Parents Active for Vision Education P.A.V.E.®
After P.A.V.E.® was founded by Marjie Thompson, it grew nationally by the reciprocal support of parents and teachers with children in their homes and classrooms who had suffered the effects of undiagnosed vision problems. After years of searching for answers to their children’s learning problems, their children were finally diagnosed and successfully treated by a Developmental/Behavioral Optometrist through a form of treatment called VISION THERAPY!
P.A.V.E.® finds it unacceptable that children and adults continue to suffer needless frustration and failure because too often parents, educators, and medical professionals are unaware of the critical link between VISION and efficient learning.
P.A.V.E.® is a national non-profit education 501(c)3, resource and support organization whose mission is to raise public awareness of the crucial relationship between vision and achievement.
P.A.V.E.® has had the wonderful privilege of being a resource to thousands of individuals who benefited from behavioral optometry. What keeps us motivated to fulfill our mission is the stories we hear every day about how we helped those individuals that were diagnosed as having visual issues that ultimately affected their learning.P.A.V.E.® ‘s goal is to share 10,000 success stories of parents, teachers and other professionals so that we all can spread the word of how important vision can be to a child not working at his/her potential.
If you have a success story you would like to share with other parents, we encourage you to email your story to us at firstname.lastname@example.org and you will bring us one story closer to meeting our 10,000 story goal.
There is an intimate relationship between posture, working distance, desk surface and lenses. Pioneering experiments by Dr. Darrel Boyd Harmon and subsequent research by Drs. John Pierce and Steven Greenspan clearly prove a reduction of stress and improved performance when conditions are arranged properly for near-point visual activities. The following changes were observed: reduced heart rate, more regular and deeper breathing, and reduced neck muscle and overall body tension.
To achieve these benefits the following must be arranged:
Working Surface: A sloping working surface must be used that is tilted between 20 and 23 degrees from the horizontal.
Posture: Seated comfortably, relatively erect, feet flat on floor or box.
Working Distance: The “Harmon Distance” is the optimal distance from the eyes to the working surface. It is the distance from the elbow to the first knuckle. This can only be assured with a proper chair height to desk relationship.
Nearpoint Lenses: A specific, low power prescription not used to correct a defect in the eyes but to put the eyes into better balance for near tasks. This enhances and integrates the posture, working distance, and surface relationship.
Instructions for Visual Hygiene
1. Do all near point activity at HARMON distance or slightly further. This is the distance from the center of the middle knuckle to the center of the elbow measured on the outside of the arm. Working at the Harmon distance reduces near point visual stress.
2. Be AWARE of space between self and the page when reading. Also, be aware of things around and beyond the book.
3. When reading, occasionally look off at a specific distant object and LET its details come into focus. Maintain awareness of other objects and details surrounding it. Do this at least at the end of each page.
4. When studying, place a bookmark 3 or 4 pages ahead. Get up and move around for at least one minute each time you reach the bookmark.
5. Sit UPRIGHT. Practice holding your back arched while you read and write. Avoid reading while lying on your stomach on the floor. Avoid reading in bed while lying on your stomach on the floor. Avoid reading in bed, unless sitting reasonably upright.
6. Provide for adequate general illumination, as well as good central illumination, at the near task. The illumination on the task should be about three times that of the surrounding background.
7. Tilt the book up about 20 degrees (this slopes up about 4 inches in 12). A tilt top for the desk can be made by screwing two door stops to the back of a piece of 1/2 inch plywood or a drawing board, and two rubber knobs to the near end so it doesn’t slip off the desk. This can be used for reading, studying, writing. It usually enables working farther away from the task than when the task is flat on the desk.
8. Do not sit any closer to TV than 6 to 8 feet, and be sure to sit upright. Maintain good posture.
9. When riding in a vehicle, avoid reading and other near activity. Encourage looking at sights in the distance for interest and identification.
10. Encourage outdoor play or sports activities that require seeing beyond arm’s length.
11. When outdoors, sight a distant object at about eye level. At the same time, be aware of where things are on all sides.
