for sticky: resources for vision and visual processing: how it shows up in reading & writing

[prairiewindmomma]

What it looked like in my student: When we began this journey with my student, they were tested as having 20/20 vision.  They had difficulties drawing simple shapes.  They had difficulties forming letters, and would either crowd the page with writing or spaced things oddly on the page. They often tilted their head or rubbed their eyes when reading.  They were clumsy, and began to have behavior issues during school time. When we finally did functional vision testing, we learned that our student was seeing in full double vision and could not track a moving object.  Every time they looked up to watch me instruct on the white board and then down on their paper, they lost track of things. Likewise, they could not read from line to line in a book. They also could not track an object in motion (which is why they were taking so many soccer balls to the face).

 

Resources for functional vision issues:

1. tests that can sort out if your student is dealing with functional vision issues:

a. Beery Visual Motor Integration (usually just called a Beery, or a Beery VMI)

b. TVPS: Test of Visual Perception Skills

c. DEM: Developmental Eye Movement Test

d. Jordan Left-Right Reversal Test

 

2. a list of COVD doctors to find one who can do vision development testing: https://www.covd.org

3. What is vision therapy? 

https://aapos.org/glossary/vision-therapy

video that shows some of the vision therapy activities: 

 

 

Note that there is some controversy regarding vision therapy.  While it has been proven to be very helpful for convergence insufficiency, there is limited evidence that it is helpful when the underlying problem is a learning difference. (In other words, if your child is dyslexic with no functional vision issues, a child's reading ability isn't going to improve by undergoing vision therapy.) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777217/  In my student's situation, the student was seen by a pediatric ophthalmologist first. We were offered surgery or a referral to therapy.  We chose to do therapy first (and would have done surgery had it failed) but had very good results from therapy. 

4. Resources we used along the way:

a. Developing the Early Learner: https://www.rainbowresource.com/developing-the-early-learner  These books have fantastic pages on developing visual tracking, sorting between visually similar letters or words, copying simple shapes, etc. I cannot recommend these inexpensive workbooks highly enough.  If your young student struggles with these pages, be aware. This may be a warning sign that further testing is needed.

b. Bal-A-Vis-X: basically, you bounce a ball to work on body-brain integration.  I thought this was incredibly stupid and would be unhelpful and didn't really stick to it.  Then my kid went to vision therapy, did the work consistently in therapy, and improved. In ye olden days, this program was an inexpensive workbook. It has now become highly commercialized and expensive. Occasionally it pops up used on amazon like this copy: https://www.amazon.com/Bal-Vis-X-eXercises-Brain-Body-Integration/dp/0990848809/ref=sr_1_1?crid=1DIQ68I9XACIT&dib=eyJ2IjoiMSJ9.m1mUp3hxLYK5L_zUSFTDACrMnxbeGzynxl613IIKeGEB9d-bfa5jsyaDyeEGUNmeIlxRAUk0GODVNJbe-1T8_A.fPDGieOlWmSJwicdQ-WF85YoEASYSWDQXyG95naupEU&dib_tag=se&keywords=bal+a+vis+x+book&qid=1708967892&sprefix=bal+a+vis+x+book%2Caps%2C235&sr=8-1  An inexpensive playground ball or basketball from StuffMart is a good inexpensive way to start. You can work your way down to smaller balls to increase difficulty, but just doing cross hemispheric work should do enough to help rewire the brain/eye motor pathway.

c. Developing Your Child for Success by Kenneth A. Lane, https://www.amazon.com/Developing-Your-Child-Success-Kenneth/dp/1878145002/ref=sr_1_1?crid=3IQLEEJLA8PB&dib=eyJ2IjoiMSJ9.wLx_3bSX299BUhZq1GqPZK7z1NlTmce7WjHcnjNg5KNMLsX0zH6SrHqOZIl_irgkkHM42J7L_vth4t0KzSKwY9NTHVDjWy4DjLP_LeAGty60g0RTr6WHqPnPo5-4XxJwfBHA0hw0w4_X9NS7rN6Fkv4e6_a771FWD4PXsfj-M3iHZt4tTjIuLezm6wyEPkjNOf7WoqBCm2aNgFAEBn2lrPM0H3b1NxsdRiCKJ-DHX_Q.ZeIJWouc0WvulvuAZB_H4YCBnJHyJX5EGkq6tZu3j4c&dib_tag=se&keywords=developing+your+child+for+success&qid=1708968341&sprefix=developing+your+child+%2Caps%2C230&sr=8-1 (look for this used--it should be $10-20)

