Book Review: ‘The hidden link between vision and learning’ by Wendy Beth Rosen

The author of this book, Wendy Beth Rosen, was so kind to lend me an e-copy of her new book for review. As I love books and am obsessed with vision, I gladly accepted. The book reminded me of a book earlier reviewed on this website: Suddenly Successful by H. Dawkins (1989). That being the case, many of its core points were not all that new to me but they still haven’t become any less relevant!  ‘The hidden link between vision and learning’ provides a basic theoretical framework for understanding binocular vision problems and vision therapy, well-written case studies involving familiar real life problems, an update on new developments in vision research and answers to common questions that pop up when initially confronted with the field of vision care. I will go over each chapter and quote and discuss the parts that most resonated with me.

 

the-hidden-link-between-vision-and-learning

 

CHAPTER 1: the difference between eye sight and vision

First of all, the author wants you to know what she means by vision and why it is so important. Vision is much more than just having clear eye sight. Eye sight needs to be integrated with the rest of the brain and body in order to be beneficial.

“There are more than a dozen visual skills that incorporate subtle forms of movement within the eyes and the eye muscles and that coordinate with other movement systems of the body. These skills affect how well we function and perform in all areas of our lives but are especially critical to a child’s overall developmental process, and especially academic achievement. These skills are not evaluated in the vision screening that utilizes only the Snellen chart and often go unchecked.”

The author excellently enumerates a wide range of visual skills and abilities. Depending on the source they might be categorized slightly differently but she does a thorough job covering her bases. Some of them, the ones I personally find important or were described really succinctly, get some extra explanation in this review. Some of these visual skills sound the same but if you read the definitions in the book, you’ll notice their meaning is slightly different and more nuanced.

1. Visual acuity

2. Eye movement control

3. Vergence

4. Eye teaming: If the eyes are not working as a team, this can result in blurred, scrambled, or moving print; problems with depth perception; and double vision. Stress on this part of the visual system can lead to confusion, difficulty concentrating, eyestrain, and frustration. When this overload becomes too difficult for the brain to handle, the brain will sometimes disregard some of the information coming in through one eye, causing what is called suppression. This can greatly reduce the amount of information the brain is able to understand and retain and can cause confusion.

5. Focus accommodation

6. Depth perception

7. Peripheral vision

8. Visual spatial skills

9. Bilateral integration

10. Visual spatial relations

11. Visual spatial orientation

12. Visual motor integration involves the facility to coordinate bodily movement with the information coming in through the eyes. These skills are often referred to as eye-body or eye-hand coordination. Information that comes in through the eyes is transmitted to the brain, which then dispatches our muscles to move a certain way so that we can complete a certain task, such as catching a ball, writing, and putting one foot in front of the other.

13. Visual memory

14. Visual spatial memory

15. Visual sequential memory

16. Figure ground

17. Visual closure

18. Visual form recognition/discrimination

19. Visual form constancy

20. Visual speed and span of perception

21. Visualization

22. Automaticity is a term used to describe the goal of all visual skills combined—for visual processing to become automatic, with minimal effort. This is central to efficient learning and optimal functioning.

“To fully grasp the profound role that vision plays in our day-to-day activities, consider this: 80 percent of the neurological pathways in the brain connect with the visual system. Eighty percent! ... We get an astounding amount of information about the world through vision.”

That is why it’s important to properly examine and follow the development of all these visual skills and not just eye sight or visual acuity alone. That is the difference between a standard vision screening and a comprehensive vision exam.

“A comprehensive eye exam is less common than a vision screening and greatly differs from a screening in that it encompasses an in-depth
evaluation of all these visual skills, as well as eye health. The American Optometric Association recommends that this exam be done first at six
months of age, then at three years, and again just before entering kindergarten. After that, yearly checkups are recommended to make sure
vision is developing normally. If it is not, catching any deficits early in these foundational years can alleviate much frustration, struggle, and stress for a child down the road. Yet only 14 percent of children are getting this type of exam by the time they enter first grade, according to the Better Vision Institute.”

Because relatively few children have the advantage of being properly examined and treated, massive amounts of children are falling through the cracks. As of to date there is no systematic approach of getting children to be examined and so they are reliant on chance. Those who have an undetected visual deficit and don’t get proper help are at a grave disadvantage.

“Clearly, when one or more of these (visual) skills are not functioning as they should, it will thwart how well we can do any number of things. … In the case where there is an existing disorder in a dominant sensory system that is compromising our ability to perceive the world around us, we are at a big disadvantage. When these disorders remain hidden and go untreated, the resulting effects can be heartbreaking. For children trying to grow and thrive in any learning environment, their senses must be fully engaged in order to keep up and succeed. If they are hobbling along with a deficient visual system, they will encounter considerable difficulty that will interfere with their progress and achievement. The consequences could follow them for life.”

 

CHAPTER 2: What are vision-related learning problems?