12. Walk with head up, eyes wide open and look TOWARD, not at, objects.
13. Become very conscious of the background of the objects you look TOWARD, be it a person, print on a page, an electric sign, the TV, or any other object.
Why can a child who is having difficulty in school be screened at school and told their vision is fine, go to an ophthalmologist or optometrist and be told there is nothing wrong, but go to another optometrist another time and be told they have significant visual problems?
It is important to be tested for both “eyesight” and “vision,” since HOW you use your vision is sometimes more important than how CLEARLY you see. Click here to Find a Doctor
Not all eye care professionals are the same. Many optometrists and ophthalmologists test, diagnose and treat eye health problems and refractive problems, such as nearsightedness, but do not emphasize the function of vision. Patients can have healthy eyes and clear vision and still have problems in these other areas, but most eye doctors providing a standard eye exam do not identify functional vision disorders. Why? They do not run the additional tests to identify these types of problems in a routine eye exam.
Learn how to find a doctor that assesses vision related learning difficulties by asking the right questions about the type of vision exam they give.
There are optometrists that specialize in learning-related vision problems, lazy eyes, wandering eyes, vision and special needs, sports vision and vision rehabilitation. They are often called Developmental Optometrists, Pediatric Optometrists or Behavioral Optometrists. Eye doctors who specialize in children’s vision receive their professional credentialing through the College of Optometrists in Vision Development, becoming board-certified Fellows (FCOVD). They will determine if you need glasses and if your eyes are healthy, but they will also run additional tests to evaluate how efficient your visual system is working when you perform your daily tasks, especially at work, school and in sports. Sometimes a behavioral optometrist will prescribe glasses or contact lenses differently than a traditional eye care professional, even for refractive problems such as nearsightedness. Behavioral optometrists are trained to prevent, slow the progression of, or remediate visual problems. Often, this means prescribing for near activities, such as computers or reading.
Approximately 1 in 4 children in a classroom have not developed adequate visual skills needed to function properly, especially when working up close during tasks such as reading, writing and computer use, which places high demands on our visual systems. Parents and teachers often attribute their children’s symptoms to other problems, such as learning disabilities or attention deficit disorders, when the real source of their difficulties in the classroom is an undiagnosed vision problem.
The entire brain is involved with vision and vision integrates with all the other senses. It takes up two-thirds of the brain pathways, while all other senses combined take up the remaining one-third. Behavioral optometrists look at visual input skills, visual processing skills, storing visual information and getting it back out again. Here are just a few of the visual skills that can impact academic performance described below:
1. Eye tracking, known as oculomotility or eye movement control, requires that the eyes move together with exquisite precision. This allows for moving the eyes along the lines of print in a book, quick and accurate shifts from far to near, and sure tracking in sports when they are well-integrated.
2. Focusing, known as accommodation, is the ability to sustain and maintain clarity on targets at different distances, such reading and writing, as well as rapidly and efficiently change clarity from distance to near, such as copying from the board. You can think of visual focus like changing the f-stop on a camera. The closer the target, the more focusing power needed to see it clearly. Visual focus is intimately related to the ability to sustain visual attention.
3. Eye teaming ability, known as binocularity, is the ability to keep a target single. The closer the target, the more your eyes have to turn in to keep it single, such as when reading. If the eyes are not accurate in where they target, or cannot maintain its ability to target, it takes more effort to take in and process visual information, can reduce visual attention, negatively impact spatial judgments, and can cause crossed or wandering eyes.
4. Depth perception is intimately related to eye teaming. If the eyes do not work together efficiently as a team, the brain will not perceive depth accurately. This can impact sports, riding bikes, scooters, etc. (driving), and cause more clumsy behaviors such as knocking over glasses and tripping down or up stairs.
5. Eye-hand-body coordination, known as visual motor integration, is essential for accurate and stress-free writing and efficient performance in sports. It is important that the visual system is sending a signal OUT to the body’s motor centers for good gross and fine motor coordination and overall balance.
