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![[ Vision and Perception Therapy ]](images/getz_thera.gif)
6345 Balboa Blvd. Bldg. III, Suite 250
Encino, CA 91316
Phone: (818) 344-EYES dongetz@pacbell.net
By Donald J. Getz, O.D., FCOVD, FAAO
A. Besides the more obvious clues of blurred vision, discomfort, double vision, words running together, etc., I feel a deeper
probe in the history might elicit some of the following signs:
In addition to
the specific items mentioned above, I believe the single most important clue is
performance that is not up to potential. Any child whose verbal ability surpasses
his ability to learn visually should be suspected of a vision problem.
Additional
signposts which alert me to a possible vision problem are statement from parents
and teachers such as "he is lazy," "he does not try," "he could do better if he
exerted more effort," and other such statements. It is obvious that various kinds
of vision problems could cause these types of observations.
It is vital that a
complete case history be obtained so that any vision problems uncovered can be
related directly to both the child and the parental observations. A vision
problem standing alone can only be of academic interest. But if that problem can
be related to observable behavior, then it takes on significance and can, in
turn, be related to lowered academic performance.
Reversals when reading (i.e., "was" for "saw", "on" for "no", etc.)
Reversals when writing (b for d, p for q, etc.)
Transposition of letters and numbers (12 for 21, etc.)
Loss of place when reading, line to line and word to word.
Use of finger to maintain place
Holding book too close
Distorted posture when reading or writing
Omitting small words
Confusing small words
Short attention span
Daydreaming in class
Poor handwriting
Clumsiness on playground or at home
A. "Dyslexia" is a term which has been much abused recently in
educational circles. It has been applied to many children without a full
understanding of the implications involved.
Various definitions exist for the
term, but some of the more prevalent are:
As you can readily see by these
definitions, all "dyslexia" means is an inability of a child to learn properly
due to some unexplained cause.
However, when the child is so labeled, the terms
sounds like a horrible disease and, consequently, teachers may unknowingly use
the label to explain why the child is not teachable.
The question arises in my
mind as to whether dyslexia is a problem in itself or rather is a symptom of a
more deeply rooted problem. I feel strongly that all reading problems have causes
which can be uncovered if the proper probes are used. We have seen many children
who have been labeled as "dyslexic" and an optometric visual analysis revealed
vision problems. When the problems were corrected with proper lenses and vision
therapy, the reading problem was eliminated. It is unfortunate that the parents
of these children simply accepted the diagnosis of "dyslexia" and did not look
further for possible causes.
We should be very careful not to label a child if
that label puts an end to further diagnosis or rehabilitation. To some people the
label "dyslexia" means that no remediation will be of value and, therefore, it
sheds more darkness than light on the problem.
A neurological impairment that interferes with learning
An inability to read due to a central lesion
A mental condition marked by inability to read properly
A. It has been estimated that 75 to 90 percent of all learning in the classroom
comes to the student either wholly or partially via the visual pathways, the
child cannot develop to his fullest potential.
There are numerous learned
skills that the child must develop in order to achieve in the classroom.
The most
obvious skill is that the child must already have learned to coordinate his two
eyes together. If he has difficulty in this area, he might be perceiving
overlapping images or -- if he is not perceiving this manner -- he is using an
abnormal amount of effort to overcome the coordination problem, thus reducing
performance.
In addition, he must have learned accurate, smooth versional eye
movements and quick, accurate saccadic movements so that he can point his eyes
where he wills with a minimum of effort.
Focusing ability must be adequately
developed so that is can be maintained overextended periods of time. Also,
accommodative flexibility must be present so that attention can be shifted
quickly, smoothly and effortlessly from book to chalkboard and back to book.
Form
perception must be developed so that he can make the many fine discriminations
necessary to distinguish one letter from another and one word from another.
Span
of perception must be wide enough so that he can read in terms of ideas rather
than letter-by-letter or word-by-word.
The left-to-right directionality pattern
must be firmly established so that eye movements are carried out in the
conventional direction for the English language.
Visualization is one of the most
important visual skills, and it is vital for reading, spelling, and particularly,
abstract thinking.
In brief, these are some of the visual skills needed for
success in school. But, I would like to emphasize that since all of these skills
are learned, it is possible to train them to a more highly skilled degree.
