Vision therapy—good/bad/necessary/do at home?

[Garga]

Not sure where to post this, but am starting here.

I have a strong feeling that my ds15 has some vision tracking problems.  I didn’t think so until last week when he said that when he reads, words sometimes disappear from in front of him.

Thinking back, whenever we did read alouds when he was younger, he was constantly skipping lines.  He doesn’t enjoy reading and says it makes him sleepy.  I didn’t realize that the sleepy part could be related to vision tracking issues until I googled it just now.  And I didn’t take much notice of the skipping lines at the time.  It wasn’t until he said last week that words disappear off the page that I realized something might be wrong.

I’m going to look into getting him an eye exam for tracking issues (he has a regular exam every year or two).  I’m not sure if anyone is doing those exams and vision therapy right now what with Covid being around.

And even if they are...what does VT involve?  Is it something that can be done at home?  I dimly remember reading some threads about it and people saying their kids hated it and they (the parents) didn’t think much of it.  

What do you guys think of vision therapy?  Absolutely necessary and a life saver?  Something that can be done at home? A racket? Somewhere in the middle?

I wouldn't think twice about taking him for VT (if he needs it) if there wasn’t the pandemic going on. I don’t really want my son to have to be in a small room with someone right now, if that’s how VT is even done. 

@PeterPan (I think you’ve posted about this in the past and might have insight, so I’d love to hear what you think.)

Edited May 25, 2020 by Garga

[klmama]

A friend's dd did it and made huge progress.  Hated it, though.

[2_girls_mommy]

It was a miracle worker here for my kid with dyslexic symptoms. When I read a book on different types of dyslexia and the typical treatments for each, the chapter that fit her symptoms the most was the one saying try vision therapy. 

We did it at a center that had her work with a special ed teacher as well. So we got the therapy in the center once a week with exercises to do at home each week, plus some guidance on way s to work with her on spelling, reading comprehension, even math facts, etc. 

In only four months time of therapy my DD quit letter reversals, stopped having headaches and getting sleepy while reading. Her spelling has improved a lot, but will never be fantastic. But the word reversals (saw for was,etc.) stopped. And just learning different methods for working on it helped us when traditional methods were all I knew before. Phonics didn't work for spelling. 

And my DD was 11, when we went. So she actually really enjoyed vision therapy. She liked the one on one attention, and worked with me fine at home too. I've heard of people saying their kids hated it, but they were younger than her. 

Edited May 25, 2020 by 2_girls_mommy

[EKS]

Both of my kids did VT.  Both had good results.  It won't fix everything--and if your provider tells you it will, run far away.  But it will fix things like convergence problems and tracking issues.

The downside--it's expensive, it can take many months, and there is homework that you must do every day.  With a young child, this is pretty straightforward--you simply make it part of their routine.  But with a teen, you're going to need their buy in.

[PeterPan]

Well I don't even know if our optometrists are open yet. Yes, my dd did VT years ago. Ironically, I've had my ds with dyslexia checked thoroughly and he does *not* need VT, which goes back to the point that dyslexia is phonological processing, not a vision problem. 

So what I would do in your situation is get the exam done by the doc you'd want for VT (developmental optometrist, whomever you can find) and just see what they say. It *does* sound like he has some vision issues going on. I know our office was working hard to find safe ways to do testing, and I'm sure as offices reopen they're figuring it out. So I would start with the exam, see what that finds. At our place there's a regular exam (the annual gig) where they can screen, and then there's a full multi hour developmental vision exam. I would just start with the regular exam and the screening and let them see if the longer eval is warranted.

The other thing you could do that won't hurt and might help is to research retained reflexes and do exercises to integrate any reflexes that are retained. Sometimes the visual reflexes and vision functions don't develop properly because the earlier steps with neonatal and vestibular reflexes weren't done. So when people are saying they did OT for their vision, that's what they mean. And when you're asking what you can do without going to an optometrist that *might* help if those issues are there, that's something that will help. In fact, if the optometrist is worth their salt, they're going to screen for retained reflexes. 

Odds are the reason my ds doesn't have developmental vision issues (except for poor VMI, which we're working on) is because we did TONS of work on retained reflexes and got quite a bit of OT. I can't say that for sure, just saying it's what I've assumed, given how messed up his sister's eyes were. 

And yes, working on the vision issues can be life altering. My dd was a pain in the butt during it, but her sensory is crazy hyper responsive. She was having pain and headaches and for her it was excruciating. We didn't understand sensory issues to realize. But this is a dc who literally gets morphine in an emergency room for pain I can't even feel. We had the same thing happen, and she ended up in the ER getting morphine and I vomited and couldn't tell why. She's exquisitely sensitive. That's not VT but her, kwim? Most kids are going to find it fatiguing because it's work so they'll appreciate a reduced load. If you do it over the summer, you should be done by fall. Also, odds are the VT docs are working on ways to do therapy by tele or by assigning more homework. You'll figure it out. That's why I would just start with the eval and see what they find.

