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Effects of a Vision Intervention Program on Intervention Program on Academic Performance

International Congress on Behavioral Optometry April 2010 • Ontario, California US A US A

Ai H Ch B O Ai Hong Chen, B Optom, PhD, F AAO, FCOVD - A

H d D t t f Head, Department of Optometry Faculty of Health S ciences Faculty of Health S ciences Universiti of Teknologi MARA k l UiTM Kampus Puncak Alam S elangor, Malaysia

Where in the World is Malaysia?

Now find Selangor, please!

I t d ti Introduction

 Vi i

l i t t l i th l i g

 Vision plays an important role in the learning process  Children need good distant vision to see the blackboard;

near vision is essential for reading and writing at a desk near vision is essential for reading and writing at a desk

 The ability of the visual system to maintain clear and

single binocular vision while changing focus from near to far and conversely is essential to insure the efficiency of the learning process

 Anomalies in the accommodative and vergence system  Anomalies in the accommodative and vergence system

could interrupt these skills and therefore affect the decoding (bottom-up) and comprehension (top-down) process during reading and learning process during reading and learning

I t d ti Introduction

B h h d di d h i

 Both the decoding and comprehension process operate

and interact with each other during the reading process

 Only one is ‘ dominant’ at any one time  Only one is ‘ dominant’ at any one time  The decoding process plays the downward role in letter

discrimination left-right fixation assembles the discrimination, left-right fixation, assembles the alphabet to form a word, and combines words to construct a sentence

 The comprehension process enables a reader to extract

meaning from text

I t d ti Introduction

Wh hild di h h ld b bl

 When a child starts reading, he should be able to

decode before the comprehension process takes place

 Any vision problems affecting the decoding process  Any vision problems affecting the decoding process

might j ust as well affect the comprehension process

 Therefore the role played by the visual system is  Therefore, the role played by the visual system is

essential for new readers

I t d ti Introduction

Ai f S t d Aim of S tudy

I hi d i i h h d l

 In this study we investigate the short-term and long-

term effects of a vision intervention program on academic achievement

 This addresses the question; if the visual system can be

made to operate more effectively, what impact would it h d i f ? have upon academic performance?

Methods

S ubj ect S ampling

M th d S bj t S li Methods • S ubj ect S ampling

R d li i d h h h

 Random sampling was carried out throughout the

S elangor (Malaysia) area under the approval of the Minister of Education

 20 schools were chosen with further approval from the

Education Department of S elangor

 Random sampling narrowed this to 8 schools and

approval was gained from the headmaster of each

 Consent letters were sent to parents and 85%

agreed for their children to take part in the proj ect

M th d S bj t S li Methods • S ubj ect S ampling

Child i Y 3 f h l l ifi d i

 Children were in Y

ear 3 of school, classified into two groups based upon their scores on year-end examinations of Y ear 2

 One group represented those with below average

academic achievement; the other with good academic hi t achievement

 S

• rting of subj ects was based upon scores in

mathematics and language skills mathematics and language skills

 Test scores less than 50%

were classified as low achievers achievers

Methods

Procedures

M th d P d Methods • Procedures

 All

ti i t gi i i t

 All participants were given a vision assessment

 Acuity  S

tatic retinoscopy (dry)

 Dynamic retinoscopy  Direct ophthalmoscopy  Vergence ranges

g g

 NPC  Phoria posture  Randot stereopsis

Randot stereopsis

 Accommodative ranges and facility  S

accades (DEM)

M th d P d Methods • Procedures

(Vi i i d)

 (Vision assessment continued)

 Gross motor skills (S

tanding in S now Test)

 Fine motor skills (Grooved Pegboard)

( g )

 S

patial Orientation S kills (Gardner Reversal Frequency Test)

 Visual Motor Integration S

kills (Beery VMI)

 Vi

l P ti (S b t f K f A t B tt )

 Visual Perception (S

ubsets of Kaufman Assessment Battery)

 Detroit Test of Learning Aptitude (DTLA)

M th d P d Methods • Procedures

78 ‘ l hi ’ h d b f h

 78 ‘ low achievers’ were approached to be part of the

intervention study: 50 males – 28 females

 They were assigned evenly into three groups (n 26) and  They were assigned evenly into three groups (n=26) and

matched in age, gender, ethnicity, and visual perception status

 Experimental Group  Hawthorne Group  Control Group

M th d P d Methods • Procedures

Th i l i i i l d d i i

 The visual intervention program included: prescription

lenses; binocular vision therapy; and, perceptual training

 Intervention was carried out over a period of 3 months;

July – S eptember 2002

 Therapy consisted of 8 total hours of preplanned

procedures

 The Experimental Group subj ects were assigned into

subgroups of perceptual therapy based on the processing mode and speed processing mode and speed