6. Visual form perception are a group of visual abilities needed for quick and accurate identification and discrimination of objects, for comparing similarities and differences, recognizing and generalizing forms, and coming to valid conclusions based on the accurate analysis of available visual information. This is important for science, mathematical reasoning and overall learning.
Visual memory and visual sequential memory is essential for optimal academic and athletic performance too. The ability to retain maximum visual information in an adequate period of time is essential for proficiency in abilities such as reading comprehension and spelling.
To know if your child is being evaluated for possible vision related learning problems, ask your eyecare professional if they evaluate at least the following visual skills:
- Eye tracking (eye movement control)
- Focusing near to far
- Sustaining clear focus up close
- Eye Teaming Ability
- Depth Perception
- Visual Motor Integration
- Visual Form Perception
- Visual Memory
Remember, behavioral optometrists are specialists in their field and are not always widely available in some areas. Click here to Find a Doctor.
Attention Deficit Hyperactivity Disorder or ADHD is being diagnosed with increasing frequency in both children and adults. Many of these individuals were previously labeled hyperactive or minimally brain damaged. It is estimated that over one million people presently have this disorder.
The fourth edition of the Diagnostic and Statistical (Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, classifies three types of Attention Deficit/Hyperactivity Disorders: predominantly inattentive, predominantly hyperactive, and combined. Six of nine symptoms of inattention, and six of nine of hyperactivity and impulsivity are necessary for diagnosis.
In each case, the symptoms must be present for at least six months to a degree that is maladaptive and inconsistent with developmental level. In addition, some symptoms must be present prior to age seven, and in two or more settings (e.g. at school, work and home). There must be clear evidence of clinically significant impairment in social academic or occupational functioning, and the impairment cannot be caused by other disorders such as anxiety, psychosis or a pervasive developmental disorder.
Even though it is generally assumed that people diagnosed as having ADHD evidence a common set of characteristics emanating from a common etiology, little agreement is found among researchers regarding these symptoms. Some symptoms seen in children diagnosed as having attention deficits include:
Making careless mistakes in schoolwork
- Difficulty sustaining attention to tasks
- Not listening to what is being said
- Difficulty organizing tasks and activities
- Losing and misplacing belongings
- Fidgeting and squirming in seat
- Talking excessively
- Interrupting or intruding on others
- Difficulty playing quietly
These symptoms are also seen in both children and adults with learning-related visual problems, sensory integration dysfunction as well as with undiagnosed allergies or sensitivities to something they eat, drink or breathe. The chart that follows illustrates this graphically.
|Symptoms||ADHD (DSM-IV)||Sensory Integration Dysfunction (Ayres)||Learning Related Visual Problems (Kavner)||Nutrition Allergies(Rapp, Crook
|Inattention (at least 6 are necessary)|
|Often fails to give close attention to details or makes careless mistakes||X||X||X||X|
|Often does not listen when spoken to directly||X||X||X||X|
|Often has difficulty sustaining attention in tasks or play activities||X||X||X||X||X|
|Often does not follow through on instructions or fails to finish work||X||X||X||X||X|
|Often has difficulty organizing tasks and activities||X||X||X||X||X|
|Often avoids, dislikes or is reluctant to engage in tasks requiring sustained mental effort||X||X||X||X||X|
|Often loses things||X||X||X||X||X|
|Often distracted by extraneous stimuli||X||X||X||X||X|
|Often forgetful in daily activities||X||X||X||X|
|Hyperactivity and Impulsivity (at least 6 necessary)|
|Often fidgets with hands or feet or squirms in seat||X||X||X||X||X|
|Often has difficulty remaining seated when required to do so||X||X||X||X||X|
|Often runs or climbs excessively||X||X||X||X|
|Often has difficulty playing quietly||X||X||X|
|Often “on the go”||X||X||X||X|
|Often talks excessively||X||X||X||X|
|Often blurts out answers to questions before they have been completed||X||X||X||X|
|Often has difficulty awaiting turn||X||X||X||X||X|
|Often interrupts or intrudes on others||X||X||X||X||X|
Physicians often recommend that ADHD be treated symptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they may mask the problems rather than get to their underlying causes.
