By Dr. Tanya Mahaphon, OD, FCOVD, FAAO © Copyright 2008.

Developmental Optometry Has Helped Kids With

• Amblyopia (lazy eye)

• Accommodative disorders (inability to keep eyes focused at distance or near)

• Anxiety

• Arithmetic difficulties

• Attention Deficit Disorder (ADD)

• Attention Deficit Hyperactive Disorder (ADHD)

• Autism

• Balance problems

• Behavior problems

• Brain damage

• Cerebral palsy

• Chronic fatigue syndrome

• Conduct disorder problems

• Convergence insufficiency (inability to cross eyes for near-work)

• Convergence excess (over crossing of the eyes)

• Coordination

• Depression

• Developmental retardation

• Developmental delays

• Difficulty with rhythm and sequencing

• Digestion problems

• Down’s Syndrome

• Dyslexia/letter reversals/left-right confusion

• Fetal alcohol syndrome

• Handwriting

• Hyperactivity

• Headaches

• Learning differences

• Learning disabilities

• Rage

• Reading difficulties

• Spatial disorganization

• Speech problems

• Short term memory deficiency

• Strabismus (eye turns in or out)

• Stress

Developmental Optometry Can Help In The Following Areas

Spirit: A child's spirit is healed when vision is improved. The child learns that he/she is not stupid or lazy, but that their vision was holding them back from achieving success in school, with reading and math, and in sports.

Body: Body awareness and being able to overcome gravity to stand upright is the foundation for visual and spatial awareness. Developmental optometry enhances a child's coordination by using visually-guided motor activities, reinforces a child's midline and bilateral integration of the body and eyes, then develops the ability to cross midline efficiently and effectively. The child develops a more grounded self and can start to explore visually rather than through tactile senses.

Mind: A picture is worth a thousand words. A child's mind that learned to utilize vision can learn non-phonetic spelling of words through visual memory, rather than using spelling rules and verbal/auditory memory. Higher levels of visual processing include the ability to create visual pictures in the minds eye; such as seeing a movie play in your mind while reading words in a book, which is important for reading comprehension.

Emotions: A child's emotions become more stable through vision therapy. Vision therapy teaches a child to become more flexible and how to adapt to new and different situations. For example: Prism therapy with bean bag toss. The prism alters the child's perception of objects by physically bending light. The child learns how to adapt to this new visual situation and compensate in order to throw the bean bag into the bucket.

Brief Description Of Developmental Optometry

• Developmental optometry is the practice of using lenses, prisms, and/or visually-guided motor activities to enhance visual performance.

• The main goals of developmental optometry are to achieve “single, clear, comfortable binocular (two-eyed) vision” and to develop visual-spatial, visual analysis, and visual-integration skills.

• Vision therapy is a medically supervised program that can treat conditions such as amblyopia (lazy eye), strabismus (turned or crossed eyes), poor eye movements needed in tracking or reading a book, visual spatial skills (such as left/right confusion and letter reversals), visual analysis skills (such as visual memory, visual figure/ground, visual form constancy), visual integration skills (such as visual-motor integration/eye-hand coordination, visual-verbal integration/rapid naming, and visual-auditory integration/seeing and hearing match.

Success With Developmental Optometry

• An 8 year old developmentally delayed young girl had tested mildly mentally retarded at a full scale IQ 70, and learning disabled with performance two grades below. After receiving 30 sessions of vision therapy she still tested borderline full scale IQ of 80, but her academic achievement was on grade level and above her potential IQ!

• A 7 year old boy in second grade with possible attention deficit was struggling with school. He had 20 sessions of vision therapy and has become more focused in school with improved grades, and he has more hits in little league baseball.

• A 13 year old girl with headaches and double vision in school was diagnosed with convergence insufficiency (inability to cross the eyes for reading). After 20 sessions of vision therapy, her headaches and double vision were eliminated and her reading and school grades improved as well.

Children & Youth Reactions To Developmental Optometry

• Most children respond positively to developmental optometry since many of the therapy sessions involve visual-motor activities; such as throwing and catching balls, building blocks, and/or three dimensional pictures. An experienced developmental optometrist with trained vision therapists will know how to create situations that are challenging and achievable by the child, which will then foster self-esteem and increased motivation to succeed.

• Depending on the therapist or doctor, most children enjoy vision therapy and react to vision therapy as if they were playing games at school.

• Many of the vision therapy activities are similar to visual processing games; such as Hidden Pictures, Mazes, Concentration, Bean Bag Toss, Trampoline, and Balance Beam.

