Gifted Issues Discussion homepage Forums Twice Exceptional Vision therapy questions

I brought my DS7 last night for the first part of a binocular vision assessment. Second part is tomorrow.

The optometrist examined him doing a lot of things that seemed to be different than a normal eye checkup. From her initial assessment she thinks he has convergence insufficiency - which I kind of suspected she might say. It was clear to me that he had trouble following a moving object, and also converging his eyes on an object brought close to him. He would be able to do it until fairly close the first time, then would get tired and so performance subsequent times was worse. She also did a bunch of things with lenses, which I didn't understand - making things fuzzy, then double, etc.

She also asked questions about whether or not he crawled and seemed to think it was a big deal that he mostly skipped that stage (he walked at 11 months). Also she thought it was a big deal that he can't really swim yet despite many lessons (which I had thought was mostly a sensory issue, maybe DCD). I don't know - I guess I don't see the connection between the crawling and swimming and binocular vision. (DD10 also went straight to walking at 10 mos. and has no vision issues that I know of.) She also started going on about retained primitive reflexes - which I've not heard of before.


I took him for assessment because he does seem to have issues that may be vision related - or they may be just DCD - or both? He bumps into things, gets tired quickly when reading or doing close work (fine motor), has trouble finding items on a crowded background. So if he has convergence issues, maybe vision therapy helps with these things?

Anybody with experience with this? How do you know when you get a good optometrist/VT? I just want to be sure we're not wasting time/money ...

Wow - thanks Portia for your detailed reply! Will definitely ask the Dr. what her plan is, and how long he might need VT at the results appointment in a couple of weeks.

We had the 2nd part of the assessment this morning (with the visual therapist). He seemed (to me) to have the most trouble with a visual maze, a board where he had to touch lights, and a binocular vision test where he had to draw a line with 2 pencils. For that one, I could see that he had trouble figuring out where to put the pencils while looking through the lenses - not sure if that is visual or motor planning...

She also had him read with goggles on that tracked his eye movements. His reading seemed to be OK - no idea how to interpret what I was seeing on the eye tracking chart. His comprehension was >70%, but the stories were boring and I also had trouble remembering the details (what color was the cow, how many eggs, and so on). The story with a fire truck he scored 100%...

She also did some primitive reflex testing - I have no idea what that was about - she seemed to think some of it was significant... Are there studies that support this type of testing and therapy?

We have an appointment to get the results in a couple of weeks, so I guess we'll have to wait and see.

He's in grade 1 and so far his teachers don't have a lot of concerns. They acknowledge that he's slow at writing and that it's messy, but claim he's not really worse than the other kids. The problems seem to mostly show up at home after school when he's tired - doesn't want to read, or draw, or write...

Sometimes I think I'm making mountains out of molehills - but then I think about grade 2 and 3 and wonder if he'll struggle with the increased demands. It makes me sad when he brings work home and tells me he 'failed' at it. Pretty much he only enjoys math and recess.

Also wondering - if he's not yet 8 (7yrs, 3 months), is it possible some things have just not developed yet?

I need input regarding vision therapy so am going to piggyback here rather than start a new thread.

My DD10 has been diagnosed with literally just about every possible LD, almost all in their most severe forms. Also has pretty severe migraines which she takes daily medication for. She is in out of district placement at a spec Ed school because of the profound learning disabilities but is doing 1-1 HS level reading comprehension curriculum (using audio books) and getting major AT support along with OT, SLP, Wilson reading and math supports for the various LD issues.

Earlier this year we did a psychoeducational eval with someone recommended by the Eides. She found DD's numbers overall significantly lower than in previous testing (probably due in large part to meds for her migraines) but still the difference between her Verbal Comprehension and all other parts of the WISC occurred in 0.0%-0.3% of the population. In other words HUGE processing issues. Among the recommendations (in the 50 page report) were to have DD evaluated for CAPD and vision therapy. Lo and behold she was indeed found to have an auditory processing issue affecting her left ear - I never suspected this. I had looked into vision therapy 4 years ago when DD's issues were first identified and I was shot down by our pediatrician and sent to an opthomologist instead. He said DD had "the best set of eyes I've seen all year" and she didn't need to be seen again for 5 years. After reading success stories here I looked into vision therapy on my own but got poor reports about out local developmental opto. After getting this latest report, though, I did some more research and found someone with good reviews a bit farther from home and took DD this week...

Developmental Optometrist says DD basically has no close up vision. 20/32 in one eye, 20/40 in the other. Double vision she can force together but it doesn't come naturally. Her eyes each see a different image so her brain has been alternately turning off one or the other. She has been compensating, compensating, compensating her whole life. Exceptional distance and peripheral vision so she is constantly taking in extraneous input. This explains why she *has* to hyper-focus on tasks and probably has led to many of her processing issues. Also likely contributing to her headaches.