In addition, many common drugs for ADD, which have the same Class 2 classification as cocaine and morphine, can have some negative side effects that relate to appetite, sleep and growth. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine rather than boost his self-esteem.
A sensible, multi-disciplinary, developmental approach treats underlying causes rather than the symptoms which are secondary.
TREATMENT OF ALLERGIES to pollen, molds, dust, foods and/or chemicals by eliminating or neutralizing them has also been shown to alleviate the identical symptoms, and without side effects.
VISION THERAPY improves skills that allow a person to pay attention. These skill areas include visual tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.
OCCUPATIONAL THERAPY for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, understanding movement, body position and touch. This allows them to pay more attention to the higher level senses of hearing and vision.
The public needs to understand that some behavioral optometrists, physicians, educators, mental health professionals, occupational therapists and allergists are all addressing the same symptoms and behaviors. The difference is that medication, special education and counseling can mask these symptoms and behaviors, while vision therapy, occupational therapy and the treatment of allergies may alleviate the underlying causes and thus eliminate the symptoms long-term.
When making a choice about treatment for attention deficits:
- Consult a behavioral optometrist for a developmental vision evaluation
- Have a child evaluated by an occupational therapist with expertise in sensory processing problems
- Consult an allergist regarding possible reactions to foods or airborne particles
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-lV), 1994.
Ayres, A. Jean, Sensory Integration and the Child, Western Psychological Services, 1979.
Crook, William G., Solving the Puzzle of Your Hard-to-Raise Child, Professional Books, 1987.
Gesell, Arnold, and Ilg., Frances L., Infant and Child of the Culture of Today, Harper) 1943.
Goodman, Gay, Poillion, M. J., The Journal of Special Education, “ADD: Acronym for Any Dysfunction or Difficulty,” Vol 26, No. 1, l992, pp. 37-56.
Kavner, Richard S., Your Child `s Vision, Simon and Schuster, 1985.
Rapp, Doris J., Is This Your Child?, Morrow, 1991.
Schmidt, M.A., Smith, L.H., Sehnert, K.W., Beyond Antibiotics: Healthier Options for Families, North Atlantic Rooks, 1994.
Smith, Lendon, Foods for Healthy Kids, Berkeley Books, 1981.
FOR RESOURCES IN YOUR AREA
College of Optometrists in Vision Development
Optometric Extension Program Foundation, Inc.
American Occupational Therapy Association, Inc.
Developmental Delay Registry
A nonprofit foundation for education and research in Vision
Self-Assessment Check List
This Self-Assessment Checklist Can Reveal Vision Difficulties
Your visual system can undergo tremendous stress these days. Students now read three times the number of textbooks their grandparents did. Adults constantly use their near vision at their work. And the growing use of computers has engaged a growing number of workers in prolonged, near-vision tasks.
Eye discomfort, headaches, blurred vision, lowered visual performance a wide variety of vision-linked problems are related to this heavy vision load in the neat, arm’s-length distance.
Human beings weren’t designed to do this stressful seeing less than arm’s length away. We have hunter eyes for survival, spotting game and enemies at a distance. Only in the last half century have so many people been forced to deal with sustained, near visual tasks. The result has been a constant stress on the visual system, producing many of the symptoms and problems described in this self test.
Many people who report these symptoms also have 20/20 eyesight at distance, yet just can’t handle the visual stress associated with near vision tasks. Visual stress is linked to the development of permanent vision conditions such as nearsightedness, astigmatism and other problems that affect how one lives and even behaves.
Effects of visual stress
When visual stress is present, people react in these ways:
- avoid the task by doing as little as they can get by with;
- experience pain or other symptoms (aches, visual and/or overall body fatigue, falling asleep when reading, etc.);
- suppress the sight of one eye (at the cost of reduced efficiency and understanding);
- develop myopia or astigmatism, or
- any combination of the above.
