Do you remember how you first learned about Vision Therapy? It probably doesn’t surprise you that most people don’t know it exists until they or someone they know is participating in it themselves. So, what about all of the children who are suffering from learning difficulties and parents and schools can’t explain why? Dr. Heike Schuhmacher’s book titled Vision and Learning, gives a detailed yet reader friendly description of vision and hearing problems that do affect a population of students in negative ways. There is hope though as she shares her knowledge in this field that can affect the lives of these kids and those who care for them. 

Dr. Schumacher’s experience as a primary care and family physician who specializes in pediatric developmental disorders has allowed her to utilize different therapies with her patients. The emphasis of her therapies has been Vision Therapy.  In fact, she was the first German physician to become a Fellow of the American College of Optometrists In Vision Development (COVD). 


Visual and Auditory Systems Work Together:

Many of us take our senses for granted. Perhaps you have been blessed with outstanding functional vision and auditory skills as expressed by a pediatrician or from a school screening. Maybe you get by okay although words appear a little blurry from time to time or we mishear what someone says. Imagine a child trying to read a book if the letters look double, or trying to make friends but can’t understand what others are saying. What if that child also got headaches every time they had to read or write and couldn’t follow the directions spoken to him as was expected. This is usually the point where educators and parents become worried. Families are looking for answers but in many cases are altogether uninformed or under informed about the key roles the visual and auditory systems have on learning. 


“Vision is the brain’s way of touching the world” is the belief of the French philosopher Merleau-Ponty. So much of our abilities to learn, experience, perceive, and understand our world is through vision. With that being so, it is important that each part of the visual system can work optimally. Dr. Schumacher includes in her book the cybernetic model of perfect vision created by Arthur Marten Skeffington, the father of developmental optometry. This model showcases how four different visual functions need to work together to make proper vision possible. Those functions are: visual acuity/focusing, binocular vision, eye movements, and processing of visual perception. To simplify, here are a few real life struggles students may display with these functions plus body awareness and motor skills:

  • Visual acuity/focusing: focusing clearly when looking near or far
  • Binocular vision: fusing visual impressions from both eyes into one image, having optimal 3D vision at all distances, 
  • Eye movements: maintaining a steady fixation on a point, visually tracking an object in all directions with control, following a line of text accurately
  • Processing of visual perception: perceiving at one glance a number or letter combination or an entire word, successfully storing and recalling the combination and sharing it verbally and in writing 
  • Body awareness/motor skills: fine motor skills, graphomotor skills, eye-hand coordination, knowing where right and left is on his own body and on others


When students are at the stage of learning to read and write they rely on their ability to process language as they hear it and also when they speak. This can induce reluctance and resistance in students who have Central Auditory Processing Disorder (CAPD). Phonological awareness and auditory working memory are 2 key skills that Dr. Schuhmacher mentions are impacted. She further gives a list of symptoms experienced by students with CAPD, some of those include:

  • Noticeable noise sensitivity
  • Asks questions for reassurance
  • Problems in following directions
  • Often looks to see what others are doing
  • Pronunciation errors persist for a long time
  • Confuses words that sound alike: them/then, fish/dish, head/bed
  • Actions do not correspond to the content of the task instructions
  • Poor auditory memory, both in duration and sequence (unable to recount sentences, stories, or task instructions or to spell out longer words)

Working Together

Without a doubt, children with visual disorders as well as auditory processing difficulties are going to struggle in school. Getting the visual and auditory systems thoroughly tested is the first step in identifying the child’s challenges. Dr. Schuhmacher encourages students who have auditory processing and speech disorders to get assessed by a developmental optometrist. Vision therapy can help those students and any student with learning difficulties to increase and enhance the connection between the eyes and the brain to help with many school subjects including: reading, writing, spelling and math. Neuroscience is now telling us that parallel sensory systems like the visual and auditory systems can have complimentary benefits on each other when one is being remediated through a therapeutic/treatment process.  