[Terabith]

We did it faithfully, had absolutely no progress; my kid developed full fledged PTSD, and when I told the optometrist we were going to stop, he said she'd wind up incarcerated because kids with her profile became juvenile delinquents.  But....I think our experience was not typical, and I think a more optimal course of therapy might have really benefitted my kid.  Not sure it would have, because her issue was not convergence insufficiency.  She was just crunchy in a pretty much every way.  But we were also trying to do it long distance.  

No point in doing it with a teen unless there's buy in, but it definitely sounds like he has issues that might be benefit from it.  

[Arcadia]

If your son is willing, he could try the exercises on this pdf https://www.choc.org/wp/wp-content/uploads/2016/05/Concussion_Visual_Exercises_CHOC.pdf

My DS14 ‘s tracking issues was mild and he was younger too. He did some of those exercises at home. Helped him to eventually read faster things like billboard posters, food court menus.

[kristin0713]

We had amazing success with vision therapy for my DS who is now 12.  Started last summer when he was 11.5 and with hard work, going twice a week all summer and doing the exercises several times a week at home, he was done in about 6 months.  He had two or three significant issues with convergence and tracking.  I could see the difference myself between his initial and final evaluations.  My only regret is not doing it sooner.  He is a brilliant kid, but spent years avoiding reading, and I always felt like he was being lazy and not trying hard enough.  

[kbutton]

If you find it's only convergence issues, there are computerized courses of VT you can do. A lot of COVDs won't touch them with a ten foot pole because it's hard to get compliance, and it's not necessarily individualized, BUT there are some people that find them effective. IMO, they should evaluate at least some reflexes--Moro seems to be the lynchpin for a lot of vision issues. Our COVD found that if they could make big progress on Moro, the others would integrate along with the bodywork in VT. You can test at home too. A good test for Moro is to see what your kid does with his hands as he tries to walk toes pointed in (pigeon) or pointed out (duck) across the room. Don't say what you're watching for. If he's not holding his hands and arms naturally and in relaxed way, there is probably some degree of Moro going on. The worse it is, the more the hands will try to do what the feet are doing, though the hands might not be open and flat like feet are. You'll likely see hands potentially curling up tightly, and/or arms bowing out with hands fisted up.

As far as older kids go, a friend whose daughter has a lot going on (ASD, ADHD, lower IQ, etc.) found out that one of her daughter's major barriers to driving is visual issues--no depth perception. She's had prism eyeglasses for a long time, but no one had offered VT. It's not the only driving issues, but it's a major one. So, it's not just reading--there could be other lifeskills that are harder as well. My mother and MIL both have convergence issues, and both have visual processing deficits, though my mom's are less pronounced. In her case, she also has mixed dominance as a result (hand/eye are not the same right/left preference), and she is nearly ambidextrous. Certain things bug her a lot, such as scrolling screens on Facebook. 

VT was life-changing in our house. Both of my kids had very short courses of VT (I think about 11 weeks or something like that)--they didn't have the whole laundry list of issues, so many of the exercises were done briefly to be "sure" nothing was up in those areas (for instance, the light box stuff for peripheral vision was a hoot when my older DS did it--his peripheral vision is astounding). 

Older DS--His initial screening or two suggested he was borderline for convergence issues, and we did watchful waiting. As text got smaller and more crowded on the page as he aged, he fell apart to the point the the COVD optometrist commented that she couldn't believe he'd been able to see well enough to read at any point. He just required significant fatigue to show enough symptoms. His issues were convergence insufficiency that showed up as strabismus; bilateral coordination problems; no direct evidence of retained reflexes (no Moro). His ability to participate in backyard sports change drastically. Turns out he was losing sight of things as they came close to his face--his binocular vision would stop up close, and he'd see things with kind of a strobe effect. He also had a Nemo fin while swimming (if he concentrated, he could make big movement, and the Nemo fin would move to the other side of his body, lol!). The bodywork he did for VT fixed all of those things.

Younger DS--He also compensated well for his issues, but because he had such horrible symptoms, the COVD tried tiring him out too. His visual processing deteriorated. He never did have strong convergence issues, but he had a lot of processing quirks. He couldn't separate hand and eye movements, which is a big retained reflex problem. When he'd look at a different part of the paper to do copywork, his hand would move with his eyes, and he'd lose his place. If he had to move his hands, his eyes would go with them, and he'd lose his place. Anyway, he had major Moro issues and other retained reflexes which caused processing issues. His accommodation was not fantastic, but it's not bad enough for bifocals. We found out later that his accommodation will never be stellar because the zonules in his eyes that focus his eye lens and hold it in place are hypermobile (Marfan Syndrome, but no lens displacement at this point). Anyway, he got a lot of reflex work and visual processing work that helped a great deal. His reflexes integrated enough that he could exhibit signs of sensory issues--the retained reflexes were so bad that he was just not activating certain muscle groups and developing postural reflexes. Those will never be perfect either due to hypermobility, but they are a lot better. And very weird bonus: he was able to hear better in background noise for the first time after doing the reflex work for VT. He had been functionally deaf in noisy environments up to that point.