Willard Bleything.pdf - Optometric Extension Program Foundation

Background and Aims
• Studies support the notion that socially disadvantaged
children are especially at risk for poor health including
vision disorders
• Most of the visual problems are functional involving
binocular vision and visual processing dysfunction
• Lenses and vision therapy remain the treatment of choice
for such disorders, however ….
• Limited access to visual care is a major concern,
particularly in the socially‐at‐risk population of youth

Socially –At‐Risk Populations
• Solon and Mozlin looked at the impact of poverty on
health, vision development and school failure 1
• Zaba examined the linkage between children’s vision, and
learning problems, delinquency, illiteracy, social and
emotional problems 2
• Duckman and Festinger made an in‐depth effort to deliver
vision care to children in foster care 3
• 1 Solan H, Mozlin R. Children in poverty; impact on health, visual development, and school failure. J Optom Devel
1997;28:7‐28.
• 2 Zaba J. Social, emotional, and educational consequences of undetected children’s vision problems. J Behav
Optom 2001;12:66‐70.
• 3 Duckman R, Festinger T. Delivery of vision care in foster care placements in New York City. J Optom Vis Devel
2002;33:116‐125.

Socially –At‐Risk – Populations
Adolescents
• Inner‐city youth: visual screening resulted in 52% referral
rate 4
• Middle /high school at‐risk children: visual screening
resulted in 97 % referral rate 5
• Socially‐at‐risk 17‐19 YO: visual screening resulted in a
80% referral rate 6
• 4 Suchoff I, Mozlin R. visual screening of an adolescent inner city population. J Behav Optom 2001; 3:71‐74.
• 5 Johnson R, Nottingham D, Stratton R, et al. The vision screening of academically and behaviorally at‐risk
pupils. J Behav Optom 1996:7:39‐42.
• 6 Johnson R, Zaba J. Visual screening of at risk college students. J Behav Optom 1995; 6:63‐65.

Health Care Delivery
• Think public health vs. private office
• Most of our experience in providing ‘private practice’ care
is with a single patient being examined followed by a
customized treatment plan of lenses and vision therapy
• The socially‐at‐risk population p has limited access to the
private practice health care delivery model
• This population is often subject to health care delivery
p p j y
under a public health model

Health Care Delivery
• How effective would it be to provide optometric care in a
group setting, based upon the enhancement of basic
visual skills, utilizing a single ‘serves all’ treatment plan
• In a sense, we are posing a question similar il to the delivery
of educational instruction
• The well‐to‐do might hire a private tutor to teach their
children, the program of studies being customized for
each student
• The public schools use a standardized ‘serves all’
curriculum that is aimed at being most effective for most
students

Aim of Study
• The aim of this project was to determine the effectiveness
of a visual intervention program, involving prescription
lenses and group delivered – visual skills based‐ single
treatment planned – vision therapy on a socially‐at‐risk at population of youth

Methods • Study Population
In 1993, Congress authorized the National Guard
to conduct alternative schools for the high school
drop out population – a group now recognized as a
key public concern.
As can be expected, learning disabilities are a
common characteristic in this special population.
Of particular significance to this project is the
research that has shown visual dysfunction to be a
key risk factor in learning disabilities, especially
reading skills.

Methods • Study Population
• Socially‐at‐risk youth between 16 – 18 years of age
• All subjects were high school dropouts and performing 4 –
6 grades below expectations
• All subjects were enrolled in the Youth ChalleNGe High
School program operated by the Oregon National Guard
near Bend, Oregon during the period of January –June
2006
• Following the tenets of the Declaration of Helsinki,
informed consent was arranged through the
administrative offices of the Youth ChalleNGe High School

Methods • Screening Protocol
• All students enrolled (n=123) were screened
• A modified version of the New York State Optometric
Association (NYSOA) Vision Screening Battery was used
• Tests omitted were color perception and form perception
• Tests added were distance retinoscopy (non‐cycloplegic),
Berry Visual‐Motor‐Integration (VMI), and the College of
Optometrists in Vision Development‐ Quality of Life
Outcomes (COVD‐QOL) questionnaire

Methods • Follow‐Up Exams
• Those referred by screening (n=55)[46%] were given
comprehensive optometric examinations by a team of 6
optometrists and 6 technicians within 6 days of the initial
screening
• Prescription lenses/frames were provided as indicated
• Of the 55 examined, 32 [58%] were provided with a new
lens prescription; an additional 7 were told to wear their
current Rx
• A total of 71% were in need of a lens Rx

