February 21, 2017
Vision Therapy, Learning Disabilities and ADHD: The Missing Links
The global therapeutic market for attention-deficit hyperactivity disorder (ADHD) is expected to reach $25 billion by 2024, expanding at a compound annual growth rate of 6.2 percent each year 1. Distractibility, weak reading skills and poor academic performance: these are signs of several learning disabilities, as well as ADHD. But they can also indicate something else — vision problems that will not be solved with Ritalin or most special education techniques.We all want to help that child still counting on his fingers or struggling to read… but since he sailed through his last eye exam, most of us never consider that his vision might be part of the problem.
Many people don’t realize that the standard eye exam is hardly a comprehensive measure of sight as a whole. It tests visual acuity but does not examine the kind of eye movements necessary for reading, or consider all the nuanced ways in which the Oculomotor Sensory System (OMS ) — that is, the eyes, the brain, and the body — works. Paradoxical though it seems, then, a child with 20/20 eyesight can still have vision-related learning problems — problems that exacerbate ADHD or a learning disability.
“Students with visual tracking problems will lose their place when reading, skip and re-read words and have more difficulty copying from one place to another. Students with focusing and eye teaming problems may experience blurred vision, visual fatigue when reading, slower reading speed and reduced reading comprehension.”
ADHD and Social Blinders
These issues, and others like them, are largely misunderstood in today’s schools. Convergence insufficiency—which causes patients to see double—has a reported prevalence of 2.5 percent to 13 percent in the United States2 and shares numerous symptoms with ADHD, for example. But the latter is better known, and therefore more readily diagnosed.
“There is no doubt that vision problems are frequently overlooked or misdiagnosed in the classroom setting. They think what they see is normal and everyone sees the way that they do,”
Students with learning or attention difficulties receive a variety of solutions to help them perform better in school, from prescription drugs and behavioral therapy to tutors, audiobooks or noise-cancelling headphones. The National Center for Learning Disabilities reports that the US government puts $11.5 billion3 toward funding programs like these every year. But those programs rarely include any form of vision therapy—despite the fact that at least 20 percent4 of learning disabled (LD) kids are suspected to also have some sort of vision problem, according to estimates from the American Optometric Association.
Even when a vision problem is evident, educators may ignore this issue and offer other solutions. Consider the case of Lauren, a nineteen year-old girl who appeared to have a lazy eye. She struggled with reading for years before seeing Dr. Leonard J. Press, author of Applied Concepts in Vision Therapy.
“Her aversion to reading was so strong that the school suggested to the family that she was dyslexic, and needed large print books and taped material. After starting a vision therapy program, Lauren—previously reading at a fourth-grade level—has shown substantial improvement.”5
Proven Therapy Improves Vision and Learning
This one story shows how significant the costs of an undiagnosed vision issue can be. While Lauren is progressing now, she struggled for years academically. Reading physically exhausted her, and yet her school suggested she was simply apathetic.
And Lauren wasn’t the only one to suffer—what about all of her classmates? A struggling student demands extra attention from teachers and additional resources from the education system. At home, siblings may resent the extra attention their brother or sister receives as a result of academic struggles. Put simply, vision-related learning difficulties aren’t just an individual’s problem. They affect society as a whole.
Accordingly, there is growing recognition that LD or ADHD students should be tested for vision problems as part of a comprehensive care program. But treating a vision issue isn’t always easy, particularly when dealing with children. Young patients may have cosmetic concerns about wearing eye patches or special reading glasses in front of their peers. Likewise, eye muscle surgery is a frightening prospect for kids, and the treatment does not always yield the best results—indeed, subsequent surgeries are often required.
Enter vision therapy or a customized, doctor-supervised regimen of eye exercises. It’s been practiced for over 75 years in the United States but is gaining greater traction now, as the link between vision problems and learning difficulties becomes more well-established. A large body of compelling research studies has demonstrated that vision therapy is cost effective and has a high success rate compared to other treatments in the remediation of vision-related learning disorders. Many of these studies show that the highest success rates occur when office therapy is combined with home vision therapy.
“Going forward, there is no doubt that innovative ways of education, communication and training will transform the marketplace, making vision therapy more visible and accessible.”
The Long View for Vision Therapy and ADHD
The mobile health movement, or mHealth, is one of those catalysts making vision therapy more accessible, empowering patients and allowing for direct collaboration with care specialists. Recent reports6 predict this sector will see massive development in the years ahead, with a compound annual growth rate of 34 percent. Apps will drive the majority of that growth. ACT, which represents the industry’s leading app companies and technology firms, projects that by 2020 the market for connected health apps will reach $117 billion7. The association also reports that 86 percent of clinicians believe such apps will become an integral part of patient health in the near future.
It’s easy to see why. Health apps enable patients to take ownership over their own care—whether through scheduling their drug doses and appointments, reviewing data from a medical device or completing therapeutic exercises at home. These apps have remarkable potential in the vision therapy space , particularly for younger patients who are also dealing with learning or attention issues.
This technology allows us to meet kids where they’re comfortable, using tools they’re already accustomed to: that is, a smartphone. This is particularly important for LD or ADHD children, who typically experience higher rates of bullying in schools. They may be wary of anything that marks them as obviously “different”—like receiving an audiobook when everyone else gets a paperback novel, or having to wear an eye patch in class.
This, we believe, is the future of vision therapy. The treatment has gained visibility—now, the industry must work to make it more accessible, bringing it from the clinic to the classroom and into the home.