The Visual Process and Self Esteem
One of my very first patients was Amy, a ten year-old girl who wasn’t reading at anywhere near the level everyone expected of her. She had an IQ score that was well above average, but she couldn’t read. Nobody could figure out why. Everything had been tried, special instruction at school, reading tutors, phonics, you name it. Well, almost everything. For five years they tried everything except vision therapy. The pediatrician and the ophthalmologist said she had “20/20 vision” so there couldn’t be anything wrong with her eyes. They were finally referred to my office by a neighbor who had seen great things happen with their child thanks to behavioral optometry and vision therapy. It turned out the other doctors were right…in a way. There was nothing wrong with Amy’s eyes. There was however something very wrong with the way her brain was using her eyes. She had poor tracking skills, poor eye teaming and unstable focusing. It is very unlikely that any doctor other than a behavioral optometrist would even think to consider these issues.
Amy had a very poor self image after all the years of trying to read better and continuing to fail despite everyone’s best efforts, including hers. Many children with visual problems have low self esteem. They often have high IQs but struggle to learn when visual information processing is involved, which is most of the time. These children probably sense that they should be doing better in school than they are, but have no way to understand what is going on.
How can a visual problem cause such difficulty?
Parents are likely to take their children to an ophthalmologist or general optometrist to have their vision tested. These doctors are unlikely to connect the dots since they are only looking at the ability to see clearly. They typically tell parents that since the child can see the blackboard (or smartboard) clearly, there is no vision problem. This is absolutely missing the point. In fact, most of the children I work with can see across the room without any trouble, but they cannot sustain the work they must do to succeed in school. They don’t have an eye problem, but they do have a visual problem.
Seeing clearly across the classroom is the least important aspect of the visual process when it comes to succeeding in school. The truly important visual skills are eye movements - the ability to track a moving target, the ability to shift the eyes from one target to another and the ability to aim the eyes at a particular target for as long as is needed, eye teaming - the ability of the brain to effortlessly and accurately aim the two eyes at the same thing at the same time, and focusing - the ability to keep an image clear at all distances and to shift the focus when looking from something closer to something farther away.
Many, if not most, children with learning and/or developmental challenges have problems with their eye movements, eye teaming and focusing. There may be a problem with only one of these skills, but it is more likely that they are struggling with all of them to varying degrees. Standard eye exams will not uncover these issues and most eye doctors are not even thinking about these issues. That is why some optometrists have come to specialize in what is called Behavioral Optometry. Behavioral optometrists specialize in evaluating and treating deficiencies in eye movements, eye teaming and focusing.
Behavioral optometrists treat these problems.
Vision therapy is a program of activities, designed by behavioral optometrists, to help people change the way their brains use the two eyes. Vision therapy is completely interactive and non-invasive. Vision therapy is about how the doctor, or therapist, arranges conditions and engages the person to use their brain and visual system in new ways that enable them to improve their ability to process visual information.
Lenses can also play an important role in reducing visual difficulty. Proper lenses can make a huge difference in these children's lives. I am not talking about the lenses you or someone you know is probably wearing right now. The lenses most people wear, while referred to as "corrective" lenses, are anything but. They don't correct anything. They simply mask a symptom - the inability to see clearly at some distance - and in most cases these lenses cause an increase in the nearsightedness (or farsightedness or astigmatism) they were prescribed to correct. In reality, the inability to see clearly at a distance (nearsightedness or myopia) is often a symptom of tracking, eye teaming and focusing problems. The lenses most doctors prescribe strictly to get to 20/20 are really just compensating lenses. Compensating lenses do nothing to address the root of the problem. I frequently prescribe lenses that actually help to improve performance. Lenses can reduce the stress on the brain and help improve eye teaming and focusing.
The continual lack of success with reading, writing and learning in general weighs heavily on the child. As the years go by and the struggle continues, these children come to see themselves as less worthy, as damaged or, unfortunately, stupid. I was one of these children and I remember every time I brought home a report card seeing notes from the teacher saying that I was not performing up to my potential - that I was being lazy. After a while I began to think that maybe I was simply incapable of doing better. Not only was my self esteem damaged, but eventually I think it was just easier to see myself as just not that bright. I never wanted to read and I rarely got the grades my parents and teachers expected of me. I quickly stopped pushing myself because the payoff was always meager compared to the effort I expended. I learned only much later that I had other visual issues that interfered with my ability to read and learn.
Little has changed all these years later. Children today are no less likely to struggle with vision problems that are often easily managed with vision therapy. A child's self esteem can improve once they are able to perform up to their potential because their visual ability is no longer an obstacle.
Next time: Some Thoughts on Myopia Reduction