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School-Based Vision Therapy

Note: When this page was first added to my website around 2008 or so what I wrote immediately below was true. However, later our local school board for the Melrose-Mindoro School District, Melrose WI, of which I was a board member, authorized an in-school vision therapy program beginning in the 2009-2010 school year. That program was ended after the 2014-15 school year. For further information on the program, see below.

To my knowledge, no public school anywhere in the country, or in any English-speaking country for that matter, offers vision therapy under the purview of the school. They offer speech therapy for speech problems and occupational or physical therapy for motor problems, but not vision therapy for vision problems. Yet, if the developmental optometrists are correct, and I believe they are, the vision problems addressed by vision therapy affect learning far more than either speech or motor problems. Still, we have no vision therapy in public schools. (If you’re reading this and know of such a school, please email me from the home page.)

Note: In December of 2009 I did receive an email from Ms. Raquel M. Benabib, a certified vision therapist, informing me that a Montessori/elementary school in Mexico City had been serving the vision needs of its students for 17 years. That school is Colegio Senda and the program is supervised by optometrist Carmen Marotto. She did say that it was a private school and that the program is therefore funded by parents. Apparently they have been satisfied enough with the results that they've continued with it for almost two decades.

Speech problems are obvious, as are motor problems, and as a society, we refuse to allow these problems to persist in school children if we can fix them. While it might be reasonable to just tell parents to hire the speech therapist on their own, it’s also reasonable to assume that taxpayers don’t feel unduly burdened by the decision to systematically address these issues so that even the neediest child will receive these essential services.

Why School-Based Vision Therapy Might Happen Eventually

Suppose learning problems are mostly caused by undiagnosed vision skills problems, as asserted repeatedly on this site. Suppose the developmental optometrists are correct. Furthermore, suppose that school personnel gradually become convinced that vision therapy is exactly the intervention that learning disabled children most often respond to. That is, suppose the adoption of the Response to Intervention (RTI) Model results in convincing schools that vision therapy is a much-needed, valuable intervention because the responses are so obvious, and beneficial.

How much of a leap is it from those suppositions to the assertion that schools should employ vision therapists just as they presently employ speech/language therapists for speech issues and physical/occupational therapists for motor issues? How much of a leap when you consider the cost of consigning a child to a career track composed of resource rooms, special education classes, low-wage employment and possibly even the welfare rolls or incarceration?

School-Based Vision Therapy Would be More Efficient

Moreover, it would be much more efficient than the present system where a parent of each child must learn to oversee home-based exercises. It would be far better to have trained aides in the schools who could work with several children each day, and who would almost certainly become more effective as they gained experience. School-based vision therapy would also be a tremendous benefit to those students whose parents lack the time, or the money, or possibly even the inclination, to see that their children get the vision help that they need.

Note: I wrote the above around 2008. In 2009, our local school initiated school-based vision therapy as described above and ran it for six years. Because of the controversy that has typically accompanied the subject of vision therapy over the years, I never mentioned the program on my website until now (October, 2015). Below you will find a report on the program as I saw it, both from the perspective of a school board member and from the perspective of one who acknowledges the importance of addressing the subtle vision issues that prevent students from achieving their potential.

The Melrose-Mindoro Vision Therapy Program (2009-2015) (Now Discontinued)

As I said in the introductory note to this page, in 2009 the Melrose-Mindoro School Board authorized an in-school vision therapy program. It ran for six years but is no longer operational. I'll attempt to describe how it operated for the benefit of those wishing to explore this option for getting vision therapy to every child who needs it.

First, we contracted with the Vision Therapy Academy in La Crosse, WI to provide the services of a developmental optometrist and two vision therapists who would visit the school one day per week. Dr. Ann Wonderling, a developmental optometrist, provided her evaluation services and oversaw the certified vision therapists she provided. Dr. Wonderling evaluated all referred students early each year, then re-evaluated those who entered the program for a progress check and a final exit check. The school district also hired the equivalent of two full-time aides who worked with the students doing VT exercises prescribed by the therapists on the other four days of the school week. 

Each student saw a vision therapist for 30 minutes once a week and then saw one of the aides (who were essentially doing the homework that a parent would ordinarily oversee in an in-office VT case) for 30 minutes per day on the other four days. The first two years, the program was run in the building housing students in grade 3 to 5, each class having about 55 students on average. (There are just over 700 students in the K-12 district.) The size of the program was effectively double what the long-term program was intended to be, so that all of the students in the building could eventually obtain VT if needed, before they moved on to the junior high building. In the first three years, about 20-25 students were given VT after which the program was downsized due to only having to cover one grade each year instead of the initial three. At that time, one vision therapist was under contract and one school aide was doing the homework phase the other four days as well as coordinating the program. 

