I am a 36 year old male and have struggled with mild to moderate amblyopia most of my life. I am able to fuse close up and have very good hand eye coordination but at distance, such as driving, I am unable to fuse and the resulting strain worsens the eye turn. Is vision therapy still a viable option at my age?

This is an impossible question to answer without the benefit for a full, thorough vision exam. This would show the cause and severity of the amblyopia, eye turn,  and other visual problems that you may have and identify areas of possible improvement.

But even without the particulars in your case, I can say a few things generally. Because the purpose of vision therapy is to help you develop visual skills that may be lacking, there is not point in life when it is not possible to receive some benefit from vision therapy. The real question is this: Are you bothered enough by your visual problem that you would like to take the steps to improve the situation. (Case in point, this video of a 101 year old vision therapy patient.)

But I don’t want to paint vision therapy as a panacea either, because some conditions are very complicated and can take a significant amount of time, effort, and expense to improve. Some conditions are best treated with a combination of vision therapy and other methods, such as special glasses or surgery. Yet other conditions are better left untreated.

I would recommend against any of the “improve your vision” ads on TV or the internet. Many of these have elements of legitimate therapy, but they tend to over-promise and do not match the person with the appropriate therapy. Instead, only pursue therapy from a doctor with specialized training in visual function and vision therapy.

Have you read Susan Barry’s book, “Fixing My Gaze“? I very highly recommend it. You may also find this blog interesting: http://seeing3d.blogspot.com/.

If you would like more information about the evaluation or vision therapy, please do not hesitate to call and speak to Edna or myself.

Best Wishes.

-Dr. Nate

Bright Eyes Family Vision Care

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Yesterday, the New York Times Magazine published a lengthy article online about vision therapy (VT). It presents some very compelling cases of patients who have received vision therapy and observed the changes it can produce when needed. Many of the comments are also from parents who have children who have lives changed from VT.

It also delves into the controversy. As a provider of VT, I feel that this article fairly characterizes how the multiple sides involved view this issue. It is accurate to say that most pediatricians and ophthalmologists are opposed to vision therapy and the parents who have experienced it often become very supportive. There is often very little middle ground.

I believe very much that patients can have vision problems that interfere with various aspects of their life and VT is the appropriate treatment. However, when I am making recommendations to patients, it can be difficult to find the line between over-promising potential results from vision therapy  and failing to provide a valuable and needed service for a diagnosable  problem. Often, even with the best available data, we may not know just how well a patient will respond. After all, there are no guarantees with any medical intervention; we can only do our best with the information we have.

I encourage all who are interested in vision and vision therapy to visit the website of the College of Optometrists in Vision Development to learn more about what is known about vision and vision therapy. Of course, you can always call our office or Ask  Dr. Nate.

See Well!

-Dr. Nate
Bright Eyes Family Vision Care
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This is an Guest Post by  Stephanie  Leary, who is training to be a Vision Therapist. Although her story is long, I encourage you to read it because it is not written by a doctor or by a newspaper reporter, but from a mother how has experienced how vision therapy can change lives. – Dr. Nate

I cannot thank my eye doctor enough for all that his vision therapy program has done for both my son and me.  The transformation that has taken place in both of us is profound and absolutely life changing!  I am writing our story in hopes that it will be given to any person diagnosed as needing vision therapy.  I hope that our story will help them decide to pursue the treatment.  I know that they are skeptical and I thought that hearing our story from the perspective of a college educated mother who herself experienced vision therapy with her son might shed some light on very unfamiliar territory.  I want them to understand the varying degrees of these vision problems and their implications behaviorally.  I want them to know that no matter what the severity, pursuing vision therapy treatment will help.  Unlike psychology, which is subjective, vision therapy is measured and you will see the results, in black and white, printed out for you from the Visagraph.   The computer will show you what your eyes are doing while you read and evaluate your comprehension.  The Gardner Test will further evaluate your visual abilities, including things like visual memory and visual discrimination.

