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Reprinted from



of the American Optometric Association

Volume 51, Number 5: pp. 489-493 May 1980.

Optometric vision therapy ­
results of a demonstration project
with a learning disabled population
Optometric vision therapy
results of a demonstration project
with a learning disabled population


have gained considerable atten­ orientation with heavy emphasis
ABSTRACT - Thirt:",-six children at­ tion during the past twenty years, on specialized reading program­
tending a priva te school for learning many of the treatment plans are ming for each individual child. The
disabled children u'ere diagnosed as still controversial. The presence of population of the school is essen­
having visual an&or perceptual disor­
ders. The expen'mental group received
visual factors, both physiologi­ tially reading disabled and/or
individual programming in visual and cal 1.6 and perceptual. 7' 14 have been neurologically impaired. Prerequi­
perceptual development at their ap­ confirmed repeatedly. The pur­ site for entrance is potential for
propriate developmental levels. The pose of this paper is to investigate average or better intellectual func­
control group received instruction in the effect of optometric vision tioning. Psychotherapy is recom­
physical education, art or music mended when indicated. This may
therapy upon children who have
classes. Both groups received individ­
ualized reading assistance. Statistical been identified as having learning take the form of individual, group
analysis of the two year demonstra­ disabilities and who have visual or family therapy. The basic phi­
tion ;Jroject, which included nine deficiencies. The goal of optome­ losophy of the school is to care­
months of actual training, indicated tric vision therapy, in the case of fully diagnose the child' s problem
that the experimental group made sig­ the learning disabled child. is to and design a pragmatic program
nificant gains in reading as compared
develop a level of functional visual to remediate the difficulties. If a
to the control group. The improve­
ment in basic instructional level of and perceptual readiness which child has a reading problem. then
The Informal Reading Inventory will enable him/her to respond teach him/her in the most direct
(Temple University), and the Word more effectively to educational and efficient way possible.
Reading and Paragraph .Weaning sub­ procedures.
tests of the Stanford Achievement
Tests, and the actual classroom read­ Purpose of the study Research design
ing levels were all statistically signifi­
The purpose is to test the hy­ Forty-three learning disabled
cant. The Informal Word Recognition
Inventory (Daniels) and the Spelling pothesis that visual and percep­ children were tested to secure a
subtest of the Stanford Achievement tual training will result in im­ sample of thirty-six children who
Tests showed a definite trend ap­ proved reading skills in learning were experiencing visual and/or
proaching statistical significance. disabled children who demon­ perceptual difficulties. Criteria for
strate visual and perceptual defi­ selection of these thirty-six
KEY WORDS: learning disabled cits. children included sub-normal per­
children, visual and/or perceptual dis­ formance on four of seven per'cep­
orders, optometric vision therapy The population
tual-motor tasks. They included:
Wordsworth Academy is a Geometric Copy Forms Test (Win­
private school for learning dis­ ter Haven). Southern California
abled children. located in the sub­ Figure Ground Test. Perceptual
While the etiologic factors asso­ urbs of Philadelphia. Pennsylva­ Constancy bub-test of the Frostig,
ciated with learning disabilities nia. There is a multidisciplinary Divided Form Board (Getman).
Volume 51. Number 5. 5/80 489
directionality, alternate hopping
and alternate ball bouncing TABLE I
(Kephart).15 Difficulties in visual Pass-Fail Criteria
functioning were also considered; Test Fail
e.g., convergence or divergence Geometric Copy Forms (Winter Haven)34 Subjective judgment based on visual·
problems, binocular coordination, motor development and organization of
limited ranges of fusional re­ Below 20th percentile
Southern California Figure Ground Tesp5
serves, and/or accommodation. Perceptual Constancy Subtest of Frostig 36 Age equivalent test score 1 year below
See Table I for pass-fail criteria. chronological age
The group of thirty-six visually Divided Form Board 37
(Time in seconds) Greater than 120 seconds
deficient children was divided into (Level) Appropriate hierarchical shift from re­
eighteen pairs matched for age, liance on tactual information to visual
sex, I.Q .. severity of visual and Directionality 1. Inability to correctly respond to
questions relating to left and right
perceptual difficulty. and degree orientation on self
of reading deficit. Initial testing 2. Inability to correctly respond to
included a complete optometric questions relating to the examiner's
left and right when facing the ex­
visual analysis, developmental aminer
and perceptual testing, the Wech­ Alternate Hopping Unable to alternately hop two times on
sler Intelligence Scale for each foot for three complete cycles
Alternate Ball Bouncing Unable to alternately bounce nine-inch
Children, The Stanford Achieve­ ball two times with each hand for three
ment Tests, The Informal Reading complete cycles
Inventory (Temple University), Near Point of Convergence Greater than three inches