We will be driving to "vision gym" 45 minutes from school/ 30 minutes from home 1-2 times a week for the next year. I'm hoping the exercises can be done in school as we have found that DD puts in 100% effort in school all day no matter how difficult as long as she doesn't have to do more after school. She compartmentalizes and school is work time as long as outside of school she can let it all go and relax, focusing on things that are easier and enjoyable. District, who has basically been agreeing to any and all requests we have made as a way of compensating for how terribly DD had been treated early on, is saying vision therapy is not scientifically proven and they usually don't support these services.

Does the developmental opto's explanation make sense to those of you who have been through this? Any questions I should be asking? I plan to argue both the compartmentalizing and the fact the this was a recommendation from the psychoeducational eval (which the district paid for...). Any other arguments I can make to have the 15 minutes 3-4x a week included in her IEP?

We've only done VT for a few months, but it makes sense to me.
I was skeptical at first - the 'not proven' part bothered me - but eventually I realized that the set of exercises to be done is so large, and the flow chart so complex, and the possible weaknesses so varied, that it would be very difficult to prove it all works.
Many of our exercises have not seemed much like homework. Our therapist trains the parent to lead the exercises at each appointment, so I would not have wanted to hand that off to the school. For us, 5 minutes in the morning and 5-10 at bedtime have worked well. Most of it has been interactive parent-child games that DD likes. Maybe others will have tips for getting it done at school.
DD seems to be progressing at about twice the rate they predicted. She had huge deficits but learns really fast when taught explicitly what she needs to do.
Hope this helps.

Thanks ljoy. It's good to hear that the exercises aren't onerous for your DD. Friends had told me that it was a daily battle which is why I was looking at doing them in school instead. DD is very excited about doing this so hopefully doing it at home won't be as big a problem as I was thinking.

Any more input out there concerning what the OD said about DD's eyes or why on earth it is so very different from what the ophthalmologist told me 4 years go?

The ophthalmologist looked at the eye itself - its shape and ability to focus across the room in isolation. The exam you just got assessed the brain's ability to finely control eye movements, coordinate the two eyes, and process the two images into one. They really aren't very related.

Hi Pemberley,

My dd13 was diagnosed by a DO with vision challenges when she was 8 years old (2nd grade). Like your dd, her diagnosis was a complete surprise to us, and came after a recommendation from neuropsych testing.


Our dd had severe double vision and like your dd, one eye was shutting off when it was too much for her brain to deal with. In our dd's case, it was the same eye that shut down each time, so we were able to look for clues re when the eye was shut down - dd would tilt her head when reading or looking at things. She also had a habit of putting her head on the table and looking sideways when she did her homework.



Just a matter of semantics here, but if your dd truly has processing issues, the vision challenge isn't really causing them. What might be happening though is that what looks like a processing issue might really be a vision challenge, and once she's had the vision issue remediated, what looked like a processing issue might disappear.

One thing about my dd - she struggled tremendously to learn to read, but after only a few months of vision therapy (at 8) her ability to read just suddenly turned on and she was reading like gangbusters. Since that time it's been a battle to get her nose *out* of a book


Absolutely!


Our dd did vision therapy for a little over a year, once per week at the DO's office and 2 times daily at home. It was a lot of work (plus we had an equally long drive), but it was well worth the time invested. I don't want to scare you with the next part of our story but I also think it's something to be aware of. The improvements didn't last forever. DD's vision never went back to as much of an issue as it was before VT, but about 2 years after she'd quit she started having double vision again and went back for another 8-9 months of VT which once again cleared it up. That's now been a few years ago and she tells me now that she does have to work at keeping her eyes focused together, but she doesn't feel like she needs any more VT. She's doing really well in school, and she's a very mature 13, so I trust her in making that decision for herself.


My dd didn't do the exercises at school, but we did take her out of school for VT. Part of the reason for that was that we've got 3 total kids all with busy after-school activities, and VT was so far away it would have created a huge challenge in terms of our family life. The second reason was, though, that VT was hard work, and I felt like it shouldn't be a huge add-on to school which was already a day full of hard work. The exercises we did 2 times per day didn't take that much time - 20 minutes each, and it was easy to fit them in as part of our morning and evening routines.

DD did do some VT things during the school day as needed to help keep her eyes focused. She has tricks - things like drinking from a straw, doing pencil pushups etc - that helped when her eyes had trouble tracking. I am not sure what she did to help with her eye shutting off, but can ask her later.