In either year 3 or year 4, the program was moved to the building housing the K, 1, 2 grade students under the assumption that it would be better to get the second graders into VT while they were still in the "learning to read" phase. That proved to be a misjudgement, as it turned out, and the program was moved back to the grade 3-5 building for the last two years of its operation.

Lessons Learned

Cost of the program: It wasn't cheap, probably amounting to $3,500 to $4,000 per student in the program, but it was a one-time cost for each particular student. Out of pocket costs were on the order of $3,000 to $3,500 per student, but a fair amount of administrative time was also required, time provided by existing administrators. A large school system would probably be required to budget for additional administrative time.

Coverage: Unlike the hit or miss way that most children today get VT, or even get evaluated for the need of VT, every student who was referred was professionally evaluated and, if the parents consented, was given vision therapy. That was a key goal of the program.

Local vs. State control: Unfortunately, even though the program was authorized by the school board, the State of Wisconsin would not provide the share of state aid toward the VT program. That is, the local taxpayers bore the entire cost, unlike every other program at the school, including sports programs. This was probably a key reason that the program was discontinued, although not the only reason.

What grade to offer it: Ultimately it was decided that 3rd grade was the optimum grade to offer the program. When the program was moved to the 2nd grade, many participating students were not developmentally ready to undertake VT. Some were, of course, but by 3rd grade, most were. Furthermore, that would give both the 1st and 2nd grade teachers an opportunity to see if a particular student would pick up the necessary reading skills.

Value of the in-school aide: Having a school aide fully trained (by the vision therapist) to continously provide the parental homework component of VT was of definite value. Each child who goes through VT in the normal way today brings with him a parent who also has to learn how to conduct the exercises at home. Many struggle to do so, or can't find the time, or just have difficulty working with their own child on such matters. In-school aides are able to quickly learn the process, know most of the children, and will get the required work done. Also, students are working on the exercises when they are alert, rather than at night, or after a day at school, as is usually the case when a parent has to oversee them at home. Another important consideration is that over time the aides should become better at their jobs, to the benefit of the students undergoing VT.

Scheduling is difficult: Initially at least, introducing the need to pull 20% or so of the students out of classes each and every day for several months of the school year created monumental problems. A student couldn't be required to miss over half of every math class or science class or even art class for most of a school year, for example. And when every third grader in the building is attending a 2 hour reading block at the same time, that would complicate matters as well. Ideally, the scheduling needs should be considered well in advance of initiating the program.

Space can be an issue: The space needs aren't burdensome unless no space is available. A relatively small room will suffice provided it's quiet and only one student is working in the room at a time. For a larger school that would have several students working with several school aides and/or vision therapists at one time, a visit to a local vision therapy facility would be advisable. For one thing, a larger school could probably afford to purchase the additional equipment used at such a facility. Otherwise, several small rooms might be preferable to one larger one to avoid having a student distracted by others in the room.

Educating the staff: A student failing to learn to read, or reading with difficulty, due to a vision problem is often treated as though he has a different problem. He's lazy, doesn't try, is disrepectful, doesn't get enough sleep, has parents who won't work with him at home, etc. But often what he really needs is vision therapy. Staff in the lower grades need to be educated to look for evidence of vision issues both so that they make appropriate referals and so that they learn to cut the affected students some slack when it comes to judging their behavior, or at least learn to judge their behavior accurately. Staff in the grades where VT is scheduled need to participate in the scheduling so that conflicts are avoided. They also need to become supportive of the program, for they will be in an excellent position to undermine it, should they choose to do so ("Oh, you're missing math again?" or "I haven't really noticed that your reading has improved, you know.") And staff in all grades past VT need to realize that they have students who are now capable of learning to read well, but might still need to be taught to do so. They also need to raise their expectations of students who were underperforming prior to undergoing vision therapy. In addition, they should be trained to look for those bright students with vision issues who slipped through the referral process when they were in the lower grades. Ideally, the program would accomodate such students as well, for they definitely exist.

Resources needed per 50 pupil class: Approximately 10-12 students in a cohort of 50 will probably be found to benefit from VT to the extent that it should be offered them. That will require one contracted-day of vision therapist time and one full-time school aide doing the parent-homework component of the exercises as well as consulting with the therapist on the day when he or she is on site.

Some Results, Anecdotal and Otherwise

While I can't speak for Dr. Wonderling, I believe she was both satisfied and pleased with the progress made by almost all of the students over the years the program was in operation. Most students saw significant improvement in the vision skills trained with vision therapy. She took objective measurements both before and after VT and issued a full report on the improvement of each student following VT. In my opinion at least, the results were exceptionally good. That said, some children would be better off with in-office VT due to the additional equipment available there. I should also emphasize here that VT doesn't teach reading per se; it trains skills essential to learning to read. The VT program was successful in training those skills. 

