In Clear View

Local physicians aim to correct vision problems in children

By Alisa Advani

»For Haley Watson, school changed dramatically in the third grade. While she and her mother, Tracy Watson, knew that the independent reading and standardized tests required during this pivotal year were a big leap from the simpler lessons of second grade, nothing prepared them for the challenges ahead. Neither Haley, her mother nor her teacher could explain why a bright, straight “A” student scored “barely at grade level” in reading assessments.

It turns out that Haley didn’t have an actual problem with reading itself. She suffered from convergence insufficiency, a condition that occurs when the brain and the eyes fail to communicate smoothly. Her eyes do not appropriately turn inward, which hinders their capacity to focus on things up close. According to the National Eye Institute, this condition affects 5 to 12 percent of school-age children and wreaks havoc on their reading proficiency. The condition is only one of myriad eye disorders that mimic learning disabilities. Amblyopia (lazy eye), strabismus (crossed or wandering eye), eye-tracking deficiencies and focusing difficulties also cause serious complications for children just as they’re learning to read. 

“Convergence insufficiency is one of the most common ones that we see,” says Dr. Jenna Liechty, a pediatric optometrist who works at VisionQuest Eyecare in Greenwood. She specializes in the diagnosis and treatment of these disorders and offers vision therapy to her young patients.

As in Haley’s case, children find themselves unable to focus on the words in their books and on the tests. “We need the eyes to turn inward to see up close for reading. When they fail to do so, words jump off the page or get blurry,” explains Liechty. “Unfortunately, children often don’t realize that their experience isn’t normal, so they might hate reading out loud or doing homework.”

And therein lies the conundrum. More often than not, children pass vision tests at school, or they believe their blurry experience to be the conventional one.

Dr. Brandon Armstrong of Richard and Armstrong Optometry in Greenwood says he detects vision problems in 20 percent of cases. Conditions like amblyopia and strabismus often go undetected until a comprehensive eye exam takes place.

Such was the case for Haley. While her mother knew something was wrong with her daughter, she never suspected that her daughter’s eyes were the culprit. “In younger grades, Haley managed by hearing the teacher read the story to the class,” Tracy says. “She became very dependent on her auditory skills.”

Tracy only uncovered the root cause during a fortuitous conversation with a fellow member of her church who overheard her talking about her frustrations with Haley’s grades and standardized test scores.

“Someone asked me if I had ever had her vision checked,” Tracy says. “I responded that ‘I think she sees fine.’” But as this woman spoke to Tracy about her own childhood experience with vision therapy, a cause and a solution for Haley’s problems took shape.

“I contacted Aaron Warner, our family eye doctor, who sent us to Dr. Liechty for therapy after he made the diagnosis,” Tracy says. “As Haley answered the questions Dr. Liechty asked, my heart was breaking. My husband and I had no idea she was having trouble physically seeing the words on the page. Of course, the school day felt long; of course, she was exhausted.”

After the consultation, Liechty suggested individualized, weekly one-hour vision therapy sessions for Haley. Through a series of exercises, patients develop better fundamental visual skills and improved visual comfort, ease and proficiency. Unlike other forms of exercise, the goal of optometric vision therapy is not to strengthen the eye muscles. Instead, the repetitions build the synaptic connections between the eyes, muscles and brain. During this progression, children experience a marked change in how they process or interpret visual information.

The College of Optometrists in Vision Development’s website also states that “20/20” only means that a child can see at a distance but may lack the skills needed for learning and further states that typical vision screenings can miss at least 50 percent of vision impairments. These techniques fill a critical need in pediatric health care.

Before the National Eye Institute’s groundbreaking Convergence Insufficiency Treatment Trial (CITT), which published in October 2008, eye care professionals debated the usefulness of this treatment approach. The 12-week long study established scientific proof of the efficacy of office-based vision therapy in children with convergence insufficiency (CI). The CITT found that approximately 75 percent of the participants who received office-based therapy along with at-home reinforcement achieved normal vision or had significantly fewer symptoms of CI. Only 43 percent of those who completed home-based therapy alone showed similar results.

Liechty says that vision therapy often can prevent the need for surgery but stresses its benefits as an adjunct to surgery, too. “Surgery is definitely sometimes needed, but then so is therapy,” she says.

Armstrong adds that “many times an eye turn (strabismus) can be managed with corrective lenses, glasses, contacts or bifocals. After surgery, therapy can be helpful in teaching a child how to use both eyes together.

“With occlusion therapy, a patch is worn over the stronger eye to force the weaker eye to start focusing,” he adds.

Luckily for Haley, she didn’t need surgery. Glasses and therapy did the job. After struggling through third grade, the youngster has turned into an avid reader. With newfound hope, she spent about seven months retraining her eyes with Liechty, keeping her focus on the end result.

“When Haley returned to school for fourth grade, the initial reading test indicated that her Scholastic Reading Index had jumped 99 points over the summer. By the end of her therapy, her score had increased another 168 points,” her mother says. “We were so grateful.”

Tracy urges other parents who recognize similar symptoms in their children to have them checked. “I have to believe that there are other kids struggling with reading who really have an undiagnosed vision issue.”