• Other vision therapy activities involve crossing and uncrossing the eyes, three dimensional pictures, and eye focusing exercises and patching. These activities may cause some discomfort to children in the beginning as the visual-motor-neurological strength of the eyes improve, which is similar to weight training for the eyes.

Basic Concepts And Components Of Developmental Optometry

• Vision is a learned process, which begins at birth and continues into adulthood. Vision is being able to receive visual information through the eyes, process the information in the brain, and then output or integrate the information using another motor response such as verbal communication, handwriting or catching/kicking a ball.

• The Developmental Model of Vision is Skeffington’s Four Circles:

• Antigravity - the ability of the body to develop into an upright/vertical position and gain balance

• Centering - the ability for a person to locate where he/she is located in space, through the use of the eyes and body; i.e., Where am I?

• Identification – the ability to analyze information through the eyes and senses; i.e., What is it?

• Speech-Language aspect - the ability to communicate what a person sees

• Most developmental optometrists will integrate visually guided gross motor/body exercises to develop a foundation for the higher level visual processing skills.

• Many vision therapy activities include sensory-integration techniques such as auditory stimuli of a metronome, balance with a trampoline or balance board.

Description of a Typical Session

• A child or youth will perform 3 to 5 different visual tasks in each session. An example would be a child will perform Angels in the Snow while lying on her/his back for body awareness, bilateral integration, and midline development.

• The child or youth will then follow a Marsden/swinging ball with letters for smooth eye tracking and crossing midline.

• The child or youth will then clear letters using lenses of different powers, similar to eyeglass lenses.

• The child or youth will look at three-dimensional pictures and learn how to cross and uncross their eyes.

Major Differences Of Opinion Between Practitioners

Some optometrists that practice vision therapy are not Developmental Optometrists. These optometrists have an eye muscle approach and will train the eyes to focus (accommodate) and to cross/uncross (vergence) without the visually-guided gross motor activities. This sort of vision therapy is also effective; however, may not have as lasting effect as a developmental approach, which works on a strong eyes-mind-body approach.

Suggestions To Make Developmental Optometry More Effective

• Parents need to be consistent with having the child attend the vision therapy sessions regularly.

• Ensure the home vision exercises are performed as directed by your doctor.

Other Methods That Complement Developmental Optometry

• Physical therapy for low or high muscle tones and to improve gross motor or core foundation of the body

• Occupational therapy for fine muscle control of the fingers for eye-hand coordination

• Speech/language therapy to help integrate visual-verbal integration

• Auditory therapy to help with rhythm, timing, and sequencing

• Any physical activity that works on bilateral coordination such as karate, tae kwon do, yoga, and swimming

• I highly recommend that parents who have had children in multiple therapies focus on vision therapy first and then add any additional therapies when vision is improved. A significant improvement in all aspects of life will be seen after vision therapy, such as improvement with speech-language, body coordination for sports, dance, and karate, improved eye movements so that reading remediation/tutoring will be more effective.

Research Papers

• Pediatric Eye Disease Investigator Group. “A Randomized Pilot Study of Near Activities versus Non-near Activities During Patching Therapy for Amblyopia.” (ATS6) JAAPOS 9, no 2 (2005): 129-36.

• Granet DB, Gomi CF, Ventura R, Miller-Scholte A. “The Relationship between Convergence Insufficiency and ADHD.” Strabismus 13, no 4 (2005): 163-8.

• Scheiman M, Mitchell GL, Cotter S, et al. “A randomized clinical trial of treatments for convergence insufficiency in children.” Arch Ophthalmol 123 (2005): 14-24.

• Maples WC. “Visual factors that significantly impact academic performance.” Optometry 74, no 1 (2003): 35-49.

Bibliography

The following books may be obtained directly from the Optometric Extension Program (OEP).

• Getman, G.N. How to Develop Your Child’s Intelligence. Santa Ana, CA: OEP/VisionExtension, Inc.

• Getman, G.N. Smart in Everything… Except School. Santa Ana, CA: OEP/VisionExtension, Inc.

• Bing, Lois, and George D. Spache and Lillian Hinds. Vision and School Success. Santa Ana, CA: OEP/VisionExtension, Inc.

• Cook, David. When Your Child Struggles The Myths of 20/20 Vision: What Every Parent Needs To Know. Marietta, GA: Cook Vision Therapy Centers, 1992.

• Richmond, Hazel and Dawkins. Suddenly Successful: How Behavioral Optometry Helps You Overcome Learning, Health and Behavior Problems. Santa Ana, CA: OEP/VisionExtension, Inc., 1990.