LEARNING RELATED VISION PROBLEMS

DIAGNOSIS AND TREATMENT

Vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition in childhood. A conservative interpretation of research indicates that at least 10%-15% of children are at risk from undetected vision impairments. Viewing this number in the context of US Census data means that as many as 8 to 12 million school age children are at risk from undetected vision impairments.

Learning related vision problems are a category of vision disorders that manifest primarily during sustained reading or other desk work.  Some of the more common symptoms are eye strain, visual fatigue, difficulty keeping place when reading, poor penmanship, difficulty copying from the board in school, and confusing common words when reading or writing them.

There are seven functional vision skills that are used during visually based academic tasks.  When some, or all, of them are deficient, a learning related vision problem is present.  The seven functional vision skills are:

DIAGNOSIS

A battery of standardized, norm-referenced tests is used to assess the level of performance for each of the seven functional vision skills.  The tests are administered following basic eye and vision testing.  The results of the tests in the battery are compared to the expected result for the age or grade.

The typical sequence of testing is 2-3 office visits for the evaluations, followed by a parent conference.  The first office visit includes a basic eye exam for optical eye problems and eye disease, and comprehensive testing of the three ocular motor skills.  The second office visit is to finish the evaluation of the ocular motor skills and to begin the testing of the four visual perceptual skills.  The third office visit is to finish the evaluation of visual perceptual skills.

After the evaluations have been completed, a comprehensive report letter is prepared and a parent conference is scheduled.  At the conference the results and diagnosis are reviewed, treatment recommendations are made, and a prognosis is established along with a predicted treatment length.

TREATMENT

The treatment for learning related vision problems is Vision Skills Therapy.  Vision Therapy is a series of procedures that require activation of a particular vision skill.  There are hundreds of vision therapy procedures for each of the seven different functional vision skills.  The procedures are targeted to vision skills diagnosed as deficient.   By participation in the procedure, the patient elevates the weak vision skill to a higher level.  The doctor and the vision therapists provide instructions, guidance and feedback to the patient throughout the process.  When the patient masters a given procedure, another one is assigned that is more challenging.  The patient works through a series of procedures for each weak vision skill aiming toward age-expected performance levels.  The goal of vision therapy is to improve the weak vision skills and solve the learning-related vision problem.

The purpose of testing for learning-related vision problems is to determine if deficient vision skills are contributing to a learning disorder.  It is believed that a learning disorder can have many causes and dimensions.  Deficient vision skills can be a contributing cause of a learning disorder.  A thorough case history and reports from other professionals are helpful in trying to understand the entire learning disorder.  That information, together with the visual exams, can help the doctor assess just how much the deficient vision skills are contributing to the learning disorder.  When deficient vision skills are a minor factor and other causes dominate, vision therapy will have a minor impact.  When deficient vision skills are a major factor in the learning disorder, and the patient is free of other learning problems, vision therapy will have a major impact.

The typical length of vision therapy is 28 visits with one office visit per week.  The length of treatment depends on the depth and breadth of the learning-related vision problem.  Vision therapy office visits are 45 minutes in length.  Vision therapy procedures also are assigned for practice at home as part of the overall treatment plan.  Professional fees for evaluation range from approximately $198 to $448.  Professional fees for treatment with vision therapy range from $1,470 to $3,675.

Dr. Greg Giles is the Vision Therapy specialist at La Mesa Vision Care Center.

Sources for additional information:

College of Optometrists in Vision Development. www.covd.org

Parents Active for Vision Education (P.A.V.E.). www.pavevision.org

Optometric Extension Program Foundation. www.oep.org

American Optometric Association. www.aoanet.org