Our Vision Therapy Experience

In the fall of 2023 Owen, then age 9, was diagnosed with multiple vision impairments. The suggested treatment was vision therapy. In this post, I share how all of this came to be, our vision therapy experience, the outcome of vision therapy, Owen’s 504 Plan, and things to be cognizant of in regards to your own child.

What is Vision Therapy?

Vision therapy teaches children how the brain controls the eyes. It aims to improve visual skills and their application for reading, learning, concentration, and attention.

Vision therapy is a customized treatment program. It focuses on strengthening visual skills and retraining the visual system for better interpretation of visual input.

Vision therapy involves more than just eye exercises. It enhances communication between the brain and eyes, improving the overall functioning of the child’s visual system.

Failed School Vision Screening

In October, 2023, Owen, then age 9 and a third grader, brought home a paper from the school nurse saying he failed the vision screening. The letter suggested we take him to an optometrist for a routine eye exam. We thought ok it’s probably time Owen gets glasses because Brad and I were in fourth grade when we got glasses.

Eye Exam

Thinking this was no big deal, I made an appointment at Target Optical for the end of October. During the exam, the optometrist had Owen do what’s called the Stereo Fly test. The test helps identify vision problems and conduct stereopsis, amblyopia, suppression, and strabismus testing.

After completing the assessment, the optometrist said Owen doesn’t have depth perception. I was very taken aback by this so I started asking questions. The optometrist was very dismissive and said “he’ll figure it out on his own”. I kept pushing, asking if there was anything that could be done. But the optometrist was becoming noticeably annoyed with my questioning. Realizing I wasn’t going to get anywhere with her, I stopped pushing for more answers and possible solutions.

During the exam, the optometrist also said Owen had an astigmatism and needed glasses. She also said he had a slight eye turn in the left eye.

Second Opinion

Over the course of the next few days, I did some research on lack of depth perception and possible treatment options. I also decided to reach out to a friend of ours who’s an optometrist and owns her own practice in Brad’s hometown. I told her what the optometrist said and my concerns. She happened to be coming to Indianapolis the following weekend and offered to examine Owen while she was in town.

On a Sunday afternoon, Owen and I met her at her hotel where she examined Owen. She confirmed that he had a slight left eye turn. She also had Owen complete the Randot Stereotest, which measures a patient’s ability to perceive depth at a finer level. It’s considered more sensitive for detecting subtle issues with binocular vision than the Stereo Fly Test. After completing the test, she informed me that Owen had no depth perception.

While doing my research, I came across vision therapy as treatment option. Our optometrist friend brought up vision therapy and suggested we get a more in-depth test called a binocular vision evaluation. She gave me the names of a couple local optometry practices who offered this evaluation and vision therapy. She warned me that vision therapy was very expense ($5,000+) and typically isn’t covered by insurance.

Binocular Vision Evaluation

After researching, I opted to go with the only vision therapy board certified neuro-developmental optometrist in the Indianapolis area. To find an optometrist who specializes in vision therapy in your area, head to the COVD website.

I called and scheduled a binocular vision evaluation for Owen for the end of November. The cost of the evaluation was $250 out-of-pocket.

Owen went through a battery of tests and a thorough examination with the neuro-developmental optometrist during the binocular vision evaluation. In all, the evaluation took about an hour and a half. I scheduled a virtual appointment for the following week where we’d go over the evaluation results with the neuro-developmental optometrist.

Binocular Vision Evaluation Results

A week later, Brad and I got on the virtual call with the neuro-developmental optometrist to go over Owen’s results.

As you can see in the chart below, Owen was significantly deficient in depth perception. His near depth perception and distance depth perception were both 0/10. Zero depth perception near and far. We learned this was because of his slight inward left eye turn– his neuro-developmental optometrist said it was “teeny, teeny tiny”.

When we look at something, our eyes turn in slightly so they’re looking at the same place at the same time. This is called eye teaming. Because of Owen’s slight left eye turn, his left eye turns too far in and over shoots the target and doesn’t team with his right eye.

With some patients, when their eyes don’t perfectly align when looking at something, they’ll see double vision. But during testing, Owen didn’t mention or complain about double vision. So Owen’s brain was turning off his left eye because it doesn’t want to see double vision. This is called suppression. His brain ignores signals from the left eye and uses only the right eye. When suppression occurs, there can’t be depth perception.

Owen also had issues with focusing flexibility, which is the ability to quickly shift your focus between objects that are close and far away. Because of the suppression of the left eye, his left eye wasn’t being used at the same capacity as his right eye so the left eye was weaker in this aspect.

Owen was also moderately deficient in eye teaming, which is a visual efficiency skill that allows both eyes to work together in a precise and coordinated way.

Official Diagnoses

Owen was diagnosed with the following: accommodative dysfunction, ocular motor dysfunction-deficiency of saccades, intermittent esotropia, suppression of binocular vision, fusion with defective stereopsis.

Vision Therapy Recommendation

After going through the binocular vision evaluation results with us, the neuro-developmental optometrist recommended 32 weeks of vision therapy. The cost was $5,500 out-of-pocket if we paid in full up front.

