by Dr. Charles Boulet
Editor’s Note: Last week, The Imprint published an article about a school official critical about vision therapy contracts made by the Los Angeles Unified School District to assist students with learning disabilities. A slew of comments followed on our website, many of them from staunch supporters of vision therapy. Following is an essay written for The Imprint by one of those commenters, Dr. Charles Boulet, owner of the Diamond Valley Vision Care Center in Alberta, Canada.
Western medical doctors will tell you that we (meaning ‘they’) do not know what learning and reading disabilities (LD/RD) are, nor is there a ‘cure’, only that it is a so-called neuro-biological condition (whatever that means) with multiple contributing factors.
Given the preponderance of what is not known, it is surprising that they can so easily and definitively state that vision and visual therapies have no place in the management of these increasingly common concerns. This is an especially odd assertion, clinically and scientifically speaking, since the human visual system is interconnected with some 80 percent of brain function and most of what we learn in school is acquired through vision.
For a prominent medical society such as the American Academy of Ophthalmology (AAO) to proclaim, then, that vision therapy (VT) has no impact on learning or reading disabilities is a clever rhetorical trick; it is misleading, to say the very least, and even dangerous.
But such is the case in this article published by The Imprint, in which a Los Angeles school “assistive technology assessor” shows a profound and important lack of knowledge regarding vision, the role it plays in child development, and what can be done about it.
This is, embarrassingly, supported stridently by Sheryl Handler, a representative of AAO.
AAO would have us all assume that people’s eyes and visual processes are all virtually the same, that is, perfectly tuned to visual needs of today’s tech-based classrooms. The impact of this false notion is far reaching, with devastating consequences. It boggles the mind that people in such positions could have no knowledge of the role of vision in a nearly 100 percent visual learning environment.
The role of vision concerns in unwanted classroom behaviour and in ballooning education costs is exquisitely documented in a recent study by a developmental optometry colleague in a well-regarded journal of ophthalmology. In this study, we see clearly how children with IEP’s (Individualized Education Plans) are much more likely to be struggling under the burden of visual impediments.
Here’s another example of real science without the politics: In the article “Academic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD“, Rouse et al. describe how convergence insufficiency (CI – the inability to draw the eyes together to target a near object) is a very likely contributor to difficulty in the classroom.
This same story is told in many ways, in many journals and books on the subject, including the recently published ‘Visual Aspects of Dyslexia’ (Stein/Kapoula, 2012, Oxford Press). You will not find studies like this referenced in the ‘official’ statements from medical societies, or by groups who uphold a strictly phonological view of dyslexia.
The fact is, there are thousands of studies implicating vision in a great many child behavioural concerns, including LD/RD, ADHD, even emotional disturbances and autism. Not knowing about this science doesn’t make it go away or any less important.
I have seen all of these diagnoses presented to me by parents eager to find solutions, and in most cases vision has either been at the root of the problem from day one, to a strong contributing factor (except for autism, where vision is often problematic but not often the reason behind the diagnosis).
Optometrists normally receive much more training in ophthalmology than family doctors or pediatricians, and they also have specialized training in visual function. Developmental optometrists, specialists in visual function and visual rehabilitation, have been aware of vision’s critical role in child development and behavior for many decades, and painfully aware of the cost of ignoring these. See the article ‘Visual Impediments to Learning’ for a more comprehensive overview of the issues and some proposed solutions.
Vision is fundamental to child cognitive and physical development. Period. It can break down on many levels with devastating life-long consequences. Not only is difficult vision a distraction, it can be very uncomfortable, even painful. More often than not, however, it is experienced as an annoyance that leads children to avoid near work, where most formal learning takes place. Visual dysfunction will also contribute to the appearance of visual perceptual concerns so frequently ‘discovered’ in psychological testing.
Prior to becoming a ‘developmental OD’, I could explain in some detail how vision worked at the level of the cortex, but I was fully oblivious to vision’s impact on my students in the classroom and in life. Knowing what I now know, I have dedicated my practice to detecting and managing visual dysfunction, as well as to professional and public education. This is, quite simply, too important to ignore and the genie will not be put back in the bottle – a similar sentiment expressed by those who attend my lectures.
Ophthalmologists guide the discussion in the medical community when it comes to vision-related concerns and they have a responsibility to also acknowledge expertise outside of medicine. They are medical specialists, but have only minimal training and experience with visual function and visual neuro-rehabilitation, preferring to prescribe surgery, patching, prescription, or nothing at all, for virtually everything.
The reality is that vision and visual therapies are life-changing for many, from young learners to adults suffering from brain injury and disease. To follow current western medical guidance on vision-related learning concerns, then, is akin to following their advice on, say, auto mechanics, psychology, or fishing.
Vision matters for many reasons, not the least of which is the critical role it plays in motor development, cognitive tasking, intelligence, language and emotional development. Children need for us to pay attention to vision, not to simply guess. Likewise, professional colleges of education, psychology, and medicine need to pay attention. The bottom line is that ignoring children’s vision needs is tantamount to abuse, and overburdens us all.