If your child is having trouble in school, should you first look at his or her eyes? The answer is yes and no. The yes part is: every child should have a thorough vision evaluation--my preference is as part of a whole, well-child workup in a pediatrician or physician's office. More than just the kind of test you have to pass at the DMV is in order--remember, classroom work involves switching from the page up to the blackboard and back--near and far-term switching, and other visual skills.
The no part is that there is little evidence that "developmental optometry" or "behavioral optometry" or "vision therapy" has any long-term beneficial effect on a child's learning disabilities. While the optometrists' official position is that Vision therapy does not directly treat learning disabilities or dyslexia., the statement then goes on to carve out a place for optometry in the burgeoning, and lucrative, field of learning disabilities.
It all begins with selecting the type of practioner (optometrist, pediatrician, or pediatric opthamologist) to perform the exam.
There is an essay by Patricia S. Lemer, M.Ed., NCC (Nationally Certified Councillor) , entitled, "Choosing An Eye Doctor" that is widely disseminated on the web, which equates the training of opthamologists and optometrists, and implies that the only difference is that ophthalmologists can do surgery. (Opthamologists, being M.D.s, have a much more diverse training, and 3-5 more years of training before entering practice.) The implicaition is that ophthalmologists always want to use their surgical training to solve all vision problems.
(Ms Lemer is the Executive Director of Developmental Delay Resources, which in addition to endorsing vision therapy also endorses homeopathy, removal of amalgam restorations, and the MMR/autism phantasm.)
I would advise parents to ignore Ms. Lemer's "advice" and have the child's eyes and hearing evaluated by a pediatrician, who can also evaluate the child's hearing, and make a referral to a pediatric opthamologist if necessary.
Optometrists want to make sure you know that ophthalmologists are not the ultimate authorities in all areas of visual health.. The same source finesses the question "Is there scientific evidence that vision therapy works?" by saying (a) we have the same kind of efficacy data as physical therapists; (b) there is solid data over there and (c) the other guys (opthamologists) do stuff before it is proven too! The PT efficacy data is much more solid and well researched; there's a paucity of well-designed papers (especially for pediatric interventions into learning differences; and (c) doesn't need ot be measured.
The behavioral optometrists from the Optometric Extention Program are spreading "scientific" babble such as this:
Our ancestors had hunter's eyes for survival in the wilderness; their vision was designed for spotting game and enemies at a distance.
In the last 100 years we have been forced to deal with sustained, near visual tasks and the resulting stress on the visual system has produced many symptoms and problems.
This is just ignorant ahistorical nonsense. People had to sew, read, thread needles, weave fabric, write--all requiring sustained near-focus tasks--usually in much poorer lighting conditions! The alleged justification of "hunter's eyes" should be your clue to hightail it to the horizon.
Optometrists regularly make some wild, unsubstantiated claim claims:
- Binocular vision impairments affect at least 12 out every 100 children.
- One in four children have vision problems that affect learning
- It's not poor teaching, it is the children's poor visual skills that lead to reading failure
- Children diagnosed with ADD, ADHD, or dyslexia are often misdiagnosed; their real problem is visual
70% of kids with learning disabilities have untreated vision problems
In the short, narrative (non-peer-reviewed) article, Is Vision TherapyQuackery?: How to separate fact from fiction and get pediatric patients the care they need. Harold Koller, MD (an opthamologist) writes:
It's difficult to believe that there is no basis at all for a discipline (vision therapy) that has attracted many intelligent and dedicated professionals. However, when evaluated by the standards of modern scientific study, vision therapy fares very poorly. The literature that exists in support of the therapy is ambiguous and vague; published accounts fail to reveal the rationale for the various therapies, and there's not even general agreement on what vision therapy is. There are numerous claims of anecdotal success, but not one well-controlled multi-subject study on vision therapy.
As nearly as I can figure out, "behavioral optometry" is just a way for a profit-squeezed optomrist to add some bells and whistles--that is, an income stream but not additional value--to his or her practice.
Problems with developmental optometry; Scotopic Sensitivity Syndrome is a Quack Diagnosis; Irlen syndrome doesn't exist
education dyslexia ADHD ADHD:Children learning disability learning skeptic
Dear Optometry for Learning Disablities,
After searching for people on google.com, I have found your site (http://lizditz.typepad.com/i_speak_of_dreams/2004/10/behavioral_opto.html). My name is Michael and I am a high school student at Rancho Alamitos in Garden Grove California. I have an essay for English about a research paper on what I would like to be when I grow up and I was wondering if I could interview you. Since 8th grade I have always liked to be an Optometrist because after seeing videos of people being operated in the hospital, I was sure I could not handle being a doctor, but I love taking care of people. So, in the end I decided that being an Optometrist would work better for me. If you have the time before the end of Sunday, April 20th, please answer some of my questions below for my research paper.
1. How old were you when you thought to yourself that you wanted to be an Optometrist and why.
2. Can you describe to me what a daily life for an Optometrist is?
3. Please list or name some of the positive and negative of the jobs.
4. Where did you study to become an Optometrist and how was it like?
5. If you were not able to become an Optometrist, who would you have become?
Thank you for taking the time to read this and if you can, reply.
Sincerely,
Michael Hoang Nguyen
Posted by: Michael Nguyen | Sunday, April 20, 2008 at 11:18 AM
The article maybe 7 years old but without a doubt a very interesting one. Observing for the eyes of a child having difficulties in school is truly necessary. A good vision reflects good learning. People should consider such fact.
Posted by: Yasmin Jane | Monday, October 03, 2011 at 09:11 PM