Wide-eyed Wonder: an artist's musings on three-dimensional vision

Some are color blind. I am stereo blind.

Schools Need Binocular Vision Screening

with 3 comments

I read about an appeal to write my congressman from the “Let Them See Clearly Campaign” to add binocular vision screening to a bill, as posted in a DIY Vision Therapy Group I belong to on Facebook.

I emailed a rather lengthy letter to my House Representative about three weeks ago, using the campaign’s information, and adding my own research and brief personal story. I haven’t heard back, but hope to. It seems to me that adding binocular vision screening to this bill would be a good fit.  Here’s why (Although I just learned after posting that the writers want to create a separate bill*):

To the Honorable ….

re. H.R 3535 the “Alice Cogswell and Anne Sullivan Macy Act” in Committee

Dear …..

H.R 3535 should add screening for binocular vision (BV) impairment to the vision screening protocol to identify students with visual disabilities.* BV is tested via an assessment of eye focusing, eye teaming, and eye movement abilities (accommodation, binocular vision, ocular motility.)**

Under the “Categories of Disability Under IDEA” (Individuals with Disabilities Education Act), “Visual Impairment Including Blindness means an impairment in vision that, even with correction, adversely affects a child’s educational performance.”(1)

The Visual Impairment definition further states: “Most of us are familiar with visual impairments such as near-sightedness and far-sightedness. Less familiar visual impairments include: strabismus, where the eyes look in different directions and do not focus simultaneously on a single point…” (2)

Strabismus (Esotropia and Exotropia) is just one of many Binocular Vision impairments. More common ailments are:

Convergence Insufficiency, where the eyes fail to team together to see things up close. “Convergence is the coordinated movement and focus of our two eyes inward on close objects, including phones, tablets, computers, and books.”

Amblyopia or “lazy eye” where the brain suppresses the image from one eye because the image is different than that of the other eye.

Diplopia or double vision

Esophoria or exophoria, where the suppression of one eye is intermittent.

Strabismus, as either Esotropia (“crossed eyes”) or Exotropia (“wall eyes”), occurs when the suppression of one eye is well established.(3)

Undiagnosed Binocular Vision Impairments are increasingly triggered in children by our convergent-based technology, which requires turned-in eye-teaming on phones, tablets and computers, with little outdoor play to aid binocular vision development. (4)

Unfortunately, at the same time, children in school are being misdiagnosed in IEP’s when binocular vision problems inhibit learning. These children can and should receive an early diagnosis and, hence, the opportunity to pursue certified optometric vision therapy and/or recommendations from an Opthalmalogist to normalize visual processing and improve learning ability and quality of life.

Furthermore, IEPs must include accommodations necessary to aid the child undergoing optometric vision therapy as advised by their Doctor of Developmental Optometry, in order to not undo progress made under vision therapy. This may include not forcing the child to read, for example, until her unstable convergence issues are resolved.

-13 to 20% of the population have impaired binocular vision that is 75% curable according to a double blind study by NEI (5)

-Studies by ADHD and vision experts show 20 -25% are misdiagnosed and have binocular vision impairments (6)

-Autism.com says studies show that 21 to 50% of autistic children also have binocular vision impairments. (7)

“Binocular vision impairments are more common than you may think. Just one type of binocular impairment, amblyopia (“lazy eye”), affects approximately 3% of the population. At least 12% of the population has some type of problem with binocular vision.” (8)

As an adult with alternating esotropia, a form of strabismus (crossed-eyes), I can’t begin to tell you how much better my quality of life would have been if my condition had been diagnosed and treated while I was a child in the 1960s. My parents gladly spent money to straighten my teeth, not realizing that all their harping about my feet turning out and my poor posture was due to my eyes not teaming to create a visual center-line for my posture and gait. This of course made gym class excruciating, as I was always the last to be picked for any team (imagine trying to catch a fly ball without any sense of depth) and also made socialization difficult as other children did not know if I was looking at them or something else.

Instead of learning how to use both eyes together, in early childhood my brain spent extra energy suppressing the vision of one eye or the other to avoid double vision. While my early well-established suppression allowed me to read without difficulty in 1st grade, it has lasted for a lifetime.

The extra energy expended by the brain to suppress vision and live and move by monocular depth cues, instead of fusing vision from both eyes to see palpable space and distance, limits one’s ability to: multitask on any level (how many jobs require this?); drive well during demanding depth needs (e.g. driving multiple sized vehicles on the job); work in food service, landscaping, auto-mechanics, carpentry, etc.; participate in sports or recreation (eg. yoga, dance, catching or hitting a ball); or watch 3D movies (the latter is impossible.)

Please, please, make screening for binocular vision issues a goal, so that 12% of the population can benefit from early vision therapy intervention to avoid the everyday pitfalls this hidden, subtile disability creates, which must be endured for one’s entire life.