FWIW, the actual VT exercises aren't all that horrible, although they can be a bit of a drudge. Some of them are a little fun. Our VT also integrated things like bal-a-visx (I think that's what it's called, can't remember for sure) and Brain Gym, and dd liked those. All my kids liked bal-a-visx

I suspect you'd have a tough time integrating the actual exercises (full suite) during the school day because it requires 20+ minutes of one-on-one time from a staff member.


There are a lot of people who believe this. You noted that the first eye dr you took your dd too didn't believe it. I think that if you want to argue convincingly to your school staff you'll first need to let them know up front that yes, there are people who claim it "cures" a whole host of things such as ADHD, LD, etc, and that's not what it is. It's a method of strengthening weakness in the eye muscles - because that's really what it is. The double vision your dd has *isn't* dyslexia etc - it's a muscle weakness, and it impacts her ability to fully participate in her FAPE.

Next thing - you have the DO's report, and you have a recommendation for DO testing through the last round of testing your dd went through. Those are professional reports which clearly have belief that it will be of benefit for your dd.
I'd ask the DO if he has any scientific research he can point you to that you can use to show it works.


Yes. Totally makes sense. I would go to her VT appointments with her and watch what they do with her. That was really helpful for me in understanding how to help our dd at home. I would also pick up a ton of clues while watching where the VTherapists would say - see how she's bending her head, that means she's shut down that one eye... etc.


Have you tried asking the DO for suggestions? It's possible they've had other patients ask for services through the schools. DD had a friend who was receiving VT through our DO at the same time DD first went through it and she was able to get the services through her IEP. That's been years ago now and we've totally lost touch so I have no idea how they actually convinced the school district to include the VT.

Another thing you might try is talking to your dd's OT (if she has one at school) - some of the things they do as VT exercises are remotely similar to OT exercises... I'm reaching here lol!

My last question - why only 3-4 times per week? Just curious. Our DO was much more aggressive about the importance of daily practice.

Best wishes,

polarbear

Sorry to catch on to this thread late, but crawling and swimming can be related to vision since they involve cross lateralization of the brain. IF a child doesn't learn to crawl properly, then they're often at risk of not using their brain and body evenly and their neurological wiring going haywire.

This happened with my ds since he was born with visual deficits as well as a neck injury (torticollis) and other physical issues. When ds was very young, it was like he had a stroke or hemiparesis on his left side. He would over compensate with his right and throw his brain/body off kilter so to speak. He spent so much time and effort avoiding his left side, his neck, and tummy muscles. Well, his early development was completely off as a result.

If you think about it, we use our visual skills very differently when we crawl and swim than when we sit and read a book, for instance. A child who skips through crawling to walking learns to compensate. Neurologically, the neural pathways can go into another direction; for example, they may take Route 66 when they should be taking Route 95. Once a child learns to compensate, then it can be very difficult for them to unlearn or get out of that default without more direct intervention.

Neurologically, one of the goals with vision therapy should be for the child to deal with those compensations and get the brain to learn new neural pathways. They prism glasses and exercises should, ideally, force the child to accept a new reality of looking at the world instead of the default, compensated one. The child therefore will naturally dislike (or even hate) the vision therapy exercises at some point because it basically forces them to change what they've accepted and been relying on. If I go back to my analogy about taking Route 66 instead of Route 95, vision therapy should help a child find and take Route 95.

Remember over 80% of what we encounter on a daily basis involves the visual system. Visual acuity (20/20 vision) is only a small part of the visual system. Visual system also involves getting your body and brain to react to what you see. That involves neurons and neural pathways being fired up and doing their job.

Hope this helps and makes some sense.

I'm trying really hard to keep my cool but I am just seething...

I first brought concerns about DD's visual perception and hand-eye coordination to my pediatrician at her 18 month check up. Despite being *miles* ahead of every other child in Gymboree in literally every exercise and game they played I noticed that she was the only baby who could not catch a bubble during the song at the end of class. The only one. Not once. Ever. Pediatrician told me "She's so far ahead in everything something that's age appropriate appears to be a deficit even when it not." No, it appeared to be a deficit because it was a deficit... For 3 1/2 years I continued to raise my concerns every, single, office, visit. She didn't want to color or do puzzles or shape sorters or crafts. She didn't want to feed herself and didn't develop a pincer grasp. She had a weird crawl - used one foot and one knee. "Crawling is not a developmental milestone. It doesn't matter how she crawls as long as she finds a way to get from one place to another." I want to scream - and go back in time and shake some sense into that woman!

So it all fits and yes I had concerns. 9 years later (and 4 years after specifically asking about pursuing visual therapy) we are finally addressing it. So now DD has all these years of accommodating to undue.

Yeah - I want to scream...

Pemberley, that is maddening! It amazes me how often parental input is dismissed, even though parents are the people with the most experience observing their children. You are a phenomenal mother. Kudos to you for persisting despite placating.