At Wow Vision Therapy, we provide our patients with the most advanced patch-free treatment for Amblyopia (Lazy Eye) and age is not a barrier to success. If you or your child has amblyopia and you’ve been told the only treatment is an eye patch or “drops”, there is a better treatment approach that does not require patching or eye drops, is faster and has better outcomes. You can learn more about this safe and effective way to treat Amblyopia by checking out the Amblyopia Project, a VisionHelp Initiative, at amblyopiaproject.com. Wow Vision Therapy is located in St. Joseph and Grand Rapids, Michigan. For information on how to schedule an evaluation, visit our website at wowvision.net.
Frustrating? Yes. Upsetting? Of course! When a bright young lady has struggled for years at school, only to be assumed she had ADD. And just because her teacher suggested her behavior was probably ADD does not mean her teacher was at fault. Her behavior did look like ADD! But that is where the problem lies, because this is a common assumption made by many people when a child has behaviors of poor attention and concentration with reading. Immediately ADD or ADHD comes up and the child is too often put on psycho-stimulant medication without the necessary rule-outs of other conditions.
But thanks to Madison’s pediatrician who performed a simple test of Madison’s binocular vision called a Near Point of Convergence Test, she found Madison had a vision problem called Convergence Insufficiency, a vision problem that affects 1 in 12 children, and referred her to see me for a comprehensive binocular vision evaluation. Take a look and hear from Madison’s mother, who tells the story about her daughter’s struggle with attention and concentration at school, disinterest in reading and loss of confidence transform into her success from the treatment of her binocular vision problems through advanced vision therapy care at Wow Vision Therapy.
Madison’s story of success through office-based optometric vision therapy is validated in the latest scientific research and published in: Optom Vis Sci. 2012 January ; 89(1): 12–18, Improvement in Academic Behaviors Following Successful Treatment of Convergence Insufficiency.
In addition, more evidence of Madison’s successful treatment is outlined by the American Academy of Optometry published in August 2013 a position paper entitled, American Academy of Optometry Binocular Vision, Perception, and Pediatric Optometry Position Paper on Optometric Care of the Struggling Student for parents, educators, and other professionals.
If you are located within Northern Indiana, Western or Southwestern Michigan and have a child who exhibits ADD-like behaviors, struggles in reading comprehension, homework is a battle, has headaches with reading or has other learning related difficulty, call our office and our patient care coordinators will help you by making an appointment with one of our Board Certified Doctors. If you are not within the region of Wow Vision Therapy go to the College of Optometrists in Vision Development at www.covd.org and click on the Doctor Locator to find a specialist nearest you.
Dan L. Fortenbacher, O.D.,FCOVD
Drs. Fortenbacher, Stull and Tran presented a lecture to the Annual Michigan Vision Therapy Study Group on February 8, 2013 outlining the latest research in visual neuroscience and techniques to treat ambyopia regardless of age and without an emphasis on occlusion therapy (eye patching).
The lecture featured one of our adult patients, Emily who at age 18 is a bright and talented young lady. In her senior year of High School she is also on the school’s swim team, a sport that she could excel, even with no depth perception. Yes, Emily’s story begins with stereo blindness.
Like so many patients who begin with occlusion therapy, the outcomes are often limited to modest improvement in visual acuity in the amblyopic eye (lazy eye) and little or no depth perception, with usually significant resistance by the patient.
Emily was referred to Wow Vision Therapy by her primary care optometrist for advanced amblyopia treatment, binocular vision therapy. Listen to Emily describe in her own words in this video entitled, Emily’s story.
To learn more details about the Advanced Amblyopia Treatment paradigm, you can view the Wow Vision Therapy 2013MVTSG Lecture – Advanced Amblyopia Treatment for faster and better outcomes, in a Slide Show video here:
The concluding 3 slides summarize the essense of the lecture
You can also download a pdf copy of Drs. Fortenbacher, Stull and Tran’s lecture by clicking here
Dan L. Fortenbacher, O.D., FCOVD
Yesterday Dr. Fortenbacher, along with Wow Vision Therapy’s Clinic Director, Dr. Lindsey Stull, and resident, Dr. Tuan Tran presented to the staff at the Children’s Therapy Center at Memorial Children’s Hospital in South Bend. The program was part of the new “Lunch and Learn” educational series that provides a much more personal and interactive experience for the OTs, PTs and SLPs at the Center.
