Near-Double Vision: Understanding Why Your Child Struggles

When a child struggles in school, the biggest question for a parent to answer is “why?”  While setting up study plans and establishing goals can be effective, many parents discover that their child’s avoidance behaviors cannot simply be corrected by rules and expectations.  The child is frustrated with reading, and grades continue to drop, despite their best efforts to improve.  Tensions rise within the family when a child cannot overcome their study struggles.

At this point, parents usually consider alternative reasons for their child’s learning block, and start to look for answers.  What if their vision is the problem?  A standard eye exam checks eyesight and for ocular diseases, but doesn’t always test the efficiency of the visual system — specifically binocular vision.  According to the American Academy of Optometry, one in twelve children suffers from a condition called Convergence Insufficiency, or what could also be described as “near-double vision.”  That means that two to three children in every classroom experience near-double vision on a daily basis, and their parents don’t even know.


Far Double Vision

Double vision is the sensation of your entire visual field splitting into two duplicate images — each eye producing its own, separate picture.  A person experiencing normal double vision would know immediately that there was problem.  On the other hand, near-double vision is, by comparison, inconspicuous.  It presents as a blurring and splitting of letters and words while reading.  Numbers and letters float around the page, because the eyes cannot effectively turn inward to look at the same near target.  As a result, the child sees moving and overlapping letters, making the task of reading unbearably challenging.

The child often complains of headaches or tiredness when trying to read, but is unable to explain why.  To unknowing teachers and parents, it looks like avoidance or laziness.  Because near-double vision usually starts in early development, children don’t know that how they see is different from other people.  How would they know that their vision is flawed or unusual? After passing a routine eye exam, “blurry vision” sounds like just another excuse to avoid and fail at reading and schoolwork.


The consequences of undetected near-double vision can reach far beyond declining grades.  In addition to being easily distracted, the child quickly realizes that their reading speed and level is below that of their peers.  When asked to read aloud in class, they stumble over basic words, and struggle to understand and retain what they read.  They look at the same sentence over and over, trying to decode a blur of letters into something with meaning.  They are scolded for not paying attention, or mocked by other kids. They feel dumb or inadequate, and their confidence suffers.  They start to define themselves by their limitations, instead of their strengths.  What started as just a visual problem grows into an attitude of “I can’t,” as the child abandons hope in their own potential.

But there is a solution.  If your child struggles with reading or learning or suffers from any of the symptoms of near-double vision, office-based optometric vision therapy is the proven solution.  A comprehensive evaluation with a developmental vision specialist will help identify if there is a visual cause for your child’s learning challenges.  The sooner you can understand why your child struggles, the sooner you can help them make real strides toward improvement, and a brighter future.

ADD: Treating the Cause, not the Symptoms

Over the past several decades, ADD and ADHD have become some of the most common behavioral labels of our children today. In 2011, the CDC reported that approximately 11% of children 4-17 years of age (6.4 million in the US) have been diagnosed with ADHD. But how often do we stop and think about the underlining cause of these conditions?

The standard treatment approach is to medicate with stimulants that force the child or adult to focus and engage their attention on tasks like reading and other school work. But is this approach just a bandaid?  Are we really helping our children overcome ADD and ADHD with medication alone?  What if there was another way?

Let’s face it. We all, at times, have trouble focusing our attention on tasks that are challenging.  Learning, by definition, is a challenge for the brain.  Learning is also a critical part of living a full life.  Our modern culture has made reading ability the prerequisite for efficient learning.  All too often, when children struggle with focusing, attention and learning, the problem begins with their basic ability to read.

Our vision and vision efficiency are the most critical human abilities that impact reading speed and comprehension.  If our eyes don’t scan words on a page efficiently, work well together as a team, or communicate information with the brain effectively, the most basic reading functions become overwhelmingly challenging tasks.  If a child can’t read as efficiently as their classmates, they fall behind.  When they fall behind, their teachers and parents become concerned.  The child is unhappy, frustrated and acting out.  The parent is unhappy and questions whether it’s their fault.  The entire family unit falls into chaos because the other children feel neglected.