After getting a broad idea of what vision in its entirety means and breaking it down in the underlying visual skills and modalities, the book gives us an idea of what happens when these skills don’t develop properly. An obvious example of parly developed binocular vision is manifest strabismus but the author consacrated more time to more subtle vision disorders. She does a supperb job of describing the experience of those living with these forms of latent or intermittant strabismus such as Convergence Insufficiency and many of the accompanying symptoms. She explained why struggle by itself, without targetted intervention to address those specific visual ailments, will not improve their situation. Ultimately we understand why so many of these kids are misdiagnosed with other more publicized disorders such as ADD and ADHD which are just an aggregate of symptoms without a clear determined and addressable cause. The chapter ends in a positive bend towards addressing these functional vision problems with functional solutions.

- Convergence Insufficiency

Many paragraphs in this chapter were spot on in describing my experience and the problems strabismics face but I am most impressed by the following passage on Convergence Insufficiency. I personally am still experiencing CI constantly and I could not have described the condition and the problems it poses more accurately.

“Convergence insufficiency (CI) is a very common condition involving weaknesses in oculomotility and binocularity, resulting in the eyes being unable to work as a team. In normal binocular vision, both eyes coordinate to focus on one place, sending one image to the brain for interpretation. When CI is present, the eyes are (unable to converge and) focusing on two different places, consequently sending two images to the brain. This results in the child seeing double. Some of the symptoms of this condition include:

• headaches
• fatigue
• blurred vision
• eyes that feel sore
• frustration
• an inability to stay on task (sound like a familiar issue we hear a lot
about?)

Now here’s where it gets really interesting. As you now know, 80 percent of what we learn comes in to our brain through the visual
system. When the brain has to make sense of seeing double, it tries to cope with this in one of two ways. The first line of attack is that it just
clamors to make sense of two images. When this occurs, the percentage of information able to be processed in the brain is cut from 80 percent to a mere 50 percent. That’s a huge drop.

But fasten your seat belts for the second tactic the brain utilizes to try to cope—it shuts down one eye. The child doesn’t know this or feel that he or she is only seeing out of one eye, but that’s what is happening. When this occurs, the percentage of information able to be processed is cut to a dire 20 percent. Imagine, then, the stress kids feel as they try to keep up in school. Moreover, coping with this condition is just plain exhausting.

When the eyes are not able to move steadily along a line of print due to the inability to automatically maneuver eye movements, tracking difficulties will occur. Precise motions enable us to move through a text, stopping long enough on a word to decode and grasp its meaning. Simultaneously, our peripheral vision is scoping out what lies ahead, preparing us to move forward and take in new information. It’s a delicate dance composed of calibrated jumps and pauses that should flow effortlessly.

When the eye muscles are not able to control their movements accurately, however, the result is a loss of efficiency and slowed comprehension. Children will often lose their place or skip words and have to go back and reread the text because these interdependent vision systems are not coordinating properly to allow them to read smoothly. Fatigue and frustration set in.”

- Effects on classroom behavior and reading

“In a classroom, this is a way of life. Children who cannot shift their focus efficiently will have a hard time keeping up in school, as they are required to move their eyes from the board to their desk, back and forth, frequently. When reading, they may not have the stamina to hold their focus. Children will intuitively seek relief by any number of means including putting their heads down on their desks, covering one eye, and avoiding close-up work.

Furthermore, children who are uncomfortable due to the physical symptoms from the stress their system is experiencing will instinctively take action to relieve this stress: they may look away from their work, wiggle and squirm while in their seat, find reasons to get out of their seat, and generally distract themselves.

When I shared these quotations with a fellow strabismic he responded with a familiar sentiment:

“Very well said. By the time children reach adulthood after this struggle, they have also suppressed memories of the struggle and pass through life without ever reading all the literature they should have consumed at a young age and always wondering “What did I do wrong?” and “Why didn’t I know what everyone else knew?” “

I too have missed much general reading, context and education throughout youth for lack of properly developed vision skills underpinning proper reading. Often times I felt out of place and didn’t understand why people who did not give the impression of being smarter than me could read much faster and  effortlessly. With the advent of Audible I am making up for that a great deal.

- Effects on gross motor coordination

“Kids who have difficulty with visual motor integration will present with more obvious physical symptoms reflecting challenges with coordination. When these problems exist, there is a faulty connection between information coming in through the eyes and the motor centers in the brain. Consequently, movement, coordination, and balance can be affected.

Children who struggle with gross motor issues will typically display problems navigating their way through space. They may have difficulty avoiding obstacles. Managing their bodily movements in relation to their body weight, the effects of gravity, and the task they are trying to accomplish, such as riding a bicycle or playing sports, is challenging for them. They may appear uncoordinated and clumsy or careless.

The strength of these respective skill areas is, in some measure, dependent on the collective formative stages that a child progresses through in the scope of his or her development. Holistically speaking, we hope that our children are able to grow fully in every way throughout the span of childhood: physically, emotionally, cognitively, and socially. To be and feel healthy and whole, each of these spheres needs the chance to unfurl at the appropriate time.”