Dr. Fortenbacher (and team) were able to present, over the course of the lunch hour, 3 recent or current patients in treatment and engage in a collaborative Q&A discussion. Written and video presentations helped to show how these children obtain the best outcomes in their overall progress through office-based optometric vision therapy and a multidisciplinary approach provided by the team at the Children’s Therapy Center.
During the discussion there were some who asked about how to obtain more information about developmental vision and vision rehabilitation. For those who want to find out more detailed information about these topics the following was recommended:
A special thanks to Kay Azar, PT for organizing this event and also our MCO Extern, Dr. Katie, for assisting!
Convergence Insufficiency is a vision disorder that affects nearly 1 in 12 children and has consequences to a child’s quality of life. This serious vision problem does not cause blindness, but it’s impact can be nearly as severe as shown by this video on The VisionHelp Channel…
A real live example of this is told by Aiden’s Success Story. His behaviors before treatment looked like ADD/ADHD.
To see what has been published in the professional journals, Optometry Times published it’s lead story in March 2009 showing the evidenced-based research.
For more information on Convergence Insufficiency, go the The VisionHelp Blog
Dan L. Fortenbacher, O.D., FCOVD
MFBF is a technique we use to accelerate vision development through office-based treatment of our patients with amblyopia. This latest research (October 2010), from Current Biology, shows that this MFBF(monocular fixations in a binocular field) treatment methods are evidenced based in Neuroscience. Read more in this interesting VisionHelp Blog post written by Dr. Leonard Press.
The significance of this research is that occlusion therapy (eye patching) the “good eye”, when utilized as the sole treatment, does not address critical aspects of binocular vision development for patients with amblyopia.
Dr. Fortenbacher has previously blogged on this topic and explains why eye patching alone is not enough to treat amblyopia. Parents need to be aware of this advancement in amblyopia treatment which is based on solid research. If you have a child who has amblyopia and the only treatment recommended is an eye patch, consider finding a doctor who will provide office-based vision therapy and the MFBF technique.
Read Dr. Fortenbacher’s previous VisionHelp post here: Amblyopia treatment – Eye patching alone is no longer the standard of care
What if your child is struggling to play the piano? Let say he is a bright 10 year-old boy who finds playing the piano difficult. He just doesn’t get it! You ask yourself, why is he having this difficulty…he just seems to be unable to coordinate his fingers to play? So, as any concerned parent, you seek professional help. But first, you go on-line to research the possibilities for a solution to this problem and stumble across a website that says, “Help your child become a piano virtuoso with simple finger exercises!”
Now wait a minute, that’s hard to believe right!? We all know that is illogical. Doing simple finger exercises will not teach anyone how to become a skilled piano player! His fingers are strong enough to move the keys on the piano, his brain just does not know how to coordinate his fingers to play the music. The answer to his problem is found when you locate a good piano “coach” who can guide him along a process of learning the skills for playing the piano. Then with practice he will improve. So, you dismiss the internet offer as another example of someone trying to promote an unproven and implausible self-help program.
Now let’s consider another scenario. This time it is your 10-year-old son who is struggling to read and keep up in school. He loses his place easily when reading. He is having trouble concentrating on a reading task and become very frustrated. He says his eyes hurt and sometimes he gets a headache when he reads. It sounds like he could be having a vision problem.
So you seek professional help and schedule him to have his eyes examined by your family optometrist, Dr. A. Your son has his eye exam with Dr. A. and what you learn from the doctor is that his eyes are healthy and he has normal 20/20 eye sight. But, he is having difficulty with coordinating his eyes together as a team when he tries to look at a book to read. Specifically he has trouble with his binocular vision (eye teaming). The doctor called it Convergence Insufficiency(CI). As it turns out, Convergence Insufficiency occurs in about 8-12% of children; affecting about 21.5 million people in the US (adults included). Often times a person with CI (especially children) will experience symptoms involving stress and strain around the eyes and have occasional double vision and avoidance behaviors. Often these symptoms look like ADD (Attention Deficit Disorder) too.
Doctor A. turns to you and says your child has a problem with proper eye coordination. His visual brain has not developed the correct neuromotor coordination abilities resulting in poor eye teaming when he attempts to do near vision work. This condition is treatable with 25-30 hours of office-based, doctor supervised, optometric vision therapy. While Dr. A. does not provide this service in his office, he recommends another doctor whose practice is dedicated to treating patients with office-based optometric vision therapy and makes the referral.