Methods • Vision Therapy
• 24 of those receiving a comprehensive exam were placed
into a vision therapy intervention group
• The remaining 31 were placed into a control group with
vision therapy being made available following the study
• The vision therapy group and control group were matched
on age, gender, and VMI Standard Scores
• Exclusion criteria selected out subjects with strabismus
j
and corneal scars from prior trauma

Methods • Vision Therapy
• Vision therapy consisted of two 1‐hour sessions per week
for 12 weeks
• Half of the therapy session was devoted to developing
basic visual skills such as eye movements,
accommodative/vergence ranges and flexibility, fusion
and stereopsis
• The remaining time was spent on computerized visual
perceptual procedures (PTS II)
• The control group spent an equal amount of time in a
structured study hall working on assignments from the
courses taken at the special high school

Methods • Vision Therapy
• A room was set‐aside within the school to treat 6 subjects at a
time
• Subjects rotated from one treatment station to another every
few minutes for a period of 30 minutes and kept a log of their
performance at each station
• In an adjoining i room, another 6 subjects received computerbased
visual perceptual training; this also went for 30 minutes
• At the midpoint of the 60 minute session, the two groups
switched places thus each subject received vision training in
each of the two treatment rooms for a total of 60 minutes twice
each week

Methods • Vision Therapy
Weeks 1 2 3 4 5 6 7 8 9 10 1
1
Visual Skill Areas
Ocular Motility • • • • • • • • • • •
Accommodative Facility • • • • •
Hand/Eye Coordination • • • •
Ocular Motility / Balance Board • • •
CheiroscopicTracing • •
Fusion / Vergence • • • •
Stereopsis /Vergence • • • • •
12

Methods • Vision Therapy
• Perceptual Therapy (Perceptual Therapy System II)
• Sequential Processing
• Temporal Vision Perception Processing
• Speed of Information Processing
• Rapid Automatized Naming

Results
• Pre and post results were compared for:
• Near accommodative and vergence measures
• Saccades
• COVD Quality of Life Outcomes Questionnaire
• Two‐ tailed Paired Student’s t‐Test comparisons were
made to test statistical significance
• While general improvement was noted in most areas
measured only those that achieved statistical significance
will be reported

Results • Accommodative Facility
• Accommodative facility
• Pre test: 7.83 cycles per minute (mean of VT Group)
• Post test: 11.67 cycles per minute (mean of VT Group)
• t=3.48 ; df=23; p=0.002

Results • NPC
• Near point of convergence • Break
• Pre test : 2.29 inches (mean of VT Group)
• Post test : 0.48 inches (mean of VT Group)
• t= 3.29; df= 23; p= 0.003
• Near point of convergence • Recovery
• Pre test : 4.83 inches (mean of VT Group)
• Post test : 1.76 inches (mean of VT Group)
• t= 3.71; df= 23; p= 0.001

Results • Saccades
• King‐Devick Total time
• Pre test : 55.09 seconds (mean of VT Group)
• Post test : 43.96 seconds (mean of VT Group)
• t= 3.66; df= 21; p= 0.001

Results • Quality of Life
• COVD Quality‐of‐Life Questionnaire
• Pre test symptoms score: 34.8 (mean of VT Group)
• Post test symptoms score; 20.8 (mean of VT Group)
• t= 4.37; df= 22; p= 0.0001
• For a more complete discussion see:
• Bleything WB, Landis SL. Effectiveness of the College of Optometrists in Vision Development –QOL
Questionnaire in a socially at risk population of youth. Optom Vis Dev 2008;39(1)33‐41

Conclusions
• While a group delivered – visual skills based – single
treatment plan delivery system has obvious limitations
measured against individualized therapy, such an
approach can have positive results in building visual skills
when the access to care limits delivery mode options.

Pacific University
Project Site
You are here

Mount Hood

Near base of Cascade Mountains

Former US Army Communications
Center

Vision Screening Station

Vision Screening Station

Vision Screening Station

Vision Screening Station

Therapy Room

Therapy Room

Hand – Eye Coordination

Eye Pursuits with Yoked Prism

Eye Fixations

Fusion with Accomm‐Vergence

Optometry Students Included in
Project

Core Team Members

Acknowledgements
• This project was funded, in part, by the College of
Optometrists in Vision Development Research Fund,
and the Kikuchi Research Fund at Pacific University. A
beginning pilot project received funding from the
Optometric Extension Program Foundation.
• Appreciation is extended to volunteers from the
Children’s Vision Foundation, the staff at the Youth
ChalleNGe High School, the general optometric
community, and especially to the staff at Integrated
Eye Care for use of facilities.
• A special note of appreciation for the work of Sandra
Landis, OD who supervised much of the on‐site
therapy.