This was literally the workbook that my COVD doctor used in therapy.  I highly recommend doing the testing. I highly recommend being overseen by a COVD or ped opthamologist to coordinate therapy. I also acknowedge that often vision therapy is private pay and out of the reach of many families. Note, if you do buy this book, be sure to photocopy pages 205, 209, 213 and other worksheets or put those pages into page protectors and use a wet or dry erase marker to be able to reuse them with your student. 

d. Developing Ocular Motor and Visual Perception Skills by Kenneth Lane: this is a shinier, newer, more filled out version of the above book. The activities are more varied and complex, and if you can only afford one book for older students, this would be the one I would get. https://www.amazon.com/Developing-Ocular-Visual-Perceptual-Skills/dp/1556425953/ref=sr_1_1?crid=1T1DB8O3OKJ5&dib=eyJ2IjoiMSJ9.Mp8DjA_9ROvtl3LXAzRwRA1kS0UPM3tBeHntWRQvQjgAJisw3rTvpYfN7N12Nc7biBvTjVrgKYxjWbwf-N_bPabC2p9prbjhCuZNCqYJsVP6rWEPD5R1rE-WYmCaJ5pw.c4JYOjY11L-QocRS7HcYq06k83jg0LL0CTl_-jfiQuk&dib_tag=se&keywords=developing+ocular+motor+and+visual+perceptual+skills&qid=1708968679&sprefix=developingocular+motor+and+%2Caps%2C258&sr=8-1  You can largely get by with the kindle version, but I prefer the paperback version because of some of the included worksheets that would be difficult to replicate. Again, this was another book our vision therapists have had access to over the years (we did therapy in a couple of different states due to moves.)

e. reading strip highlighting bookmarks: https://www.amazon.com/dp/B09HH3XKLV/ref=sspa_dk_detail_6?psc=1&pd_rd_i=B09HH3XKLV&pd_rd_w=BwS2B&content-id=amzn1.sym.386c274b-4bfe-4421-9052-a1a56db557ab&pf_rd_p=386c274b-4bfe-4421-9052-a1a56db557ab&pf_rd_r=KN0ZJH38S84MHTQ89K8X&pd_rd_wg=xDSZg&pd_rd_r=02b74dea-24b0-4efa-a162-fc4d6d307924&s=office-products&sp_csd=d2lkZ2V0TmFtZT1zcF9kZXRhaWxfdGhlbWF0aWM  Long story short, yellow filters activate the magnocellular visual pathway.  Longer story from an academic journal: https://www.dpag.ox.ac.uk/publications/238347

f. Marsden ball you can buy: https://www.accuspire.com/prime-performance-marsden-ball/?sku=108100&gad_source=1&gclid=EAIaIQobChMI-vzZ9sXJhAMVaAutBh1gswUaEAQYAyABEgId5PD_BwE  If you make your own, you want something softball sized, but attaching the string is a PITA and so is getting the letters to stay stuck on.  Other tools are more easily made for therapy activities, but this one is better purchased.

Edited February 26 by prairiewindmomma

[kbutton]

Covd.org has providers

Customized therapy that includes body work and work on retained reflexes (if present) seems to be gold-standard.

Mine with strabismus/convergence issues had trouble catching a ball. It would get close, and then he’d kind of duck and turn his head. He also batted left-handed even though he is right-handed. Mixed dominance is common—I have an adult relative with convergence issues (mild), and she had mixed eye/hand dominance when doing shooting sports and bats/golfs left handed even though she writes, eats, etc. right handed. She doesn’t like scrolling much on the internet. She has to take it slowly.

