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Seeing Through New Eyes: Changing the Lives of Children with Autism, Asperger Syndrome and Other Developmental Disabilities Through Vision Therapy
Book Notes ophthalmologists. All too often, books in the public domain emphasize what optometrists are notdfor example, optometrists are not medical doctorsdinferring a higher level of knowledge or skill on the part of ophthalmologists in all matters of the eye. Sue boldly states that ophthalmologists are not skilled in vision therapy, acknowledging eye surgeons for their areas of expertise while guiding readers toward optometrists for their clinical expertise in affairs of the visual brain. The author is married to Dan Barry, a retired astronaut, and the interplay between her expanding visual awareness and Dan’s perceptions of her experiences are as delightful as they are insightful. The sixth chapter celebrates Sue’s emerging stereopsis and the palpable space she discovers between herself and objects and between objects themselves. The chapter concludes with Sue revealing how Fred Brock’s writings about stereopsis captivated her and why he had such uncanny understanding of strabismus. Chapter 7 elaborates emergent properties of binocular fusion and the qualitative features of acquired stereopsis. This is the most liberally illustrated chapter in the book, and the photographs and drawings complement Sue’s points beautifully. The pooled success stories of patients interviewed by the author spill into chapter 8, framed nicely in the perennial debate of nature versus nurture. It is in this chapter that the reader is introduced to the Nobel Prize-winning work of David Hubel and Torsten Wiesel and how their ideas were misappropriated for claims of critical periods of binocular vision development. The book’s back jacket contains a tribute from Dr. Hubel to Sue for her clarity in illuminating these topics. The concluding chapter of the book reveals how the misnomer of critical periods has handcuffed doctors’ thinking and shackled patients with strabismus into resignation about their visual compromises and struggles. Blending science with personal experience, Sue stakes her claim that stereopsis is a quale every bit as significant as
547 motion detection, color vision, and other properties of vision considered to be indispensable. She convincingly demonstrates why normal binocular vision is not just icing on the cake, but an essential ingredient. It would be fair to say that 6 years ago, when a neurobiologist from Mount Holyoke College walked into Dr. Theresa Ruggiero’s office on a referral from her primary care optometrist, Dr. Steven Markow, no one envisioned Fixing My Gaze as the outcome of their serendipitous meeting. In hindsight, it seems less surprising. This book is a marvelous ode to what can be accomplished when doctor and patient encourage one another to aim higher and further. Subtitled A Scientist’s Journey into Seeing in Three Dimensions, it is so much more. As Nigel Daw, Professor Emeritus of Ophthalmology and Neuroscience at Yale University, wrote on the book’s inside back cover, ‘‘It is not yet clear what percentage of patients may be like Barry, but Fixing My Gaze will encourage eye-care practitioners to go ahead and find out, with definite benefits to their patients. Moreover, the book is fascinating reading.’’ Leonard J. Press, O.D. doi:10.1016/j.optm.2009.07.007
Seeing Through New Eyes: Changing the Lives of Children with Autism, Asperger Syndrome and Other Developmental Disabilities Through Vision Therapy Kaplan M. Philadelphia: Jessica Kingsley Publishers, 2006. Soft cover, 208 pages, $19.95. Researchers estimate that now 1 in 150 children has a pervasive developmental disorder, up from 1 in 10,000 a generation ago. Many autistic behaviors are visual: poor eye contact, staring at lights or spinning objects, side viewing, or flicking fingers in front of the eyes. No wonder parents are seeking optometric opinions with increasing frequency. Reading Mel Kaplan’s book is a good start to learning about these fascinating patients and how to help them. A pioneer, with decades of experience in the field of autism, Kaplan is a veteran at using lenses and yoked prisms and creating vision therapy activities for this population. The book is divided into 3 parts. In Part 1, Kaplan describes the relationship between mild visual issues and problems such as reading and coordination problems; moderate visual processing problems and poor depth perception, which can cause anxiety and other emotional dysfunction; and the severe visual disorganization seen in patients with autism and related disorders. The more severe the visual problems, the more ‘‘autistic’’ a child is. Those with mild visual dysfunction often are classified as having attention deficits or learning disabilities, whereas those with moderate issues may be labeled PDD (for pervasive developmental disorder) or Asperger syndrome. Those with full-blown autism usually show severe visual disorganization. In Part 2, Kaplan describes both formal and informal testing. This section includes very helpful advice on history-taking and dealing with some