In-Office Vision Therapy Appointments

We lucked out and scored a standing vision therapy appointment on Tuesdays at 5PM. His first vision therapy appointment was on December 19, 2023.

The biggest drawback was the distance to the vision therapy location. And since it was during a busy traffic time of day, the drive to vision therapy would often take 50-60 minutes to/from. So vision therapy was a nearly 3-hour commitment once a week. As the primary vision therapy transporter, I reminded myself this wasn’t going to last forever.

I would drop Owen off for his 45 minute vision therapy sessions. During the sessions, he would complete various exercises and activities with his vision therapist.

Vision Therapy Homework

Vision therapy is critical to the success of vision therapy. The homework is non-negotiable. Owen was expected to complete 30 minutes of homework 5 days a week. He was allowed to skip homework on the days he had vision therapy, and he was given one day off. Owen didn’t enjoy the homework. He was warned by his neuro-developmental therapist and vision therapist that the homework would be challenging. There was a lot of pushback and arguing from Owen. We had to keep reminding him that vision therapy wouldn’t last forever and that he usually did better and finished the homework quicker when he was calm.

For homework, there was typically a computer component and a vision therapy exercise or paper-based exercise. The computer homework consisted of a computerized binocular home vision therapy program called Home Therapy System (HTS). His vision therapist would cue up the exercises which were tailored for his specific needs. Owen would wear special glasses over his eyeglasses while completing his HTS homework.

The vision therapy exercises were Life Saver BI/BO, Saccadic Strips, ABC tracking, pencil push-ups, 4 corner Saccades, etc. Depending on the exercise, Owen would have to use an eye patch or focusing flippers.

The paper activities were letter tracking exercises, mazes, HART chart coding, hidden pictures, and word searches.

Vision Therapy Progress Evaluations

Every 8 weeks Owen would have a progress evaluation. During a vision therapy session, his vision therapist would assess certain things. Then, Owen and I would meet with his neuro-developmental optometrist. She would run a battery of tests on Owen to see how he was progressing. She would then tailor his vision therapy exercises to address where he needed to improve. The progress evaluations were helpful as a parent to see what progress Owen was making.

Vision Therapy Results

Owen completed his 32nd vision therapy appointment on July 23, 2024. The next week we went back for his progress evaluation. His vision therapy practice also does a three month follow-up evaluation to make sure everything “stuck”. During those months Owen didn’t do any vision therapy exercises or activities.

Owen, age 10, had his final follow-up progress evaluation on December 10, 2024– nearly one year after starting vision therapy.

Here are his final results:

• Near depth perception improved from 0/10 to 9/10.
  Distance depth perception improved from 0/10 to 7/10.
• Initial evaluation showed no fusion of vergence ranges with suppression.
  Final evaluation showed fusion at all vergence ranges with no suppression.
• Final evaluation showed saccadic function at the level of an 11 year old.
• Final evaluation showed pursuit function at the equivalent greater than a 12 year old.
• Final evaluation showed visual analysis skills in the 75 percentile or above.
• Reading comprehension improved from 60% to 100%.
• Copying improved from 55 letters per minute (4th grade level) to 75 letters per minute (7th grade level).

School Improvements

Owen has always been an A student. So we didn’t see improvement in his grades. However, we did see improvement in his NWEA reading and math scores and his reading level.

Owen’s NWEA reading score increased from the 75th percentile at the start of vision therapy to the 91st percentile. His NWEA math score went from the 84th percentile to the 96th percentile.

At the beginning of vision therapy, while in the third grade, Owen’s Lexile Range was 685-835L (upper end of 4th grade to the lower end of 5th grade reading level). After concluding vision therapy, while in the fourth grade, Owen’s Lexile Range was 935-1085L (around 7th to 9th grade reading level).

School 504 Plan

Because Owen was diagnosed with multiple vision impairments, he qualified for a 504 Plan at school. A 504 Plan is a document that outlines accommodations for students with disabilities in order to help them succeed in school.

In Owen’s initial binocular vision evaluation report, his neuro-developmental optometrist listed specific classroom accommodations we could write into his 504 Plan.

Some of Owen’s classroom accommodations are using a tabletop slant board, increase font size by 25%, be seated nearest to the classroom instructional area, minimize the amount of copying material from board to paper, short visual work periods, take breaks from near work every 20 minutes.

What You Can Do for Your Child

Whether or not you think your child has a vision impairment, get them an eye exam between the ages of 6 and 12 months. Then, get them another eye exam between ages 3 and 5. And then they should get an eye exam every 1 to 2 years after age 5. Owen had an eye exam at age 2 and the optometrist conveyed no concerns. But he didn’t have another eye exam until age 9 when he failed the school nurse’s screening.

No matter their age, if your child struggles with reading, I highly suggest getting them an eye exam. They may be struggling because they have vision issues.

The most common signs are:

• poor reading comprehension
• frequently losing their place when reading, writing, or copying
• reduced attention span while reading
• confusing similar words
• rubs or squints their eyes when reading
• turning head to the side or covering one eye when reading
• omits or re-reads words or sentences
• writing words, numbers, or letters in reverse
• complains of words floating or moving on the page
• experiences eye strain or headaches when reading