- Effects on higher level visual processing

Visual information processing engages those functions in the brain that are of greater complexity. Within the extent of these processes, the spotlight is less on physiology and more on thinking and perceptual abilities that tie in with the other sensory systems in the body—vestibular,proprioceptive, auditory, and motor. These skills essentially allow for a person to make sense of what he or she is seeing and derive meaning from it. The importance of being adept with these processing skills cannot be underestimated.

- Vision Therapy to remediate vision development deficits

When development goes array and vision is affected, the process of vision therapy can help. Vision therapy (VT) consists of specially tailored activities that are implemented under the guidance of a behavioral optometrist and vision therapist. The activities help retrain the brain and eyes to function properly.
 
Vision therapy, as explained by the American Optometric Association, is defined as follows:
 
“Vision therapy is a sequence of neurosensory and neuromuscular activities individually prescribed and monitored by the doctor to develop, rehabilitate and enhance visual skills and processing. The vision therapy program is based on the results of a comprehensive eye examination or consultation, and takes into consideration the results of standardized tests, the needs of the patient, and the patient’s signs and symptoms. The use of lenses, prisms, filters, occluders, specialized instruments, and computer programs is an integral part of vision therapy. The length of the therapy program varies depending on the severity of the diagnosed conditions, typically ranging from several months to longer periods of time. Activities paralleling in-office techniques are typically taught to the patient to be practiced at home, thereby reinforcing the developing visual skills.”

 

There is a beautiful, innate order to human development that has its own rhythm, timing, and logic. People are natural beings, and as in every realm of nature, our development and functioning are interwoven with all other manifestations within the greater order of the natural world. With the right conditions and support, humans have the capacity to course along and move through ages and stages quite ably. Of course, we know it is not always this simple. Physical environment, genetics, social milieu, relationship dynamics, economics, and a host of other factors influence how equipped we become.

In reflecting on her experience in the classroom, Kranowitz eloquently described the remarkable improvements she observed in her students who had undergone vision therapy: “When little kids received VT, it made them more confident, and it relaxed them so they could focus their energy on using their feet, singing, and clapping their hands. They were no longer hanging back; now I saw them fully engaged.”

Human beings are not born with all the vision skills we need. The abilities to use our eyes together as a team, focus efficiently, and move them fluidly are all skills that must be learned. And sometimes people need some extra help and emphasis to do that.

 

CHAPTER 3: why haven’t I heard of this before?

That’s a question I’ve heard many times over the years I have been working on the topic of strabismus and binocular vision disorders. Why has no one told me about this solution? Why aren’t doctors addressing root causes or referring to someone who does? It’s obvious vision can impact academic performance, why is no one looking into this? Why isn’t this checked with all school going children?

To understand why the medical establishment is not quick to adopt superior practices and why interprofessional politics often interfere with patient care, the book gives us a history of the field of behavioral optometry and its interaction with ophthalmology. Later in the book and the review we will see there are positive developments when it comes to finding agreement and common ground based on research.

Up until now many people discover VT by accident or when they hit rock bottom after years of struggle and possibly strabismus surgery. It’s a common thread. The internet is a certainly helping with getting the word out there about binocular vision disorders and possible solutions. The internet can be the great equalizer in the market place of ideas, if properly used.

The chapter illustrates how people go from being a sceptic, to being helped to realizing that vision therapy is a logical extension of other forms of physical therapy and modern day neuroscience. A story from the book that particularly touched a nerve with me, because it is very similar to my history, is Jonah’s story. Except in Jonah’s case his parents knew what to do and he did not have to suffer through frustration and subpar performance for years before breaking down. Jonah got help!

“Jonah, a sixth grader, brought home his report card and handed it over to his parents after dinner one night. It was a beautiful report card. They congratulated him on all his hard work and effort and showered him with praise. Jonah was a good student, and they were happy to see him continuing on his successful path into his middle school years.

His facial expression and body language, however, did not reflect a child who felt a sense of accomplishment, and it came as a surprise to them to hear what he had to say next. “I just don’t feel like I’m doing as well as this says I am,” he said. When asked why, he said he felt like he was working harder than he should have to and just didn’t feel like he was actually doing as well as everyone seemed to think he was doing.

Jonah’s parents were familiar with vision-related learning problems and, after hearing this, took him for a comprehensive vision evaluation. Sure enough, and to everyone’s surprise, they learned he was dealing with convergence insufficiency and several other vision disorders. Jonah went through four months of vision therapy and was completely rehabilitated, and his school-related stress went away as quietly as it came.

His confidence was back on track, as was his comfort level with the demands of school. His parents were relieved, grateful, and delighted to
see him return to himself again. The concealed nature of a whole category of vision problems that many people are unaware of, and an incomplete understanding of what vision is, give rise to substantial limitations (for people who could actually be helped).”

 

CHAPTER 4: But I was told this was a bunch of hooey!

