Developmental Optometry

Developmental Optometry For Children & Youth

By Dr. Tanya Mahaphon, OD, FCOVD, FAAO, © Copyright 2008.

Developmental Optometry Has Helped Kids With

  • Amblyopia (lazy eye)
  • Accommodative disorders (inability to keep eyes focused at distance or near)
  • Anxiety
  • Arithmetic difficulties
  • Attention Deficit Disorder (ADD)
  • Attention Deficit Hyperactive Disorder (ADHD)
  • Autism
  • Balance problems
  • Behavior problems
  • Brain damage
  • Cerebral palsy
  • Chronic fatigue syndrome
  • Conduct disorder problems
  • Convergence insufficiency (inability to cross eyes for near-work)
  • Convergence excess (over crossing of the eyes)
  • Coordination
  • Depression
  • Developmental retardation
  • Developmental delays
  • Difficulty with rhythm and sequencing
  • Digestion problems
  • Down’s Syndrome
  • Dyslexia/letter reversals/left-right confusion
  • Fetal alcohol syndrome
  • Handwriting
  • Hyperactivity
  • Headaches
  • Learning differences
  • Learning disabilities
  • Rage
  • Reading difficulties
  • Spatial disorganization
  • Speech problems
  • Short term memory deficiency
  • Strabismus (eye turns in or out)
  • Stress

Developmental Optometry Can Help In The Following Areas

Spirit: A child’s spirit is healed when vision is improved. The child learns that he/she is not stupid or lazy, but that their vision was holding them back from achieving success in school, with reading and math, and in sports.

Body: Body awareness and being able to overcome gravity to stand upright is the foundation for visual and spatial awareness. Developmental optometry enhances a child’s coordination by using visually-guided motor activities, reinforces a child’s midline and bilateral integration of the body and eyes, then develops the ability to cross midline efficiently and effectively. The child develops a more grounded self and can start to explore visually rather than through tactile senses.

Mind: A picture is worth a thousand words. A child’s mind that learned to utilize vision can learn non-phonetic spelling of words through visual memory, rather than using spelling rules and verbal/auditory memory. Higher levels of visual processing include the ability to create visual pictures in the mind’s eye; such as seeing a movie play in your mind while reading words in a book, which is important for reading comprehension.

Emotions: A child’s emotions become more stable through vision therapy. Vision therapy teaches a child to become more flexible and how to adapt to new and different situations. For example: Prism therapy with bean bag toss. The prism alters the child’s perception of objects by physically bending light. The child learns how to adapt to this new visual situation and compensate in order to throw the bean bag into the bucket.

Brief Description Of Developmental Optometry

  • Developmental optometry is the practice of using lenses, prisms, and/or visually-guided motor activities to enhance visual performance.
  • The main goals of developmental optometry are to achieve “single, clear, comfortable binocular (two-eyed) vision” and to develop visual-spatial, visual analysis, and visual-integration skills.
  • Vision therapy is a medically supervised program that can treat conditions such as amblyopia (lazy eye), strabismus (turned or crossed eyes), poor eye movements needed in tracking or reading a book, visual spatial skills (such as left/right confusion and letter reversals), visual analysis skills (such as visual memory, visual figure/ground, visual form constancy), visual integration skills (such as visual-motor integration/eye-hand coordination, visual-verbal integration/rapid naming, and visual-auditory integration/seeing and hearing match.

Success With Developmental Optometry

  • An 8 year old developmentally delayed young girl had tested mildly mentally retarded at a full scale IQ 70, and learning disabled with performance two grades below. After receiving 30 sessions of vision therapy she still tested borderline full scale IQ of 80, but her academic achievement was on grade level and above her potential IQ!
  • A 7 year old boy in second grade with possible attention deficit was struggling with school. He had 20 sessions of vision therapy and has become more focused in school with improved grades, and he has more hits in little league baseball.
  • A 13 year old girl with headaches and double vision in school was diagnosed with convergence insufficiency (inability to cross the eyes for reading). After 20 sessions of vision therapy, her headaches and double vision were eliminated and her reading and school grades improved as well.