Vision Therapy is the process of developing more efficient functions of the visual system and the brain’s comprehension and processing abilities of the information we read on the page or computer screen, as well as many other areas of daily living.  When a child or adult has difficulty focusing or maintaining attention on a single task, in many cases, a vision dysfunction is a likely cause of attention deficiencies.  So rather than treating the symptoms with medication, we treat the cause with noninvasive Vision Therapy.  As a result, the patient is able to focus on vision intensive tasks, like reading, with greater ease.  Comprehension is improved, which makes learning easier and ultimately the patient feels more competent, confident, productive and in general, happier.

Better vision skills gives competitive advantage in sports and in life

Child winningAll athletes want a competitive advantage. After all, the goal in most sports is to win! To the serious competitor, that competitive advantage is a result of hard work, body conditioning and practice at developing the fundamental skills that are unique to the sport. But what truly differentiates the good players from the great players is not being the strongest or the one with the best technique. The real differentiator that provides the competitive advantage for the player is having developed the best visual skills for the game.

Arnold Palmer, while discussing the Senior PGA Tournament once said, “You will see some excellent golf being played on the senior tour. Some of them can hit the ball farther than they ever did in the regular circuit. The only difference is, sometimes they three-putt.” His point was that the seniors have established their technique involving a great tempo, rhythm and swing. Plus you would think that their experience would make them experts at reading the greens. So, what is missing? The one area that is often missing is concentration on visual position and then the visual skills to execute an accurate motor response. These specific visual abilities can be divided into 3 major sports vision categories:

  1. To visually fixate and focus on a specific primary ball position which is very dependent on the shot
  2. To binocularly align the eyes for effective stereopsis or 3-D vision to effective judge spatial elements of the course, especially the greens
  3. To mentally rehearse and prepare for the shot through the act of visualization which sets the stage for the eyes and the visual brain to tell the muscles what to do.

An excellent book, entitled An Insight to Sports – Featuring Trapshooting and Golf, written by Wayne F. Martin, O.D. outlines some of the key visual skills as well as some sports vision activities that can be doneAn Insight to sports at home to sharpen the visual skills that are often a part of an intensive office-based sports vision/vision therapy program.

The key to understand is that these visual abilities can be developed and as a result the individual will gain a competitive advantage.

Senior PGA GolfThis is true for the golfer, even the senior golfer like those playing in the 73rd Senior PGA Championship at Harbor Shores Golf Club . This big event brings a spot light of focus to our practice community in Benton Harbor and Saint Joseph, Michigan from May 22-27, 2012.

Getting better in one’s own game is the focus of both the professional athlete and the weekend amateur and also the children in vision therapy at Wow Vision Therapy Child and trophywith vision-based reading disabilities. For the parent, the goal is to see their child gain in their reading abilities. This is truly a confidence builder. But what is the “icing on the cake” for a child who has had vision therapy is their newly found competitive advantage in sports. There is nothing like the feeling of success for a child who gains the visual skills and the competitive advantage in sports as well as in the classroom.

Here is an example of what this means to a child!

Dan L. Fortenbacher, O.D.,FCOVD

4th Annual Pediatric Symposium centers around the collaboration of OT and VT

On Saturday, May 12, 2012, I had the pleasure of being a keynote speaker for the 4th Annual Pediatric Symposium sponsored by Memorial Children’s Hospital – Children’s Therapy Center in South Bend and the Logan Center.