“Comprehensive Testing of all relevant visual and auditory functions is essential for all school children with learning problems,” Dr. Schuhmacher states in bold print in her book. School screenings are not enough to make sure kids are equipped with the skills they need to succeed in school. Developmental optometrists, pediatric audiologists and speech/language pathologists can administer assessments to identify any problems and create plans to improve them. Doctors, teachers, and you with the knowledge you have of these struggles can change the trajectory of your child’s schooling.

If your child is experiencing troubles with learning we want to help! Contact us at Nebraska Visual Integration Center to help determine if a functional vision evaluation may benefit your child, to get more information, or simply to ask any questions you have about vision and learning. You can reach us by phone at 402-502-0043 or by email at [email protected] 

We look forward to hearing from you! 



Vision and Learning: A Guide for Parents and Professionals 

by Heike Schuhmacher M.D. 

The term “learning disability” is expressed frequently between concerned parents, educators, and anyone who feels they have one. You may know of a relative, a friend’s child, or even your own child who has been diagnosed during their school years. The LD Resources Foundation¹ states on their website that 8-10% of children under 18 have some form of a learning disability. One of the top 5 most common is Dyslexia, often thought of as a disability in reading. When looking for a cause of symptoms it is important to determine if the person has strong functional vision skills or if a deficit is causing learning problems mimicking Dyslexia.

What is Dyslexia?

What do you know about Dyslexia? Common knowledge leads us to understand it is a problem with reading. While that is true there is a little more to it than that. This definition posted on the Edublox Online Tutor Website² brings to light visual dyslexia. 

“Dyslexia is considered to be a neurological disorder in the brain that causes information to be processed and interpreted differently, resulting in reading difficulties.

The terms visual dyslexia and auditory dyslexia are often used by scholars to describe two main types of dyslexia. Visual dyslexia, also called surface dyslexia, dyseidetic dyslexia, or orthographic dyslexia, is a subtype of dyslexia that refers to children who struggle with reading because they have problems remembering and discriminating visual gestalts.”


What are common symptoms of Dyslexia?

Not every person with Dyslexia will present with symptoms identically, though they often have symptoms that affect 3 skill sets. Someone with Dyslexia typically struggles with phonological awareness, verbal memory, and verbal processing speed. The Optometrists Network³ wrote an article giving a detailed description of what Dyslexia is and how it presents in different age groups. This is not an exhaustive list, but it does demonstrate how the person is impacted by the 3 symptoms mentioned above.

  • Under Age 5 
      • Recognizing letters and their sounds
      • Getting the letters confused when saying a word
      • Learning frequently used word progressions (ex. Days of the week)
  • Age 5-13
      • Saying a word backwards/switching letters when reading (ex. saw vs. was)
      • Incorrectly saying/writing letters and numbers that look similar (ex. p vs. q and 2 vs. 5)
      • Remembering math facts
      • Remembering spelling rules
      • Following directions in the correct order
  • Age 13 and Above
      • Reading out loud and/or below grade level
      • Recalling the main ideas of a story/comprehension
      • Understanding jokes
      • Managing time

Can functional visual problems present similarly to Dyslexia?

Before beginning a formal assessment to determine if someone has Dyslexia, it is recommended they undergo a specialty vision examination to evaluate the 3 areas of visual functioning: integrity of the visual pathway, visual efficacy, and visual information processing. Oftentimes binocular vision problems (especially convergence insufficiency) can be confused with Dyslexia or may accompany the diagnosis. Those symptoms, taken from Dyslexia and the Vision System⁴, are listed here:

  • Reversing letters like “b” and “d”
  • Skipping words or entire sentences when reading
  • Struggles to copy off the board
  • Words look blurry or move
  • Has trouble spelling
  • Low reading comprehension
  • Reading slowly
  • Becomes easily tired and eyes feel strained when reading

Can Vision Therapy help?

Yes! In many circumstances where the person is diagnosed with a vision issue they can work on various skills in Vision Therapy to improve the brains’ ability to coordinate the eye muscles and the connection between the eyes and the brain. Several patients begin therapy citing struggles with reading. We know the importance of reading, writing, memory work and being able to plan ahead as well as several other life skills. A few activities that may help get the eyes into the proper alignment and help the person know where they need to look include: reading charts in a certain way, using a set of special blocks moved in different patterns to form words, and using specific glasses to fuse 2 images together to create 1 image with clarity and depth. It can be a life changing experience to receive Vision Therapy amidst school, work, or life struggles.