As for anecdotal results, I will share one story that captures one overall view of the program. At a regular school board meeting following the fourth year of the program one item on the agenda was to consider the discontinuing the program. In an unusual confluence of events, two different topics had brought a number of parents to the board meeting, one related to starting a pre-Kindergarten program and the other to a sports matter, but the vision therapy discussion was listed ahead of those items on the agenda. When the board discussion began, out of the blue, at least a half dozen of the parents present chimed in to quite vociferously support the program based upon their experience of having their own children go through it in the past years. The impact on the board and the administration was significant enough to get the program continued, for the time being. I should also note that the administration had changed since the program was initiated.

Some Concrete Results

Note: I have a science/math background and I'm well aware that it's possible to cherry-pick data when attempting to demonstrate results. Below is a study that I did of results for one class cohort. I left out no students unless they were not present for both the pre-testing in 4th grade or the post-testing in 7th grade. While I'd actually be surprised if additional evaluations yielded the same degree of success, I suspect readers will find the results presented below quite interesting.

Unfortunately, despite some effort to do so, not much hard evidence was actually gathered as to the overall impact of the program. However, the board was presented with evidence regarding one VT group consisting of ten students who took VT in their 5th grade year in the first year of the program. All students who took the 4th grade Wisconsin standardized test battery and three years later took the 7th grade test were compared. The measure used for comparison was their percentile reading rank which ranged from 0 to 100. A ranking of 75, for example, indicated that they performed better than 75% of all Wisconsin students on the reading portion of the test.  Each student's 4th grade reading rank (before VT) was compared to their 7th grade reading rank. Then the entire group of ten was compared to their the rest of their class's performance, numbering 30 students who didn't have VT. 

The thirty students who did not have VT had changes in reading rank ranging from an increase of 28 points to a decrease of 27 points. As one would expect, those 30 students averaged together saw little change in ranking overall, the result being a mild decrease of just under 2 points. That is, all Wisconsin students as a group improved their ranking slightly versus the 30 students in the "no-VT" group at Melrose-Mindoro. 

In contrast, of the ten VT students, only one saw a drop in ranking (of 3 points) while the rest saw increases, with the entire group increasing by an average of over 16 points. Five had increases of 20 points or more. Many of them had relatively low rankings in 4th grade, but ended up at about the average for the overall class in statewide reading rank in 7th grade. Ironically, at least to my mind, due to the outperformance of the ten students who had VT, the overall class rank actually improved against the state average by approximately 2.8 points. I also found myself wondering whether the four students in the group of thirty who did not have VT and whose rankings dropped by more than 20 points from 4th to 7th grade might also have benefited from the program. All of them were in the top half of the rankings in 4th grade testing incidentally, but smart kids with vision problems can sometimes learn to read despite their vision issues. Later, the sheer volume of reading required to keep up becomes overwhelming due to their visual discomfort.

To my knowledge such data wasn't collected after I left the board in 2013, although it could have been. In any case, the program was not renewed for the 2015-16 school year. By that time, three of the most supportive board members were no longer on the board and new leadership was in place at the school. As I said earlier, the lack of state aid for a locally-authorized program was probably a significant factor in the decision, though I didn't participate in that decision so I can't say that for certain. 

My Personal Recommendation

If you read the vision-related pages of this website you will learn that I'm a strong advocate for vision therapy. I also sincerely believe it should be provided by school districts, for that is the only way that every student who needs it will get it. It's too expensive for many families to provide on their own, it's too difficult for a parent to determine the need for it, and most students just won't ever get the help they need. In fact, I believe that would be the case even if vision therapy were widely covered by insurance. Many children still wouldn't get the therapy they need.

I also believe it's essential to tackle this issue from the top down. If the State of Wisconsin provided the same level of state aid to the Melrose-Mindoro Vision Therapy Program that they currently provide to all other school purchases of services and equipment, the program might still be up and running. Furthermore, the lack of aid prejudices the decision beyond just the cost, for it serves as a judgement as to whether or not the service is worth providing. Were I to undertake the effort to get VT back into the school district, any school district, I would start in the state capitol with both legislators and the Superintendent of Schools. Before you do so, I recommend reading Why Such a Secret? on my website to get some idea of the obstacles you might face.

In closing, I would like to thank Regina K. Coates, M.Ed. of Richmond, VA. Her present interest in school-based vision therapy motivated me to add the information on the Melrose-Mindoro vision therapy program to my website. Hopefully parents and others interested in seeing vision therapy provided in the public schools will find our local school system's experience useful to their efforts. 

The next page, Vitamin D3 Supplementation, discusses the prospects for addressing the current epidemic of vitamin D3 deficiency with a change in public policy.