My topic 2.5 hour lecture was entitled , Understanding the Role of Vision in Helping Children with SPD, ADHD, Autism, LD and Acquired Brain Injury. The audience was made up of Occupational Therapists, Speech Language Therapists, Social Workers, and other professionals in the rehabilitation community…all interested in helping children with developmental delays.
For those who might be interested in more information on this presentation, please feel free to drop me a note in the comment section below. Click here for more photos of the presentation.
Dan L. Fortenbacher, O.D., FCOVD

Lindsey Stull, O.D., FCOVD – Congratulations for her Board Certification

Dr. Nhin(left), Dr. Stull (center), Dr. Fortenbacher (right)Wow Vision Therapy would like to acknowledge our Clinic Director, Dr. Lindsey Stull (center) in her recent accomplishment of attaining Board Certification in Developmental Vision and Vision Therapy through the College of Optometrists in Vision Development (COVD) during the COVD Annual Meeting in Las Vegas October 26-29, 2011.  Congratulating Dr. Stull in this photo is our Resident, Dr. Nhin Nguyen (left) and Dr. Fortenbacher (right).

Dr. Stull is now a Fellow in COVD which is one of the highest honors and recognition in Optometry, specific to the specialty of developmental/behavorial/rehabilitative optometry. For more information about Board Certification through COVD you can go to the COVD website here.

We are all very proud of Dr. Stull who now has the distinction of placing FCOVD after her name! CONGRATULATIONS Dr. Stull!!


Vision Therapy can give the competitive advantage!

Mack, who came into the office today for his vision therapy session, presented with some exciting news!

Mack is a bright young man who likes sports but (before vision therapy) was inconsistent in his batting. Mack struggled with a common binocular vision problem that affects 1:12 children and adults leading to headaches, transient blur and occasional double vision when reading. This common binocular dysfunction, known as Convergence Insufficiency, often affects the individual in many ways.

Dr. Len Press and I wrote a series for The VisionHelp Blog entitled: CI: The Private Eye Goes Public. To read more about this condition check out these posts:

CI: The Private Eye Goes Public – Part 1

CI: The Private Eye Goes Public – Part 2

CI:The Private Eye Goes Public -Part 3…who’s looking out for the kids?

CI: The Private Eye Goes Public – Part 4

CI: The Private Eye Goes Public – Part 5

Dan L. Fortenbacher, O.D., FCOVD

When visual dysfunction causes motion sickness

Do you know of a family member who is plagued with motion sickness when ever they go for an extended car ride? Recently I posted on The VisionHelp Blog the details of a visual problem that affects millions of people, coined The See-Sick Syndrome. Once diagnosed and treated, those with SSS can have life long resolution of motion sickness.  Dr. Lindsey Stull and I presented a lecture to area primary care optometrists entitled: The See-Sick Syndrome…Practical Diagnostic and Treatment Applications for the Primary Care OD.


Hear a mom describe how her son has responded to treatment at Wow Vision Therapy.

Dan L. Fortenbacher, O.D., FCOVD

Stereo Blind…when you can’t see Avatar in 3-D means more than missing out on a good movie

Avatar2 The ability to see in stereo. What does that mean? Basically, stereo-vision is the ability to see depth in our visual space. That is, the ability to tell that space exists between objects in the environment.  In essence stereo vision is your 3-D vision. It is the ability to judge depth because you actually see depth. This is accomplished through normal binocular (two-eyed) vision.

Most of us relate to this as we see 3-D pictures or 3-D movies. However, it is much more than that…stereopsis provides a quality of vision that is much like color vision. To those who are color blind, the ability to “see” exists, but the color deficient individual lacks a quality of vision that can only be described as a phenomenon of see the world with a quality of color perception. The world of color can not be easily put into words. The same is true with stereo vision. Until you see it you don’t know what you are missing. But, to be sure the stereo-blind are missing a lot!

Stereo blindness occurs when the two eyes do not work together in a normal way. If a person has only one eye they are truly stereo-blind with no hope of gaining stereopsis. However, most patients who are stereo blind have two eyes, but just lack the ability to use the two eyes together in a normal way. Examples of this are those individuals with strabismus (crossed or turned eyes), amblyopia ( lazy eye) and another more common condition, non-strabismic binocular vision dysfunction. This later condition is where the individual has some ability to use their eyes together but, they just do it poorly.

Unlike color blindness, the good news is stereo blindness in the patient with a binocular vision problem, is usually curable with office based vision therapy. The other good news is for those who have a non-strabismic binocular problem the treatment time is much shorter!