Gosh, you were hoping for an easy fix like a new pair of glasses! But what you are hearing is that it is much more complicated and will take several trips to another doctor over an extended period of time.
In the mean time, you think about it and decide to check around on your own and take your son to another doctor, Dr. B. for a second eye examination. Dr. B. completes his eye exam of your son and agrees with the diagnosis…yes, he has CI. But this doctor’s approach is entirely different. Dr. B. describes the problem with your son’s eyes is that he just has “weak eye muscles” which need to be strengthened. He advises you that your child’s problem can be solved with some simple “eye exercises”! All you have to do is make his eye muscles stronger by asking him to look at the tip of a pencil as you move it closer to his nose. In addition you are given some “work books” that have your son doing “tracking exercises”. You are puzzled by the lack of consistent treatment recommendations between the two doctors but since the recommendation is coming from a doctor, it must be true…right? Besides he accepts the minimal payment by your insurance and the treatment plan sounds a lot easier than what Dr. A was recommending.
So…who do you believe? Why if both doctors agree on the diagnosis, don’t they agree on the method of treatment? Who has got it right, Dr. A or Dr. B?
First, let’s remember the first example of the 10-year-old boy who was having trouble playing the piano. Is it logical to think that doing simple finger exercises will help him learn how to successfully play the piano? The answer seems pretty obvious right?
Surely the coordination of a person’s eyes is equally as complex as coordinating ones fingers to play a piano. So it would seem illogical that doing simple eye exercises would be effective at treating a problem with both eyes coordinating when attempting to read. However, over 50 years ago, many doctors were taught that Convergence Insufficiency (CI) was a problem with eye muscle strength. While techniques in the area of visual rehabilitation were also beginning to emerge about that time, there were still some text books that the had the old-fashioned remedy for CI as just a “series of simple eye exercises”. The problem was that the eye-exercise model of treatment was based on an assumption and not based on research. Therefore, many doctors to this day still hang on to an old outdated model of treatment that was never based on proven research.
Therefore the answer to the question, “Who has got it right, Dr. A. or Dr. B”, can only be answered based on double-blind multicenter research. What’s more, the research on the best methods to treat CI was completed in 2008. It is a landmark study called the Convergence Insufficiency Treatment Trial (CITT). The CITT was funded with a $6.1 million grant by the National Institute of Health and conducted through the National Eye Institute along with several sites around the country including Mayo Clinic and Bascom Palmer plus 6 Colleges of Optometry.
What this double-blind, multicenter research did was to compare office-based doctor supervised vision therapy (OBVT) to home based eye exercises called “pencil push-up therapy” as well as compared to a placebo, called “placebo therapy”
What did the research prove? It found that the “eye exercise therapy” had about the same effectiveness as the placebo. In fact the research proved that both the “eye exercise therapy” and the placebo therapy were found to be ineffective in treating Convergence Insufficiency.
However, office-based vision therapy was found to be effective and in subsequent research found to be the cure for convergence insufficiency. Dr A was correct!
The research is clear. So why do some doctors persist to advise patients about old-fashioned and ineffective treatment for Convergence Insufficiency? This can be difficult to answer in each case, but certainly when this condition, Convergence Insufficiency (CI) is accepted by the entire optometric and medical community as an important public health issue, then and only then will the majority of doctors get it right.
To address this fundamental public health problem and its realitive importance in the eye-care community, I wrote an article that was published in the Journal of Behavioral Optometry (Vol 21/2010/#2) entitled: “Does Convergence Insufficiency Really Matter”(download)
Dan L. Fortenbacher, O.D.,FCOVD
Amblyopia, other wise known as “lazy eye”, is the most common cause of preventable blindness in children. While the loss of vision usually occurs in one eye, rarer forms of bilateral amblyopia do exist. This type of “blindness” occurs in approximately 2 out of 100 healthy children. In amblyopia the loss of vision is not from a disease of the eye but rather the lack of development of the visual brain. Therefore, by definition, a child with amblyopia has healthy eyes, yet the brain can not see.
Therefore, the cause of amblyopia is not due to a disease process. Instead the cause of amblyopia is when there is interference in the infant’s binocular visual development. This means that amblyopia occurs when the visual brain of the baby stops developing normally from the lack of proper “two-eyed” visual input. As a result, even with healthy eye structure, the child is not able to see clearly from the affected eye. So, a child with amblyopia will typically have 20/20 eye sight in one eye and the other eye will be poor. The severity of the amblyopia will be measured by how poor the eye sight is in the affected eye. In addition to poor sight, the child with amblyopia will also have “stereo blindness” or poor depth perception. This only adds to the visual difficulty since the child who is “stereo blind” will not be able to experience the benefits of three dimensional vision.
