August is the 20th annual observation of National Children’s Vision & Learning Month and a perfect time to shed light on the vision problems associated with concussions that impact academic performance.
Shelby Hedges’ concussion occurred during the first soccer game of the high school season. Prior to her concussion Shelby was an avid reader, but afterwards, she had trouble with reading and focusing as soon as she started trying to do her schoolwork. After about 1 month it was obvious her difficulties were not improving. A trip to her concussion specialist resulted in a referral to a developmental optometrist who helped Shelby return to her normal life as it was before the concussion.
According to Dr. Kara Heying, President of the College of Optometrists in Vision Development (COVD) , “Shelby was very fortunate to have a concussion specialist who knew where to send her. Our member Doctors often see patients after they have struggled for years with no improvement.”
Kelsey Ransom wasn’t as fortunate as Shelby. Reading was already a struggle for Kelsey and after she received her second concussion playing basketball the change in her academic performance was not as obvious as when she received her first concussion. She had been diagnosed with a Non-Verbal Learning Disorder prior to this concussion and the psychologist had told her mother that her I.Q. was “off the charts,” so her mother thought that Kelsey was just “lacking focus” and she was just experiencing normal “kid” issues when her struggles got worse.
It wasn’t until Kelsey was seen by a developmental optometrist, “that it dawned on us she had residual effects from the concussion” her mother, Lori Harris-Ransom, shared; “when Kelsey was having trouble doing homework, I would tell her, ‘Kelsey you have to focus and concentrate and put in more effort.’ – I didn’t realize she wasn’t capable of doing so.”
Kelsey was in 6th grade, reading at a 4th grade level. Lori explains, “She had been complaining for a year of visual issues, we just didn’t know they were due to VISION. We thought it was a learning issue.”
In addition, Kelsey shared that one of her teachers would actually chastise her for not paying attention because she was writing and not paying attention to what he was saying; when in fact, she was still trying to copy information from the board before he would erase it. Once she understood her difficulties were due to a vision problem , she was able to explain the situation to her teacher.
While Kelsey is only halfway through a program of optometric vision therapy , she is already seeing major improvement. Lori shares, “I am seeing dramatic differences in the last couple of months. She avoided studying and felt so defeated before. She has so much more confidence now.”
Before starting vision therapy Kelsey was trying to read To Kill a Mockingbird for school. As she was improving during her vision therapy Kelsey found it easier to understand the book. Kelsey proudly shares, “I did not have to focus on what to read and I was fully enjoying it. I read it and understood what I was reading.”
Both Kelsey and Shelby had convergence insufficiency which is an eye teaming problem (also known as an eye coordination disorder) where the eyes don’t work together in unison; often resulting in difficulty with reading. “Convergence insufficiency is very common after a concussion,” Dr. Heying explains; “It is also very common in children who struggle with reading who have not had a concussion.”
The majority of vision screenings performed in schools and pediatricians’ offices are not designed to test for eye coordination, eye tracking, or eye focusing problems. In fact vision screenings miss at least 50% of vision problems. In addition, general eye exams often do not thoroughly evaluate all the visual skills required for academic success . The diagnosis and treatment of convergence insufficiency is a specialty field within optometry performed by developmental optometrists.
A cross-sectional study was performed of adolescents (ages 11 to 17 years) from the Concussion Care for Kids: Minds Matter program at Children’s Hospital of Philadelphia with co-investigators from the Pennsylvania College of Optometry at Salus University, Michael Gallaway, OD, FCOVD, FAAO and Mitchell M. Scheiman, OD, FCOVD. Sixty-nine percent of one hundred children examined were found to have one or more vision problems.
In an interview in Infectious Diseases in Children , a Healio publication, pediatric sports medicine specialist and associate professor of clinical pediatrics, Perelman School of Medicine at the University of Pennsylvania, Christina L. Master, MD, FAAP, CAQSM, discussed the study; “All these children can see 20/20, but the problem is that their eyes don’t work well together. It’s the idea of eye teaming, focusing and tracking. If you go to a regular eye doctor for a vision assessment of visual acuity, the typical tests will not detect these problems that we found associated with concussion.”
In a recent study published in the June 2015 issue of the journal of the American Academy of Pediatrics, Academic Effects of Concussion in Children and Adolescents, it was found that those with higher severities of concussion experienced extended recovery time from symptoms that can interfere with academic performance. These post-concussion symptoms include problems with concentration, eyestrain, loss of place while reading, slower processing speed, headaches and fatigue. These symptoms are very similar to symptoms relating to binocular vision disorders.
“We have known for years that concussions cause vision problems , and these are some of the types of vision problems that developmental optometrists specialize in treating to help children get back on track with their academics after a concussion,” Dr. Heying explains; “To help parents and medical professionals in managing post-concussion children with their visual symptoms we are issuing Return to Learn: A Guide to Visual Recovery after Concussion . ”