Gifted Issues Discussion homepage Forums Twice Exceptional Vision Therapy?

I took both my kids to a regular optometrist and I asked him about Vision Therapy, he told me it was basically a scam (and he said he has a child that was gifted). I then spoke to someone who specializes in giftedness about my son's underachievement and anxiety and he said that he would recommend having someone check my son's eyes for Convergence Insufficiency (and basically whether or not he would need vision therapy). I told him what the eye doctor had said and he said that vision therapy does work.

So now I'm confused as both people were very convincing and I felt they were giving me their honest opinion and looking out for my best interest. For those who have tried it, did it work?

Personally, I wouldn't rely on anecdotes for such a decision. But there are quite a few threads here discussing success.

The American Optometric Association's Clinical Practice Guideline has researched based intervention on best practices. They clearly support therapy for specific conditions targetting specific outcomes:

http://www.aoa.org/documents/CPG-18.pdf (around pg. 36)

But I would think therapy not tied to a specific visual issue seeking a specific outcome would be suspect. A developmental optometrist or ophthalmologist would seem a better place to start.

DS's neuropsych said he reviewed the literature at one point and said that the research doesn't support it for the most part. It probably depends on whether a) that is really the child's problem and b) how the therapy is done. I would want to see solid data before investing in that (unless you are lucky and insurance pays).

One thing to ask for is a depth perception test. A regular eye doctor can do this. DS had strabismus as a result of a brain injury, where a nerve in his brain was paralyzed and his eyes were literally looking in two different directions and it was very obvious. He also had obvious double vision, if someone held up two fingers and asked how many fingers he saw, he would say four. I remember he was trying to grasp a balloon ribbon one day, and he kept grasping at air about 12 inches to the right of where the real balloon was. When kids have eyes that aren't aligned, they have no depth perception. So when he was given the depth perception tests at the eye doc, they would ask him to pick the picture that was popping out. It was obvious he was randomly guessing. As his strabismus gradually resolved, the depth perception tests got better and he could see the easier more obvious ones (but still struggled with the difficult ones). After about 8 months he could do the whole test effortlessly, and then I knew his strabismus must be resolved.

Vision Therapy is controversial, but my take on it is that the controversy arrises from situations where some optometrists sell it as a cure-all for everything under the sun from dyslexia to adhd etc. - which it really isn't. It is, however, incredibly amazing and successful when it's done under the guidance of a qualified and responsible Developmental Optometrist for specific types of diagnoses. I've seen it work amazingly well for one of my children, so I have personal experience both with seeing it succeed and with being exposed to the two flip sides of the controversy surrounding it.

My first thought for you, LAF, is - have you had any kind of professional suggest to you that a D.O. eval might be worth looking into? If not, what are you specifically seeing in your child's academics or other functioning that would make you suspect there is either an issue or suspect a vision issue specifically?

In my dd's case, we had lots of signs of a vision issue but didn't recognize them until she was in 2nd grade and came home telling us she couldn't read what the teacher wrote on the board. We took her for an exam with our regular eye dr and she didn't find any issues - instead she found 20/20 eyesight - so we then assumed nothing was an issue with dd's eyes… and later that year landed in a neuropsych eval when school became insanely difficult for dd. The neuropsych recommended a D.O. eval based on dd's testing results and her observations of dd while testing. I was sooooo so danged skeptical - but I also had an acquaintance who's slightly older dd had been through vision therapy with the same dr we were referred to, so I asked her opinion and found out that her dd went from a struggling reader to loving reading within just a few months of focused therapy and daily exercises. That *still* wasn't enough to convince me to give it a try, so I went back to our regular eye dr to ask her if it was hocus-pocus or worth pursuing, and she told us that YES, it really was worth pursuing, if it was an issue related to muscle weakness in the eye. She also told us that nothing she did as a regular part of her eye exams would pick up an issue with muscle weakness, tracking, or anything related to the eyes working *together* - her exams were all about eyesight acuity in each individual eye. So, we went for the eval and found out (I saw this with my own eyes at the eval) that my dd had severe double vision (among other issues). Never in a million years would I have guessed my dd had double vision, but when we asked her, she said "Well yeah,I always see two of everything. I thought you knew!". Anyway, I'm rambling. DD went through over a year of vision therapy, and it worked. The first three months, in particular, were simply amazing - like our friends' dd, she went from a struggling reader to a girl who loves loves LOVES to read and is always walking around hiding her face behind a book

I realize "anecdotes" don't count for much, but fwiw, I also ran into an adult acquaintance when dd was in VT who told me she, too, had been in VT for awhile because when she hit that 40-something age point where she her eyes started bugging her and she thought she needed reading glasses, her *regular* eye dr did some type of screen and found the issue wasn't her eyesight, it was convergence/tracking issues related to muscles weakening. She too had very successful results with VT.

And - again, anecdotal, but fwiw - it's been several years now since my dd was diagnosed and treated. We still see the same "regular" eye dr - and that eye dr now includes screening in her regular exams for things like double vision and tracking, and regularly refers patients to our local DO when there is a concern from the screening.

So maybe it's anecdotal, but yes, I've seen it be very successful for a child with a legitimate *need* and diagnosis, and I also feel like I've had very reliable referrals for it from a neuropsych and a "regular" eye dr.

Also anecdotal, but I have an acquaintance who's dd had VT that was paid for as part of her IEP services through the local school district. That in and of itself must say *something* about the credibility of it - it's danged tough to get *anything* in the way of services here

Best wishes,

polarbear

Did this person actually do some type of evaluation for your children, or did you just have a conversation with him? I'd be wary of putting $ toward one specific type of eval based on just a conversation - there are so many possibilities of what can cause different types of issues/challenges/underachievement at school.

polarbear

Just want to clarify that when eyes aren't aligned or aren't coordinated, there is not a complete lack of depth perception. People like myself who are born or develop very early eye coordination issues use many other coping mechanisms like lens muscle contraction feedback, relative sizing, lighting queues, ground position, shadows, trajectory, etc. to draw our 3d worlds. The mechanic missing is parallax vision which is awesome for small and faster moving things, areas that give me much more difficulty.

When there is a traumatic disruption to someone that has already gone through their critical development period (1-2yrs old) with coordinated parallax vision, then I'd expect very vivid results as you've described.

How do you do on the depth perception tests at the eye doc? Can you still see the objects popping out? DS was able to accommodate fairly well, in an amazing amount of time, for instance he didn't have any trouble getting around, going up and down steps, etc. I think that if someone has poor results on the depth perception test, it would make me more suspicious of a convergence problem. If they had great results (esp. a child), I think it would be fairly unlikely. With DS you could tell he was struggling, and had to look at at the items on the test for a while before answering. I'm sure it's not foolproof, but it's one test that can point one direction or the other. If many/most people with no or limited depth perception are still able to do well on that test, then they might as well throw it out.

Polarbear, it was a conversation but I had already sent him 20 pages of notes, plus DS9's report cards, NNAT, OLSAT and WISC IV results. He reviewed the material and test scores and said that to rule out an LD he would suggest we first do an evaluation with a DO and also have a OT do an assessment as he saw a lot of sensory stuff going on with him. He said he wasn't sure it was vision, but based on the fact that he seemed to have issues with the PCI that he would look at that first.