For most people, the response to stress is reduced achievement and understanding.
How To Use This Test
The questions in this self test cover the most common symptoms optometrists observe in their patients. If you experience one or more problems on the list, it may be time to contact a behavioral optometrist. Take this self-test with you on your first appointment. The results will help with the assessment of your visual problem.
Visual Function Self Test
|Do you wear glasses for your reading?|
|Do you enjoy reading?|
|Do you think you should be able to read faster?|
|Do you understand what you read as well as you’d like?|
|Is it an effort to maintain your concentration while reading? (Short attention span.)|
|Do you tend to skip words or lines of print while reading?|
|After reading, do you look up and notice that distant objects are momentarily blurred?|
|Does print tend to appear blurry after reading for awhile?|
|Do your eyes itch, burn, water, pull or ache?|
|Do words appear to float or move while reading?|
|Do you tend to lose your place while reading or copying?|
|Do you tend to use your finger or a marker to keep your place while reading or copying?|
|Do you have to re-read words or lines while reading?|
|Do your eyes feel tired at the end of the day?|
|Do you sometimes have to squint, close or cover one eye when reading|
|Do you ever experience headaches during or after reading?|
|Are you especially sensitive to sunlight or glare?|
|Are you aware of any tendency to move your head closer to, or away from what you are reading?|
|If you use a computer, does the video (VDT) screen bother your eyes?|
|How long can you read before you are aware of your eyes getting tired?|
|How many hours daily do you spend at a desk, or reading, or at other arm’s length vision distances?|
What Is a Behavioral Optometrist?
Behavioral Optometrists spend years in post- doctoral education to master the complex visual programs prescribed to prevent or to normalize -visual problems and enhance visual performance. Behavioral optometry is an umbrella term which also includes developmental and functional optometric practices. Not all optometrists practice behavioral optometry. To find one who does, call or write OEP Foundation for a referral list in your area.
Optometric Extension Program Foundation, Inc.
Pamphlet Copyright © 1989, OEP Foundation, Inc. – A nonprofit foundation for education and research in Vision. Permission to reprint the contents of this brochure granted to P.A.V.E ® – 12/6/96 by the Optometric Extension Program Foundation, Inc.
The following symptoms may indicate that YOU or your CHILD has a VISION PROBLEM:
What does your optometrist mean when he or she says you are seeing “20/20”? It means that when standing at a distance of 20 feet from the eye chart, you can see the same row of letters that the average person can see at this distance. It is a measure of the sharpness of sight, but does not tell you anything about how your brain is processing what you see.
In fact, there are over 20 different skills visual skills that an eye chart does not detect. The visual system is so complicated, it utilizes 65% of ALL our brain pathways. “20/20″ eyesight represents only a very small part of this process.
Behavioral optometrists differentiate between the terms “sight” and “vision”. “Sight” is the ability to see and the eye’s response to light shining into it. “Vision” is the ability to interpret and understand information that comes through the eyes.
The visual system is a significant part of how we process information and a key factor in how we learn. 80% of what you perceive, comprehend and remember depends on the efficiency of the visual system.
Vision is a learned skilled, just like walking and talking. If vision does not develop efficiently, even a bright child can have difficulties with reading, writing, spelling and math.
One out of four children has a vision problem which interferes with their ability to learn efficiently and achieve in school.
Most school screenings only check how clear a child sees. Unfortunately, most of the kids impacted by inefficient visual skills pass this type of school screening. The children who fail school screenings actually tend to be the high achievers in the classroom.
Treatment for inefficient visual skills can be in the form of lenses, developmental guidance or an individualized vision therapy treatment program. Vision therapy re-organizes neural pathways by building new synapses, thereby affecting the patterning of the brain.
According to the California Department of Youth Authority, 70% of juvenile delinquents tested have vision problems affecting learning. When optometric vision therapy was performed on incarcerated youths, recidivism reduced from 45% to 16% at the Regional Youth Education Facility in San Bernardino, CA.