As far as treating binocular vision disorders is concerned, historically two professional branches are involved. On the one hand you have ‘conventional’ eye doctors or ophthalmologists (MDs) and on the other hand you’ve got the behavioral or developmental optometrists (ODs). Many ophthalmologists falsely stick to their believes that the only two treatment options are patching (occlusion) and surgery leading to a vast amount of misinformation out there. When it comes to pioneering the behavioral, neuro-rehab approach to strabismus, however, behavioral optometrists have always taken the leading role, both in research and clinical practice. This has lead to a substansive body of research scientifically underpinning Vision Therapy.

“The Effectiveness of Vision Therapy in Improving Visual Function, a lengthy report put out by the American Optometric Association, documented clinical research that lends significant support. The report cited more than two hundred references, and “the clinical research, scientific studies, and professional articles listed in the bibliography were first published in refereed scientific journals, meaning each were examined by outside experts before publication to validate their science, value, and research methodology.

As stated in the conclusion of this report, In response to the question, “How effective is vision therapy in remediating visual deficiencies?” it is evident from the research presented that there is sufficient scientific support for the efficacy of vision therapy in modifying and improving ocular motor, accommodative, and binocular system disorders, as measured by standardized clinical and laboratory testing methods, in the majority of patients of all ages for whom it is properly undertaken and employed. The American Optometric Association affirms its long-standing position that vision therapy is an effective therapeutic modality in the treatment of many physiological and information processing dysfunctions of the vision system. It continues to support quality optometric care, education, and research and will cooperate with all professions dedicated to providing the highest quality of life in which vision plays such an important role.”
 
Even though behavioral optometrists have been leading the effort towards functional solutions, some ophthalmologic researchers have caught on with modern trends in behavioral optometry, neuro-science and vision sciences.
 
“Dr. Guyton, along with his colleague Dr. Michael Repka, both of whom are world-renowned ophthalmologists, describe how they’re beginning
to consider the connection between vision problems and reading ability, especially in low-income families. In the article “Classroom
Insights,” published in the 2014 annual report of the Wilmer Eye Institute at Johns Hopkins University, they discuss how they and their colleagues are examining whether the origins of a reading difficulty might be based in a visual problem. In collaboration with the Johns Hopkins School of Education, they have launched what is being referred to as a pioneering study to seek answers to these questions and solutions to
these difficulties.
 
This exciting effort contains many ingredients that, when combined, can produce a potentially wonderful result. The ophthalmology researchers bring to the mix expertise in the realms of public health and clinical research and care. The education research is under the auspices
of Robert Slavin, PhD, the director of the education school’s Center for Research and Reform in Education. Their collective goal? Read on.
This is really an epidemiological study and is pretty aggressive in its plan to identify, intervene and retest all within a single school year. If we’re successful—and we have every reason to believe we will be—the next big step will be to create a system for schools to manage vision problems as a normal part of their reading program nationwide,” Slavin says. … David Friedman, director of the Dana Center for Preventive Ophthalmology adds “You’re talking about a lot of kids—millions, perhaps. It would have an enormous impact on real lives.” “

CHAPTER 5: Sensory overload

As we have seen, vision is more than eye sight and vision is not a localized process. Normal development goes through a number of stages building upon and interacting with each other and it is recommened that those take place in a more or less normal sequence. Ideally we gradually learn to take on more and more sophisticated sensory loads.

“… explains that by age seven or eight, motor coordination and brain maturation synchronize along with eye muscle control, allowing for eye teaming and binocular vision to come about naturally. It is a stunning, awe-inspiring progression. The human brain prepares to learn about the world even while in utero. The vestibular system goes into action from the moment of conception. Responding to gravity and movement, this system coordinates with the brain, core muscles, and the eyes, creating a foundational mechanism for learning.

We tend to think of vision and visual functioning as a local task. “Vision is a very complex phenomenon, with only a small percentage (less than five percent) of the process occurring in the eyes. The other ninety-five percent of vision takes place in the brain from association with touch, hearing and proprioception,” explains Dr. Hannaford.

… Likening the progression of a child’s maturation to the building of a house, William Crain points out that the integrity of the finished structure will only be as strong as the stability of the foundation.

This chapter warns for external and internal factors which might influence or even disrupt visual development. These include a chronically stressful environment, bad posture, excessive use of electronics, lack of exercise, and so on. Here are two particular passages on chronic stress and posture which were of particular interest to me because they sound so familiar.

- Chronic stress

“Another surprising effect on vision involves the stress response. When one senses danger, the reflexive response that moves the eyes outward to see what threat is looming greatly impedes the ability of the eyes to team and track along a line of print. If a child lives in chronic stressful conditions, this can affect the child’s eye muscles and make it hard to focus and track.

While we all experience stress at times, which can even be helpful in motivating our actions, undue amounts of stress can diminish quality of life. This is tragic when it affects innocent children who are bursting with energy, curiosity, excitement, and wonder.”

