Does Vision Therapy Work?

If you've already read the previous pages in this section of Understanding the Dyslexia Puzzle, you're probably curious about vision therapy, but still wondering if it really works. The reason I'm personally so certain that vision therapy works is that I happened to establish a working relationship with a vision therapy department after a time and saw the impact it had on some of the children I taught. I noticed how their ability to pick up the phonics information I was teaching them would improve both during and after vision therapy.

But the purpose of this page is not to convince you that it works. Earlier in this section I covered the effectiveness of vision therapy in addressing a common vision problem typical of many struggling readers. (See the page titled Convergence Insufficiency Study.)

Instead, the purpose of this page is to explain why you could get a discouraging answer to the question "Does vision therapy work?" when you ask the person you probably trust most to know the answer, your family eye doctor.

Why Does Vision Therapy Remain a Secret to Many Parents?

Nearly every parent who has a child struggling to learn to read will have taken that child to an optometrist for a routine vision evaluation. In most cases they will have been told that their child’s vision is “just fine” after any acuity problems have been corrected.

Yet, in my opinion, the majority of children who continue to struggle with reading are still suffering from undiagnosed vision problems. So the question becomes, why was something missed? What is it about these particular vision issues that makes it so difficult for parents to learn about them?

Business Considerations Come Into Play

I can answer that question without casting doubt on your family eye doctor. First, however, consider that if your family physician detects something requiring surgery during your physical, he’ll readily refer you to a surgeon, knowing that you will return to him after the surgery and that you will probably be grateful that the problem was caught and handled.

In contrast, if your family optometrist decides to set up his practice to diagnose the sort of vision problems diagnosed routinely by developmental optometrists, he would find himself with two choices, both of them unappealing. If he diagnoses a problem, he either has to set up his practice to deal with that problem which is a huge business decision involving significant investments of time and money, or else he has to refer his patient, your child, to someone else who can deal with it, that is, to a vision therapy center. However, nearly all vision therapy centers are run by developmental optometrists that potentially compete with your family optometrist for patients.

It would be wonderful if all family optometrists would decide to refer children who are experiencing reading problems to a developmental optometrist since they don't themselves, do all the testing required to uncover the relevant vision skills problems. However, in doing so they risk losing not only the referred patients, but entire families, to a competitor.

Your family eye doctor generally doesn't conduct the same testing as a developmental optometrist does

As a consequence, an eye exam by your family optometrist is unlikely to be as extensive as one done by a developmental optometrist looking for poor visual skills and is therefore less likely to result in a referral to a vision therapy center. Unfortunately, in the absence of such a referral, most parents conclude that their child's vision is not an issue when it comes to learning to read.

I recommend that before you assume that poorly developed visual skills are not the cause of your child’s reading struggles, you need to ask your family optometrist if he ever refers to a developmental optometrist who runs a vision therapy center. If the answer is no, or is evasive, or is disparaging of vision therapy, you can safely assume that your child’s vision still needs further evaluation. If his answer is yes, tell him that your child is struggling with reading and ask him who he refers to in your area, and whether he found anything in his testing of your child that had him thinking about making such a referral.

Differences in Testing

I’m sometimes asked what developmental optometrists test for that is missed by the family optometrist. Some of the testing is the same, but the developmental optometrist will perform further testing and will recommend vision therapy when indicated, whereas your family optometrist might, for example, mention that your child’s convergence ability is somewhat weak and suggest “pencil push ups” or some other home exercise. (Recent research demonstrates that vision therapy is effective where pencil push ups are not. See the Convergence Insufficiency Study for more information.)

It’s also quite possible that your child actually did pass all the regular optometric testing with flying colors and still has a vision problem. The reason is that reading requires sustained effort. Your child might indeed be able to converge his eyes on the print and focus clearly for quite a long time, easily passing a standard convergence test done by your family optometrist.

Have you noticed that your child starts to make mistakes, slow down, act tired or uncomfortable after reading two or three pages?

But reading even one page of print will take longer than the testing usually does. Have you noticed how your child seems to read easily and fluently sometimes? Have you also noticed that he starts to make mistakes, slow down, act tired or uncomfortable after two or three more pages? He’s telling you by his actions that he can’t sustain the effort visually.

A developmental optometrist will do all the standard vision testing and if a problem is detected in that testing and especially if you are concerned about a reading problem, it is likely that you will be told that your child should have a full developmental vision examination. This exam will probably run over an hour during which your child’s vision will be tested in several ways that are relevant to the reading process, as well as being relevant to many more activities in the daily life of a child. (For example, if he can't seem to catch a ball no matter how often he tries, it could be due to poor visual skills that can be properly developed with vision therapy.)

In addition, he will have to prove that he can sustain the effort when he’s taking these tests. Some children do fine for a while then gradually their performance starts to fall apart because they simply can’t sustain the effort. Reading absolutely requires the ability to not only exercise several vision competencies up close, but also to sustain those abilities for long periods of time.

If You Made Up Your Mind Before, Reconsider

The current situation is unfortunate, since parents end up being convinced that they’ve covered the vision issue when often vision is the issue. This situation will gradually change as more and more parents learn that vision therapy was the answer to their own child’s reading problem, or at least an important missing piece of the puzzle. I had one mother tell me that she was told by a developmental optometrist several years earlier that her child had a vision problem, but that she decided against pursuing vision therapy. She came back recently only because in the intervening time several other mothers in her area told her that vision therapy had helped their own children.

You need to realize that your child’s visual skills might not be in place even if you’ve been led to believe otherwise. Vision therapy is expensive, and it’s easy to take your family optometrist’s statement that he “finds no problems with your child’s vision” and to reinterpret him as saying “your child’s vision is fine.” Actually what he really said is that he didn’t find a problem during the testing he performed. It doesn’t mean that he did the tests that a developmental optometrist will recommend if he suspects a visual skills deficit.

Put all of this together, the possibility of losing business, the reluctance of some optometrists to acknowledge the effectiveness of vision therapy, the testing differences, and the fact that responsible parents have had their child's vision checked and have been reassured that the child's vision is fine, and it's not surprising that, for many such parents, the existence of a treatment that has helped many other children like their own remains a secret. Fortunately, that is slowly changing.

Next, in Growing an Architect I’ll explain a pet theory of mine on why so many people diagnosed with dyslexia have chosen to become architects and engineers.