Dr. Harold Solan — Visual Attention and Reading

Dr. Harold Solan received the Skeffington Award in 1990.  At that point, his body of work was quite impressive.  But he was only getting started!  He continued his research, writing and scholarship for many more years.  In many ways, his post-Skeffington Award work was even more influential.  It is very difficult to choose one “topic” or article to highlight his contributions to developmental optometry.  I suppose I shall have to write more about Dr. Solan’s work. 

Dr. Harold Solan

Attention is often defined as the ability to focus on relevant stimuli as well as a decrease in responsiveness to irrelevant information.  In reading, visual attention increases the ability to read efficiently across a line of text.  Readers must learn to use the oculo-motor system to move their eyes accurately.  First they must focus on the first word on the line, then they must shift their attention to the right as they prepare to move their eyes to the next fixation point, then they must sustain their attention in order to allow for processing of the text.  These three principal elements of attention–focus, shift and sustain—are the link between perception and cognition.  Perception makes the visual information available but not necessarily recognizable.  Cognitive processes allow the reader to use the visual information in order to gain meaning.  In other words, reading comprehension is dependent upon visual attention as expressed by accurate oculo-motor control.  Therefore, vision therapy that is directed at improving focus on relevant stimuli, shifting attentional focus within a complex visual environment, and sustaining attention for an appreciable interval might be expected to improve reading comprehension.

Dr. Solan and colleagues investigated this relationship in a group of 6^th graders with moderate reading disabilities.  These students attended public school in New York City.  On a standardized reading test, their reading comprehension scores averaged 2.2 years below their grade level.  The students’ attention skills were assessed using a standardized testing battery.  Then they received 12 one-hour sessions of vision therapy.  The therapy consisted of specific procedures which were aimed at improving or enhancing focusing, shifting and sustaining visual attention during oculo-motor (eye movement) activities.  After completing the 12 hour therapy program, the students were retested with both the standardized reading and attention tests.  Their scores improved significantly on both measures.  After 12 hours of vision therapy over 5 months, their average reading scores jumped an entire grade level, from the 4^th to 5^th grade level.  This is in sharp contrast to the first 5 years of schooling, when their reading scores improved from a 1^st grade to a 4^th grade level.

Dr. Solan’s research supports the notion “that a link exists between visual attention, oculomotor readiness, and reading comprehension…”  He acknowledged that uncertainties still exist.  For example, the therapy also incorporated memory, speed of processing and executive functions.  How does the engagement of this triad influence cognitive performance and reading comprehension?  Dr. Solan’s research always answered BIG questions but at the same time, left more questions to consider.  That way, he never ran out of ideas for his next research project.  Now, he has left these unanswered questions for others to consider.

Read more about eye movements here.

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Optometry & Vision Development: Call for Papers

To All Potential Authors:

Optometry & Vision Development, the official journal of the College of Optometrists in Vision Development, seeks high quality papers of clinical significance in all areas related to vision and vision care. Our open access, no cost to authors, peer reviewed journal is reaching out to all potential authors including  our international colleagues.

This journal is interested in any articles involving vision and vision development. This includes articles on 3D Vision Syndrome (the problems/symptoms associated with watching 3D movies, television, video-games), binocular vision dysfunction, treatment modalities, and related areas.

In previous issues of the journal we’ve had well known researchers and clinicians publish in OVD. An example of these articles include:

Instability of Fixation in Dyslexia: Development – Deficits – Training
by Burkhart Fischer, Dipl Phys; Klaus Hartnegg, Dipl Phys

Saccade Control in Dyslexia: Development, Deficits, Training and Transfer to Reading
by Burkhart Fischer, Dipl Phys; Klaus Hartnegg, Dipl Phys

Predicting Accommodative Insufficiency and Academic Problems using the Conlon Visual Discomfort Survey
by Chris Chase, PhD; Chinatsu Tosha, PhD; Eric Borsting, OD, MS, FAAO,FCOVD; William H. Ridder III, OD, PhD, FAAO
Improving Magnocellular Function in the Dorsal Stream Remediates Reading Deficits
by Teri Lawton, PhD

Validity Reassessment of Developmental Eye Movement (DEM) Test in the Italian Population
by Alessio Facchin, MA; Silvio Maffioletti, FAILAC; Tony Carnevali, OD, FAAO

The Blink Frequency Relationship between Reading from a Computer Screen and Reading from a Printed Page
by Kenneth C. Koslowe, OD, MS, FCOVD-A; Hadas Waissman, B.Opt; Marta Biner-Kaplan, B.Opt