Respectfully
Lynda Rimke
https://leavingflatland.wordpress.com
*For reference:
Title II—IMPROVING THE EFFECTIVENESS OF SPECIAL EDUCATION AND RELATED SERVICES FOR STUDENTS WITH VISUAL DISABILITIES
Subtitle A—General Provisions
Sec. 201. Identifying students with visual disabilities.
https://www.govtrack.us/congress/bills/114/hr3535/text/ih

** https://covd.site-ym.com/?page=Exam

(1) http://www.parentcenterhub.org/repository/categories/

(2) http://www.parentcenterhub.org/repository/visualimpairment/

(3) http://www.covd.org/?page=VisionConditions

(4) https://nei.nih.gov/sites/default/files/nei-pdfs/VisionResearch2012.pdf p50 “spending time in bright outdoor light appears to be important for normal eye development…In 1972, approximately 25 percent of the U.S. population, 12–54 years of age, were nearsighted, compared to 42 percent 30 years later”

The Binocular Vision Dysfunction Pandemic http://c.ymcdn.com/sites/www.covd.org/resource/resmgr/ovd41-1/editorial_binocularpandemic.pdf

(5) https://nei.nih.gov/news/pressreleases/101308

(6) http://www.add-adhd.org/vision_therapy_FAQ.html

(7) https://www.autism.com/treating_vision

(8) http://www.children-special-needs.org/questions.html

For further reading:

American Academy of Optometry Binocular Vision, Perception, and Pediatric Optometry Position Paper on Optometric Care of the Struggling Student For parents, educators, and other professionals August 2013
http://c.ymcdn.com/sites/www.covd.org/resource/resmgr/position_papers/revised_oct_18_bvppo_positio.pdf

http://www.covd.org/?page=VisionConditions

http://www.covd.org/?page=Vision_Therapy

* Let Them See Clearly Campaign LTSCC just commented on my Facebook share today: After meeting the HR 3535 writers from the American Federation for the Blind, they thought that though HR 3535 should pass that BVD needs its own bill. They said it was a statement piece that the extras may bog down my efforts and never pass. I do think a BVD on its own would be best and will talk to my legislation writer and my rep contacts about options. Thanks for the blog. HR 3535 should pass and will help with BVD along with a comprehensive bill. Working on that. :) Thx for your help

I replied: Let’s hope for the best. I’m going to add your comment to my post. Thanks.

And then, later: I’ve been thinking about this. I’m not happy they think comprehensive screening isn’t part of the bill. I mean, come on, how hard is it to add a simple cover uncover test and use a pen light? https://www.youtube.com/watch?v=ZErvGS1EqyM

And just now: Ok, I remember— those two tests only discover well-established strabismus and not other binocular vision issues such as convergence insufficiency, which is far more common. Maybe a full bill just for Binocular Vision Disorders is the better idea … if it ever gets written!

 

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3 Responses

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  1. Reblogged this on The VisionHelp Blog and commented:
    Excellent advocacy efforts by Lynda Rimke!

    • Thank you, Dr. Press! I just learned the writers want to create a separate bill for binocular vision impairments and have added that info to the post.

      Lynda Rimke

      July 7, 2016 at 6:06 pm

  2. My Congressman emailed his reply July 15: “Dear Lynda,

    Thank you for contacting my office regarding H.R. 3535, the Alice Cogswell and Anne Sullivan Macy Act. As your Representative in Congress, I appreciate your input on this issue.

    As you may know, the Individuals with Disabilities Education Act (IDEA) was signed into law by President George H.W. Bush in 1990 to provide students with an education tailored to their specific needs. This law committed the federal government to paying forty percent of the average per pupil expenditure for special education each fiscal year. IDEA is composed of six elements created to ensure students with disabilities have the same opportunities as students without a disability. These elements include: Individualized Education Programs (IEP), Free Appropriate Public Education (FAPE), Least Restrictive Environment (LRE), appropriate evaluation, parent and teacher participation, and procedural safeguards.

    On September 17, 2015, Rep. Matt Cartwright (D-PA) introduced H.R. 3535, the Alice Cogswell and Anne Sullivan Macy Act. H.R. 3535 amends the Individuals with Disabilities Education Act to require a state to identify, evaluate, and provide special education and related services to children who have visual or hearing disabilities, or both. This legislation also authorizes grants for training special education personnel in preparing individuals to become qualified teachers and early intervention specialists for children with hearing disabilities. In addition, H.R. 3535 establishes the Anne Sullivan Macy Center on Visual Disability and Educational Excellence within the Department of Education (ED) to support students with visual disabilities. Most recently, H.R. 3535 has been referred to the House Committee on Education and the Workforce.
    You may be interested to know, Rep. Chris Van Hollen (D-MD) introduced H.R. 551, the Individuals with Disabilities Education (IDEA) Full Funding Act on January 27, 2015. H.R. 551 would amend the Individuals with Disabilities Education Act to reauthorize the grant program to assist states in providing special education and related services to children with disabilities. This legislation would require regular increases in IDEA spending each fiscal year from FY 2016 – FY 2024. Appropriated funds would be determined using a formula that multiplies the number of children receiving special education services by the average per-pupil expenditure in public elementary and secondary schools. H.R. 551 has been referred to the House Committee on Education and the Workforce. As Congress considers special education policy and funding, I will be sure to keep your thoughts in mind.

    Again, thank you for contacting my office. Please continue to keep me informed on the issues that are important to you. “

    Lynda Rimke

    July 16, 2016 at 3:42 pm


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