Jury Out on Vision Therapy for Troubled Teens

Stan Kaseno thinks teen-agers get locked up in juvenile hall because they don’t see the world the way it is.

“They don’t need eyeglasses,” Kaseno said, “they need vision therapy.”

Kaseno, a San Bernardino optometrist, is at the heart of one of the hottest debates among professionals in distinct--and sometimes competing--disciplines concerned with young people: whether quality of eye movement is a significant factor in why many young people have trouble coping with life.

‘Very Confusing’

“There is such difference of opinion on this subject and the controversy over vision therapy and visual perceptual problems is very confusing to everybody,” said Sheila Fulton, executive director of the Juvenile Justice Connection Project, a treatment and referral agency for troubled youngsters in the San Fernando Valley.

“Those who feel (vision therapy) works are evangelistic and those who feel it is not are equally evangelistic,” Fulton said, adding that “people’s eyes that don’t focus properly is what they are really talking about.”

Kaseno said that “most people have a huge cushion of eye focusing ability that they don’t need.

“But if you don’t have that cushion, if you can maintain focus only by stressing yourself, then you quickly get tired and lose interest in the sorts of activities required for success in schools, like looking at a book and then far away at a blackboard and then back at your book and so you don’t succeed in school and then you experience only repeated failure until you may end up here.

“These are problems you won’t get by having children look at the standard eye chart,” Kaseno said. “They can read the letters, but there’s still something wrong and the kid knows it even if we don’t screen adequately to find it. You have to use other tests to find these problems.”

Powerful Allies

Vision therapy has begun gaining some powerful allies. California Atty. Gen. John Van de Kamp has sent a letter to every juvenile court judge in the state saying Kaseno’s project for “detection and treatment of vision deficiencies results in a dramatic reduction in recidivism and in improved adjustment attitude and learning ability.” Van de Kamp wrote that after 12 therapy sessions the youths, whose median age was 16.2 years, improved their reading level from beginning fifth-grade level to mid-eighth-grade level.

Kaseno says that, compared to other juveniles, re-arrest rates after vision therapy are 80% lower, although he acknowledges this data would be challenged by some researchers as lacking sufficient methodological rigor.

Barry J. Nidorf, the Los Angeles County chief probation officer, wrote in a letter last March stating that “while there remains the need to more clearly define certain aspects of the project, I am persuaded” that Kaseno’s ideas merit “close attention.” Nidorf wrote that he wants to screen youngsters for visual perception problems, following Kaseno’s model, at the three juvenile halls in Los Angeles County.

Earlier this year, Gov. George Deukmejian vetoed Assembly Bill 1896, which would have financed a study of juvenile delinquents with vision disorders. He said it would duplicate another bill, which authorizes the state Department of Education to develop a school testing program which includes some aspects of the vision therapy concept.

Now, Los Angeles City Councilman Richard Allatore’s office is looking into the possibility of the city funding a pilot vision-therapy project.

At San Bernardino County Juvenile Hall, 90% of those held more than three days are given tests in which they must focus on a tiny red ball as it is moved progressively closer to their nose, must shift their eyes between two parallel columns of letters and read them out loud, and do other tests designed to let Kaseno and optometric interns examine how well their eyeballs move and their lenses focus.

“What we do is work with kids to improve their quality of eye movement, their ability to use stereoscopic vision, to switch focus between objects near and far, to follow a line like printed words on a page and their pursuit of moving objects.

“In screening more than 4,000 boys and girls who have been in Juvenile Hall here in San Bernardino we have found that we have a 93-94% failure rate” on a battery of tests designed to measure quality of eye movement. Kaseno said studies by other optometrists show that about one in three people have poor quality eye movements which interfere with their ability to take in information visually.

Behavioral Problems

Vision-therapy advocates contend that, since 80% of the information reaching the brain comes from the eyes, major behavioral problems can and often do result in those who cannot focus well, cannot shift focus between objects near and far and cannot make effective use of the stereoscopic vision made possible by having two eyes.

Kaseno, 53, calls himself a behavioral optometrist, an expert in how vision problems influence behavior and in correcting those vision problems. And he contends, as do a growing number of optometrists, that they can teach eye-movement skills that improve patients’ ability to see and, thus, help them relate better to the world.

But critics say even defining vision therapy is difficult and that no credible scientific studies of its effectiveness exist. In a 1984 article in the journal Pediatrics, two researchers concluded that there is little evidence indicating vision therapy can help solve reading problems.