548 of the sensory issues, such as tactile defensiveness, seen in patients with autism. Knowing a child’s history helps determine appropriate treatments, not just in the area of vision but also possible complementary interventions. Kaplan appreciates the role of adjunct professionals, such as doctors providing biomedical treatments and therapists who can normalize function in other sensory modalities, and encourages collaboration with these colleagues as part of a comprehensive treatment program. Because many of the patients cannot comply with test standardization, Kaplan recommends many performance-based activities. He has combined several of these to form the Kaplan Nonverbal Battery, in which tasks are arranged hierarchically, allowing the doctor to observe how patients deal with increasing demands on their visual systems. For higher-functioning patients, he adds classic assessments, such as the Gesell, Van Orden Star, and the Keystone 21-point battery. What makes Kaplan’s recommendations for testing unique are his use of prism lenses during the diagnostic process. His intuition about the ‘‘right’’ lens to elicit appropriate behaviors is uncanny. The opportunity to learn from his wisdom is one of the most valuable parts of the book. Part 3 is the essence of this publication. It has the potential to be life changing for optometrists considering adding vision therapy (VT) to their
Book Notes practices. Those who already do VT will hone their skills by adding some of Kaplan’s activities that combine his holistic understanding of the visual system with Tai Chi–type movements, reflex integration, lazy eights, and breathing exercises. Activities are divided into sections for improving spatial organizational issues, problems with orientation, and treating strabismus. Throughout the book Kaplan provides many dramatic case studies from his practice, demonstrating how to interpret findings and design a visual management program to meet each patient’s unique needs. His examples of how prism lenses resulted in significant changes for those with convergence insufficiency, accommodation deficits, and strabismus are compelling. His goal is always to maximize each patient’s performance by looking at the organism as a whole, not just at eyeballs. Some may recall Kaplan’s seminal work with Rickie, the daughter of psychiatrist Frederic Flach who was diagnosed with childhood schizophrenia (a predecessor to the autism diagnosis) at age 13. After years of failing to respond to medications, psychotherapy, and even electroshock therapy, Kaplan determined that Rickie’s visual system had broken down to the point where she was legally blind. Although skeptical of vision therapy at first, Dr. Flach quickly saw its efficacy, as he watched his daughter turn around. The 2 unlikely partners later collaborated
on research that revealed that two thirds of the psychiatric population has visual dysfunction. More recently, Kaplan has been working with Stephen Edelson, Ph.D., the director of the Autism Research Institute (ARI) in San Diego, to evaluate the role of visual issues in this generation of children with autism. Dr. Edelson’s foreword to the book describes some of the behavioral changes he has witnessed, including immediate normalizing from toe walking to flat-foot walking, improved eye-hand coordination and posture, and a reduction of inattentive and hyperactive behavior. Even though Seeing Through New Eyes is written for the public, optometrists at all levels can benefit from reading it. The glossary in the back is particularly valuable for educating the public about how optometry views vision as different from eyesight, and how visual intervention can help all aspects of functioning. For young ODs still searching for a niche in their chosen field, this book gives them a historical overview of the growing field of vision therapy and opens an exciting door to a growing population of patients whose lives can be improved through optometry. After reading Seeing Through New Eyes, most will agree with Kaplan’s statement that ‘‘the fastest way to change behavior is through a lens.’’ Patricia S. Lemer, M.Ed. doi:10.1016/j.optm.2009.07.008
547 motion detection, color vision, and other properties of vision considered to be indispensable. She convincingly demonstrates why normal binocular vision is not just icing on the cake, but an essential ingredient. It would be fair to say that 6 years ago, when a neurobiologist from Mount Holyoke College walked into Dr. Theresa Ruggiero’s office on a referral from her primary care optometrist, Dr. Steven Markow, no one envisioned Fixing My Gaze as the outcome of their serendipitous meeting. In hindsight, it seems less surprising. This book is a marvelous ode to what can be accomplished when doctor and patient encourage one another to aim higher and further. Subtitled A Scientist’s Journey into Seeing in Three Dimensions, it is so much more. As Nigel Daw, Professor Emeritus of Ophthalmology and Neuroscience at Yale University, wrote on the book’s inside back cover, ‘‘It is not yet clear what percentage of patients may be like Barry, but Fixing My Gaze will encourage eye-care practitioners to go ahead and find out, with definite benefits to their patients. Moreover, the book is fascinating reading.’’ Leonard J. Press, O.D. doi:10.1016/j.optm.2009.07.007