The following two paragraphs describe what I mean about varying degrees of vision problems and their implications behaviorally and academically for that matter.  The Visagraph showed that my eyes jumped 110 times, 70 is the norm for adults, and that I had poor tracking.  My symptoms were that I lost my place while reading.  When I got to the end of the line I had trouble getting to the next line of text and would often skip lines.  As a child, I went to a reading tutor who taught me to put a piece of paper under the line of text that I was reading so that I could not skip lines.  I read slow and hated doing it.  I could not remember half of what I read so I learned to become an excellent listener and take great notes.  I watched every book that I ever had to read in high school.  I rented the super old version of the movie, you know the one that they would show you in class after you read the book and took the test.  I avoided reading.  I could do it, I just wasn’t very good at it.  My brother had to read the movie Dances with Wolves to me because I could not keep up with the subtitles.  I could not do a puzzle for the life of me and I was gifted a C in high school geometry.  I simply did not understand it but I tried, I went to after school tutoring, so my teacher passed me. I graduated from college with a 3.24 grade point average and a degree in both management and marketing.  I did not know that I had a problem and I thought that I was smart.  When the Gardner Test was administered and scored I could not believe how poorly I had done.  I mean embarrassingly low scores, no pathetic.  My visual memory score fell in the negative 1 percentile and many other scores were in the 3^rd and 11^th percentile.  When I told my grandmother who was a teacher, she asked how I ever got through school.  I told her that it was certainly not by reading the books.  I compensated by listening really well.  I was the master at taking notes.

In contrast, my son’s Visagraph results showed that his eyes were jumping 400+ times when 100 was the norm for children, and that he too had tracking problems.  When he looked at print on paper, it literally moved around the page.  It did not sit still.  Because this is how he had always seen, he did not know that others did not see things the same way and I had never thought to ask what it was that he was seeing.  Below is the rest of our story and how we found our miracle – Vision Therapy.  All I can say is that this treatment is worth every penny.  I know that it can be expensive if insurance does not cover any of it but I hope that you will consider this.  It is not any more than you would spend on braces for your child and it is so much more important.  This treatment can mean the difference in being “learning disabled” and being at the top of your class.  That was certainly the case with my son.  There is not a person alive that would not benefit from vision therapy, but some people will not be successful without it.

I had this little guy that was struggling. He seemed so very angry at a very young age. I could not figure out why at ages 3, 4 and 5 that he was so angry. His behavior was out of control and punishment did not affect him at all.  He did not seem to care. He would not look you in the eyes and he avoided doing any type of schoolwork like flashcards, coloring or writing.  He would not even play hand held video games.  He would say that he was not smart and that he wanted to switch brains with me and with his little brother. He just seemed frustrated/angry all the time.  You had to threaten him in order to get him to do anything.  I was sure that when school started that I would be in the principal’s office every day.

At age 3, I took him to a psychologist. She labeled him ADHD/ODD/Pervasive Developmental Disorder (Autism category) and many other things. She suggested that we go to developmental preschool, which was free through our school district, and see her again when he was 5, just before entering Kindergarten. He received speech and occupational therapy through the school and it helped a little. The summer before Kindergarten, I went back to see the doctor as instructed. I was hopeful but was shattered by the doctor’s analysis.  She said that he had all of the things listed above and that he was going to be in a self contained special ed class and need an Aid to get through school. I was mortified! She continued to tell me that therapy would not work, that I could spend millions of dollars and would just be wasting my time and money. The only thing that would help in her opinion was medication, “a magic pill”. My reply was with a question with which the answer disturbed me immensely.  “You said that he has numerous disorders, yes?  You would not give someone with ADD/ADHD the same medication as you would someone with Autism or ODD, correct?”  She replied that she would give my son ADHD medication and based on his reaction that would tell her if he definitively had ADHD.  It was her theory that you rule out possible disorders based on chemically altering a child and observing their behavior.  In other words, she wanted to use my 5 year old as her lab rat to rule out possible disorders.  I now refer to this doctor as Dr. Rx.  I said that I did not believe in medicating a five year old and that I would go waste my time and money on therapy.   How dare she portray the bleakest of futures for my son!  I refuse to let that happen.  I will show her, nothing motivates me more than being told that I can’t.  I dedicated the summer to private therapy.  I was determined to prove Dr. Rx wrong and fix my son before he ever had a chance to fail in school.

I went to the pediatrician to tell her of the experience that I had with Dr. Rx from their referral and asked if they knew of a psychologist that believed in therapy and not medication.  Even the pediatrician made the comment that it was ok to explore therapy as long as it was not affecting the other kids at school.  Again, another pro-medicator.  There are tons of them out there.  She gave me another referral and I went to check out.  I happened to push over one of those free Arizona kids magazines onto the check out ladies desk.  She looked at me disgusted, so I immediately picked it up.  It was all about summer camps around the valley.  I took it home and began my summer of therapy.  I decided that the things that one needs to be successful in life are to read, write, speak and hear.  Inside the magazine I found an ad for a handwriting summer camp.  I thought to myself how cool, exactly what I need, so I gave them a call.  The owner answered.  I told her that my son was entering Kindergarten in August and he was still fisting the pencil.  I told her our story and said that I was not sure if he could just take the class or if he would need more help than just that.  She said that she was an OT that specialized in handwriting and would evaluate him.  They offered private OT as well as the classes so we would see where he would best fit.  She evaluated my son and thought that he had convergence insufficiency. She said that when you look at something on a piece of paper, your eyes come together to look at the point (converge) and when you look up, your eye separate back out to normal.  She said that she was not seeing that with him and she wanted us to see a behavioral optometrist for screening.

