Restoring Visually Disabled Children to Normal Vision 

Vision therapy is a series of treatment procedures prescribed by optometrists to improve vision problems that cannot be corrected with only glasses or contact lenses.  Vision therapy is much like physical therapy for the eyes, during which vision disorders are corrected to improve the patient's visual function and performance. Although many adults can benefit from vision therapy, school-aged children are the primary candidates for vision therapy care.  This is because they spend up to eight hours a day using their eyes at close ranges, often reading small print. 

Vision therapy treats learning-related vision problems such as poor tracking, eye teaming, and focusing.  Vision therapy also corrects lazy eyes and crossed eyes--without the need for surgery.  These vision problems are all types of disorders of "binocular" vision, meaning how we use our two eyes together. 

Dr. Harl has received special training in vision therapy. He studied under one of the country's leading developmental optometrists who specialized in vision therapy and also completed an internship working in a vision therapy clinic.   

Please find more information below on special visual concerns in children. 

Vision-Based Learning Problems

All parents recognize how vital good vision is to their children's development and school performance. As children grow and mature, over 80% of what they learn is processed through their eyes.  However, most people have a limited understanding of what good vision means.  Good vision involves much more than just seeing clearly without glasses.  

When most parents think about vision, they think about their child's clearness of sight, or visual acuity--in other words, the sharpness of vision as measured by the eye cHarl.  When a child has 20/20 vision, it means that each of his eyes can see what an average person sees at a distance of 20 feet.  If a child fails the eye cHarl test, he can get glasses or contacts to correct his blurry vision.  But the eye cHarl's use is limited to only checking a child's sharpness of vision, usually measured at distance.  

The eye cHarl, a distance test, cannot check the important close-up visual skills that children need, especially in school.  For example, the eye cHarl can't check how well children team or coordinate their eyes to maintain single vision, how well they can track a line of print without losing their place, how well they can adjust focus changes from their desk to the board, or how well they can understand and make sense of what they see.  Children can have good sharpness of vision (20/20) and still have serious problems in these other areas.

Below is a demonstration on how children with eye teaming problems often see, especially when they are forced to read small print over an extended period of time. 

Do you find reading this way difficult?  Frustrating?  Did you want to quit?  Statistically, print may look this way for up to 15% of school-aged children.  These children can't control their eye movements at close ranges, and as a result they fight double vision every day, especially when reading. Still others struggle with print that blurs or jumps around. Is it any surprise these children are not doing well in school?  

If your child is struggling to read or finding it difficult to remain on task, the cause may be an undetected vision problem. According to the American Optometric Association, one out of four children have an undiagnosed vision problem that interferes with their ability to read and learn.  Many of these children are often suspected of having learning disabilities, dyslexia, or attention deficits when the real culprit is their vision.  Over 60% of children with learning disabilities have poor visual skills that are contributing to their struggles in school. 

Symptoms of Vision-Based Learning Problems:

Children with poor learning-related visual skills may struggle to read, have poor comprehension, frequently lose their place, omit or miscall words, have short attention, become easily distracted, take too long to complete assignments, frequently rub their eyes or blink excessively, have headaches, tire easily, tilt their head when reading, have poor handwriting, perform poorly in sports, develop low self-esteem, and become easily frustrated. Early detection can save years of struggling.  If your child has been labeled ADD, learning disabled, dyslexic, unmotivated or even "lazy," please call our office to learn more.  This may be the single most important thing you do for your child this year!

Crossed or Wandering Eyes (Strabismus) 

Vision therapy is also used to treat strabismus. Strabismus, commonly referred to as crossed or wandering eyes, occurs when one or both eyes turns in or out, up or down. The condition is caused by the brain's inability to coordinate both eyes simultaneously. The brain is the master control center of vision, and somewhere early in a child's visual development, the brain failed to develop "binocularily," or the ability to use both eyes at the same time.  The condition usually develops before a child is two but can occur as late as age six.   It is important  that strabismus receive prompt treatment.   Children do not outgrow crossed eyes, and the condition can worsen over time.  Children with strabismus may develop additional complications with amblyopia, or "lazy" eye.

Strabismus in which the misaligned eye turns in or out is divided into two categories: esotropia ("crossed" eye) means an eye turns in towards the nose, and exotropia ("wandering" eye) means an eye turns out away from the nose. In addition, the eye turn may be constant or happen only at times, such as when the child is tired; it may be the same eye which always turns, or the left and right eyes may turn alternately. The child's eye may turn  only when he is looking at objects close up, or it may turn when looking both near and far. The degree of eye turn may be so great that it is readily noticeable, or slight enough that parents may fail to recognize there's a problem.

Because the brain has not learned to align the eyes and use them together, each eye aims independently of the other.  In other words, both eyes do not point at the same place at the same time. When each eye is looking at a different place, the brain receives two different "pictures." This would normally result in double vision. However, these children's brains learn to protect themselves from seeing double by suppressing, or "turning off" the crossed eye. The brain refuses to receive the visual input from the turned eye; children with a crossed or wandering eye only see out of one eye at a time. 

Lazy Eye (Amblyopia)

Vision therapy also effectively treats lazy eye. A lazy eye, technically referred to as amblyopia, means that one eye has not developed normally and always has blurred vision, even with the best glasses or contacts the eye doctor can prescribe. Amblyopia is caused when the brain favors one eye and refuses to use the other.  Simply stated, amblyopia is a dysfunction of the brain which blocks vision from one eye because it can't use the two eyes together.  Because the eye is "turned off, " clear vision does not develop in the lazy eye.  Amblyopia affects 2 to 3 percent of the population. 

Children with normal vision learned to use both eyes together in the first few months of life.  Their brains developed the ability to take the pictures coming in from both their left and right eyes and "fuse" the two pictures into a single image. This is called "binocularity," or normal two-eyed vision. 

The brains of children who have a lazy eye, however, did not learn to use their two eyes together. At an early age, these children only used one eye, and their brain "turned off" or blocked the in-coming picture from the other eye. Turning off an eye is called suppression.  Because the brain suppressed the lazy eye very early in life, normal sharpness of vision, called acuity, did not have a chance to develop.  This "use it or lose it" syndrome means that the child has lost the ability to see clearly out of the lazy eye, even with the best pair of glasses or contacts the eye doctor can prescribe. How poor the vision is in the weak eye depends in part upon how early in the child’s visual development the brain turned the eye off.

Vision Therapy Can Help!

Before a child can begin a vision therapy program, he or she must be seen by Dr. Harl for a complete developmental vision evaluation and diagnostic workup. In addition to checking the child's eye health and sharpness of vision (visual acuity as measured by the eye cHarl), Dr. Harl will complete a comprehensive assessment to evaluate the child's eye teaming, tracking, focusing, visual perception, and eye-hand coordination skills. 

The child's vision therapy program consists of an individualized plan of in-office treatment procedures using lenses, prisms, instrumentation, visual exercises, and occlusion meant to return the patient to normal vision. Usually home therapy is also prescribed to reinforce the new skills the patient is learning at the doctor's office.  Eye patching is often a part of the treatment program. 

The encouraging news for parents is vision therapy is very effective in restoring normal vision. If you suspect your child has a vision problem, the first step is scheduling a developmental vision evaluation with Dr. Harl.  Once the problem has been identified, vision therapy can return your child's visual system to normal, usually in less than six months!

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