Precilla Pena’s story started out like many stories in the special education world. Things seemed to go well for her daughter Ava throughout preschool and kindergarten. There were little things, here and there, she said, a turned letter, typical pre-literate confusion. No one was worried.
“They told us she’d grow out of it,” Pena said.
Ava got by on memorization, and avoided written work whenever possible. She memorized what she could and had other things read aloud to her. Such patterns are typical of children with reading disorders, but they are hard to spot in the early years.
By second grade, however, things were going downhill quickly. Not only was their daughter struggling in school, Pena said, but she was also coming home with splitting headaches.
“We were at our breaking point,” Pena remembers. She didn’t know how much the two concerns were linked, but both had her worried.
Clues to a Need for Vision Therapy
Ava’s teacher recommended dyslexia evaluation. While they were waiting for that, a friend suggested vision therapy, which was not available in Corpus Christi, where the Penas live. Most optometrists are not trained in vision therapy, which has more to do with strengthening muscles and coordination than corrective techniques like lenses or surgeries. However, a relatively simple evaluation to recommend occupational therapies can be life changing for young children whose mysterious and seemingly unconnected symptoms all come together in the visual system.
Though bright and easy to talk to, Ava had always seemed shy and averse to the chaotic playscapes of childhood. She came across as uncoordinated and a little clumsy, and was prone to severe car sickness. Considered separately, each of those attributes could be the quirk of a completely neurotypical child— definitely not something that would compel parents to drive three hours for an evaluation. However, Pena and her husband were at that familiar stage in the diagnostic process in which every personality trait, every quirk, every challenge becomes a clue in unraveling a mystery.
They traveled to Austin for an evaluation. Upon learning that Ava had been using one eye for 70 percent of her visual intake, with the other eye considered amblyopic (a “lazy eye”), had reduced peripheral vision, and had binocular dysfunction that affected her depth perception, many of the quirks and habits that Pena had observed started making sense. Ava’s eyes were not working together as a team, and were sending information to her brain in scrambled, irregular patterns. As a result, the brain didn’t recognize letter and number patterns as familiar. Her visual information gathering, at age eight, was like that of a five-year-old.
Realizing the strain her daughter had been under, Pena began crying. “We’d spent a year and a half thinking that she just wasn’t trying,” she said.
Vision Issues in the Classroom
No amount of unstructured “trying” can resolve the vision issues that make it difficult for some children to thrive in a classroom setting, vision therapist Melody Lay explained. They don’t know that what they are seeing isn’t what they are supposed to be seeing, and they certainly don’t know what their visual system is doing to compensate. Their vision may be blurred, doubled, going in and out of focus, or discolored, Lay said, “But kids don’t know that’s not where they’re supposed to see.”
A day of reading, looking at a blackboard or smartboard, iPad, teacher, and the numerous other visual tools of the classroom requires two eyes to work together to gather information far and near and send it to the brain for interpretation. Repetition creates familiarity as long as every repetition is sent to the brain in a reliable way. For students whose eyes go in and out of focus, whose field of vision is compromised, or whose eyes are perpetually seeing different things (think difference between letters “c” and “o” when your eyes are tired or if you squint) the day is frankly, Lay said, exhausting. Vision experts say that 90 percent of human sensory input is visual. If that input is chaotic or strenuous, Lay explained, kids cannot interpret or “learn” it.
The exhaustion—actual ocular muscle fatigue as well as brain exhaustion—leads to frustration and lost focus. Many of these students end up identified as having ADHD and dyslexia. It’s difficult to know, said Lay, how often the vision problem is creating the inability to focus or the disordered reading. She’s not sure how often years of untreated vision problems could lead to comorbidities, and how often solving the vision problem leads to a resolution of other issues.
“Vision therapy is all about neurology,” Lay explained, and the way stimuli shape and wire the brain is not often as simple as a single diagnosis or therapy.
Vision Evaluation and Therapy
Vision therapy begins with a doctor visit, and at Vision Therapy of San Antonio that is Jason Deviney. Then therapists assign various exercises and therapies to do at home between weekly check ins, either in office or by video conference. Some of the therapies target the eye muscles directly, such as wearing a patch over the stronger eye. Others have to do with coordination and reflexes.
Learning to read requires 17 distinct visual skills, Lay explained, and each of them is connected to a whole suite of brain functions. Balancing exercises, hand-eye coordination, following movement with both eyes—all of these create connections in the brain that will be used to read.
For most children, Lay explained, all of these skills develop naturally over the course of infancy and early childhood. Babies are constantly being picked up, whizzing around on their parents’ shoulders, rolling, falling, grabbing, climbing, and establishing balance in a world that is moving far faster and more deftly than they are. Most will slowly develop the sensory systems they need to navigate, but others—one in six, Lay says—develop differently. Without any physical or mechanical reason (no injuries or birth defects), their muscles and brains do not make the necessary connection and the necessary time. Because they don’t know they’ve missed something, they will compensate and reinforce the less ideal pathway.
Unless the vision issue results in wandering or turned eyes, Lay said, many struggles go unnoticed. No one says a person must be excellent at throwing and catching balls. Kids trip all the time even if their eyes are working fine; they’re kids. It is reading—a skill developed well into a child’s neurological development—that usually sounds the alarm. Lay would like to see screening happen earlier. Therapy for infants is as simple as swinging, bouncing, and other natural movements done at higher frequencies or sustained periods. Simple things could help the brain rewire faster without the years of struggle and compensation.
Vision Therapy to See the World More Clearly
After almost a year of therapy, Pena said, Ava has made huge strides. Her school district, London ISD, did not have experience with vision therapy, but was ready to learn and help, she said. They put Ava on a 504 plan to ensure accommodations like large print text and visual aids close to her desk.
Now in third grade, Ava is reading at a fourth grade level. She loves mystery novels. Most of her grades are A’s and high B’s. She’s started playing volleyball and dancing, neither of which she would have tried before. In fact, one of the most exciting changes for Pena, she said, was the confidence her daughter now shows, and the pride in her progress.
A lot of work went into seeing the world as it is. Pena said, “There’s so much appreciation for it.”
About the Author
Bekah McNeel is a San Antonio-based education writer who focuses on equity, innovation, and social-emotional learning for publications such as The 74. Over the years, we have republished local education coverage from her Hall Monitor site, and last November she wrote for us a four-part series, “Punished, Not Served,” about unfair discipline for students with disabilities.
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- “Celebrate Dyslexia: Education, Identification, and Celebration of Dyslexic Students,” Bekah McNeel, San Antonio Charter Moms, June 10, 2020
- “What Special Education Parents Want to Keep From COVID-19,” Bekah McNeel, San Antonio Charter Moms, May 27, 2020
- “MTSS: Behavior Support That Comes Before Special Education,” Bekah McNeel, San Antonio Charter Moms, May 13, 2020