A. The left to right direction pattern of the English
language is a convention of our culture. As you know, some languages are read
right to left and some are read in a vertical top to bottom direction.
This left
to right directionality must become a habit, unconsciously used as a movement
pattern in large movements, in small activities and in eye movements.
Many
reading problems are rooted in the failure to develop a good habitual movement
pattern and most poor readers have faulty movement patterns.
These directionality
problems can be uncovered by observing the direction of his pencil strokes by
observing the pattern in which the child arranges his work, and by observations
during his oral reading. A child with directionality problems often reverses
words and may attack words from the right end rather than the left.
With regard
to laterality, it is important that a child be aware of his own right and left
sides, because this is a vital prerequisite of projecting left and right out into
space. A child lacking in firm laterality often reverses words when reading and
writes letters and numbers in a backwards direction.
In teaching a child the
difference between left and right, it is important to first make him aware that
he has a left and right side and these must be teamed together in order to
achieve bilaterality. This can be accomplished with such activities as balance
boards, walking rails, trampolines, etc.
Then it becomes important that a child be
able to label "right" and "left" on himself and then later out in space. This can
be accomplished with such activities as "Angels in the Snow," "Simon Says," jump
board activities with right and left directions, eye fixations, catching with
right and left hands, doll and stick figure play, etc.
In developing the left to
right pattern, the training is first started with large muscle, wide scan
activities such as connecting dots on a chalkboard, and making various right to
left as well as left to right patterns on a chalkboard. Thus, he learns the
difference between the movement patterns. This graduates to small muscle, small
scan activities with paper and pencil. Both of these are accompanied by eye
movement training since eye are used to direct all of these activities. Visual
tracking procedures are then used to embed the skill so that the end result is
good laterality and firmly entrenched left to right direction patterns.
Visual
tracking procedures are then used to embed the skill so that the end result is
good laterality and firmly entrenched left to right direction patterns.
A. A child learns a visual skill
or abilities just as he learns to walk and to talk. Unfortunately, he doesn't
have the opportunity to mimic his parents and siblings as he does in learning to
walk and to talk. By the same token, a parent cannot observe how his child's
visual skills are developing as he can in observing his child learning to walk
and talk.
We can watch the child learn to roll over, lift his head , sit up,
crawl, creep, stand, walk, etc., but learning to see is a process that goes on,
generally, without assistance and without even concerned or informed awareness.
The child who is learning vision:
It is possible that some parents restrain their progeny in limiting the full range of activity through the restricting use of playpens and walkers. By so doing, they prevent adequate range of movement and the normal development patterns found necessary during this period through crawling and creeping activities.
Later, children are given scooters and wagons which they invariably learn to push with a particular foot and leg. This contributes to shortening the leg on that side and hence a change takes place in the pelvic height that distorts the body balance.
Children who don't creep long enough or who are restricted in the physical exploration of their environment, frequently head into life with a physically produced disability. This may handicap them throughout life and never show in the usual routine physical or eye examination.
From a developmental viewpoint, a child must first learn to team the two halves of his body together before he can team his two eyes together. Also, from a developmental standpoint, a child must first learn to control his large gross muscles before he can control the fine muscles of his eyes. Consequently, when we find a problem in bilaterality, we find a problem in binocularity and visual perception.
Therefore, apparatus such as balance boards, walk rails, jump boards and such activities as crawling and creeping constitute an integral part of a developmental visual training practice.
must learn his own center,
must learn to team the two halves of his body,
must learn where he is in relation to other visually observable stimulae,
must learn to move against gravity and to operate in a gravitationally controlled environment.
A. We are
aware of the more obvious postural distortions that can be observed in many
patients entering our offices. When a patient tilts his head laterally, we
frequently find astigmatism at an oblique axis. Likewise, when we see a patient
with his head inclined backwards leading with his chin, we frequently discover
that he is a myope [has myopia or nearsightedness]. When a patient has his head
rotated to one side, he may well be found to be an anismetrope.
However, in this
article we are primarily concerned with the problems associated with binocularity
[two-eyed vision, eye teaming], and there are many postural distortions typically
exhibited by a child with inadequate binocularity.