Developmental Optometry Is Appropriate For Ages

  • Birth to death

Children & Youth Reactions To Developmental Optometry

  • Most children respond positively to developmental optometry since many of the therapy sessions involve visual-motor activities; such as throwing and catching balls, building blocks, and/or three dimensional pictures. An experienced developmental optometrist with trained vision therapists will know how to create situations that are challenging and achievable by the child, which will then foster self-esteem and increased motivation to succeed.
  • Depending on the therapist or doctor, most children enjoy vision therapy and react to vision therapy as if they were playing games at school.
  • Many of the vision therapy activities are similar to visual processing games; such as Hidden Pictures, Mazes, Concentration, Bean Bag Toss, Trampoline, and Balance Beam.
  • Other vision therapy activities involve crossing and uncrossing the eyes, three dimensional pictures, and eye focusing exercises and patching. These activities may cause some discomfort to children in the beginning as the visual-motor-neurological strength of the eyes improve, which is similar to weight training for the eyes.

Extra Care Is Needed

  • Children & youth with short attention spans and poor behavior may require shorter and more frequent vision therapy sessions; such as twice weekly-30 minute sessions, versus a once a week-50 minute session.

Contraindications: When Developmental Optometry Should Be Avoided

  • The only contraindication with developmental optometry is when a serious medical condition exists that needs to be treated prior to vision therapy. There are some serious neurological conditions that have symptoms of double vision, blurred vision, headaches, poor memory, and reduced/poor eye movements. These neurological conditions need to be ruled out with a comprehensive vision examination with a dilated fundus exam before vision therapy is started.


  • The father of developmental optometry was an optometrist named A. M. Skeffington. He was one of the founders of the Optometric Extension Program in the 1920’s.
  • Optometrist G. N. Getman and an educator, Glenna Bullis, combined Skeffington’s theories with their training in the Gesell Institute for Child Development, and their written works have emerged to be the foundation of developmental optometry.

Basic Concepts And Components Of Developmental Optometry

  • Vision is a learned process, which begins at birth and continues into adulthood. Vision is being able to receive visual information through the eyes, process the information in the brain, and then output or integrate the information using another motor response such as verbal communication, handwriting or catching/kicking a ball.
  • The Developmental Model of Vision is Skeffington’s Four Circles:
  • Antigravity - the ability of the body to develop into an upright/vertical position and gain balance
  • Centering - the ability for a person to locate where he/she is located in space, through the use of the eyes and body; i.e., Where am I?
  • Identification – the ability to analyze information through the eyes and senses; i.e., What is it?
  • Speech-Language aspect - the ability to communicate what a person sees
  • Most developmental optometrists will integrate visually guided gross motor/body exercises to develop a foundation for the higher level visual processing skills.
  • Many vision therapy activities include sensory-integration techniques such as auditory stimuli of a metronome, balance with a trampoline or balance board.

Description Of A Typical Session

  • A child or youth will perform 3 to 5 different visual tasks in each session. An example would be a child will perform Angels in the Snow while lying on her/his back for body awareness, bilateral integration, and midline development.
  • The child or youth will then follow a Marsden/swinging ball with letters for smooth eye tracking and crossing midline.
  • The child or youth will then clear letters using lenses of different powers, similar to eyeglass lenses.
  • The child or youth will look at three-dimensional pictures and learn how to cross and uncross their eyes.

Major Differences Of Opinion Between Practitioners

  • Some optometrists that practice vision therapy are not Developmental Optometrists. These optometrists have an eye muscle approach and will train the eyes to focus (accommodate) and to cross/uncross (vergence) without the visually-guided gross motor activities. This sort of vision therapy is also effective; however, may not have as lasting effect as a developmental approach, which works on a strong eyes-mind-body approach.

Fees/Costs In 2007 – Northern California

  • Average of $85 to $175 per session

Average Time Per Session

  • Bi-weekly 30 minute sessions, to weekly 45-50 minute sessions

Recommended Length Of Time Between Sessions

  • At least once a week for maximum effect – with daily home activities for reinforcement

Estimated Length Of Time Before Improvements Can Be Expected

  • About one month (or 4-8 sessions)

Suggestions To Make Developmental Optometry More Effective

  • Parents need to be consistent with having the child attend the vision therapy sessions regularly.
  • Ensure the home vision exercises are performed as directed by your doctor.