- Posture

“Desk height is another factor that ultimately affects visual dexterity. As is common, the accommodation that the body must make to fit into this personal physical workspace that is framed by the boundaries of the furniture can cause strain, leading to fatigue. When the larger muscles tire out, it becomes more challenging to resist gravity and remain in a balanced postural position.

Flat work surfaces put stress on the neck muscles, as they must hold up the head in a bent-over position. Awkward head positioning changes the angles at which the eyes focus on close-up material. In turn, this can distort the information coming in through the eyes to the brain. Ultimately, this can interfere with proper visual development. Dr. Harmon was able to document correlations between specific visual dysfunctions and environmental conditions.

A top-heavy workload is challenging enough for ten months out of the year. Nevertheless, in recent years, it has become the norm to give children summer assignments, too. Gone for many are the carefree days of summer when kids could feel free to explore their own interests, read books of their choosing, or just have time to themselves. Now they have assignments hanging over their heads, robbing them of the mental break from school they deserve and need after working so hard throughout the year.”

When development goes wrong or follows a more laboured trajectory and things get redressed through appropriate stimulation, true healing and feeling okay again might take some more time. Although a final stop to the difficulties and properly integrated senses are a liberation, years of struggle tend to leave some scars.

“Beyond the need for repair, there is also much that needs healing. Fixing and healing are two different things. Fixing what’s broken is an immediate action in response to a need stemming from a flaw that causes dysfunction. Healing is the process of restoring wellness, balance, and wholeness to that which suffered injury or disorder inflicted by the brokenness.

Taking action to remedy these problems can be life changing. Blazing new trails toward an approach to educating our kids in ways that will support them in their full development rather than work against them may not only benefit individual lives, but perhaps even initiate a cultural renaissance.”

 

CHAPTER 6: changing lives

Even if patients, parents of patients or teachers figure out that it is not normal that “letters move on the page all by themselves”, as one girl’s story in this book affirms, it is very hard to find the right kind of help or intervention. After the initial euphoric moments of finding this visual clue to solving the puzzle of the dysfunction, they found there was no easily available help. Aside from knowing her vision was unstable, they needed to know more specifics which normal standard eye screenings don’t provide. To figure out what was going wrong and how to treat it, her parents needed to get her a comprehensive vision examination. These examinations are far from current practice for the moment. The adults in the child’s life, whether these are a parent, teacher, counselor, or coach, grasp at whatever resources are available and within reach to try to handle the behavior and its effects. Limitations of time, money, energy, and answers to the problem are realities that can encumber this effort. And because the existance and treatment of binocular vision disorders is so unknown, they often go undetected. Vision is so integral to learning yet does not receive uniform acknowledgment, attention, and support in the majority of learning environments.

Dr. William Moskowitz once said that knowledge about vision-related learning problems will change lives and change the world. Indeed, he maintained, it may even save lives. There is great depth to his words. Most certainly a child who is struggling academically will face challenges emotionally, socially, and psychologically. Self-esteem erodes in the face of such constant strain. Frustration sets in when a student is trying yet still failing, which can eventually lead to rebellious and deviant behavior. Tragically, individual lives can fall through the cracks when the real problem at the root of a child’s struggles goes unrecognized.

Giving up on oneself is tragic, yet this bleak reality is what so many children live with day in and day out. Unquestionably, getting through each day must feel like a survival situation, as they are not equiped with the basic visual skills to handle their task load. They look around and wonder why it seems so easy for others. They feel defective and doubt themselves and their future. In an attempt to gain acceptance and belonging during these critical formative years of their life, they seek recognition in other ways.

Embarrassment and shame are powerful motivators in the very worst sense. For children who aren’t succeeding in school, repeatedly falling short of the goal line can feel out of their control, which is very uncomfortable. To relieve this tension, they will focus on succeeding with something that is in their control, such as distracting attention away from the daily activities that expose their failures. When success is eluding kids through conventional measures, deviant tactics may take up residence. The root of the problem has been sorely missed, and they have begun a descent into a lifelong battle with themselves and the laws and expectations of society.”

- (Juvenile) delinquency

“According to research carried out through the former Catalyst Vision and Learning Program, the inability to read is the largest common denominator among juvenile delinquents.  Vision problems affect 66 percent of illiterate adults, 70 percent of juvenile delinquents, and 75 percent of prisoners. These strained lives affect society. This is why educating the community about the connection between visual deficits and criminal behavior is key, in the words of the late Margie Thompson, founder of P.A.V.E., Parents Active for Vision Education. Margie was a visionary, and her advocacy work was pioneering.”

The book goes on showcasing, in more detail, the particular studies underpinning some of these numbers. I had seen many of these numbers and the names of the practicioners carrying out these studies before in the book ‘Suddenly Successful’ by Dawkins.