If you or someone you know would like to schedule a functional vision exam feel free to contact us by phone at 402-502-0043 or send an email to [email protected]



The Top 5 Most Common Learning Disabilities and their Symptoms¹,dyscalculia%2C%20dysgraphia%2C%20and%20dyspraxia.

Visual Dyslexia: What It Is and How to Treat It² 

Does My Child Have Dyslexia³ 

Dyslexia and the Visual System⁴


Conclusion: More to School than Meets the Eye

There is more to school than reading a book, writing a paragraph, or solving a math equation. What about all those sometimes forgotten skills that help us to be successful as we take notes, follow directions, play a game, take a test or interact with classmates? These abilities cannot be ignored no matter if the student is primarily an auditory, visual or kinesthetic learner. I have learned that since the eyes take in the information and the brain makes sense of what it sees, the visual system is of high importance. 


General School Difficulties

  • Having efficient speed/accuracy/ memory needed to copy from the board to their paper
  • Forgetting which way was right or left when playing games
  • Mixing up cardinal directions
  • Following multistep directions
  • General ability to process information and remember it
  • Wearing shoes on the wrong feet
  • Proper organization of school supplies/work
  • Needing to touch everything to know how it feels



Education and Vision Therapy

I am sad when I think of my students who lost confidence to do their work correctly and retreated into themselves. I also had students do the opposite, who acted out behaviorally because doing the work was so hard for them. Staying at either end of the spectrum for too long is not a place we want a child to be. Something that vision therapy offers is the chance to be in an environment where making mistakes is okay. During vison therapy we learn and grow in multiple ways at each session. While working on eye focusing skills we learn patience. We teach our eyes to work as a team, while being a part of a team that encourages each other to do our best. Our eye tracking abilities improve while we push ourselves. We gain spatial awareness and appreciate the body God gave us. A positive attitude helps foster and encourage our visual thinking skills. As a former classroom teacher and current vision therapist, I am blessed to continue my work of helping others learn more than classroom skills, but life skills as well. 

Part 4: Math is More than just Numbers

Math is usually one of those subjects you absolutely love or totally despise. Although math was never one of my favorite subjects when I was a student, as a teacher I grew to appreciate the various processes, tools, songs and hands-on ways to make learning more fun. Visually it can be cumbersome to understand how mathematical concepts work and are related. This doesn’t even include the act of reading, interpreting, and correctly writing the problem to find a solution which is a more advanced skill. Since the basic levels of math require number recognition, some students who struggle with math have difficulties starting at this level. Perhaps their difficulties begin when they have to use spatial awareness to write the numbers down in a certain way, or draw a visual representation of the mathematical work they are doing so that it makes sense. Math is a subject where you need to master one skill before moving onto the next level. In third grade this was made obvious as we progressed from mastering multi digit addition and subtraction, to learning how to multiply, to introducing division. 


Common Math Difficulties

  • Writing numerical answers in the correct order/place value (ex. Understanding 123 is very different from 321)
  • Recognizing patterns in numbers, counting
  • Skip counting
  • Lining up numbers correctly to solve problems
  • Following the appropriate steps to solve a problem
  • Clockwise/Counter clockwise
  • Symmetry of geometric shapes (ex. Drawing the rest of the picture so the sides match)
  • Memorizing math facts
  • Being able to read a word problem, understand what it is saying, and find a way to solve
  • Drawing a visual to solve a word problem 
  • Concepts of measurement such as weight/size/ distance/ length



Math and Vision Therapy

I have done several activities so far as a vision therapist that help promote visual awareness, memory, processing speed, seeing things from a different perspective, and patterns. Spatial awareness activities can include orientation, number order, and require a person to solve any problems that come up while working. One activity we use to promote visual logic is a version of tic-tac-toe where the patient cannot see the board and has to plan and visualize each move in their head, much like planning for how to solve a math problem. Working through these vision therapy exercises could promote mathematical growth as well as numerous other brain skills. While vision therapy doesn’t strive to teach math skills, it helps improve the child’s conceptual understanding of math through numerical literacy and visual thinking. It’s exciting to know so many areas of the brain can be enhanced at the same time. 

