By: Dr. Briana Larson, OD, FCOVD, FAAO, FNORA
Executive Director and Founder of OCVT
Personal life experience and challenges with undiagnosed vision system deficiencies
Growing up, I was the child who was always pulled out of class for reading tutoring and reading intervention. I still remember some of the readers vividly (the dog and the bubble gum) that I had to read over and over and over. I could not understand why I had to read these simple “boring” books and my peers got to read exciting books of their interest that they hand-picked at the library. I will never forget that feeling, palms sweating, heart racing when the teacher called on me to read in front of the class, why did it make me so nervous? I never gravitated towards eye-hand coordination sports involving contact with balls, I pursued activities like dance and gymnastics. I was the one in the family that my parents had to stop the car for on road trips as I was feeling motion sick. I struggled with spelling and handwriting and later math concepts like algebra. Then I turned 16! I recall struggling to pass the hands-on driving test, noticing that I had to focus harder than my peers to perfect parking, turns, estimate my distance from other cars and my car from the street lines. Once I got the license, I quickly learned my friends did not want to ride with me, they had enough of me not seeing signs and bumping into curbs.
In high school, I recall being up all night reading an assignment my peers would read in an hour. They would be out having fun and I would be at my desk, falling asleep as I read or finding myself reading the same passage over and over to understand it. I would study for a test all night, only to finish at 6 am and turn around to take the test at 8 am. I suffered from multiple injuries, concussions and overall clumsiness. I would come home every day with a headache in high school which became the norm for me. Standardized testing was always a major struggle for me. I never finished the reading passages and always bubbled in my answers incorrectly to the Scantron form.
I made it to college. I was a hard worker, driven by my passion to serve and help others. I had developed a love for the health sciences and always wanted to work with children, and thus I was pursuing a biology-psychology major at the University of California, Santa Barbara on a pre-med track to become a pediatrician. As one of my side jobs in college, I was a reading tutor for young children. I quickly realized how many of the children I tutored resembled my early struggles with learning to read and reading to learn. They were often skipping small words, confusing similar looking words and sounding out words as if they were seeing them for the first time when they had just read them on the previous line or page. I reviewed sight word cards with these children and observed they would get the words accurately most of the time, but when seen as a trail of words on a page in a book, they would miss the same words consistently. They showed decreased reading speed and often reduced comprehension, except for those that could compensate with context cues. These observations fascinated me, I knew there was more to their reading challenges than phonetic awareness. I wanted answers so I could better help these children and not have them struggle the way I did and grow-up to despise reading.
My answer to help these children soon came…I attended a lecture as part of my health profession’s club at my college campus and the speaker was a Developmental Optometrist. I went into the lecture hall thinking what could I possibly learn from this doctor. I have seen optometrists and ophthalmologists over the years, I am corrected to 20/20 eyesight and have healthy eyes, some of the children I am tutoring have glasses so clearly vision is not the reason for their reading challenges. Boy was I wrong! In just a few minutes into the presentation, I learned that VISION is so much more than 20/20 eyesight. In fact, 20/20 eyesight does not do much for us in the classroom environment where 90% of classroom learning is visual and 80% of individuals with reading disabilities have difficulties with one or more visual skills. I learned that all the symptoms and functional challenges I had been dealing with my whole life were a result of possible vision deficiencies that go far beyond needing glasses.
I later went for a visual evaluation with a developmental optometrist who validated that I had an eye teaming deficiency (inability to coordinate my eye-muscles together) which you would think would be automatic, but when I went to read or copy from the board my eyes were in different positions and even the slightest misalignment can make it difficult for the brain to put each image together from the individual eyes to make sense of what you are seeing. This was causing me to overexert myself from a neuro-muscle level and therefore taking away crucial neurological energy needed to process what I was seeing, understand it, and be efficient. I was able to piece together that the eye teaming deficiency was the root cause of my poor depth perception, clumsiness, difficulties with eye-hand coordination, motion sickness, and when I was tired as an adult causing double vision, reduced eyesight in one eye, and a noticeable wandering eye. Conditions of eye teaming deficits often magnify overtime with increased visual demand, i.e. with increasing grade-level, entrance to college or a new job, all of which are often accompanied by more reading, copy work, screen time, smaller font, more words on a page, etc. I learned that I also had a deficit in eye focusing (muscle structures inside the eye not sustaining clear visual images for prolonged near work or for shifts in focus like copying from a board). This deficit was causing my daily headaches, eyes train, fatigue and lack of stamina for near work.
The eye tracking deficit (inability to coordinate the eye muscles to move together from left to right) I was diagnosed with was one of the most intriguing as I could clearly see the direct transfer of this diagnosis to what I thought was going on with some of the children I tutored. The eye tracking deficit was causing me to skip small words as my eyes could not coordinate on shorter stimuli. I was better at locking my eyes onto longer words for this reason. The eye tracking deficit was responsible for me confusing similar words and guessing at words, re-reading words and lines of text, and not recognizing words that I just read in the previous sentence. These were all things that I recall my teachers and tutors being puzzled by with me as a child, “we just read that word Briana, why do you not know it?” Finally, some answers. The eye tracking deficit was even the source of my poor comprehension. I did much better with comprehension if the passage was read orally to me, but if I had to read it myself my eyes were working so hard to focus on the word and get to the next word that I did not have any energy left over to predict what I was reading, process the material and let alone enjoy it, it was work! I was amazed to learn that this was affecting my spelling as my visual mechanics were so unstable I was not consistently seeing words written correctly, “cat” often looked like “cta” and so when I went to write words I relied on phonetics.
The developmental optometrist even administered tests on me that went far beyond 20/20 eyesight and eye health that is typical of an annual eye exam. He measured my visual spatial, visual memory, processing speed, and visual-motor abilities. Skills that further accounted for my difficulties in advanced math concepts, hand-writing, and following maps or directions.
As an adult in my twenties, I finally got the help I so desperately needed. I went through a vision therapy rehabilitation program and it changed my life. I soon dedicated myself to learning all I could about this magical field so that I could help children get identified early with visual efficiency and processing deficits to save years of struggle and despair. I became a vision therapist and then doctor of optometry, and continued on to complete a prestigious residency in vision therapy rehabilitation at the State University of New York. I then committed myself to obtaining the highest level of education and certification in this field and earned 3 fellowships that set me apart as 1 of 18 in the country. Now I am fully confident I can help not only those children suffering with visual-related learning issues but people of all ages who have visual efficiency and processing deficits. Some of the most rewarding moments in my working day take place when I am educating a parent about their child’s visual deficit and then the parent realizes that they compensate in the same ways as their child, I often hear, “that is how my eyes probably move when I read” and “could this be why I avoid reading?”
One in four individuals have a visual-learning deficit and this number increases to 80% with diagnosed reading problems and attention deficit disorders. We also know a leading cause of these deficits are genetics and thus it was no surprise to my husband and I when our child at 2 years old started vision therapy.
The brain is placid and we can remediate visual dysfunctions in adults and individuals of any age, we do it every day. I find the gains are often surprising and game changing to most adults who have compensated for their deficiencies for so long. For instance, we have many successful career driven adults complete OCVT’s vision therapy rehabilitation program who cannot believe the level of efficiency they now possess, new-found love for reading and sports, and the realization of how much they were compensating prior to their vision therapy program. I am still and will forever pursue my passion.