- Study Dr. David Dzik

“Vision-related learning problems are present in the general population in epidemic proportions. In the juvenile delinquent (JD) population alone, they are present in the majority of young offenders. One of the earliest studies in this realm dates back to 1949. Optometrist Dr. David Dzik found that 91 percent of the population in a Tennessee juvenile facility tested below grade level. Further visual testing revealed that nearly all of those participants in the study had a vision related learning problem. Dr. Dzik’s work was considered groundbreaking.

In an article published in the January 5, 1968, issue of The Optometric Weekly, he points to the rising crime rate and the tens of billions of dollars this costs the United States. The increase of delinquency, he acknowledged, makes “it more and more clear that something must be done.”

Some alarming statistics compiled four decades ago that emerged from Dr. Dzik’s work include the following findings from research done with children at the Hamilton County Juvenile Court in Chattanooga, Tennessee:

• Of the 125 children tested in early 1965, 94 percent failed the reading and comprehension tests.
• Of 111 children tested between January and May 1967 for reading and comprehension, 90 percent were from one to seven grade levels below actual grade level.
• Seventy-four percent of children administered vision screening tests failed one or more tests in 1965.
• Over 70 percent of children screened failed one or more of the vision tests between 1966 and 1967.
• Over $40,000,000 per year is the cost incurred to educate first through sixth graders who repeat a grade in school in Tennessee”

- Studies by Dr. Paul Harris and Dr. Stan Kaseno

“Additional studies spanning several decades beyond Dr. Dzik’s initial look at JD populations, by behavioral optometrists and lead researchers
Dr. Paul Harris and Dr. Stan Kaseno, showed the percentage of offenders with vision-related learning problems averaged 94 percent.

Undetected vision problems were found in 74 percent of adjudicated adolescents as of 2000, and a 2003 national assessment of prison inmates found that only 43 percent had graduated from high school or earned an equivalency diploma prior to being incarcerated.”

- Wright report

“In his 1974 address to the World Congress on Dyslexia cosponsored by the Orton Society and the Mayo Clinic, Peter D. Wright presented his reviews of the literature linking learning disabilities and juvenile delinquency. The North Carolina Crime Study Commission conducted its own study, intrigued after Wright shared related research conducted by Dr. Dennis Hogenson with the assistant attorney general in Virginia.

The first two paragraphs of their report, Learning Disabilities and Their Relation to Crime and Delinquency, read as follows:
In attempting to formulate comprehensive crime prevention programs over the years, innumerable study commissions, blue ribbon panels, penologists, investigative agencies, and other experts in all phases of the criminal justice field have grappled with the problem of identifying the primary underlining causes of crime and delinquency. The Crime Study Commission is cognizant of and concurs with many of the most recent efforts which have found such factors as (1) deprived socio-economic status, (2) unemployment, (3) poor school performance, (4) broken homes and (5) mental illness, as being primary contributing factors.

The Crime Study Commission in this report will attempt to go one step further in the search for the cause of crime by postulating a theory, which simply stated, will argue that, “reading failure is the single most significant factor in those forms of delinquency which can be described as anti-socially aggressive.” If we believe that a significant amount of serious crime is committed by individuals who
began their anti-social behavior as school dropouts and who graduated from juvenile delinquents to youthful offenders to adult criminals,
then this theory, if proven, becomes a vitally important indicator for crime prevention. Citing extensive research corroborating low reading levels with delinquency, Wright makes the case for a child’s right to an education with the full support of services working in their favor, as opposed to against them.

It was noted that while some offenders are testing social boundaries or rebelling against authority, and move past this behavior as they mature, those who are struggling with a learning disability do not. They continue to decline. “The major concern is that uncompensated learning disabilities in delinquent youth lead to a recurrent cycle of destructive acts, whereas delinquents without learning disabilities tend to outgrow their delinquent ways,” affirm Drs. Wheeler and McQuarrie.

- Vision for the future / prevention / treatment

Given the clear link between vision problems and delinquency and anti-social behavioral problems, a clear solution could be treating and preventing those binocular and functional vision issues. The author goes on to make the case in the second half of this chapter and the following chapters.

“Enter a vision for the future—preventing vision-related learning problems early on by providing universal comprehensive vision examinations, so that all children who need help get help. Not only will this reduce the number of children who wind up in special education classes unnecessarily, or mistakenly medicated, it can prevent young lives from deteriorating and winding up incarcerated. In addition to the creation of a standard for vision evaluation programs in schools, additional preventive programs must be established for at-risk kids. This will require collaborative community organization. The investment of time and resources is well worth it.

Studies have shown that vision therapy can play a pivotal role in the rehabilitation of an offender. Whereas there is often a host of issues needing attention in this process, the vision piece is so significant that leaving it out of the approach can limit the effectiveness of other treatment practices. Repeatedly, vision therapy was found to help these individuals overcome visual deficits, learn to read, and make conscious choices to turn their lives around and even pursue their education.

Think about this—as a society we can actually fight crime by rehabilitating vision and teaching prison and JD populations how to read. This constructive act of triage would address the current downfall of individual lives that may have fallen through the cracks for lack of information. It will give hope for new beginnings and a new start with newfound skills and capabilities.