and The Informal Word Recogni­ Phorias Exo or Eso Deviation without compen­

satory fusional ranges of operation. b

tion Inventory (Daniels). The (Findings which would customarily re­

eighteen pairs of matched children sult in the diagnosis of convergence ex­

cess, convergence insufficiency, ac­

were then randomly divided into commodative insufficiency, etc.)

eighteen experimental children
and eighteen control children.
Both the experimental and control
group children continued to re­ Age and 1.0. (WISC) Full Scale at Onset of Project
ceive specialized reading program­ Experimental Control
Group Group T·Test
ming. The experimental group re­
ceived vision therapy for thirty (n = 18) (n = 18)
minutes per day, four days per 1.0. (At Onset of Program) 102.9 98.8 Not Significant
week. The perceptual therapy and Range (SD 12.6) (SD 15.8)

127 - 77 125 - 76

visual training stressed the correc­ Age Months
116.8 120.6 Not Significant
tion of deficient functions and (At Onset of Program)
(SD = 14.5) (SD 10.7)

skills. Each child in the experimen­ Age Range (Months)
90 145 95 - 141

tal group was programmed indi­
vidually according to his/her spe­
cific needs and his/her specific TABLE III
development level. The control Covariance Analysis of Visual and Perceptual Measures of

group participated in adaptive Experimental and Control Groups

physical education, art or science Mean Mean
classes for an equal period of time. Pre Test Post Test F P
All of the children in both the ex­ A. Percentual Measures
perimental and control groups re­ 1. Frostig Test Form
ceived daily specialized reading in­ (Raw Score)
struction with a reading specialist, Experimental 9.7 13.4 4.3*
Control 9.6 11.5
which included individualized
2. Divided Form Board
direct reading activity (DRA) with LEVEL
follow-up class. a Ex peri men tal 4.3 5.8 6.1 *
Control 5.0 5.0
The program of remediation in­ 1 =Tactual Low
cluded techniques described by 2 =Tactual High
Continued next page
Getman, 16 Kephart, 15 Barsch, 17 So-
490 Journal of the American Optometric Association
lan,I8 Cruickshank,I9 Frostig,20
TABLE III continued
3 = Tactual-Visual Low Winter Haven,21 Ayres,22
4 =Tactual-Visual High Birch,7.23.24 The Gesell Insti­
5 = Visual-Tactual Low
6 = Visual-Tactual High
tute,25.26.27 The Optometric Ex­
7 = Visual Low tension Program,28.29.30 Seider­
8 = Visual High
man,31.32 and others.
3. Divided Form Board (Non-Sig.)
Time (Seconds) In general, perceptual therapy
Ex peri mental 147.9 64.9 was based on a developmental hi­
Control 124.9 75.9
4. Southern California
erarchy beginning with gross­
Figure Ground (SCFG) motor controL The develoment of
(Percentile Score) the body schema, form perception,
Experimental 33.7 56.8
Control 31.1 46.9 fine-motor control, visual percep­
B. Visual Measures tion including analysis and syn­
1. Near Vision, thesis, sensory-motor and visual­
Convergence Break ~ motor, and intersensory
Experimental 11.0 21.8 5.6" .05>p >01
Control 11.0 14.9 development followed sequen­
2. Near Vision
tially. The final stage was the de­
velopment of conceptualization.
Recovery ~

Experimental 5.8 12.1
When the child can process and in­
6.3" .05 >p >,01
Control 4.9 5.9
tegrate information through the
3. Distance Vision, sensory modalities, he is then ex­
Convergence Break (L:::J posed to the formulation of con­
Experimental 9.3 23.5 4.7* .05 >p >,01
Control 14.0 19.9 cepts through the use of his per­
4. Distance Vision,
cepts.32 Visual training was

administered and continued to the
Recovery ~)