My incomplete visual development kid was more about the processing. He had major Moro issues and the neck reflexes too. He did lots of body work, and it helped. He also did lots of visual puzzles, which helped.

Kids with some kinds of connective tissue disorders can be more likely to have convergence issues.

If they have Marfan Syndrome, they can have trouble changing between near and distance vision because the zonules that hold the eye lens get stretched. Lenses can dislocate entirely. Dislocated lenses pretty much mean either Marfan Syndrome or one other syndrome, and it’s absolutely imperative to refer to a cardiac geneticist asap. 

 

[Wishes]

@prairiewindmomma and @kbutton You both have been so helpful with information. I feel like our kids must be similar. Just took my son to a Vision clinic and he was assessed with convergence issues as well as a (very slight) exotropia. They, of course, recommend therapy. I have been trying to find out more about it and read this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777217/

It seems like my son would be helped with the convergence issues. My daughter has a more extreme exotropia - very noticeable, and I was thinking about having her assessed, but it looks like research supporting vision therapy as helpful is slim. She already sees a opthamologist who has recommended waiting to see if surgery is needed (it has worsened over the last year). I found another article that seemed positive. https://www.journalofoptometry.org/en-vision-therapy-for-intermittent-exotropia-articulo-S1888429620300819 I would like more research articles if you know of them. I have bookmarked the sources you wrote about @prairiewindmomma. I will admit, two kids having vision therapy once a week for a possible two years (as per doctor's thoughts - but not set in stone) would be extremely expensive. Were the results significant enough to warrant therapy?

[prairiewindmomma]

I agree with the first link you posted, and it matches my experience.  If I were to add more to that opinion, it's that I think that pencil pushups and computer exercises (which we tried first) are insufficient and can often delay access to quality vision therapy that actually helps. My pediatrician and our first ophthalmologist were both not really qualified to understand the issues or what vision therapy is---going to a pediatric ophthalmologist who was qualified finally got us hooked up to a COVD who was qualified to do the therapy work.

My ds also had mild exotropia that did resolve with therapy--but more extreme exotropia would have me leaning towards surgery.  It really depends on severity and how it's affecting the kid.  My dh has exotropia when he is tired or about to be sick---it's not a big enough of an issue to address. He just knows he needs to go to bed. 😉 

Our insurance did not cover vision therapy.  We stretched sessions out the first time by putting a lot of homework time in between.  I'd try to find someone who will give you homework, or use the books I listed above to work on things at home (bal-a-vis-x is what I would recommend you start with, fwiw--you do the brain integration work while they work on saccades or other things that require specialized equipment).

[prairiewindmomma]

@Wishes, if I were to offer you some encouragement---at 6 I thought my kid had a lot more labels than he actually did.  A lot of his "attention issues" actually stemmed from him not being able to see well and feeling posturally unstable as a result.  He had to keep moving around in order to know where his body was in space, and he was constantly repositioning his head/eyes to try to get an image to resolve.

There's some pretty strong anecdotal evidence between functional vision issues and subitization issues. You may find some stuff resolves a bit.  My kid still struggles with math, but it's not nearly what it was before we resolved the vision stuff. 

If I were to add another thing to your windshield of stuff to be looking at, it'd be primitive reflexes.  I thought PeterPan was a bit nuts when she brought it up a long time ago, but decided to take a leap of faith--if it worked, great, I'm ok with a placebo pill, iykwim....and if it didn't work, then I was out nothing but a bit of time. Uh, yeah, so I was greatly humbled on that one and I bow to PeterPan and her awesomeness.  Do a bit of a search on YouTube about integrating primitive reflexes, take a leap of faith, and see what happens with your kid. Look specifically at ATNR, STNR, and TLR for sure.

[kbutton]

@PeterPan might have articles, @Wishes. I knew several people who did VT before us, so I was trusting.

Since then, I’ve been in to a seminar about vision issues with a mainstream ophthalmologists who said the evidence for convergence issues is good.