I had never heard of such a thing. I came home and started researching all this stuff: Behavioral Optometrist, Vision Therapy, Convergence Insufficiency. I discovered that I also had a form of this so I made an appointment for us both to be screened. Turns out that yes, we both needed vision therapy. How can this be?  I had been to an optometrist every year and worn glasses since I was in the sixth grade.  I have never had an eye exam as thorough as the one I received from my COVD certified Optometrist.  He not only asked me to read an eye chart to evaluate my eyesight, he went further and evaluated my vision at close range.  This further probe evaluates the skills needed for reading and schoolwork.  Since Dr. Rx said that therapy did not work, I decided that I would go through it with my 5 year old son and see for myself. OMG – it was the most amazing thing that we have ever experienced! With every single visit, I noticed a considerable difference in my son’s behavior. After 4 units in five short months, he was cured. He never talks about not being smart anymore. In fact it is all about how brilliant he is. Vision Therapy was able to solve his problem before he was ever unsuccessful in school and disliked it. Before it ever had a chance to affect his self esteem.  We were very fortunate to have found this when we did and I am eternally grateful!  Prior to vision therapy, my son did not know his ABC’s and just yesterday he brought home an all-star student award from his school and he gets to go to an NBA basketball game as a reward. Only the top three kids academically and behaviorally were chosen from each classroom.  This is no easy feat, as my son goes to a college prep elementary school where they are doing 1st grade work in Kindergarten.  His success brings me to tears – happy tears!

Speaking from someone who has experienced vision therapy. It makes everything in your or your child’s life easier. Things that I could never do before now come so easily. My speed and comprehension in reading have more than doubled! I am able to process information more quickly, therefore I think faster and react faster.  My peripheral vision has also increased.  I am so fascinated and awed by the transformation that has taken place in both myself and my son, that I want to be trained as a vision therapist. I have an overpowering need to help others and save them from the struggle I, and more so, my son experienced.  I need to save all the children from medication!  I want to use my marketing background to spread the word. Vision therapy is the cure for learning related issues and most behavioral issues. The change that has taken place in both of us is so profound and so powerful that it feels like I have the “cure for cancer” and I want to shout it from the rooftops!!  How can people not know about this?

Please share our story with potential clients.  I want them to know that if they are skeptical or hesitant at all, please know that they have made a wonderful decision to pursue vision therapy.  It is worth every penny that you will spend on it and then some!!  It makes everything in your or your child’s life easier!

For all of the parents out there who have children that have been diagnosed with some form of Autism Spectrum Disorder and have been sold false hope time and time again, this is the treatment for you.  THIS ONE WILL WORK!  It can change your family forever in a way that you never thought possible.  It will change your life and that of your child’s forever in the most positive way imaginable.  Your retina is actually made up of brain tissue.  Your eyes are actually an extension of your brain (80% of learning is done through the visual system) and by changing how your child’s visual system behaves, you will open up and change their brain forever.  Visual skills are learned and your child has an underdeveloped system.  Learning to use your eyes is like learning to ride a bike, once you get it, you never forget.  If you are still skeptical, I beg you to give it a shot.  Do it to prove me wrong if you must, but just do it, I dare you!  Give it one last shot, take one more leap of faith, it certainly won’t hurt.  The very worst that can happen is that nothing changes.  I bet that you will be pleasantly surprised, no make that ecstatic about the results.  Please share your stories and experiences, both good and bad, with me at www.visiontherapyadvocate@gmail.com.  I will be your biggest cheerleader and I wish you and your family the best of luck!

Sincerely,

Stephanie Leary

We love to see these stories! If you have a Vision Therapy Story, send it it and will will post in on the blog and link to it from Facebook book and Twitter.

-Dr. Nate

Bright Eyes Family Vision Care
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“If you imagine it, you can achieve it.  If you dream it, you can become it.”- William Arthur Ward

How many times have we seen the impossible become possible through a simple thought or dream?  Can you imagine all the possibilities and opportunities that would open up in your life just by taking one small step towards your dream or goal?

In Dr. Lynn F. Hellerstein’s book, See It.  Say It.  Do It!, she reinforces this concept of visualization.  By teaching a child to visualize first,  then to verbally affirm that goal as if he has already achieved  it, and finally to take the necessary actions to accomplishing that goal, you are giving that child invaluable tools that will last him his whole lifetime.  You will have instilled a self-confidence that would ensure him to become successful in any area of his life.