Part 3: Writing as Communication

Once learning has taken place, how do you show what you know? My students demonstrated their learning in the classroom through speaking, teaching another student, acting, drawing, using response cards and playing games. One method used daily in most subjects though was writing. The skill of writing is important on so many levels. It allows us to show what we know and communicate with the world. It’s been said that your brain remembers things better when you write it down. What if the physical and mental act of writing is less than fluid for the participant? We utilized writing for the common worksheet, writing notes, tests, learning cursive, and paragraph writing. Writing a math equation is not surprisingly very different from writing a 3 paragraph essay. In both cases though a student must use their brain to formulate an idea, remember how to form the letters/numbers correctly, how to set up and format the writing to be easily read and understood. 


Common Writing Difficulties

  • Frequently reversing some letters and numbers (ex. Writing b instead of d or 6 instead of 9, or similarly writing 51 instead of 15)
  • Mixing capital and lowercase letters within a word or starting every word with a capital letter
  • Disregarding spacing when writing a paragraph (ex. Writing all words on only 1 side of the page)
  • Writing words in an appropriate size based on the size of the line on the worksheet, lined writing paper, or free writing
  • Setting up the paper correctly with a heading or proper paragraph writing specifications, pencil grip, slanting the page, posture, forming the letters and numbers correctly
  • Brainstorming ideas in their head and being able to write them as sentences


Writing and Vision Therapy

Sometimes I would ask students if they could find which letters or numbers they wrote backwards…some students would notice and fix the mistake, others didn’t seem to think anything was wrong. This could indicate that the visual system has trouble processing and remembering what each letter and number means/how it should look. Many students did not use the space on a paper well. Some would write as if there was no line at all, some wrote on the line, but made their letters so large they would fill up the entire line space. This potential spatial awareness problem as well as others can be addressed with vision therapy.



A patient’s writing BEFORE starting Vision Therapy.

vision therapy writing

That same patient’s writing AFTER finishing Vision Therapy


Part 2: Why Reading is so Important

If there is one area of education that often concerns parents and teachers the most it is reading. We live in a world where being able to read the words on a page clearly and understand what we read is essential to our learning and our future. It’s undeniably a lifelong skill. As a teacher I remember being mystified at times by the few students I had over the years that continued to struggle with reading through the end of third grade. Some students could tell you every single detail about a story if it was read to them, yet couldn’t read on their own. Listening is a very valuable skill, yet so is reading.  We used to say that third grade was a pivotal year for students because they were transitioning from ‘learning to read’ to ‘reading to learn.’ This step in independence is not easy for some, especially if the student, teachers, and parents are putting in extra effort to make independent reading happen and something still isn’t clicking. Maybe these issues will go away on their own, but what if they don’t?


Common Reading Difficulties

  • Being able to listen to the story and answer questions about it accurately, but couldn’t read the print themselves
  • Often losing their place when reading, which led to losing their attention easily
  • Skipping words or entire sentences
  • Spending so long trying to read a sentence and make out the words that they had no idea what they just learned
  • Having the ability to make a picture in their head of what is happening in the story
  • Matching the letter or blend to its sound to say words fluently
  • Not being able to find the sentences on the page they volunteered to read aloud



Reading and Vision Therapy

If I had known about vision therapy I would have asked those students a few questions. 

  1. Do the words seem blurry or fuzzy to you? If yes this could be an accommodation problem. This means the eyes are having trouble maintaining clear focus. 
  2. Are the words moving or overlapping? This could be an eye teaming problem which has to do with the eyes working together to monitor spacing and depth. 
  3. Are you having difficulty keeping your place on the page? This may be an eye tracking problem where the eyes cannot maintain focus while moving to read along a page or following something that is moving. 
  4. Can you make a movie of the story in your head? If not, this may be a visual perception problem and this may impact comprehension and retention. 