The best way to treat a problem is to prevent it before it occurs.
A developmental vision problem can be diagnosed during the pre-school years and can often be corrected before the child enters school. Children do not grow out of vision problems. Children with vision problems become adults with vision problems.
The Vision Council of America recommends that children’s vision be examined before the age of 1, again at age 3 and 5 or before starting school. From the age of 6 through adult, everyone should have an annual exam.
Remember, not all eye care professionals emphasize the function of vision. You want to be tested for both “eyesight” and “vision” to determine not only eye health, how clear you see and if you need glasses, but how efficient your visual system is working. Ask your eyecare professional if they evaluate at least the following visual skills:
- Eye tracking (eye movement control)
- Focusing near to far
- Sustaining clear focus up close
- Eye Teaming Ability
- Depth Perception
- Visual Motor Integration
- Visual Form Perception
- Visual Memory
Authored by: Mary McMains, O.D., M.Ed., F.C.O.V.D.
It is currently estimated that 1 out of 4 school age children and 7 out of 10 juvenile offenders suffer with undiagnosed vision problems that effect performance in school and in life.
According to the American Foundation for Vision Awareness, vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition in childhood.
70% of what a child learns in school is processed through the visual system. Even a minor visual processing problem will interfere with a child or adult performing to their potential
Did you know that visual perceptual and visual efficiency problems, which interfere with learning, can be permanently resolved?
Yet, according to the Better Vision Institute, only 14% of children have had a comprehensive vision exam by first grade. Based on research, the National PTA and the National Society for the Prevention of Blindness estimates 10,000,000 students suffer with undiagnosed vision problems in our schools and that good visual skills are necessary for successful learning.
I had an interesting conversation today with a mother from Pennsylvania. Her daughter has been struggling in school for some time, and after a vision exam has been diagnosed with a “visual issue”. The doctor — who I know first hand to have an excellent reputation –recommended 6 months of Vision Therapy.
It was evident to me early on in the conversation that this mother was very concerned about her child. Mom spent a few minutes explaining her daughter’s difficulties, explaining the significant financial considerations and sacrifices she and her husband were going to endure because the costs for Vision Therapy are considerable, explaining the drive of over an hour (each way) to complete these weekly visits, and explaining the overall lifestyle adjustment the entire family was considering in order to get this little girl Vision Therapy. After a long pause, mom came to a question of “Is Vision Therapy worth it?
My answer: Yes
See, Vision Therapy offers patients the opportunity to rebuild and replace the inefficient visual skills. Since vision is the predominant sense in human beings, so much of what we know about the world, even beyond academics, is based of visual input. In fact, it is estimated that 92% of our brain’s input is through the visual system. The other four senses are relied upon to a far lesser degree. Therefore, if your visual system is inefficient , your input is not always going to correct. If your input is incorrect or inaccurate, your response will most definitely be inappropriate because you are making judgements based on bad information. I believe this child is trying hard….probably harder than anyone else in the class. The problem is the information she’s processing and using to form decisions is inaccurate because of poor visual skills, and therefore no amount of effort will produce the correct answer.
After I explained this to this mom in Pennsylvania, other pieces began to click. “Could this be why she can’t kick a rolling soccer ball?”, I answered “Yes, she cannot time the kick because of poor visual input”. “Could this be why she gets car sick?”, again I answered “Yes, when the visual system is inefficient, it can create ‘mismatches” from one eye to the other. That is to say the brain is receiving two totally different pictures; one from the right eye and one from the left eye, and the pictures do match. When you have this condition is a dynamic setting, like a car, the person can have a visceral response as the brain becomes overloaded with these mismatches”. I went on to explain that anything her daughter does with her eyes opened is affected by vision. All the concerns she had about her child could be directly related back to the visual system and faulty input.
As the conversation concluded I asked her “do you now think Vision Therapy is worth it?”
Her answer: “Yes”
Thanks Meredith, you made my day!