Other Methods That Are Similar To Developmental Optometry

  • Occupational therapy would be the most similar practice to developmental optometry; however, occupational therapists are not authorized to use lenses and prisms to train the eyes.

Other Methods That Complement Developmental Optometry

  • Physical therapy for low or high muscle tones and to improve gross motor or core foundation of the body
  • Occupational therapy for fine muscle control of the fingers for eye-hand coordination
  • Speech/language therapy to help integrate visual-verbal integration
  • Auditory therapy to help with rhythm, timing, and sequencing
  • Any physical activity that works on bilateral coordination such as karate, tae kwon do, yoga, and swimming
  • I highly recommend that parents who have had children in multiple therapies focus on vision therapy first and then add any additional therapies when vision is improved. A significant improvement in all aspects of life will be seen after vision therapy, such as improvement with speech-language, body coordination for sports, dance, and karate, improved eye movements so that reading remediation/tutoring will be more effective.

Nature And Length Of Training To Be A Practitioner

  • All optometrists must complete a Bachelor’s degree from an accredited undergraduate college and then complete a four year graduate program in the field of optometry and obtain an OD (Optometry Degree).
  • Afterwards, some optometrists complete an optional one year residency in vision therapy, binocular vision, and pediatric optometry.
  • Developmental optometrists can obtain a Board Certified Fellowship in Developmental Optometry (F.C.O.V.D.) which is granted by the College of Optometrists in Vision Development. This fellowship consists of written essays, three written case reports, 100 hours of vision therapy experience, a written examination and an oral interview.

Certification/Licenses Held By Practitioners

  • All optometrists must be licensed and certified by state and national board license exams and requirements.
  • There are no specific certification and licenses required for optometrists to practice developmental optometry; however, board certification for Developmental Optometry (F.C.O.V.D.) is highly regarded by the optometric community.
  • Affiliations and memberships to the College of Optometrists in Vision Development (COVD) and Optometric Extension Program (OEP) are also considered Developmental or Behavioral optometrists.

Professional Associations To Contact For Names Of Local Practitioners

  • College of Optometrists in Vision Development; 215 West Garfield Rd., Suite 210;
    Aurora, OH 44202; Ph: 330-995-0718; Fax 330-995-0719; Website: www.covd.org; Email: info@covd.org
  • Optometric Extension Program; 1921 E. Carnegie Ave., Suite 3-L; Santa Ana, CA 92705-5510; Ph: 949-250-8070; Fax: 949-250-8157; Website: www.oep.org

Number Of Certified Practitioners In U.S., Canada, And Mexico

  • Several hundred

What To Look For When Choosing The Best Practitioner

  • How well does the developmental optometrist interact with your child? Communication and trust between the child and the doctor/vision therapist is critical for the success of vision therapy.
  • Does the developmental optometrist have experience with similar problems that your child has? For example, not all developmental optometrists specialize in special needs, head trauma or strabismus (cross-eyed).
  • Look for consistency of relating and disciplining the children.
  • Look for a loving person with clear boundaries and solid communication skills.
  • Look for a convenient location. Vision therapy is only successful if you, the parent, can bring the child or youth in for consistent and regular sessions. If there is a will, there is a way.
  • Look for clear movement/instruction from the practitioner.
  • Look for emphasis on safety and injury prevention.

Research Papers

  • Pediatric Eye Disease Investigator Group. “A Randomized Pilot Study of Near Activities versus Non-near Activities During Patching Therapy for Amblyopia.” (ATS6) JAAPOS 9, no 2 (2005): 129-36.
  • Granet DB, Gomi CF, Ventura R, Miller-Scholte A. “The Relationship between Convergence Insufficiency and ADHD.” Strabismus 13, no 4 (2005): 163-8.
  • Scheiman M, Mitchell GL, Cotter S, et al. “A randomized clinical trial of treatments for convergence insufficiency in children.” Arch Ophthalmol 123 (2005): 14-24.
  • Maples WC. “Visual factors that significantly impact academic performance.” Optometry 74, no 1 (2003): 35-49.