5.4 15.7 8.3" " p<.01 extent that there was no doubt
6.2 8.2 that each child would be able to
5. Near Vision,
Divergence Break (L:::J sustain effort comfortably at the
Ex peri mental 14.7 17.1 Trend reading distance for extended pe­
Control 15.1 16.0 riods of time. b
6. Near Vision

The inidividualized program at

Recovery ~
the appropriate developmental
9.4 11.3 Trend level enabled the chid to improve
9.1 9.1
deficient skills while experiencing
7. Distance Vision,
Divergence Break ~ repeated successes which led to a
Experimental 4.8 7.6 salutary effect on motivation.
Control 6.9 7.9
There were sixteen boys and two
8. Distance Vision,
girls in each of the experimental
Recovery (~
and control groups. The age and
2.6 3.9
3.6 4.1 I.Q. of the two groups are shown in
9. Near Point of Table II. Training occurred In
Convergence (inches) groups of three with individual­
(Low Score Better)
Experimental 3.7 1.7 2. p >05 (Trend) ized programming rela ted to each
Control .8 2.4 child's specific needs and develop­
10. Near Vision: ment level.
Phoria (Deviation
from Expected Norm)b
(Low Score Better) Results
Experimental 7.7 5.6 3.2 P >.05 Trend
Control 5.0 6.4 The children participated in
11. Distance Vision: their respective experimental and
Phoria (Deviation
from Expected Norm)b control groups during two aca­
(Low Score Better) demic years which included nine
Experimental 3.5 2.6
Control 1.7 1.9 months of actual training. That is,
the training program included
"Significant at .05 Level
""Significant at .01 Level
nine months of training over a two
year period of time; January, Feb-
Volume 51, Number 5, 5/80 491
Sub-test and The Individual Word
TABLE IV Recognition Test (Daniels). In­
Covariance Analysis of Reading Achievement Test Scores of
spection of Table IV shows that
Experimental and Control Groups
the children in the experimental
Mean Mean F group made almost twice the gains
Pre Test Post Test Ratio P of the children in the control group
Standard Achievement Test in areas of reading development.
Paragraph Meaning
(Grade Equivalent Score)
Experimental 2.18 3.76 7.7* * p<.01
Control 1.93 2.74 Discussion and conclusions
Stanford Achievement Test
Word Reading The results of this investigation
(Grade Equivalent Score)
Experimental 2.31 3.89 4.7"
confirm the efficacy of a program
.05>p >,01
Control 2.14 3.02 of perceptual and vision therapy in
Stanford Achievement Test the improvement of reading skills
(Grade Equivalent Score)
with a learning disabled popula­
Experimental 2.25 3.21 2.1 p>.05 Trend tion. By improving their binocular
Control 2.24 2.89 coordination and sensory process­
Informal Reading Inventory (Temple University) ing skills, learning disa bled
Basic Instructional Level children who had formerly expe­
Mean Mean
F rienced deficits in these areas were
Pre Test Post Test
Ratio P
able to respond more effectively to
Experimental 3.1 5.6 4.3* .05>p >.01
Control 3.3 4.6 reading instruction. The results
showed statistically significant
Individual Word Recognition Test
(Daniels) gains for the experimental group
(Total Flash Score) compared to the control group in
Experimental 288.7 512.9 2.1 p >.05 Trend
Control 243.6 427.9 all areas of reading performance
Reading Level tested with the exception of spell­
Experimental 6.4 10.4 4.8* .05>p >.01 ing (where a trend was noted) .
Control 6.3 9.0
Hence "carryover" to academic
*Significant at .05 Level skills is favorably demonstrated.
* *Significant at .01 Level
Of particular interest is the lack of
significant change in divergence
findings at the reading distance,
ruary, March during the first year measures of reading achievement although a trend was noted. One
and October through May during were found to be statistically sig­ may postulate that either the vis­
the second year. The results can be nificant at the .05 level or better: ual training techniques were at
seen in Tables III and IV.C Statis­ 1. Word Reading sub-test of the fault, or that this identified experi­
tically significant results at the Stanford Achievement Tests mental group was particularly re­
.05 level or better were obtained 2. Paragraph Meaning sub-test sistant to improvement, or that
for the following visual and per­ of the Stanford Achievement divergence findings are not re­
ceptual findings: Tests lated to academic gains. Expe­
1. convergence break at dis­ 3. Basic instructional level of rience suggests that the last al­
tance the Informal Reading Inven­ ternative is the least probable.