If a child does not possess
good binocularity, or if he cannot maintain binocularity over a period of time,
he will attempt to make compensations so that he doesn't have to use the two eyes
together. The easiest way to do this is to adjust his posture so that one eye is
taken out of the act.
One way to accomplish this is by rotating the head so that
one eye is blocked by the bridge of the nose; another way is by putting the head
down so that one eye is covered by an arm. Still another way is by holding a hand
over one eye, or by bring the head down so that one hand covers an eye. All of
these compensations can produce postural warps which, if continued for some time,
can cause other problems.
A child who has difficulty in binocularity usually
becomes a head mover rather than an eye mover. He will move his head as he looks
at successive words with a reluctant stress on head, neck and shoulder muscles.
There are also environmental conditions that can create visual and postural
problems. In a experiment conducted at the University of Texas, with over 6,000
children, it was found that the minimum of stress occurs when the reading or
writing material is parallel to the plane of the face.
In some of today's
so-called modern classrooms, most reading and writing materials are placed on a
flat desk. In order to achieve the parallel, minimum stress position, the child
must bend over. This often brings his eyes within just three to four inches of
his task.
The focusing and converging effort for this close distance is at least
five times greater than that required for a usual working distance and this
increased effort usually lowers performance. Therefore, it becomes important that
we realize the direct interrelationship that exists between vision and posture.
A. I feel
that there is an absolute direct relationship between the child's ability to team
his two eyes together and his ability to learn to read successfully.
A child is
born with two eyes, but he must learn to team those eyes together. Most children
learn to do this quite well, but there are others who do not adequately develop
this skill.
I would like to discuss the problem that a child who has developed an
exophoria might encounter during the task of reading. There has been some
controversy over the definition of exophoriA. Some define exophoria as a tendency
of the eyes to deviate outwards. Others define exophoria as that visual situation
where the eyes converge beyond the plane of regard for accommodation.
Regardless
of the definition for exophoria, the same situation exists during the act of
reading. The visual demand while reading is for the eyes to point inward at the
printed page. Since the relaxed posture for the exophore is for the eyes to go
outward, it means that he must use an excessive amount of energy and effort just
to keep the eyes pointing at the reading distance. Many university studies have
shown that the greater the amount of effort involved in the reading process, the
lower the comprehension and thus the lower the performance.
Eye movement
photography show that when the saccadic eye movements are made during the act of
reading, and each time fixation is broken as the child moves from word to word,
an exophore's eyes will move outward and then move in to regain fixation.
Consequently, the eyes will often regain binocularity two or three words over
rather than on the next word. Therefore, it is not uncommon for him to make up
the intervening words to make the sentence make sense. Typically, then, we have a
reader who substitutes little words, confuses little words, and doesn't
understand what he is reading.
Human nature being what it is, the child would
rather not do anything that is difficult to do. Thus, we observe an avoidance
reaction in which the child would rather look out the window or talk to his
neighbor than have to concentrate on the difficult visual task of reading. He
often is labeled as having a short attention span not trying, having a behavioral
problem, or being just plain dumb. It is possible that there is nothing else
wrong with him other than an undetected visual problem.
The problem is further
complicated by the fact that anything that a child doesn't do well, he would
rather not do. Consequently, we often observe a child who gives up and develops a
strong dislike for school.
An exophoric child often will make compensations in an
attempt to minify the effect of the problems. It usually is helpful for him to
use his finger when reading to prevent the loss of place associated with a break
in fixation. Unfortunately, too many educators have been taught not to let a
child use his finger when reading. Fortunately, however, modern educational
training teaches that when a child uses his finger, he is displaying to the teach
that he has a visual problem in teaming the two eyes together and that he is
unable to read successfully without the finger.
Children will also distort that
posture in an attempt to eliminate one eye during the act of reading. Many will
cover one eye with a hand, or put their head down on their arm so that one eye is
covered. Others will rotate their arm so that one eye is covered. Others will
rotate their heads in such a manner so that the bridge of their nose will act as
a shield between one eye and the printed page. Therefore, the observation of
these postural distortions should alert the observer to the possibility of the
existence of an eye teaming problem.
A. It is the feeling of most
authorities on the subject that there is a very positive correlation between the
two kinds of problems. Furthermore, it is felt that a cause and effect
relationship exists between visual problems and school behavior problems.
