training program composed of an organized group of activities that challenge a child’s cognitive skills. He also offers free seminars in his office for interested parties to learn about the link between vision problems and learning disabilities in children. It’s important that a child being treated with vision therapies be interested in the therapy. “When doing this therapy, you have to keep in mind that kids have to like it. You have to make it pleasant, and make it something they are going to want to come back and do the following week,” Dr. Lieberman urges. “It should be interesting, and done in a non-threatening environment. It has to be fun for them.” Dr. Lieberman frequently uses computer programs. “I use activities where the child looks at a computer screen with a series of numbers and letters. Let’s say there are 250 letters and 21 numbers: with a cursor and joystick they have to find the 21 numbers in the array of 250 letters. They have to find all of them, and the test is timed.” Memory games also are used in vision therapy. “We do a lot with blocks,” Dr. Friedman says. “We ask children to copy pictures using blocks. There also are a lot of games we can play with the kids, which they like and can do with their parents at home as well.” Vision experts recommend that all children, regardless of their learning ability, be tested at least once by a developmental optometrist. “There could be difficulties that the child may not be aware of that could hinder them later on,” Dr. Ettinger says. However, some in the medical community say more research needs to be done to accurately link learning disabilities to vision related problems. “Ophthalmologists believe that most learning disabilities have no visual relationship to their cause,” says Norman B. Medow, M.D., director of pediatric ophthalmology at Manhattan Eye, Ear and Throat Hospital, and professor of ophthalmology at Weill College of Medicine of Cornell Medical School. “We believe children who have problems in school with reading and writing should be evaluated at 3, 4 or 5 years of age by educators who have a specialty in learning disabilities.” They should also have an evaluation for their vision and hearing, as well as an educational and psychological evaluation, he adds. “Once all these factpors have been evaluated, then a proper approach to treatment should be instituted.”