Seeing Through New Eyes: Changing the Lives of Children with Autism, Asperger Syndrome and Other Developmental Disabilities Through Vision Therapy Kaplan M. Philadelphia: Jessica Kingsley Publishers, 2006. Soft cover, 208 pages, $19.95. Researchers estimate that now 1 in 150 children has a pervasive developmental disorder, up from 1 in 10,000 a generation ago. Many autistic behaviors are visual: poor eye contact, staring at lights or spinning objects, side viewing, or flicking fingers in front of the eyes. No wonder parents are seeking optometric opinions with increasing frequency. Reading Mel Kaplan’s book is a good start to learning about these fascinating patients and how to help them. A pioneer, with decades of experience in the field of autism, Kaplan is a veteran at using lenses and yoked prisms and creating vision therapy activities for this population. The book is divided into 3 parts. In Part 1, Kaplan describes the relationship between mild visual issues and problems such as reading and coordination problems; moderate visual processing problems and poor depth perception, which can cause anxiety and other emotional dysfunction; and the severe visual disorganization seen in patients with autism and related disorders. The more severe the visual problems, the more ‘‘autistic’’ a child is. Those with mild visual dysfunction often are classified as having attention deficits or learning disabilities, whereas those with moderate issues may be labeled PDD (for pervasive developmental disorder) or Asperger syndrome. Those with full-blown autism usually show severe visual disorganization. In Part 2, Kaplan describes both formal and informal testing. This section includes very helpful advice on history-taking and dealing with some
548 of the sensory issues, such as tactile defensiveness, seen in patients with autism. Knowing a child’s history helps determine appropriate treatments, not just in the area of vision but also possible complementary interventions. Kaplan appreciates the role of adjunct professionals, such as doctors providing biomedical treatments and therapists who can normalize function in other sensory modalities, and encourages collaboration with these colleagues as part of a comprehensive treatment program. Because many of the patients cannot comply with test standardization, Kaplan recommends many performance-based activities. He has combined several of these to form the Kaplan Nonverbal Battery, in which tasks are arranged hierarchically, allowing the doctor to observe how patients deal with increasing demands on their visual systems. For higher-functioning patients, he adds classic assessments, such as the Gesell, Van Orden Star, and the Keystone 21-point battery. What makes Kaplan’s recommendations for testing unique are his use of prism lenses during the diagnostic process. His intuition about the ‘‘right’’ lens to elicit appropriate behaviors is uncanny. The opportunity to learn from his wisdom is one of the most valuable parts of the book. Part 3 is the essence of this publication. It has the potential to be life changing for optometrists considering adding vision therapy (VT) to their
Book Notes practices. Those who already do VT will hone their skills by adding some of Kaplan’s activities that combine his holistic understanding of the visual system with Tai Chi–type movements, reflex integration, lazy eights, and breathing exercises. Activities are divided into sections for improving spatial organizational issues, problems with orientation, and treating strabismus. Throughout the book Kaplan provides many dramatic case studies from his practice, demonstrating how to interpret findings and design a visual management program to meet each patient’s unique needs. His examples of how prism lenses resulted in significant changes for those with convergence insufficiency, accommodation deficits, and strabismus are compelling. His goal is always to maximize each patient’s performance by looking at the organism as a whole, not just at eyeballs. Some may recall Kaplan’s seminal work with Rickie, the daughter of psychiatrist Frederic Flach who was diagnosed with childhood schizophrenia (a predecessor to the autism diagnosis) at age 13. After years of failing to respond to medications, psychotherapy, and even electroshock therapy, Kaplan determined that Rickie’s visual system had broken down to the point where she was legally blind. Although skeptical of vision therapy at first, Dr. Flach quickly saw its efficacy, as he watched his daughter turn around. The 2 unlikely partners later collaborated
on research that revealed that two thirds of the psychiatric population has visual dysfunction. More recently, Kaplan has been working with Stephen Edelson, Ph.D., the director of the Autism Research Institute (ARI) in San Diego, to evaluate the role of visual issues in this generation of children with autism. Dr. Edelson’s foreword to the book describes some of the behavioral changes he has witnessed, including immediate normalizing from toe walking to flat-foot walking, improved eye-hand coordination and posture, and a reduction of inattentive and hyperactive behavior. Even though Seeing Through New Eyes is written for the public, optometrists at all levels can benefit from reading it. The glossary in the back is particularly valuable for educating the public about how optometry views vision as different from eyesight, and how visual intervention can help all aspects of functioning. For young ODs still searching for a niche in their chosen field, this book gives them a historical overview of the growing field of vision therapy and opens an exciting door to a growing population of patients whose lives can be improved through optometry. After reading Seeing Through New Eyes, most will agree with Kaplan’s statement that ‘‘the fastest way to change behavior is through a lens.’’ Patricia S. Lemer, M.Ed. doi:10.1016/j.optm.2009.07.008