When
vision is difficult and requires greater effort than normal, the child will
usually exhibit an avoidance reaction to near point work, and thus will appear
not to be trying or day-dreaming.
The child with an undetected visual problem is
often accused of having a short attention span and is often told he could do
better if he tried harder. However, the child soon learns that no matter how hard
he tries, success is not possible. Consequently, he soon gives up academically
and must find other ways to occupy his time. Unfortunately, most of his
alternatives are not socially acceptable in a large classroom.
Human nature also dictates that what the child does not do well, he would rather not do.
Therefore, he will look for things which he can do well and these, also, might be socially
unacceptable in the classroom.
The answer does
not lie in stricter discipline and regimentation of these children, but rather in
making a stronger attempt to detect and correct the underlying visual problems
with the proper lenses and/or vision therapy.
For the reasons stated above, some
children with undetected vision problems are inaccurately diagnosed as having ADD
(attention deficit disorder) or ADHD (attention deficit hyperactivity disorder.
In the last decade, the diagnoses of add (attention deficit disorder) or ADD-ADHD
(attention deficit hyperactivity disorder) have become very popular (some would
say epidemic). Before labeling a child as having add (attention deficit disorder)
or ADD-ADHD (attention deficit hyperactivity disorder), it would be wise to
evaluate them for developmental problems such as problems with visual
development, motor development and/or auditory development.
A. This is a
question which has generated a great deal of controversy. There are some
"authorities" who have claimed that cross dominancy is the leading cause of all
reading failures. There are still other "authorities" who claim that there is
zero relationship between cross dominancy and reading failures. This controversy,
however, has had the beneficial effect of pointing out the relationship of visual
skills to academic success.
A large part of the controversy has been created by a
failure to define terms, especially what is meant by the dominant eye. Various
tests have been designed to determine the so-called "dominant" eye. Many of these
tests merely determine which is the dominant eye for "sighting." The dominant eye
for sighting may or may not be the same eye which is dominant during the process
or reading. It is even less likely to be the same eye if the sighting tests are
done at a distant object rather than an object located at the reading distance
and position of the particular child.
Most of the studies that I have read show
that a larger proportion of cross dominant children exist in a population of
under-achieving children than in a normal population. I feel, however, that a
mistake has been made in drawing a cause-effect conclusion from this information.
It has been assumed by many that the cross dominancy was the cause of the reading
problem. It is felt by most authorities in optometry today that the cross
dominancy is not the cause of the reading problem but, rather, just another
symptom of the neurological disorganization which is at the root of the reading
problem.
It has been my observation that most children who are cross dominant
display a right to left visual direction pattern. It is this directionality
problem which, I feel, has the more direct relationship to the reading problem.
Therefore, vision therapy, which is directed towards establishment of a firmly
established left to right direction pattern will produce more positive results in
a shorter length of time.
A. The answer to that question is "frequently, yes," but whether or not a
child will grow out of perceptual-motor problems must be related to the
environmental demands on and opportunities open to the child.
Most of the
perceptual-motor skills which are prerequisite for academic success are skills
which are developmental in nature. In other words, they are learned skills. Since
children learn at different rates, it can be assumed that these skills will be
mastered at different chronological ages.
The problem to the child is created by
the culturally imposed task of being required to learn to read at a definite
chronological age. Some children are ready to learn to read at this age and other
are not.
The child who has not developed the necessary perceptual motor skills
may eventually develop these skills if left to his own devices. However, at the
time he develops the skills, he might be hopelessly behind the rest of his class.
It is also possible that he may never be exposed to the cultural experiences
which would lead to the natural development of the perceptual-motor skills in
question, in which case, unless he received therapy to develop these skills, he
has no way of growing out of the problem. In addition, he might develop such
negative attitudes towards education, based on his personal failures, that his
natural desire to learn might be nullified.
It is the goal of optometric vision
therapy to provide the child with these necessary perceptual-motor skills at the
time he most needs them so that he will be able to meet the demands of the
culture at the time that they are imposed on him.
Don't hesitate to contact Dr. Getz!
Phone: (818) 344-EYES
He will gladly respond to your inquiry via email or phone.
E-mail: dongetz@pacbell.net
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