Girl and vision therapy

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

In 2009 the Melrose-Mindoro School Board in Wisconsin 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 misjudgment, 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, although perhaps administrative tasks could be re-prioritized instead.

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. Referrals were also very liberal. If a child was having reading issues, a referral was made. A key goal of the program was to get help to any who might need it.

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 continuously 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 to get a feel for the best setup. Also, a larger school might be able to 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 disrespectful, 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 referrals 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 some 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 accommodate 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.

However, vision therapy given every day from the beginning of the school year should enable most students in the program to graduate well before the end of the school year. Two options would be to wind down the program gradually as the year progressed and students graduated, or add new students who might benefit but were passed over on the initial selection process.

The Dangers of Starting Slow

The leadership of Melrose-Mindoro took the vision therapy program seriously. The initial program was intentionally double the anticipated final size. This enabled the school to catch students in 4th and 5th grade, while eventually working down to the 3rd grade level that it settled at.

While it's not necessary to begin that large an effort, starting too small risks starting with only students who have far more than just vision issues confronting them. That will make eventual evaluation of the program's effects very difficult.

In a large district, with several elementary schools, it would be preferable to start a 3rd grade program in one of the schools and plan to provide vision therapy to at least 15% of the students in that grade, and possibly more. Then evaluate the program over at least two years, preferably three. After all, vision therapy doesn't teach reading; it enables it.


I have little doubt that, properly run, any school district that tries this, and does it right, will see significant gains in student ability. Furthermore, eventually instruction overall will improve due to the reduced number of struggling readers in the upper grades.

And, in time, the budget strain from the program will be compensated for by the lessened budget for resource rooms as the number of students needing them is reduced.