There can be many causes for amblyopia. But, the underlying mechanism for amblyopia is when something prevents a developing child from seeing with both eyes simultaneously. The most common causes are strabismus (eye teaming failure, such as crossed eyes) and unequal refractive error (example: high farsightedness in one eye while the other eye is normal).
Debunking old myths and practices:
Over the years amblyopia was thought to be only treatable if caught before age 6. This myth has been disproven. Current research shows that amblyopia can be treated even in 18 year olds. More research needs to be done, but what we know is that there is “plasticity” in the human visual brain at nearly any age. I have personally successfully treated amblyopes well into their 60’s.
A commonly prescribed form of treatment for amblyopia, yet insufficient by today’s standards (based on Clinical Practice Guidelines), is what is called “occlusion therapy”. Occlusion therapy or “patching” is where the patient wears an eye patch on the “good eye” for typically hours at a time during their waking hours. While the research shows that a child’s visual brain will show improvement in their amblyopic eye sight with a patching regimen, this “old school” approach (when used alone) can be very difficult and disruptive for the developing child to handle. It creates visual disorientation and confusion in spatial judgements. This in turn creates frustration and often emotional upset in the patient. Furthermore, unilateral patching therapy only teaches a patient how to be a “one eyed person” since it does not address the underlying cause for the amblyopia which is the lack of binocular (two-eyed) vision development.
Therefore today’s “best practices” approach for the treatment of amblyopia involves a combination of monocular and binocular training of the visual brain through office-based vision therapy. This is done with a vision therapist under the direct supervision of a Doctor of Optometry along with prescribed home-oriented visual activities to complement the weekly or bi-weekly in-office procedures.
This treatment approach yields the best outcomes, often resulting in normalization of eye sight in the amblyopic eye and the development of stereo vision (3-D vision) for the child. Eye patching alone is no longer the standard of care.
Read more about Amblyopia from the College of Optometrists in Vision Development (COVD). Click here!
Read about the Clinical Practice Guidelines established by the American Optometric Association. Click here!
Dan L. Fortenbacher, O.D., FCOVD
“Eye movement is a predictor of academic success”. This month marks the 10 year anniversary when the Harvard University Graduate School of Education made this announcement. The research clearly shows that there is important association between effective eye movement control and academic success.
Ever since this breaking news a decade ago, further evidence of the association between eye movement and academic success continues to be recognized. For example, in Volume 27 Issue 8 of the Journal of Brain Development in 2005 the titled research is, the Voluntary Control of Saccadic and Smooth-Pursuit Eye Movement in Children with Learning Disorders.
While the testing of eye movement is relatively easy, the clinical presentation of poor eye movement control can often be missed and misunderstood. For example the testing of smooth-pursuit eye movement control can be easily performed with a bead on a stick or the tip of a pencil or pen. The examiner simply asks the child to look at the target (held about 10 inches from the nose) and follow it with their eyes as the target is slowly moved horizontally, vertically (on the midline) and in a rotation. The child should be able watch the moving target with minimal head movement. Furthermore, the child who is years and older, should be able to “visually track” the target with a minimal amount of distraction such as asking simple questions (cognitive loading).
With the advent of web-based professional networking sites, like Sovoto, a platform now exists to help doctors and other professionals who work with children to see an example of a child with oculomotor dysfunction. To see an example of a child with oculomotor difficulty that was associated with his reading difficulty click here.
The American Optometric Association has published the symptoms of eye movement disorders in the Optometric Clinical Practice Guideline (CPG) Care of the Patient with Learning Related Vision Problems. They are:
- Moving head excessively when reading
- Skipping lines when reading
- Omitting words and transposing when reading
- Losing place easily when reading
- Requiring a finger or marker to keep place when reading
- Experiencing confusion on return sweep phase when reading
- Experiencing illusionary text movement
- Having deficient ball playing skills
More importantly, once identified, the child who is diagnosed with a problem in eye movement, such as smooth-pursuits, can be treated with vision therapy. Specifically office-based optometric vision therapy provided by a vision therapist (supervised by the doctor), can effectively treat disorders of voluntary eye movement. The results can often be a dramatic improvement in the child’s reading efficiency.