Now think about this—we can actually reduce the crime rate going forward by restructuring our education system to not only treat vision problems in children but also prevent them in the first place. Some very forward-thinking studies have discussed the cost-effectiveness of funding this type of intervention for children as young as kindergarten age versus what it costs to give special education services to a child all throughout the child’s schooling.

Dr. James Heckman, who won the 2000 Nobel Prize in Economics, along with colleagues Dr. Jack P. Shonkoff and Deborah Phillips, and who published From Neurons to Neighborhoods, a National Academy of Sciences study on early childhood neurobiological development, points out one of the primary inadequacies of public policy as it fails to recognize the long-term effects of academic failure and deficient socialization.

More recently, Drs. Heckman and Shonkoff and their colleagues framed it as follows in the quoted head note they cited: “Skills begeskills, success breeds success, and the provision of positive experiences early in life is considerably less expensive and more effective than the cost and effectiveness of corrective intervention at a later age.”

This gives us pause to think about how many don’t receive this specialized help in their lives and the losses incurred as a result. We know how it plays out for a child. Furthermore, in this increasingly unsustainable era of extreme expenditures, it stands to reason that investing our dollars in proactive objectives will ultimately be more cost effective. There is a choice, along with great hope. It is important to realize that inaction is also a choice, and with this choice comes an undeniable cost.”

 

CHAPTER 7: their future, our future

This chapter goes on to talk more the influence of modern electronics and environments along with recent US educational policies on neurological and visio-motor development. We have to strive for an environment which nurtures our children and allows their biology to reach developmental milestones. It doesn’t make sense to jump the gun and immediately go for higher order cognitive skills without a proper vision and motor foundation including the development of good posture. This goes back to the concept of grounded or embodied cognition as mentioned in previous book reviews on this web site. I have isolated some passages here which I personally found most interesting.

“Successive studies of preschool and school-aged children contributed a rich cross-section analysis of general sequential behavior. The expansive study of whole child development at Yale was a comprehensive endeavor comprising four areas of specialized focus: motor behavior, adaptive behavior, language behavior, and personal-social behavior.

Throughout cumulative inquiry, distinct studies of visual behavior grew from these in quantity and significance. It became clear that vision played an active role in all four areas of concentrated study listed above. Of particular importance is the recognition that vision is highly engaged with movement and the motor systems of the body. Gesell regarded them as “inseparable.” How visual development progresses in a child is largely an expression of the hardwired embryonic schematic that governs this unfolding process throughout maturation. This includes what Gesell calls the “action system,” referring to the natural progression of movement and coordination. In the nature versus nurture discussion, we can think of this as the “nature” piece.

As children’s motor abilities increase and they adapt to their spatial surroundings, take on more activity, and increase their extent of exploration, the interplay between their physical stature and the structure of their environment will be a factor in their developing physical posture. This is a key influential ingredient in determining the course of their visual development. This is where the “nurture” piece plays into the picture.

We take for granted a plain fact that Gesell paid much attention to— we are continually adjusting our bodily position in space to counter the constant pull of gravity. Posture is a key aspect of visual function. The highly intricate configurations of muscle groupings throughout the entire body have evolved ingeniously to work in concert and support movement as well as sensory processing. In addition to the more obvious larger muscles, even the smallest muscles of the eyes play into the manifestation of a person’s posture.

Gesell explains, “The eyes are always in the total behavior picture. At any given moment, either they are directing the postural set of the entire organism, or they are registering the effect of local and general postural sets.”

In other words, the processing of information coming into the brain through the visual system has a direct affect on how one perceives and maneuvers one’s body and actions in relation to one’s spatial context. Likewise, how a person interacts with his or her surroundings will greatly impact that person’s visual perception and functioning.”

 

CHAPTER 8: vision for learning

In the final chapter the author reemphasizes the importance of visual development in all children and the costs associated with failing to prevent, detect and treat developmental problems that might arise. The science is clear and the solution is clear but major social, political and organisational road blocks remain. The main thing left to be done is explaining this issue and convincing all the actors involved in education and child development that this is a solvable problem. It just requires a minimum of understanding and political will to ‘eradicate’ most developmental vision issues and give a large chunk of children a chance at a productive and self-reliant future.

- Cost and damage of not preventing, detecting and treating

“Here we further build the case for comprehensive vision evaluations becoming standard. A joint study by Drs. Joel Zaba, Rochelle Mozlin, and William T. Reynolds compared the outcomes of vision screenings versus full vision examinations. Their findings bring to light striking concerns.

In addition to making a case for this on a strong emotional level, the most practical way to effect positive change may be to do the math. Funds can be more efficiently and appropriately channeled toward resources that will support the recognition and treatment of vision problems. This is where the savings will occur. That is, recognizing and treating hidden vision disorders will save schools tens of thousands of dollars. With 25 percent of children affected by a vision problem that is impeding their ability to learn, many of these children wind up in special education programs. In some cases, children are shipped out of district to special schools, costing the district even more money for transportation. In other cases, children will drop out of school, costing society on many different levels.