M th d P t l Th Methods • Perceptual Therapy

Si lt S ti l S d Th Simultaneous Sequential Speed Therapy High High High S pecific deficits Low Low Low All processes High High Low S peed Low Low High S equential- S imultaneous High Low Low S equential High Low Low S equential High Low High S equential - S peed Low High High S imultaneous h l d Low High Low S imultaneous - S peed

Methods • Perceptual Therapy for E i t l G Experimental Group

T f Th N b f S bj t Types of Therapy Number of Subjects S imultaneous 6 S equential-simultaneous 5 All processes 4 S imultaneous - speed 3 S peed 2 S peed 2 S pecific deficits 2 S pecific deficit - speed 1 l d S equential - speed 1 S equential Total 24

M th d P d Methods • Procedures

Ni i i l d i i i h

 Nine optometrists were involved in supervising the

therapy all following a set protocol designed by the author

 Overall completion times ranged from one month to two

months and from 4 sessions to 8 sessions

 This variation was largely due to absence from school

and the need to work around scheduled classroom examinations examinations

M th d P d Methods • Procedures

Th i d h H h G i i h

 Those assigned to the Hawthorne Group spent time with

a non-optometrist doing activities such as sharing stories

• n visual hygiene and eye-care, storytelling, random

painting activities or time socializing with each other

 Those in the Control Group remained ‘ untouched’ – no

ti it i activity was given

Results

Analysis

R lt A l i Results • Analysis

All d l hi d ll d i Y 3

 All students were low achievers and enrolled in Y

ear 3

• f their studies

 Only test scores for Mathematics and Language (Malay)  Only test scores for Mathematics and Language (Malay)

were used in the evaluation of school achievement

 Only national-type (public) schools were used in the  Only national-type (public) schools were used in the

study as Malay represented the language of instruction and such schools follow a standard curriculum

 All students were matched on age, gender, ethnicity,

and visual perception status

R lt A l i Results • Analysis

E i i ll d i fi f h

 Examination scores were collected twice; first for the

short-term effect and second for the long-term effect

 The short term effect was assessed within a month after  The short-term effect was assessed within a month after

completion of the vision intervention program; results were taken from the Y ear 3 final examinations

 The long-term effect was assessed 9 months after

completion of the vision intervention program; results were taken from the Y ear 4 mid year examinations were taken from the Y ear 4 mid-year examinations

Results

Visual Processing

R lt Vi l P i Results • Visual Processing

I l bl d b i

 In general, process problems seemed to be twice as

common as specific deficit problems

 S

imultaneous related visual processing problems such

 S

imultaneous related visual processing problems, such as simultaneous, sequential-simultaneous and simultaneous-speed was relatively more common and d b t 54% f th ti i l i made up about 54%

• f the entire visual processing

concerns

 S

peed related and sequential related processing

 S

peed-related and sequential-related processing problems were 27% and 23% respectively

Results

Academic Outcome Measures

R lt A d i Results • Academics

S d i h E i t l G h d

 S

tudents in the Experimental Group showed a statistically significant improvement in Mat hemat ics in

long t erm measures (p=0.04), but not in short term

measures

 S

tudents in the Experimental Group showed a t ti ti ll i ifi t i

t i L kill

statistically significant improvement in Language skills

in short t erm measures (p=0.02) but not long term

measures

R lt A d i Results • Academics

S d i h H th G h d i i ll

 S

tudents in the Hawthorne Group showed a statistically significant improvement in Mat hemat ics in both short term measures (p=0.002) and long term measures (p=0.01)

 S

tudents in the Hawthorne Group did not show a t ti ti ll i ifi t h i L kill i h t statistically significant change in Language skills in short term or long term measures

R lt A d i Results • Academics

Child i h C t l G did h

 Children in the Control Group did not show any

statistically significant improvement in Mathematics or Language S kills on short term or long term measures

Conclusions

In a controlled study of year 3 low achieving students where a match was made on age students, where a match was made on age, gender, and visual perception status, those who went through a vision intervention g program showed statistically significant gains in academic performance (mathematics and language skills) when compared to a control group of students.

T ti hild Testing children

T ti hild Testing children

T ti hild Testing children

A k l d t Acknowledgements

This project is part of a larger multifaceted study This project is part of a larger multifaceted study This project is part of a larger multifaceted study This project is part of a larger multifaceted study funded by the funded by the Malalsia Malalsia Ministry of Ministry of Science,Technology Science,Technology, and , and Innovation, IRPA Grant Number 06 Innovation, IRPA Grant Number 06-

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A k l d t Acknowledgements

P i A h

 Presenting Author  Willard B. Bleything, OD, MS

, F AAO, FCOVD, DPNAP

i i i h d i i f f O d bli

 Dist inguished Universit y Professor of Opt omet ry and Public

Healt h, Emerit us-in-Residence

 College of Optometry

 Pacific University  Forest Grove, Oregon  US

A

Assoc Prof Dr. Ai Hong Chen chenaihong@ salam.uitm.edu.my