To see the same patient after 24 sessions of office-based vision therapy click here. His reading efficiency and fluency has improved and he is enjoying reading!
Dan L. Fortenbacher, O.D.,FCOVD
Last week I saw a 17 year old girl for a new patient comprehensive vision evaluation. While most patients find their way to our practice as a referral from an eye doctor or an occupational therapist, this patient landed in my exam chair due to the determination of her mother to find an answer.
You see, our patient – lets call her Mary, is a bright, articulate high school senior who wants to go to college next year, but due to her difficulty reading, she and her family are concerned that she will be unable to handle the college work load. What’s more, her avoidance behaviors and mannerisms started to make her mother suspect something was “a miss” with Mary’s eyes, even though she had had previous eye exams and was fit with contact lenses for nearsightedness. Mary complained of words overlapping and would turn her head or cover an eye when trying to read.
Thanks to the persistence of her mother through her own personal research, she began to find the answers to her troubling questions. Why was her bright daughter complaining of words moving on the page when reading? Why did she turn her head or furrow her brow when doing her paper pencil tasks? What she learned was that there exists specific types of vision problems that can cause bright kids to demonstrate reading and learning performance problems. One thing led to another and the family found our specialty practice; dedicated to the diagnosis and treatment of the vision related learning problems.
My examination revealed that Mary’s eyes were healthy and her existing contacts properly corrected her eyes for a mild condition of nearsightedness. But, in spite of her 20/20 corrected eye sight, Mary was unable to coordinate her two eyes at near. She in fact had double vision for objects within 18-20 inches from her face! To further complicate this, Mary demonstrated poor eye tracking, eye focusing and poor visual processing skills. The diagnosis for Mary was convergence insufficiency, accommodative dysfunction,oculomotor dysfunction plus delays in visual information processing.
In spite of having the diagnosis, which explained why Mary struggled with reading and learning, it was painful for Mary’s mother when she realized that Mary had been struggling with these symptoms since she was in 3rd grade. Thanks only to the determination of her mother through home schooling, Mary received the individual attention which enabled her to progress academically, albeit in spite of many compensatory strategies.
To restate the case, Mary’s vision problems are not eye sight problems or eye health problems. Her eye muscles are normal and strong. Her neurology is normal. Instead, her vision problems are developmental. That means at age 17, Mary had simply not acquired the expected eye coordination and visual processing abilities that most us gain naturally through a process of normal childhood experiences.
The treatment required for Mary is office-based optometric vision therapy (VT). VT is scientifically validated and proven safe and effective. Once Mary receives this treatment protocol, research has shown that she will not require any further treatment for these problems of eye coordination. Yes, there actually is a cure!
What makes Mary’s case disheartening is that her visual issues could have been recognized early on. Mary should never have had to struggle for years with this binocular vision problem – convergence insufficiency. As a consequence of her binocular vision problem, Mary and her family have unnecessarily gone through years of frustration. They had to adjust their family around a home school model to support Mary’s needs for individual attention primarily because she could not use her vision to apply herself academically.
On a positive note, Mary will soon be starting treatment…office-based vision therapy. And while she has had to tolerate her symptoms associated with these vision problems for years, within 4-5 months of treatment, I’m confident that Mary’s binocular and other related “eye-coordination problems” will be resolved. What’s more because she is bright and capable, once Mary no longer has near point double vision, she will be better prepared for the visual demands of college!
Fortunately, more eye doctors are becoming aware of the critical importance to recognize, diagnose and properly manage patients like Mary. For example, Dr. Dominick M. Maino, Editor of the journal Optometry and Vision Development and Professor of Pediatrics/Binocular Vision at the Illinois Eye Institute/Illinois College of Optometry has recently written a compelling journal editorial emphasizing this to the profession entitled, The Binocular Vision Pandemic.
Dr. Rochelle Mozlin, Associate Professor at State University of New York, State College of Optometry with a Masters Degree in Public Health also recently wrote on the COVD Blog, Vision Therapy — Where is the Evidence?, listing the evidence based Clinical Practice Guidelines, written by a team of optometric experts, and published by the American Optometric Association.
With greater professional and public awareness of the impact of binocular vision problems on reading performance, fewer children like Mary will have to struggle for years without getting the help that they truly need. For more information go to www.covd.org
Dan L. Fortenbacher, O.D.,FCOVD