To hear more about stereo blindness, the following Podcasts may be of interest.

Dr. Sue Barry, author of Fixing My Gaze…A scientists journey into seeing in three dimensions

Joe Palca of NPR radio…Learning to see in stereo

How can you tell if  your child has stereo blindness? One good way is to see if they can see the depth or “float” of the images in the 3-D movie Avatar (or other kid friendly 3-D movies). If a child says it just looks “smeary”or “blurry like” and not really “coming out” you should  suspect a problem with their binocular vision. Contact your family eye care provider for an appointment to check their vision including their “stereo-vision”! If there is a problem, make sure that your doctor will be able to prescribe treatment or make a referral to a specialist in treating binocular vision problems with office-based vision therapy. If you need assistance finding a doctor who can treat stereo blindness go to the College of Optometrists in Vision Development website at and click on the Doctor Finder. There you should look for those Doctors who are Board Certified Fellows.

Dan L. Fortenbacher, O.D.,FCOVD

August is National Children’s Vision and Learning Month

Brainy The College of Optometrist in Vision Development (COVD) has issued the following information regarding the critical link between vision and learning:

1 out of 4 children struggle with reading and learning because of undiagnosed vision problems.

  • Problems with attention, reading, and learning, are just a few of the symptoms that can be improved when vision disorders are found and treated appropriately.

The symptoms of learning-related vision problems are often overlooked or mislabeled, yet they are usually very visible.  Following is a list of some of the more obvious symptoms parents and teachers should keep an eye out for:

  • Frequent loss of place when reading
  • Confuses similar looking words
  • Poor reading comprehension
  • Sloppy Handwriting
  • Failure to recognize the same word in next sentence
  • Complains of eyes hurting or headaches after reading
  • Avoidance of close work (such as reading)
  • Attention problems

Any of the above symptoms may be a sign that your child may be struggling with a learning-related vision problem.  Fortunately, through vision therapy many learning related vision problems can be corrected.

For a more in depth checklist of symptoms, information on vision therapy and the critical link between vision and learning or to find a doctor near you…visit this link.

April is Autism Awareness Month

Autism Autism is the fastest growing developmental disability in the United States affecting 1 in every 150 individuals.  Autism is categorized under the term ASD, which stands for autism spectrum disorders.  A spectrum disorder refers to the varying degree of behavior affecting the individual.

One might ask how vision therapy can benefit an individual with autism.  To fully answer that question it is important to realize that our vision is composed of two distint systems, ambient and focal.

Our focal system allows us to answer the question, “What is it?”  This particular area of our vision utilizes the central field of vision, is a conscious process and works independently from our other sensory systems.

In contrast, the ambient system involves more of our full visual field, is a non-conscious process and has an integral role with the other sensory systems.  The questions of, “Where am I?” and “Where is it? are examples of those addressed by the ambient system.

Those with autism tend to have a preference for their focal visual system which can be quite detrimental since the ambient system allows us to accurately judge distances, the speed of moving objects, as well as interpreting the body language of others.  This lack of visual attention creates a barrier for the brain to interpret and process information received from the ambient system.

Vision is a learned process, and can therefore be accelerated by retraining the visual system to work more efficiently.  Vision therapy is a individualized treatment program designed to improve on the patient’s fundamental visual skills. The development of the ambient system can also be enhanced through vision therapy as well as the integration of the focal and ambient systems, necessary for accurate visual processing to occur.

If you have an interest in learning more about the relationship between vision therapy and autism there will be an informational presentation by Dr. Dan L. Fortenbacher, O.D.,FCOVD at WOW Vision Therapy on Monday April 21 at 7:00 p.m.  This free seminar is put on by the Autism Awareness Project, which is a cooperative effort between parents and service providers in Berrien county dedicated to raising awareness of ASD in our community.  The presentation will be held at WOW Vision Therapy, 2908 Division Street in St. Joseph, Michigan 49085.

If you are interested in attending the presentation, please RSVP at (269) 983-3309 by April 18, 2008.