Our guidelines for authors can be found here: http://www.covd.org/Home/OVDJournal/InstructionstoAuthors/tabid/171/Default.aspx

If you would like to submit one or more articles email then to me. If you have any quesitons, please contact me soonest at:

Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Editor, Optometry & Vision Development
dmaino@ico.edu

Thank you…

Dominick

Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Distinguished Practitioner, National Academies of Practice
Leonardo da Vinci Award of Excellence in Medicine, Recipient
Professor of Pediatrics/Binocular Vision
Illinois Eye Institute/Illinois College of Optometry

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Dr. Harold Solan

Developmental optometry has lost a giant.  Dr. Harold Solan passed away yesterday.  He was an extraordinary man in so many ways.  As a developmental optometrist, he set the bar very high, as a clinician, researcher, scholar, teacher, and mentor.  Dr. Solan made countless presentations at COVD’s annual meetings.  He won both the Getman Award and the Skeffington Award.  Every developmental optometrist in practice brings something that they learned from Dr. Solan to every patient encounter, whether or not they realize this.  He has touched the lives and careers of developmental optometrists all over the world, and through them, he has had a positive impact on more patients than can be counted.

I will write more about Dr. Solan’s work and writings sometime soon.  In the meantime, please leave a comment, tell us how Dr. Solan touched your life as a developmental optometrist.

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Research on Convergence Insufficiency (CI): Insurance Companies Disregard for Patient Welfare

 It is important that we know and understand the research concerning CI for our patients’ benefit. This research clearly shows that in-office optometric vision therapy is the most efficacious treatment for convergence insufficiency. Major insurance companies are denying in-office vision therapy unless you conduct out of office/home therapy first. This rationale for the patient having 12 out of office/home based therapy sessions before in office therapy is inappropriate, unsubstantiated by research and potentially harmful to our patient’s well being and quality of life.They are recommending the least effective, most time consuming, and costly methodology of treatment. These insurance companies should reconsider this ill advised policy immediately.

If you are a patient reading this, go to your employer and ask them to support vision therapy by telling your insurance company to do no harm, to waste no money, and to support treatments shown to be effective.

Research on Convergence Insufficiency can be found by clicking here. DM

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Behavioral Vision 101

Today’s guest blogger is Dr. Steven Gallop.  Dr. Gallop practices in Broomall PA.  He is a prolific writer, with many published articles and several books!  Visit his website to learn more about developmental vision.  This article also appears here.

This is a photograph of a familiar object…… what is it?

Most people think of 20/20 when they hear the word vision.  Many eye doctors spend most of their time helping people see the 20/20 line on the eye chart.  Once it is determined that the eyes are healthy many eye doctors are interested in little else.  You may not realize this but 20/20 is nothing more than average eyesight.  It is the ability to see a certain size letter at a certain distance.  Some people can see better than 20/20, some cannot see 20/20 even with what are referred to as “corrective lenses.”

The lenses we know as corrective are really not corrective at all.  They are actually compensating lenses.  They do little more than mask an outward symptom – the inability to see clearly at some distance.  These compensating lenses often ignore any underlying reasons for the symptom they cover up.

There is much more to vision than just seeing clearly.  That is why I avoid the word vision and use visual process in most of my communications with people.  The visual process is a dynamic process that occurs in the brain, not in the eye.  The retina (the inner back surface of the eye, which processes light) is in fact part of the brain.  The visual process develops, and continues to do so throughout our lives.  The primary purpose of the visual process is to direct action.  The visual process is learned and therefore trainable at any age.  People can also experience visual difficulties at any age.  Behavioral optometrists are trained to analyze, diagnose and treat every type of functional visual problem.

So there should be much more to an eye exam that just trying to see smaller letters across the room.  Behavioral optometrists evaluate much more than that.  Behavioral optometrists evaluate the ability to smoothly and accurately track a moving target and how efficiently a person is able to shift their eyes from one target to another.  That is why what behavioral optometrists do is not an eye exam, but a visual evaluation.

Here is the issue in a nutshell. 

Vision, or something akin to it has evolved from some of the simplest creatures in the history of our planet, all the way up to what some consider the most highly evolved, most intelligent creatures in our planet’s history – dolphins, I mean human beings.  Different creatures have different types of eyes for different reasons.  Different types of eyes provide different types of advantages.  For example, flies have compound eyes to provide maximum awareness of their surroundings to avoid being swatted by creatures that have, to their way of thinking inferior, simple eyes.  However, I don’t think that, even if they were able to reach the gas pedal, their compound eyes would ever enable them to operate a motor vehicle.  Those compound eyes provide a very different visual experience from our simple eyes.  Other creatures, like lizards, have eyes on the sides of their heads to give them the ability to keep track of more of their surroundings.

