When does your child need vision therapy?

When my daughter was 12 years old, she struggled to read fluently. She knew how to read but skipped words and lost track of where she was on the page. She disliked writing and struggled to space words when she wrote on paper. Diagnosed with learning disabilities, her struggles extended to life skills such as staying organised or finding things in a cluttered environment. She sometimes could not identify her black objects inside her black school bag.

Around the same time, The Gateway School of Mumbai, which works with children with learning difficulties, recommended vision therapy. Here’s what’s interesting: Vision is not just the ability to see or read letters at the bottom of an eye-chart. It is about using our eyes properly and effectively as a team with our other senses to make meaning of what we see.

Vision therapy includes a wide range of activities used to improve visual skills and enhance vision. It is backed by research, including a 2020 study titled Interventions For Convergence Insufficiency by Mitchell Scheiman, Marjean T. Kulp and team, which describes the benefits of therapy to improve visual skills.

“In vision therapy, we teach somebody how to be more flexible and more efficient with their visual system and we give them techniques to do that," says Dr Fran Reinstein, a New York-based developmental doctor of optometry specialising in vision therapy, who is also on the advisory board of The Gateway School of Mumbai.

For example, when you read, your eyes should move inward together at targets at near range in a smooth and easy motion. For some children, their eyes either meet too near or too far away. Vision therapy works on many such skills.

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Dr Reinstein cites the example of a boy on the autism spectrum who came to her when he was 8 years old. “He got scans and MRIs done but no one recommended an eye exam," she says. “I saw that he could not eyeball anyone because he found it uncomfortable to focus. He was a non-reader but when we gave him a pair of glasses and worked with him, he caught up with the rest of his class and later went to an Ivy League university."

According to the American Optometric Association, 80% of a child’s learning in school is through vision. In fact, Dr Reinstein recommends that children have their first eye exam when they are six months of age, followed by yearly eye exams.

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“With early eye checkups and vision therapy, I see many children advance a tremendous amount by just learning to use their eyes together," she says.

Look for the signs

Do your children rub their eyes frequently, cover one eye when reading a book, struggle with homework, complain of headaches, skip words when reading, hold books close to their eyes, or struggle with organisation and time management? If so, it is advisable to go for a comprehensive vision exam with a developmental optometrist.

A vision therapy session has activities tailored to suit each child’s needs. Apart from eye exercises, optometrists use prisms, patches, filters and even computer-based programs in their sessions. You will see children wearing red and green glasses to read pages with red and green stripes or using focusing flippers to shift focus from near to far, and back again. Children enjoy exercises that give them a lot of feedback and activities that integrate more than one system. When children track with their eyes to the sound of a metronome, for instance, it improves their cognition and attention.

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Dr Abhinav Maharwal, a Jaipur-based optometrist who works extensively in areas like neuro-vision and vision therapy, says, “When we talk about vision, it is not just the eyes that are involved and vision therapy works beyond the eyes and on the brain, developing new connections between both."

In fact, the benefits go beyond academic outcomes. Rema Iyer, whose nine-year-old son goes to the Milestones Therapy centre in Bengaluru, was surprised at how vision therapy developed other skills in him. “It helped him synchronise his thinking and movements," she says.

“While vision therapy is a well-established science treating successfully lazy eye and squint for many years, it is also found effective in treating learning disabilities and is gaining popularity in co-managing neurological conditions like autism, cerebral palsy, and ADHD to name a few," adds Maharwal.

While vision therapy is not a new practice in India, not many parents are familiar with it and its benefits. Indira Bodani founded the The Gateway School of Mumbai in 2014 after noticing this gap. A parent of a son with neuro-diversities, Bodani first encountered vision therapy when she went to the US more than 20 years ago. “I met Dr Fran Reinstein to get my son’s vision tested and she explained the importance of vision therapy and how it impacts our day-to-day lives," she says.

My daughter now reads faster, retains information longer, and is more organised. She is also ready to graduate from her vision therapy programme. It is a step forward.

Shweta Sharan is a freelance journalist based in Mumbai.