Of course, since vision problems do more than impact children academically, these challenges can take an emotional toll and spiral into behavioral problems resulting from low self-esteem. Beyond needing help with learning as they struggle in school, children then also need support from guidance counselors, school social workers, and psychologists for emotional problems that are secondary symptoms. The need for these services to address these consequential problems is overflowing, feeding into a system unequipped to address this critical area. It is a vicious cycle.

Getting back to the math, there is a price for the domino effect that results from untreated vision problems. The U.S. Department of Health and Human Services reported that, in 1995, the monetary impact of vision disorders and disabilities on the U.S. economy was more than $38.4 billion.

The same report that has its sights set on current and future objectives as outlined in the “Healthy People 2020” program proposes a 10 percent increase in the number of preschool children who receive vision screenings, bringing the percentage from 40.1 percent to 44.1 percent.
Developed by the U.S. Preventative Services Task Force, the screening aims to assess visual acuity and detect for amblyopia and related risk factors. It would stand to reason that the $38.4 billion price tag referenced above did not take into account the unidentified costs linked to children mistakenly classified or medicated due to an incorrect diagnosis. This reasoning is based on the observation that the “Healthy People” model only attends to visual acuity and amblyopia. If it factored in all the other vision disorders that affect children, the cost would likely be radically different.

Children with vision problems that go undetected inevitably grow up to be adults with vision problems, and this reality is reflected in the literacy problem that compromises our workforce. Many of the conditions in today’s workplace demand a high degree of skill, organization, and the ability to function efficiently in a fast-paced, ever-changing environment. Deficient literacy skills, it has been shown statistically, cost U.S. taxpayers and businesses billions of dollars in profits and productivity.”

- Case for comprehensive vision examinations rather than standard screenings

“Economics are often used to justify vision screenings as the best system to reliably detect most vision problems at a much lower cost than providing vision examinations for all children. Certainly, if one considers only the direct costs of services, then a vision screening is far less expensive than a comprehensive vision examination. However, in order to be valid, all indirect as well as direct costs associated with each procedure must be included in the comparison. Given the large number of vision disorders that are missed by vision screenings, the indirect costs are likely substantial, if not incalculable. How can the negative impact of an undiagnosed vision problem on the academic performance and quality of life of these children be calculated?

That said, in 2006, $5.9 billion was spent by U.S. organizations to teach basic skills such as remedial reading, writing, and math to employees. This potentially higher cost resulting from choosing not to invest resources in comprehensive vision evaluations over screenings should get communal attention.”

- Solutions and action

“So much of the hard work has been done. We have the know-how and science to detect these disorders and treat them successfully. We know that doing so will improve individual and collective lives. In order for this to occur systemically so that all children who need help will get help, there are actions to be taken on educational policy and economic fronts. There are important answers and solutions to logistic challenges that need to be found. This is achievable.

Dr. Leonard Press holds the view that VT in schools is feasible, and that it should be a nationwide model. While the first question most often asked is how we will pay for it, this is not where his focus lies. Not because it isn’t important, but because something else needs attention first. He conveys that we have to rectify the “simplistic, archaic view of what vision is,” as he points out. Many still understand it to be only about eyesight. The world needs to become “vision literate.” To accomplish this, he explains, a logical means to this end would be through teacher training. The broader knowledge of what vision is and its relationship to learning must become common knowledge among educators.

Education needs a serious overhaul, and it should start with recognizing the function that vision has in how kids learn. “Vision development, its role in learning and behavior, and why it needs to be addressed with services in schools is critical, and this information needs to reach everyone,” Dr. Press contends. “Whether we are talking about AD/HD, poor school performance, autism or concussions, we are still coming back to the same bottleneck because we’re using an 1800s model of evaluating children for visual problems. As a result, they are going unrecognized and kids are falling through the cracks,” he further emphasizes.”

CONCLUSION

This book is a passionate piece of writing done by an informed citizen who was confronted with a problem and wanted to contribute to solving that problem.  The author properly conveys all the relevant information in an accessible way. The reader gets away understanding the intricate role of vision more fully and being able to avoid pitfalls in the current health and education systems. For people confronted with these kinds of vision problems this information is absolutely vital. Personally being affected by these problems, I enormously appreciate the apt descriptions and explanations for a wider audience. This makes us feel better understood and acts as a bridge to the wider world. Hopefully this manifesto will help inspire policy makers to make the necessary structural improvements. If it does not, the book will still make a crucial change in many individual lives.

My main criticism of the book would be that it seems a bit chaotic and unstructured but that might be due to reading the e-version. Computer reading does not foster overview in my case. International readers should also be aware that this book is clearly aimed at a US market as particular national education policies are discussed. Even so, international readers can learn plenty about the link between vision and learning (no pun intended) regardless of where they are. Enjoy!

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