What if this is how you saw things when attempting to read? Would you enjoy reading? It’s important to understand that a pair of glasses will NOT fix this issue.

 Vision therapy may be the answer.

Part 1: My Road to Vision Therapy

It is still a shock to me that if I had the knowledge I do now about the visual system and how the brain takes in information, I could have spared some of my students’ continuing struggles. Before 2 months ago I had never heard of the words “vision therapy,” nor even knew that vision was different from someone just needing eyeglasses. As a third grade teacher for 5 years, I figured that with the school screenings we had each year, reminding a student to actually wear the glasses they “forgot” in their backpack, or contacting a parent whose child said they couldn’t see well satisfied their eye needs and any further struggles they had were unrelated.

Now I see things differently, no pun intended. Every parent and teacher wants a child to use his/her God given gifts and abilities to reach full potential. Though everyone will struggle at some point in their lifetime, it is nice to have some extra help along the way, that’s where vision therapy comes in.  I left the classroom behind this summer and began my new journey as a vision therapist. I can say I wish I could check in with some of my past students. Perhaps some of them are doing very well now, others may still encounter the same challenges…I wonder if vision therapy could help.

This will be the first in a series of posts I make about some of the struggles I observed among students from this new perspective. I will go into more detail on some of the reading, writing, math and general challenges I witnessed as a teacher. 

What is Binocular Vision Dysfunction (BVD)?

Before discussing BVD, it is important to understand what binocular vision is. Bi- means both and -ocular means eyes, so binocular vision  means seeing with both eyes. In their post about binocular vision, Vivid Vision¹ discusses how the brain receives separate signals from both eyes, and combines them together in order to see. We can generally coordinate our eye movements when both eyes are well-functioning. Additionally, both eyes see slightly different visual fields, which is why we have depth perception. When the eyes are functioning well this all works seamlessly, but when the eyes do not properly align or team, a number of uncomfortable symptoms can occur. 


According to the Dizziness and Headache Optometry Center², binocular vision dysfunction is “…an ocular condition that occurs when the eyes don’t align properly with one another”. Symptoms of BVD result when our brain tries to correct or compensate for this misalignment, which can take a substantial amount of effort. 

Types of BVD³

  • Vertical Heterophoria
    • A vertical misalignment of the eyes
  • Esophoria or Exophoria
    • Tendency for the eyes to drift inward (eso) or outward (exo) during certain tasks
  • Convergence Insufficiency
    • The inability to turn the eyes inward and keep single vision at a near point
    • The #1 cause of eye strain
  • Convergence excess
  • Divergence excess
  • Divergence insufficiency


Signs and Symptoms of BVD

  • Double vision or blurred vision
  • Fatigue when reading or doing computer work
  • Poor balance or coordination
  • Nausea or motion sickness
  • Poor depth perception
  • Pain in the eyes, neck, back, or face
  • Head tilt
  • Headaches or migraines with near work
  • Anxiety in crowds or large spaces
  • Restless sleep
  • Difficulty with comprehension and attention


How Vision Therapy can help treat BVD

In his editorial piece “The Binocular Vision Dysfunction Pandemic”, Dominick M. Maino, OD, MEd, FAAO, FCOVD-A writes that “…Evidence based medicine has shown that the best and most efficacious treatment for convergence insufficiency (a type of binocular vision dysfunction) is office-based optometric vision therapy”. He describes how most other binocular vision dysfunction disorders would also benefit most from vision therapy.


Dr. Maino provided plenty of support for his findings through textbooks, case reports, studies, and other qualified individuals: “Dennis Levi, OD, PhD, Dean of the Optometry School at Berkeley, noted that perceptual learning (vision therapy) is a quite successful intervention if it is intensive, engaging and appropriately challenging”.


Those who have binocular vision issues due to brain injuries, autism, or other developmental, genetic, or intellectual disabilities can also greatly benefit from vision therapy. 


If you suspect you or your child may have Binocular Vision Dysfunction, contact our office to schedule an appointment at 




Vivid Vision

Dizziness and Headache,are%20associated%20with%20the%20condition

The Binocular Vision Dysfunction Pandemic