Some creatures have their eyes stuck right on the front of their face, pointing straight ahead.  The greatest advantage provided by this set-up is the ability to judge space and depth with a great deal of precision.  This was initially helpful in tracking and catching moving prey.  Now it is also helpful for copying from the board, running without slamming into the door frame, hitting a baseball, shooting a basket, driving a car without hitting other cars, parallel parking and many other things we do every day.

It is much easier to gauge speed, direction of movement and distances with the type of visual equipment we humans have.  The visual process provides not only information, but is the guidance system we use to direct all of our actions.

Nowhere in creation have eyes evolved for the task of reading, nor for staring endlessly at a computer screen, iPad or smart phone.  There are two important factors that make these tasks stressful for a visual system that is designed as ours is.  First, these activities are two-dimensional.  Second, they involve very little movement other than a few fingers or thumbs flitting around a keyboard, or lips moving to read a few difficult passages.  For a visual system designed for action and three-dimensional seeing, the constant, prolonged encounter with a two-dimensional surface is like walking into a brick wall.  We are all happier to be able to walk around in any direction we would like.  Walking straight into a solid wall for hours on end, day after day would cause not only extreme boredom, but severe frustration, stress and fatigue.  This is similar to what is happening to our visual systems when we subject them to prolonged exposure to two-dimensional tasks.

Prolonged visual tasks without movement present a similarly undesirable situation.  It turns out our eyes are in constant motion.  If not for the fact of these constant microscopic eye movements, we would not see.  Period.  Experiments have been done that simulated a situation where the eyes were perfectly still.  They showed that if an image was projected to the exact same spot on the back of the eye it would fade from conscious awareness in a matter of seconds.  This constant wiggling of the eyes keeps this from happening.  The point here is that, from the bottom up, from input to output, the visual process is intimately involved with movement.  However, we are more concerned here with movement of the body.  Our visual systems are best suited to activities that involve our moving around in some way.

I hope you can see that the visual process is so much more than just sitting in a chair reading letters on a wall.  It is complex, elegant and pervasive in human behavior.  Don’t settle for an eye exam; have your visual process evaluated as soon as possible.  All children should receive a thorough visual evaluation before entering school because most visual problems go undetected without the input from a behavioral optometrist.

Even if you have 20/20 eyesight, were you able to “see” the cow in the photograph?  Vision is more than 20/20!

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The Science and Splash are Back

So today, let’s talk science.  I recently had a conversation with a well-known pediatric neuropsychologist in my area. She is a very caring and competent practitioner by all counts.  She expressed some concerns about referring patients to me.  She said while she felt the science would validate vision therapy in the future, she did not feel that there was enough scientific evidence currently demonstrating the relationship between the vision problems we treat, such as Convergence Insufficiency, and academic performance.  She felt that the science certainly shows that functional vision problems exist and that vision therapy would help alleviate discomfort associated with these vision problems, but that the science did not yet show that treating these vision problems would impact school performance.

I was happy to report to her that the future is here.  In fact, I would like to dedicate the next several “Science” posts to the great research being done showing the correlation between vision and academic performance.

The article I would like to focus on today was written by the same authors of the Convergence Insufficiency Treatment Trial.  In this original research article sponsored by the National Institute of Health these scientists validated what so many of us have known for a long time.  Convergence Insufficiency and many other functional vision problems not only exist but cause a host of problems such as double vision, headaches, eye fatigue, slow reading and poor reading comprehension.   The treatment trial found that in-office Optometric vision therapy is by far the best treatment to alleviate these symptoms.  After completing this research, I am sure they must have encountered some of the same skepticism elicited by my colleague.

Their latest research article found in the journal of Optometry and Vision Science demonstrated that children with symptomatic Convergence Insufficiency showed significant improvements in reading comprehension after being treated with vision therapy. To see  the article click here.  Sounds like an academic performance link to me.   However, their research is by no means the only research out there.  I am happy to report I was able to send many other research articles as well to the practitioner in my area and have to say that she responded very favorably.  I am excited to share more of these research articles with you in the coming weeks.  Stay tuned…

For more information on vision problems that affect school performance, learning, and reading please visit the COVD website at www.covd.org.  To find a developmental optometrist near follow this link.

I hope to be blogging here more often.  I want to give a shout out to all of the COVD blog authors who put in so much time to getting the word out about how vision can impact the lives of so many.  Especially a thank you to Dr. Rochelle Mozlin whose dedication to this blog has helped the lives of many seeking to learn more about these critical and often silent vision problems.

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