Skepticism Encouraged

Among many who work with troubled youths, the notion that some physical or medical problem will explain why large numbers of youngsters get into trouble with the law is a recurring theme, one that has been disproved time and again. Kaseno acknowledges this history and contends it encourages skepticism and discourages inquiry.

The notion of vision therapy is opposed by some optometrists and by most, and perhaps all, organizations representing ophthalmologists.

Ophthalmology is the medical specialty concerned with care and treatment of the eyes. Optometrists, who are not medical doctors, are licensed by the state to examine eyes, measure refractions and prescribe corrective lenses.

Expanding Practices

Vision therapy also represents an effort by some optometrists to expand their practice. It can be quite lucrative. Kaseno said that some optometrists charge $80 per visit for weekly therapy sessions that continue for six months or more.

Kaseno, who said he gets $150 per day for his work with teen-agers at San Bernardino County Juvenile Hall, said he has been trying for years to get funding for a rigorous study of eye movement quality, a study that he is certain will demonstrate a need for screening all youngsters and will help reduce juvenile delinquency.

In the meantime, encouraged by psychologist Paul Boccumini, chief of clinical services for the San Bernardino County Probation Department, Kaseno and his staff do intensive vision therapy with long-term juvenile hall residents.

“The skeptics are concerned that vision therapy is too simple,” Boccumini said. “Unfortunately, most people try to make things more complicated than they really are.

“This program costs us about $60 per kid, including 24 therapy sessions, and so what do we hear? ‘Something that can be this effective can’t be this cheap.’ Well, it is cheap and it does work,” Boccumini contends.

In one vision-therapy exercise, Juvenile Hall detainees jump on a tiny trampoline built for running in place exercises. The young people are asked to perform progressively more difficult tasks such as swinging both arms in an arc in time to a spoken beat and to call out a pattern of arrows on a sheet of paper as they bounce up and down.

In another room patients stand still, their eyes following a softball, hung from the ceiling on a string and covered with stick-on letters, as it swings in front of them. Another exercise involves looking at complex outline drawings and then trying to reproduce them.

But skeptics abound, ranging from those who think vision therapy is an intriguing notion to those who dismiss it outright as poppycock.

‘Grandiose Assumptions’

“The behavioral optometrists make grandiose assumptions,” said Sandy Babcock, an educational therapist who is writing her doctoral dissertation at UCLA on the connection between learning disabilities and delinquency.

“This is not to say there aren’t children who have near-point vision focusing problems. But there is absolutely no evidence correlating this to delinquency.”

She noted, as did others interviewed, that delinquency itself is a term fraught with definitional problems.

“Accepting vision therapy requires huge leaps of faith,” Babcock said. “He (Kaseno) first says kids who can’t compensate (for inadequate eye movement quality) develop education problems and these lead to failure and feelings of frustration and that leads to social failure which leads to delinquent behavior. There’s just too many variables in there which he has neglected--home life variables, individual learning style, achievement, temperament, behavior characteristics and it is just too broad an assumption.”

She emphasized that she does not dispute that in some children poor-quality eye movements can interfere with their visual perception.

“There are children with vision problems and they can be corrected with vision therapy,” Babcock said. “But we don’t know that if when we correct these problems that kids will feel better or behave better. You just can’t say that relates to anything else.

‘It Happens in the Brain’

“Underneath the surface, almost all learning problems are vision related. While learning disabilities people talk about visual perception, it’s not at the level of eyeball. It happens in the brain and you can’t measure it with eye instruments,” she said.

J. Lee Wiederholt, editor of the Journal of Learning Disabilities, which recently published an exhaustive review of vision-therapy literature, said there are “no data to indicate” vision therapy works “other than possibly a couple of clinical cases.”

Wiederholt said that because vision therapy is “nonvalidated doesn’t mean its not true. What I’m saying is it hasn’t been demonstrated.”

Not all education therapists are as skeptical as Babcock and Wiederholt. Dorothy Ungerleider, an Encino education therapist and author of the 1985 book “Reading, Writing and Rage” (Jalmar Press, Rolling Hills, $8.95), said “vision therapy is still out with the jury for me.”

Ungerleider, founding president of the Assn. of Educational Therapists, said that organization is meeting with behavioral optometrists and is “trying to find out if there is real validity because if there is we don’t want to discard it.

“I work with juvenile delinquents and I know I’ll get a kid I’m working with who in reading is constantly losing his place, leaving out lines, skipping lines, and so I send him to an ophthalmologist. The ophthalmologist will tell me everything is fine, but I know that this kid is under stress.

“I know perceptual problems occur at the level of brain, not the eye, but I know that from my training and not for sure,” Ungerleider said in urging more study.