It sounds so simple, and yet we don’t even realize what an impact it could actually have in our daily lives.  Some of us already use visualization and don’t even know it, but we don’t use visualization to its full potential.  But if we start now , we can teach ourselves, children, and others how such a simple, yet powerful concept can truly alter people’s lives forever.

Dr.  Hellerstein shows us how easily we can learn and teach visualization techniques by giving us step-by-step instructions and fun activities that can be utilized in any age group.  If you want to make a difference in someone’s life, or even in your own, then you need to read this book and discover for yourself just how powerful your visualization can be for you!

Edna Moore, Vision Therapist

Bright Eyes Family Vision Care
Westchase, Tampa, FL
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I’ve been a big fan of Susan Barry ever since I first read about her in The New Yorker several years ago. I was an even bigger fan after her book “Fixing My Gaze” was published this year. As a neuroscientist and educator, she has written a very accessible book about her remarkable experience with vision therapy as an adult.

I’ve become so enamored with “Fixing My Gaze” that I have shared many copies with friends, held an online contest to give a the book as a prize, and even interviewed Dr. Barry. So I was delighted to see this morning that the book has been selected as the #4 top science book by Amazon.com for 2009. This is very fitting, due to the easy-reading style of a very complex and fascinating subject.

Congrats to Dr. Barry for the well-deserved praise for a fine piece of work!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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My daughter just had academic testing done. She is in 2^nd grade.  She is a great reader and has no problem writing.  Her struggle is with visual perception and long term retrieval.  She has difficulty with math; specifically with shapes, graphs and tables.  She does not seem to understand or can not see the relevance to the math problems presented.   Can you tell me if you have heard of this math issue having to do with a vision problem?

Well, without being too technical, math does involve complex visual perceptual skill. It is certainly possible that a challenge in specific visual processing can result in difficulty with math. The relationships that are involved in math are typically rooted in tangible concepts that are readily processed visually.  (Here is a simple example). This can even be the case even if your daughter is a good reader – it is also possible that her language verbal skills are so very high that they compensate for visual difficulty, or that the visual processes may not be the same used primarily in reading.

Has your daughter and a complete vision evaluation? I would start there, followed by an optometric visual information processing evaluation. After these are completed, it would be possible to tell you if  some form of intervention (glasses, contact lenses, vision therapy)  may benefit her.

And, of course, she should continue to receive the needed instruction and any tutoring/remediation/addition instruction that is appropriate.

I hope this information has been helpful. If you have further questions, you can call the office at 813-792-0637 or email me directly.

Be Well!

Nathan Bonilla-Warford, OD, FAAO
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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This video features optometrist Julie Ryan and shows vision therapy in action.

Thanks to Maino’s Memos for the find.

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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For those that follow vision therapy, you likely have read about this Joint Plicy Statement by the American Academy of Pediatrics, Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus;  and American Association of Certified Orthoptists.

Well, this has created a stir, not so much for the policy that essentially has not changed in decades, but rather the tactics that were used to arrive that the policy statement. This is from the American Optometric Associatio Newsblog:

The policy statement …  sheds doubt on the claim that vision therapy treats dyslexia – a claim that vision researchers and clinicians have not made for decades.

It also ignores the evidence of the proven benefits of vision therapy, such as in well-designed studies, most notably the Convergence Insufficiency Treatment Trial (CITT), which was funded by the National Eye Institute. This study showed that vision therapy administered in an eye care provider’s office is the best course of treatment for that condition.

Unfortunately, this is not new.  As Leonard Press, O.D., writes in A flawed statement on vision therapy, learning and dyslexia is reissued:

The American Optometric Association in a joint policy statement with the American Academy of Optometry has previously pointed out the flaws with the joint policy statement of the organizations above (1997, at www.aoa.org/x5420.xml ).  A point-by-point rebuttal of the misleading information intended to discredit optometric vision therapy was published by the American Optometric Association in its journal, Optometry.  (Bowan MD, 2002).  This latest iteration in the form of the Pediatrics article unfortunately recycles the same straw man arguments as the prior joint statements.

The issues of reading and learning are highly complex and multifactorial. I do honestly believe that all profressionals involved feel they are acting in the best interest of children. Unfortunately, some organzzations are slow to change, even in the face of highly credible evidence.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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As readers of this blog and those that follow us on Twitter know, there is an exciting book was recently been published about a woman who achieved great success with vision therapy at age 48. It is called “Fixing My Gaze” by Susan Barry, Ph.D. It has been very popular and at one point was the 367th most sold book on Amazon.com

When the book was released, I pre-ordered copies for my office. I read it and had the staff read it. I loved the way Dr. Barry writes and her accessibility. In fact, I liked it so much that I recently held an online contest to give a copy away.