2. convergence recovery at dis­ tory (Temple University) The study confirms the hy­
tance 4. Instructional reading level as pothesis that appropriate opto­
3. convergence break at near determined by the appropri­ metric visual and perceptual
4. convergence recovery at near ate reading specialist therapy enables learning disabled
5. divided form board (Getman) That is, the post-test results of children to respond more effec­
6. the Perceptual Constancy the experimental group were sig­ tively to reading instruction and
sub-test of the Frostig nificantly better than the control school learning. AOA
Trends were noted for near point group, the difference in initial test
Submitted for publication in the
or convergence and near phoria. scores having been treated as co­ J AOA in October 1978
When the experimental and con­ variant factors.
trol groups were compared, im­ Trends were noted in the Stan­
provement in the following ford Achievement Test Spelling
492 Journal of the American Optometric Association
ACKNOWLEDGEMENTS 5. Seiderman AS: Visual function assess· gram for the Development of Visual
ment. in Adamson WC. Adamson KK Perception. Chicago. Follett Publish­
The authors wish to acknowledge the con­ (eds): A Handbook for Specific Learn­ ing, 1964.
tributions of Jacob Rosner for his assis­ ing Disabilities. New York. Gardner 21. Curry G: Winter Haven's Perceptual
tance during the second year of this study, Press. 1979. pp 145-185. Testing and Training Handbook. Win­
and for the collaboration of Bernard 6. Sherman A: Relating vision disorders ter Haven, Fla .• Winter Haven Lions
Cooper. Ph.D. and Mary Jane Kirkpatrick, to learning disability.J Am Optom As­ Research Foundation, 1969.
M.A. in this project. soc 44 (2):140-141. Feb 1973. 22. Ayres AJ: Sensory Integration and
The authors would like to thank Harold 7. Birch H: Dyslexia and the maturation Learning Disorders. Los Angeles.
A. Solan, O.D., M.A. for his critical review, of visual function, in Money J led): Western Psychological Services, 1972.
insights, and suggestions in the prepara­ Reading Disability. Baltimore, Johns 23. Birch HG. Belmont L: Auditory-visual
tion of this manuscript. Hopkins Press. 1962. pp 161-169. integration, intelligence, and "reading
This project was funded through Penn­ 8. Coleman HM: Visual perception and ability in school children. Percept Mot
sylvania PL 89·313. reading dysfunction. J Learn Disab 1 Skills 20: 295-305, Feb 1965.
The opinions expressed are those of the (2): 116-123, Feb 1968. 24. Birch H. Lefford A: Visual differentia­
authors and do not necessarilv reflect those 9. Coleman HM: West Warwick visual tion. intersensory integration, and vol­
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Assoc 43 (5): 532-543. May 1972. Child Dev 32 (2) serial 110, 1967.
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administrative and professional staff Child 38 (8): 613-621. Apr 1972. 26. Gesell A. Ilg F, Bullis G: Vision, Its De­
and faculty was that the Hawthorne ef­ 11. Kane M: Physiological theory of learn­ uelopment in Infant and Child. New
fect was adequately controlled. Ac­ ing: The role of developmental vision in York, Paul B Hoeber, 1949.
tually, a reverse Hawthorne effect may academic achievement and learning 27. Skeffington AM: Clinical optometry.
have been active, i.e. many of the disabilities. in Wold RM (ed): Visual Optom Ext Prog postgraduate course,
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Clinical Refraction 3l have been used as in children with reading disability. Bull 29. Getman G, Bullis G: Developmental
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===0> The purpose is to disabled and/or neurologically children in the control group in
test the hypotehesis that visual impaired. Prerequisite for en­ areas of reading development.
and perceptual training will re­ trance is potential for average
sult in improved reading skills or better intellectual function­
in learning disabled children ing. ===0> The study confirms
the hypothesis that appropriate
who demonstrate visual and
optometric visual and percep­
perceptual deficits.
===0> Inspection of Table tual therapy enables learning
IV shows that the children in disabled children to respond
===0> The population of the experimental group made more effectively to reading in­
the school is essentially reading almost twice the gains of the struction and school learning.

Volume 51, Number 5, 5180 493