By Kristen Spina | Reprinted from 20/20 Magazine, July 2009
By the time my son entered kindergarten, it was clear to me that scoring 20/20 on the eye chart and being given a clean bill of eye health by a renowned and much recommended pediatric ophthalmologist was not going to be the last word on his vision.
There were still too many unanswered questions. Questions like: Why was he always tired? Why did his eyes hurt? Why could he see the tiniest speck of a jet plane 35,000 feet above the earth, but not walk down a flight of stairs without becoming paralyzed with fear?
There were other signs as well, the constant rubbing of his eyes, the way he’d zone out in front of the TV, not really watching or seeing what was on the screen. And there was the whole issue of personal space, his lack of orientation to where he was in relation to other objects and people in the room.
While I was told that his vision was perfect, the truth was, my son’s visual system wasn’t working properly, or at least not in a productive or efficient way.
Skip ahead to May 15th, 2009. My son, now seven-and-a-half-years old, is standing at his vision therapy graduation ceremony, a proud and knowing grin on his face as his therapists congratulate him for all his hard work over the last six months.
This place, this happily ever after, is the place I was not sure we’d ever find ourselves. It took nearly three years and a long and winding road to bring us, finally, into the capable hands of Dr. Michele Bessler, a Long Island, N.Y.-based developmental optometrist, and her team. We learned a lot along the way. Educating ourselves, sometimes moving forward on faith alone—despite the fact that many of the well-trained professionals we crossed paths with over the years often dismissed vision therapy as a waste of time and money.
“Snake oil,” a school administrator told me once. “These people take advantage of parents. I wouldn’t bother if I were you.”
“What exactly is a developmental optometrist?” our pediatrician asked. “Can someone please explain it to me?”
Vision therapy is not a new discipline. Some sources indicate the practice has been around, in one form or another, for centuries. A type of physical therapy for the eyes and brain, vision therapy is a non-surgical intervention for many common visual problems—from lazy eye and double vision to convergence insufficiency and crossed eyes. The treatment protocol is designed to improve and correct binocular, oculomotor, visual processing and perceptual disorders.
“This is such a vital part of optometry,” says Dr. Bessler. “And yet, society still believes that 20/20 means perfect vision. Not everyone realizes that you can have 20/20 vision, but still have visual problems in other areas.”
And when it comes to kids, these problems can have a tremendous impact on academics and self-esteem.
Though the symptoms are often misinterpreted by school officials, doctors and parents, vision problems can and do interfere with learning. “In kindergarten and first grade, kids often compensate. But by third grade, it becomes more challenging,” says Dr. Bessler. “By then, the work is harder. Kids are more challenged by reading and writing. Their self-esteem and motivation are in jeopardy if they can’t keep up with their class work. We can treat kids at any age, but if it’s caught early enough, it prevents a lot of frustration and we can turn it around more quickly.”
Though I knew my son had issues related to his vision, it wasn’t until he was starting second grade that we finally made the commitment to move forward under Dr. Bessler’s care. In spite of all the knowledge I had and research I had done, I have to admit I was still skeptical.
I didn’t think he’d do the home exercises. I was wary of committing two afternoons a week to in-office treatment. It was hugely expensive and not covered by our insurance. And I didn’t fully trust Dr. Bessler’s claims that he’d show significant improvement in four to six months.
It wasn’t that I didn’t trust her, more that I didn’t trust us. The success of any program lies not so much with the doctor or therapist, but with the participants.
Despite my skepticism, we had to try. My son was struggling. He couldn’t read. He couldn’t copy homework assignments off the blackboard. He was tired all the time. He hated school.
We had to take a chance.
“When I was an undergrad, I knew I wanted to be involved in healthcare, but I wasn’t sure exactly how,” says Dr. Bessler. “At Brooklyn College I became involved with the Infant Study Center, learning how the visual system develops from birth to six months. We developed early detection techniques for infants and I worked with a lot of vision scientists. I loved it.”
Leveraging her strength in math and her love of optometry and kids, Dr. Bessler moved into the field of developmental optometry, eventually joining and taking over the New Hyde Park, N.Y.-based practice of one of her professors. Seven years ago, the office moved to Westbury, N.Y.
“We have four women doctors here, all of us working part-time, juggling families and our careers,” says Dr. Bessler. There are also five vision therapists and three office administrators on staff. The practice is referral-based. “We get some referrals from pediatricians, occupational therapists, ophthalmologists and optometrists.” And when the referral comes from another vision professional, Dr. Bessler has a system in place to ensure that patient is referred back to his/her original doctor once therapy has been completed.
“Awareness is increasing, but there just aren’t that many of us out there,” she says. Some estimates, in fact, put the total number of developmental optometrists somewhere in the area of 3,000 to 5,000 nationwide.
An extension of the fine motor system, vision is controlled by some of the finest muscles in the body. Sometimes, those muscles don’t develop the way they should and that can lead to problems as a child matures. “It’s developmental,” says Dr. Bessler. “Not necessarily something you notice as it changes and grows. Infants put everything in their mouth, that’s how they learn. But as we get older, we learn by seeing and looking. Vision therapy teaches kids how to access their eyes, how to see at an appropriate level.”
Dr. Bessler spends a great deal of time working within the local communities, speaking at schools—to administrators, teachers, support staff and parents—to raise awareness of how visual problems can impact education. “There is still a lack of awareness of the research and concept of vision as a whole, so it’s important for us to help others recognize the early warning signs.”
I remember asking Dr. Bessler once what would happen when we stopped doing the exercises. Is it like going to the gym? Do you have to keep up the work to maintain the benefits?
I was relieved to hear that in most cases, it’s more like riding a bike. Once you know how to do it properly, you really never forget.
I know my son better than anyone and still I was surprised by his commitment to the program and the significant progress he made. In the end, it’s really all about the therapists—their ability to motivate and inspire. One of the last exercises he was given was designed to improve his visual memory, a skill that requires a great deal of concentration and focus. As his therapist explained to me what he needed to do at home, I asked, “Yes, but can he do this?” And she, misunderstanding, said, “Sure he can.”
What I meant was, had she ever seen him do it, was he completing the exercise in therapy or was it something we needed to work our way up to at home.
“Oh no,” she said, “He really CAN do it. You’ll see.”
She was right. And then he turned the table on me. “You try it, mom. You look at the picture and I’ll ask you the questions.”
Guess what? I couldn’t do it.
One Mom’s Story
“We want this to be a loving and supportive environment. We are very responsive to the needs of individual kids. These kids have to work hard because their eyes aren’t functioning well,” says Dr. Bessler. “The art for us is to know how to apply the therapy, to know the things they can achieve and then gradually ramp it up. We have to lead them to success.”
Approximately 80 percent of the practice is focused on treating learning-related vision disorders in kids between the ages of four and 18. But Dr. Bessler and her team also work with adults, including trauma patients and people who have had strokes or neurological injuries.
v“Sometimes we will hear doctors say they are uncertain whether or not to refer a patient to us, but typically they are glad they did,” she says. “And parents? More often than not, I am asked, ‘why didn’t anyone tell us about this sooner?’”
The walls of Dr. Bessler’s waiting room are papered with testimonials and Polaroids of program graduates. It’s a comfortable space, a place where parents strike up conversations with each other as they wait for their kids.
“I feel lucky,” she says.
Luck? Maybe. But hard work and dedication too.