When children have multiple developmental delays, we often focus most on physical, speech, and occupational therapies. However, poor vision and poor use of vision can severely impact all areas of development. Children can see enormous improvements in overall development after receiving vision therapy services.
Our early intervention Occupational Therapist was the first person to mention both getting an eye exam and vision therapy for my then 14-month-old son, Lucas. What she noticed was that he wasn’t really using his eyes during tasks, and that he was relying on his sense of touch for the activities she was doing with him.
It was an awful time in my son’s life. He didn’t have a diagnosis and he was going for various tests across a number of specialists and hospitals. He cried, vomited, cried, and vomited more through every appointment. I put the vision exam off and I regret it.
After getting my son’s diagnosis of Koolen de-Vries Syndrome six months later, I received a list of additional testing that should be done based on the known presentation of the condition. A vision exam was on the list, along with a 24-hour EEG, and ultrasounds of various organs. Again, the vision exam became the thing I scheduled last.
When we finally saw the Neurophthalmologist at 22 months, we learned that Lucas is extremely farsighted, which means he could see distant objects clearly, but his vision up close would be very blurry. The exam involves the doctor looking through a series of lenses until the curvature of the eye looks correct. The child doesn’t have to say which side is clearer. My son was non-verbal and barely participated in the exam. Exams can also be done under anesthesia.
I had been so focused on the other medical needs that I wasn’t really considering how his vision might be impacting his overall development. He cruised forever before taking his first step, because he didn’t see well. He struggled with fine motor coordination from low muscle tone, but it was made so much worse because he couldn’t see the task at hand.
Lucas got his glasses and he loved them. He didn’t try to take them off. And, if you ever want strangers to stop asking about your toddler’s feeding tube or backpack, get glasses. All they will want to know is how you do an eye exam on a child under two!
Once he got his glasses and he could see, then you would think he would rely on his eyes more, right? Well, no. He needed to learn to use his visual input because he had never used it before. He had already learned ways to compensate for the vision he didn’t have.
Lucas had problems with spatial relations, which meant he wasn’t a confident walker and he lacked depth perception. It made him overly cautious as if he was trying not to fall or bump into things. Like many kids who have developmental delays, he had issues with crossing midline. Children will use the right side of the body for things on the right, and the left side for things on the left. Given that he was left dominant, he would turn his body so that he could use his left hand and look straight.
He also has issues with visual motor integration, the ability to have the hands work with the eyes. For example, he is able to see two objects on a page, but he has a hard time drawing a line between them. He would color and not look at the page at all, even when hand over hand.
Shortly after getting his glasses, Lucas was evaluated for vision therapy though his Early Intervention program. It can be challenging to find vision therapists, especially good ones. We also were also advised to see a Developmental Optometrist, who can identify activities to help integrate vision and further development. A Developmental Optometrist can be used in addition to vision therapy, and even to help guide it. My non-compliant, crying, vomiting preschooler didn’t cooperate enough for the exam. Vision therapy in our home was really the only path we could take.
Vision therapy can look a lot like other types of therapy, but the focus is on teaching children to use their vision to support other tasks. Rolling or catching a ball and using your eyes to follow it, puzzles and games where you have to scan, drawing lines from point A to point B, and look and find books all support developing visual-motor skills.
Through therapeutic play with his vision therapist, Lucas learned to scan using his full field of vision. He found his right side and was more likely to use his eyes rather than turn his head.
Vision therapy also supported other therapies. We saw improvements in his spatial relations, which helped his physical development (e.g. stairs and climbing) and his fine motor skills (e.g. working with puzzles). All of his therapies supported crossing midline and working on integrating his vision into how he uses his body.
He received vision therapy through Early Intervention and then through preschool special education services for nearly three years. Years later, we still have to do a lot of prompting for him to look at his paper during homework, especially with writing and coloring. But, now I can more confidently say that he is choosing not to attend to it fully, rather than he is unable to. He has less difficulty using his vision skills for tasks where he has more interest.
In the end, I wish that I had placed more of a priority on the vision exam and vision therapy sooner. We certainly would have seen even greater benefit in his overall development.