Eyeing Vision Therapy

In many Heimishe communities, vision therapy has become the treatment of choice for childhood conditions from learning and kriyah to inattention and anxiety. Yet, a close "look" at the science behind this therapy leaves the impression that it's not always so "eye-eye-eye."

The upcoming issue of the New York Times Magazine features an article that is sure to arouse some controversy, dealing with the validity of vision therapy for childhood learning and behavioral disorders. The piece is written by Judith Warner, author of the recently released "We've Got Issues: Children and Parents in the Age of Medication," a straight-talking reevaluation of the oft-toted notion that today's children are wildly overmedicated.

 In short, “behavioral optometrists” and the American Optometric Association claim that 25% of all children have achievement-limiting vision problems, including most children identified as “problem learners,” and that vision therapy is the answer to a range of issues from learning and concentration to motivation and frustration tolerance.

Meanwhile, there is no scientific data that indicates that this treatment is effective. (One single randomized, placebo-based study by NIH’s Query the National Eye Institute found evidence of efficacy, but only for the specific disorder of convergence insufficiency).


Why, then do parents continue to buy in to this therapy? Here is my take on her suggestions, as applied to the frum community. Parents' choosing vision therapy is, in effect, their way of choosing how to understand and frame their child's condition. Going with vision therapy allows parents to straddle the fence between the clear-cut, blame-free medical perspective and the harder-to-swallow psychopathology perspective.

Many professionals who treat members of the frum communities find that there are two major mindsets regarding treatment preferences. Some are loathe to use psychotherapy, yet are perfectly fine with a “big doctor” giving them medicine for the same issue. Others are fine receiving eitzos from a professional, but would never consider letting themselves or their children be medicated. (These, of course, exist in all communities, but the resistance can be more pronounced in some than in others.) Vision therapy has an advantage over both psychosocial and psychiatric treatments, as it is generally not invasive of the body or the psyche.

In the Chassidishe communities, there is an additional factor relating to the fact that most of the instruction and reading is in Yiddish. Most, if not all, of the research-based, normed instruments for assessing reading and learning are simply unavailable in Yiddish, meaning that even trained professionals have difficulty pinpointing the precise source of difficulty with ivrah, or kriyah and learning. To my knowledge, there are few trained reading specialists who specialize in Yiddish, and even the number of instructors trained in reading remediation and multisensory instruction is relatively small. For parents who know their child is struggling, but have found few clear explanations why, hearing a behavioral optometrist state definitively that vision therapy is the answer is naturally compelling.

Vision therapy is also non-stigmatizing. Saying to a child, in effect, “It’s not you, it’s your eyes” has the benefit of not forcing parents to address the behavioral, social-emotional or intra-psychic issues that often elicit the fear of stigma and can, at first, leave parents feeling blamed. It also implies that, ultimately, there is nothing really wrong with the child. Whatever behavioral or achievement deficits he or she displays reflect nothing but that the child has yet to receive enough vision therapy. That sounds a lot better to potential mechutanim.

To be sure, there is no indication that vision therapy can harm a child. Parents with the resources to add it to the therapeutic mix will probably be none the worse for the experience. However, when it takes the place of other, proven ways of addressing the issue, jumping to vision therapy can detrimental. As the American Pediatric Association, the American Academy of Ophthalmology, and other medical organizations warned last summer in a joint statement  after reviewing 35 years' worth of literature on the topic:

Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child’s learning difficulties are being addressed, may waste family and/or school resources and may delay proper instruction or remediation.