Well, the contest caught the attention  of  “Stereo Sue”, as she is nicknamed, and she graciously agreed to an online interview.

Dr. B: Dr. Barry, thank you so much for being participating in this interview. I know that vision therapy programs can vary tremendously from patient to patient. How long was your office therapy with Dr. Ruggiero?

Sue: I had about 12 months of office therapy spread over one and one-half years.

How long before you saw definitive progress?

I began to see progress within the first month. My gaze appeared more stable and I began to notice pockets of space between objects.

Regardless of whether a patient is 5, 45, or 95 years old, vision therapy can be a lot of work. Was it hard to stay motivated?

Yes and no. The changes in my vision encouraged me to continue. I also saw myself as my own experiment and liked thinking about how I was changing my vision and what changes were occurring in my brain. The most important thing I did to keep motivated was to keep a journal of how far I could go with each procedure. This taught me that I was making progress even during the weeks when I felt that nothing was happening. My vision therapists were extremely encouraging and fun to work with. My optometrist, Dr. Theresa Ruggiero, was always so positive that she made me feel like I was 10 feet tall.

In “Fixing My Gaze” you mention several vision therapy activities such as Marsden Ball, Brock String and  Vectograms. Is there one activity that was your favorite?

My favorite activity was the Brock string because it gave me the feedback to learn how to point my two eyes simultaneously at the same place in space. I could feel my eyes moving in concert and this was very exciting. The first time I saw stereo depth in the Polaroid vectograms – it was the clown vectogram – was also very special.

Now that you’ve had stereopsis for several years, do you find yourself at times taking it for granted as most people do?

No. My vision continues to improve and I have taken to walking everywhere just so I can feel myself moving through this three dimensional world. I am still surprised by what I can see. One advantage, I suppose, of not having stereovision for half a century is that I never take my vision for granted. I feel like I have been given a great gift.

You did such a marvelous job making the book accessible to many people from laypeople to doctors and scientists. Did you find that difficult to do, or did it come naturally?

I am a college biology professor and enjoy teaching, especially finding straightforward ways to explain complicated things. I learned this from my mother who was also a teacher. I also learned a great deal about vision from the many optometrists I spoke with.

Several people have commented on the readability of the book. What steps did you take to achieve this?

I made the decision about the font. I told the publisher that I wanted the book printed in Garamond font at the largest acceptable font size and spacing between letters, words, and lines. I was concerned that the people who might find the book interesting and beneficial are also the ones with difficulties tracking the letters on the page. The Harry
Potter books (which I loved) are printed in Garamond font, and one of the people I mention in my book had told me that he found Harry Potter easy to read because of the font and spacing. Also, my father, now 86, was a calligrapher and graphic designer and so I asked his advice about the fonts as well. He told me that the font should have some serifs (the little curley cues around the letters) as Sans Serif can be hard to read. However, the font should not be too complicated. We got out his old font books and looked over many different fonts and agreed that Garamond would work. I was very happy that the publisher honored my wishes here.

Thank you for writing “Fixing My Gaze.” My colleagues and I are very happy about it. Have you been surprised at its reception?

I never expected my book to be embraced so enthusiastically by so many people from people with binocular vision problems to scientists to optometrists.

Thank you for your time. Is there anything else you’d like add before we go?

I hope my book will teach people that the brain is capable of rewiring at any age, will broadcast the importance and effectiveness of optometric vision therapy, and will help many children as they progress through school.

I encourage all my readers to read “Fixing My Gaze.” You can get it at any bookstore or on Amazon.com. Alternatively, we have office copies that we are lending to patients. If you’d like to borrow a copy, just stop by Bright Eyes and ask for one.

Happy Reading,

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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Update: Here are some links for more information:

Audio Podcast Interview with Susan Barry
http://www.perseuspodcasts.com/main/podcasts/book.php?
isbn=9780465009138

Print Q&A with Sue from the New Scientist, June 6, 2009
http://www.newscientist.com/article/mg20227112.900-how-i-learned-to-
see-in-3d.html

Sue’s Psychology Today Blog, Eyes on the Brain
http://blogs.psychologytoday.com/blog/eyes-the-brain

Los Angeles Times OpEd
http://www.latimes.com/news/opinion/commentary/la-oe-barry22-
2009jun22,0,350826.story

Just a brief note to say that our Vision Therapy Home Manual is now online.

You can find it in PDF form here.

Be well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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