The eyes have it

By Nick Hanson
The Free Press

MANKATO May 15, 2006 12:20 am

— Keri Solheid knew something was wrong with her daughter.
But she couldn’t figure out what.
Lindsay, could read, but not very well. She was easily distracted, irritable and antsy, too.
“I knew in first grade that something wasn’t right,” she said.
Solheid could tell Lindsay was intelligent from things she’d say, express or recall from memory.
The solution was unearthed during a summer school session, when a teacher suggested Lindsay might benefit from vision therapy.
Probably like most people, Solheid hadn’t heard much about the procedure. So, she and her husband, Dan, were a little skeptical — at first.
That all changed once Lindsay started therapy. Gradual changes began to occur.
“She could read before (treatment). She would give her best attempt, but she was struggling,” Solheid said.
The difference?
“She enjoys reading now.”
After 36 weeks worth of vision therapy, Solheid said she couldn’t be much happier with her daughter’s improvement.
“I’m 150 percent glad we did this,” she said.
Vision what?
Vision therapy is based on the notion that good vision is actually a set of learned skills, not an eye test revealing 20/20 sight.
Good vision involves moving eyes together as a coordinated team; effectively scanning a line of type across a page; shifting focus from far to near quickly; and remembering how a word is spelled when eyes are closed, among other things, said Gerri Struss, an Owatonna vision therapist for eight years.
“The visual system is a developmental skill,” she said. “A very smart child struggling to learn doesn’t make sense. Good eyesight does not equal good vision.”
She believes an example like Lindsay Solheid is living proof. Therapy didn’t teach her how to read. It taught her how to effectively use her eyes to become a better reader.
“Most of the students we work with do not have glasses,” Struss said. “It’s not a lack of not being able to read. It’s just for them, it’s equated with something really, really hard.”
Vision therapists say children — and adults — have the ability to correct those problems through a variety of eye and physical exercises.
“We break down the old habits and retrain the eyes,” Struss said. “It’s very tailor made to the individual child.”
She said therapy can fix double vision, space orientation and improve motor skills and directionality problem, such as reversal due to regressive eye movements (i.e. confusing a ‘b’ with a ‘d’).
According to Struss’ statistics, about one in four people suffer from at least some type of vision malady.
And although sometimes controversial, vision therapists and Struss say children with vision disorders are sometimes misdiagnosed with a learning disorder such as attention deficit.
Those children may end up on heavy medication or in a special education program for no reason, Struss said.
“Are there kids who need those drugs? Yes,” she said. “But you can’t tell me that it’s as high as it is.”
Mankato satellite
A tour of the Mankato Vision Therapy Center in Madison East Center revealed several of the corrective techniques vision therapists use. Three therapists, Nancy Beran, Teresa Krohn and Kim Thompson, run the center.
Balance beams, special-lens eyeglasses, tracking exercises, unique projector slides, complicated motor skill movements and near/far focusing games are just a few of the tools often used in the vision center.
For at least one news reporter, trying some of them left a feeling of frustration and some disorientation.
Beyond weekly 50-minute sessions, students are required to complete about 30 minutes of home eye exercise per day.
“It takes a lot of hard work,” she said. “If they don’t do the homework, it’s not going to work.”
Beran, Krohn and Thompson are not doctors (nor is Struss). Initial diagnosis occurs at the official Minnesota Vision Therapy Center in Edina by a doctor. Patients are then referred to their closest geographic center for treatment by a therapist.
Beran said therapists are required to read an extensive training manual, apprentice others and attend mandatory training.
“We have to change our techniques with certain children,” she said.
Krohn was a dental hygienist for 23 years before she decided to change her career and eventually landed in vision therapy.
“There are programs out there that claim to do things and I researched and found out this wasn’t a hokey-hokey thing,” she said.

Cost, coverage
While the initial diagnosis is free, depending on the amount an individual’s insurance covers, a weekly session can cost up to $150.
In certain circumstances, insurance companies such as Blue Cross Blue Shield of Minnesota offer at least partial coverage for vision therapy treatment, spokesperson Jan Hennings said.
“We provide vision therapy for a couple of those more medical types of treatment that are accepted medical practice,” Hennings said.
According to the Blue Cross medical and behavioral health policy manual, therapy provided in the office setting for very specific disorders is accepted medical practice. At-home exercises are not medically necessary and vision therapy is deemed investigative for all behavioral health disorders.
Is therapy worth the hefty price tag, especially if insurance doesn’t cover the bulk of coverage?
Fourth-grade Fitzgerald teacher Barb Wendlandt says yes. Her daughter, Sarah, was in therapy.
“When we started the program, she hated reading and at the end she would actually admit that she likes reading,” she said.
Wendlandt now suggests a diagnosis to parents of students she suspects have vision problems.
“(Those) students have gained confidence in their reading and writing skills,” she said. “It’s definitely worth it.”
Results?
What it all boils down to is: Does it work?
Those who thoroughly complete the extensive/sometimes costly therapy and daily homework say yes, at least to a degree. But if patients don’t complete the homework or attend sessions for only part of the expected time, therapists say they can’t expect results.
Viktoria Davis runs an optometrist clinic in Madelia. The doctor said she believes vision therapy can be beneficial at times.
She compared vision therapy to physical therapy. If everybody were tested on the strength of their muscles, she said, they probably wouldn’t be up to par.
“For certain vision conditions, it’s certainly helpful,” she said. “(But) I don’t think it’s an alternative for everything.”
When asked if she believes the statistic suggesting one in four are impaired with a vision problem, she wasn’t sure.
“Does one of every four of my patients get vision therapy? No,” she said.
But: “There are a fair number of people I treat who could benefit from vision therapy.”
Skeptics
Mankato Clinic ophthalmologist Dr. Todd Gavin doesn’t buy into vision therapy at all.
“The eyes themselves are basically like a camera. They pick up an image and send it back to the brain and it interprets what you see,” he said.
Meaning the brain is the problem, not the eyes. For example, he said, there are people who have gross eye abnormalities, such as blindness, who can still learn how to read.
According to a statement from the American Academy of Ophthalmology, “Eye defects, subtle or severe, do not cause the patient to experience reversal of letters, words, or numbers.”
The academy also claims there is no scientific evidence that supports treatments can cure children with academic and learning disabilities
“There is really no evidence that shows it (works) and our academy puts this in bold print,” Gavin said.
Although, he said, “It’d be nice proving that (the techniques) work or either don’t work.”
So why do some local parents and educators testify to vision therapy and its effectiveness?
“A problem has been identified and is being addressed. Now mom and dad and the teachers are spending more time with the child, and defacto the eye exercises are being given credit,” Gavin said. “Over a six- or 12-month time period, a child is older and more mature and they are smarter than they were earlier.”
Educators should play the ultimate role in providing help for the learning disabled, he said.
“I want these children to learn, but it’s best to advocate proven therapies when a person is spending thousands of dollars for an unproved therapy,” Gavin said. “My hope is that they’re aren’t just doing what they’re doing for their financial gain.”

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