The following books may be obtained directly from the Optometric Extension Program (OEP). (See: www.oep.org.)

  • Getman, G.N. How to Develop Your Child’s Intelligence. Santa Ana, CA: OEP/VisionExtension, Inc.
  • Getman, G.N. Smart in Everything… Except School. Santa Ana, CA: OEP/VisionExtension, Inc.
  • Bing, Lois, and George D. Spache and Lillian Hinds. Vision and School Success. Santa Ana, CA: OEP/VisionExtension, Inc.
  • Cook, David. When Your Child Struggles The Myths of 20/20 Vision: What Every Parent Needs To Know. Marietta, GA: Cook Vision Therapy Centers, 1992.
  • Richmond, Hazel and Dawkins. Suddenly Successful: How Behavioral Optometry Helps You Overcome Learning, Health and Behavior Problems. Santa Ana, CA: OEP/VisionExtension, Inc., 1990.

Helpful Tips For Parents

  • Allow your child to explore his/her world with all the senses: touch, smell, taste, hearing, and vision. This provides the child with sensory memory matches to objects seen visually. For example, an orange fruit: let the child explore the fruit and if the child is old enough, write a flash card that spells orange. Soon a child will be able to visualize the look, smell, taste, and feel of an orange just from the symbolic word “orange”.
  • Make sure your child has developed the ability to creep and crawl in a coordinated fashion using the right arm/left leg, left arm/right leg pattern. This helps develop a midline and ability to use both the right and left brain. If your child has difficulty creeping and crawling, get their eyes thoroughly examined. Depth perception and blurry vision can make the activity of creeping and crawling a frightful experience.
  • Have your child perform activities such as building blocks, wooden puzzles, coloring, tracing pictures with tracing paper, dot-to-dot pictures, mazes, hidden pictures, concentration game/flash cards. All of these activities develop visual processing skills of eye-hand coordination, visual closure (seeing completed pictures from fragments), visual figure-ground (seeing hidden images within a distracting background), visual memory.
  • Practice left to right/top to bottom eye tracking patterns. When you read with a child or youth have them use their finger to point from left to right/top to bottom with the sentence you are reading.
  • At the end of the day before bed, have your child or youth tell you about his/her day and see if they can get a mental image in detail of what they experienced for the day. For example, what the child ate for lunch or the clothes worn. This builds visual memory and visualization.

Biography Of Dr. Tanya Mahaphon, Author

  • Years Experience: 9
  • Approximate number of children and youth treated: over 200+
  • Degrees: B.S. in Animal Physiology and Neuroscience; Optometry Degree from Pacific University, College of Optometry
  • B.S. in Animal Physiology and Neuroscience from UC San Diego
  • Residency
  • Residency certification in Vision Therapy from SUNY, State College of Optometry

Dr. Tanya Mahaphon’s Personal Statement

I have seen numerous children’s and parent’s lives changed by vision therapy and it has been a blessing to be part of the process. Children who were non-readers become avid readers, failing students become honor students, poor self-esteem children become social butterflies, and frustrated parents become happy and proud parents again. Please see: www.visiontherapysuccessstories.com; and: www.pavevision.org.

To Contact Dr. Tanya Mahaphon, Who Contributed This Chapter

2291 Soscol Avenue; Napa, CA 94558; Ph: 707-253-7111; Website: www.eyespyvision.com; Email: eyespyvision@sbcglobal.net

Marie Mulligan’s Comment About Developmental Optometry: I have had many friends and children of friends who have been helped a great deal by Developmental Optometry.

Rick Geggie’s Comment About Developmental Optometry: Developmental Optometry is one of the most powerful tools in helping children be ready to learn. The time and expense are worth the investment. It works!

One adult client, who started the program totally unable to read, spell or write, thanked her Toronto-based Developmental Optometry practitioner for “giving me back my life; I want to name my soon-to-be born child after you”.

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