What about Vision Therapy?

A colleague wrote in a few days ago and she raised a topic that I thought might be of interest to others. She gave me permission to post part of her message here:

I have been doing LOTS of research on struggling readers and have found some instresting information on vision therapy. Rod Everson from Wisconsin (Ontrackreading.com)says that 80% of his reading students improve in their reading after developmental vision therapy. Have you ever heard of this or had any experience with vision therapy? I wonder if this third grader might be having some sort of vision problem..... I am looking at any possiblities to help her and her mom.

My strongest feeling is that she is lanugage deprived, (like I wrote to you in earlier posts). But I also wonder if a vision problem may be affecting her fluency. When I was working with her she could read 1st grade material at 80 -90 wpm, but at 2 and 3rd grade she struggled continually between 50 - 70 words per minute. I wonder if this might be related to a visual problem.

I worked with her intensly on phonics and syllable separation strategies so she could decode longer words. She picked up on that information quickly. She also had a strong grasp on the phonics rules (not sure about now).

In conclusion, I still think two things for sure are at play - 1) language, vocabulary, 2) practice practice practice... but am really wondering about this vision thing. Any insights????

Hmmm. Vision therapy has been questioned since the early 1980s (that's when I started teaching and I recall this controversy then) regarding it's effectiveness in the treatment for dyslexia. I did some searching, and found several articles dated in the late 80s and early 90's.

In BC, we went through a period where children with reading problems were put through vision exercises,especially "eye-tracking" in the early 80s. It is still in practice in some environments. It is natural to suspect that there is something wrong with the visual mechanism in the brain if a person struggles with reading- it is obviously a task that requires vision. Way back, the thinking was that dyslexics saw words backwards. So this is actually a re-emergence of this issue as far as I am concerned. (by the way, the best way to improve eyetracking for reading, I think, is to read print more, not to follow a light or red ball on a stick)

In the past 10 years there has been exciting and compelling evidence brought forth that indicates that dyslexia a problem in the language system, based in the processing of the speech sounds and rapidly attaching them to printed symbols.

In my search, I found an article, published in the Journal of Optometric Vision Development, 2004 and it reported a positive but weak relationship between oculomotor vision therapy and reading improvement in people with non-specific reading disability. Non-specific disability means that the subjects in the 11 studies discussed did not have dyslexia, so we need to keep that distinction in mind. The results say that the improvement was about the same as what was achieved with straight reading therapy. There was a slightly better result when the two were done together. The article also mentions that the study samples were small, many had no control groups, and that larger samples would be needed to draw hard conclusions. The 11 studies were collected from 1940-2004.

So- here's what I think. I think vision therapy could well be warranted in kids with dyslexia, if near vision testing indicates problems with vision skills. But then, one would assume that anyone tested with these issues would probably benefit, whether they had a reading problem or not. If dyslexic children don't have any weaknesses as determined by testing, then it would not benefit them to go through it.

What I don't agree with is a blanket assumption that the therapy would benefit all people with reading problems and would produce results in reading. In a position statement on vision therapy, dated 1985, the American Optometric Association affirmed that optometrists don't teach reading- educators do. Optometrists treat vision problems. So if there are diagnosed vision problems, therapy is going to hopefully fix the vision problems. By itself, it will not improve reading. Reading skills still have to be taught explicitly and intensively.

It would be like saying glasses will improve reading in people with reading disability. Well, they will certainly make it easier to see, IF the learner also happens to be far-sighted. As a matter of course, we always start with vision (not just vision acuity, but near vision skills too) and hearing testing in kids with reading problems. If the learner needs glasses, they are advised to get glasses, but we don't put glasses on a learner just because he is struggling to learn to read.

While the article I mentioned makes a distinction between dyslexia and non specific reading disability, the gentleman you mention above doesn't seem to. I do find it interesting, in reading some of his comments about dyslexia, that he believes that dyslexia is an inherited trait (I agree) and that dyslexia manifests itself as a vision skills problem. That finding seems to be at odds with much of the latest research. He does admit that he is not that comfortable talking about dyslexia, and doesn't have it completely figured out yet. While I don't think anyone has it completely figured out, there certainly is compelling evidence that dyslexia is a language based problem, not a visual one.

To summarize- I don't think there is anything wrong with vision therapy if it is warranted. I don't agree with assuming it is warranted in all people with dyslexia, or any other reading problem, and I don't agree that the therapy itself is responsible for reading improvement.


About the third grade learner mentioned in the quote above... it is tempting to question the phonological and language basis of the disability when appropriate treatment doesn't seem to have fixed the problem... but we need to remember that we can't cure dyslexia. The issues with rapidly translating the letters into speech sounds persist into adulthood. With TONS of reading practice we can make huge improvements and make the whole process easier (thus making that volume of practice more palatable)- but the fluency problem, in my opinion is based in the phonological processing and slower conversion of letters into speech sounds.

That's my two cents.