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Wobbling a bit like a wee Olympian on a long balance beam, 7-year-old McKay Shively slowly pads barefoot down a lacquered 2-inch by 4-inch plank, her brown eyes locked on a weird white ball full of alphabet letters that's swinging from the ceiling of her optometrist's office.
"Look at the letters," urges vision therapist Elaine Rosenfeld. "Now clap your hands. Again. Keep your eyes on the ball."
McKay, a perky second-grader from Cumming, is in her fifth week of work at the Roswell offices of Dr. Sharon Berger, an optometrist and specialist in the relatively new field of vision therapy, which is aimed at detecting and fixing eye problems in children that often cause them to be misdiagnosed with attention deficit hyperactivity disorder or a myriad of other learning disabilities.
It's also somewhat controversial and currently is not endorsed by ophthalmologists or pediatricians. But Berger, one of 1,600 members nationwide of the College of Optometrists in Vision Development, said that thousands of children who're tagged with the "learning disability" label actually have correctable problems involving eye muscles or a disconnect between what the eyes see and what registers on the brain.
The COVD contends that up to one in four kids starting school has vision problems that affect his or her performance in the classroom. And most of them have 20-20 vision acuity.
What that means is they often can read the eye charts in their pediatricians' offices, but those lines of letters don't reveal flaws with eye or hand-eye coordination, lazy eye or a host of other problems such as "eye teaming," which involves depth perception.
Such conditions often cause kids' teachers or parents to think they have learning disabilities. And Dr. Leonard Press, a top official of the American Optometric Association, recommends that moms and dads, faced with such concerns, ask tough questions at parent-teacher conferences --- many of which are scheduled for this week across metro Atlanta.
"You should be familiar with the warning signs of possible vision problems," he says. "Almost one child in four has vision problems that are significant enough to affect academic performance. Children often don't know that they are not seeing as well as they should. They don't know what they don't know."
Ophthalmologists, medical doctors trained for the eye, caution that there's no "scientific evidence" that such therapy remedies such vision disorders. "We don't see proof that it's true that vision therapy works," says Dr. Donald Schwartz, an official of the American Academy of Ophthalmology in Long Beach, Calif. "Ophthalmologists need more convincing than optometrists about this whole area. We're skeptical."
So is the American Academy of Pediatrics, which recommends vision screening in pediatricians' offices rather than eye exams conducted by optometrists.
Parents seeing results, however, disagree.
McKay's problems, which her mother, Michele Shively, says have improved dramatically, involve "eye teaming," or using her eyes together, and hand-eye coordination, which affects handwriting and reading. Reading made her feel nauseated, and she would often omit small words, drop letters and skip lines without knowing it, Berger said.
Her weekly therapy sessions, Berger says, are aimed at making her eyes stronger. She wears prism or 3-D glasses to help with eye coordination. She spends time in front of a computer that flashes letters across a screen, requiring her to press arrows on a keyboard. In another exercise, she moves her arms to the left, right, up or down --- like a sailor giving takeoff instructions to a pilot on an aircraft carrier --- to show Rosenfeld as fast as possible which direction letters are pointing.
Typically, Berger says, youngsters show clear progress within 12 weeks.
But McKay's mom says her child already is showing improvement and isn't dropping as many letters as she reads.
"She didn't know anything was wrong," says Shively, 38, whose older son Blake, 14, had "double vision" that held him back until he received therapy from another optometrist, Dr. David Cook of Marietta.
Symptoms of kids with vision problems that often aren't picked up by routine eye scans in pediatric offices include red or itchy eyes, jerky eye movements, squinting, rubbing, excessive blinking, crying, headaches, temper flare-ups, head tilting and dizziness.
But vision therapists are having a hard time getting the word out, in part because the American Academy of Ophthalmology dismisses the techniques in an official policy statement. Optometrists have their own studies, however, that show that vision therapy works.
They also have testimonials from parents of children like Molly Howel, 11, of Decatur, who was placed in special education classes when she started school. Now in the fourth grade, Molly has been recommended for the gifted program, her mother, Darlene Howel, says.
Although Molly had 20-20 vision, she could only focus on one letter at a time and had vision therapy to help correct that and other eye problems, Howel said.
"If it hadn't been for vision therapy, I don't know where we'd be," Howel said. "They do so much for these kids, and seeing better also helps their self-esteem."
Maggie David of Alpharetta says her son Robbie, now 15, was diagnosed eight years ago with ADHD after a psychologist tested him and suggested Robbie take Ritalin. Instead, she sought a second opinion at Emory University, where tests showed Robbie had scotopic sensitivity syndrome, which involves how the nervous system sees and translates information. It is one of the conditions treated by optometrists who specialize in vision therapy.
"Now he's on the honor roll," says David of her son, who once had illegible handwriting. "He had 20-20 vision, but his eye muscles needed to get stronger."
One study, published recently in Optometry: The Journal of the American Optometric Association, found that 5 percent of kids had conditions such as lazy eye or crossed eyes that their parents hadn't noticed.
And Press says other studies show that at least 35 percent of children diagnosed with learning disabilities have some sort of vision problem that therapy can help. He says most children start school without ever having had anything more than a perfunctory scan by a pediatric nurse.
Only 14 percent of children have received a comprehensive eye exam before entering school, and nearly 10 million have undetected vision problems, according to the COVD. A study last December of 1,846 youngsters 6 and younger found that 70 percent had never had an eye exam. Optometrists recommend eye checks no later than age 3 and then every two years thereafter.
"Children need comprehensive eye exams before they start school and only one state, Kentucky, requires them," he says. "We're still in the Dark Ages when it comes to awareness of the need for vision therapy." ON THE WEB www.covd.org; www.pavevision.org.
Copyright 2004 The Atlanta Journal-Constitution