Some "learning disabilities" may actually be vision problems

From the LA Daily News. In the picture, Dr. Lori S. Nishida-Eugenio works with 8-year-old patient Jenna Robins while using a 3D vectogram.

You're making a lot of mistakes at work. You feel clumsy. You have trouble copying notes from a blackboard. You read slowly, and sometimes see double. But at your regular eye exam, the optometrist says you have 20/20 vision.

What gives?

You might suffer from a visual efficiency problem such as poor depth perception, lax eye coordination or focusing difficulties, which won't show up on a traditional eye exam.

And you may be able to overcome these issues with vision therapy, a little- known treatment program that incorporates exercises and specialized devices to improve eye problems unsolved by eyeglasses or contact lenses alone.

"We're retraining the brain on how to use the eyes," said Dr. Lori Nishida-
Eugenio, an optometrist at the Burbank Optometric Center.

Like physical therapists for the eyes, practitioners tailor each therapy program to the individual patient. They may use corrective lenses - such as glasses or contact lenses - but they also employ specialized equipment such as balance boards, prisms, eye patches and electronic targets with timing mechanisms.

Standing on a balance board, for example, may teach patients to engage both their left and right sides, improving the left-to-right directional eye movements used in reading. Prism glasses appear to shift the location of objects and force patients to overcome the visual distortion.

Patching a strong eye helps correct amblyopia, commonly known as lazy eye, by forcing patients to use their weak eye. And a metronome can help patients modulate their reading speed, slowing down, for example, patients who make too many mistakes at their normal pace.

Sometimes, people find they can give up their glasses or contact lenses after vision therapy corrects the underlying problem, although vision therapy is not primarily a cure for near- or farsightedness, said Dr. Stephen Chase, a Torrance-based optometrist.

Most vision therapy patients are children, many of whom have been diagnosed with learning disabilities or special needs. Because of undetected vision problems, these children perform poorly in school, making simple tasks such as reading or copying notes from the blackboard uncomfortable.

About 15 percent to 20 percent of the school-age population has a visual efficiency problem, according to the American Optometric Association.

"These kids are often mislabeled as lazy or inattentive or causing trouble because they're chatting with their neighbor, because it doesn't feel good. They're trying so hard, and yet they're being told they're not trying hard enough," Nishida-Eugenio said.

But many adults have undiagnosed vision problems, too, and for them, vision therapy could be a life changer, some optometrists say.

"I've seen such amazing changes in people who have gone through therapy," Nishida-Eugenio said.

Despite its champions, vision therapy remains on the fringes of optometry, and many ophthalmologists - medical doctors who specialize in eye care - remain dubious.

Ophthalmologists generally agree that vision therapy can improve amblyopia and convergence insufficiency, in which the eyes have trouble changing focus from distance to near. A 2008 Mayo Clinic study found that children with convergence insufficiency improved faster with office-based vision therapy compared to at-home exercises or no treatment.

"Beyond that, I would be skeptical," said Dr. Leif Hertzog, an ophthalmologist at Hertzog Eye Associates in Long Beach.

Hertzog said he's seen patients with other conditions spend money on vision therapy to no avail.

"The reason is, there's no science behind it," he said.

Ivory Wilderman, however, swears by vision therapy. When her son was in elementary school, his teacher told her that if his reading comprehension skills did not improve, he would need to repeat the second grade. Wilderman was shocked.

"When I would read to him and ask him questions myself, he was always between 90 and 100 percent in comprehension," the Hawthorne resident said.

Thinking that her son might have poor eyesight, Wilderman took him to Chase. There, she discovered that her son's eyes did not track well together, making the words appear to move on the page.

To help his eyes learn to work as a team, her son stared at colored beads held at varying lengths, shifting his gaze from near to far.

After vision therapy, Wilderman's son was reading just fine.

"It was really, really remarkable, and he has not had any problems with reading ever again," she said.