Exercise for eyes puts life in focus By M.J. Place - Pittsburgh Post-Gazette – FYI - East
Thursday, March 30, 1995
To check Jonathan Van Bremen's progress, optometrist Dr. Hans Lessmann watches
the 8-year-old's eyes as he does an eye-strengthening exercise.
Sarah Maloney, a 16-year-old freshman at Oakland Catholic High School, and Johann Stamm, a 54-year-old mechanical engineer from Murrysville, have more in common than meets the eye.
"There were times as a kid that I would crawl into a corner and cry," said Stamm. "I would do anything to avoid reading."
Maloney, 16, almost didn't get into Oakland Catholic because her test score on an entrance exam was so low, but now she's doing well in school for the first time in her life.
"According to her previous test scores, she shouldn't be achieving what she is," said Sarah's mother, Sandi Maloney.
Maloney and Stamm, both patients of Swissvale optometrist Hans Lessmann, lack normal binocular vision. Their eyes, unlike most people's, do not work together as a team. This results in limited depth perception and causes the brain, since it receives a different image from each eye, to reject the one from the "turned" eye. Called suppression, the reflex can result in a permanent inability to use that eye.
The conventional treatment for crossed or turned eyes — strabismus is the medical term — is surgery.
But Lessmann and other optometrists who use what is known as behavioral optometry (also called functional or developmental optometry) believe that in many cases surgery is a temporary, ineffective and purely cosmetic solution.
"I have referred people for surgery, but I prefer to use visual training first," said Lessmann, 34, who has a bachelor's degree from Purdue University and a doctorate from the Pennsylvania College of Optometry in Philadelphia.
Recent studies have shown that the visual therapy for strabismus has a 75 percent success rate with children, which is about four times the success rate for surgery.
Optometrists concentrate on examining and treating the eyes for visual defects. They are doctors of optometry, not medical doctors. Ophthalmologists are physicians who specialize in eye diseases and surgery.
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A Swissvale optometrist puts the eyes of his patients through their paces in order to improve their functioning. The patients, many plagued by learning problems, say the alternative to surgery is a godsend.
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Behavioral optometry is a field that requires additional, advanced training. In the United States, it is practiced by about 12 percent of the 24,000 doctors of optometry.
The visual therapy techniques that Lessmann and other behavioral optometrists use are about 60 years old. They are based on the work of A.M. Skessington, O.D., who believed that good vision was the result of the relationship of the eyes, the brain and the rest of the body.
In 1987, Lessmann began working with noted behavioral optometrist Harry Wachs in a practice in Oakland. Lessmann bought the practice from Wachs three years ago and last year opened the Vision Development Institute in the Towne Centre Offices at Edgewood Towne Centre.
More and more, said Lessmann, people are turning to visual therapy as a safe, noninvasive way of treating eye problems, such as strabismus, amblyopia or "lazy eye," near- and farsightedness and astigmatism, the development of unequal curvature of the cornea.
"Distance acuity charts say nothing about the quality of vision, and it's the quality that counts," said Lessmann.
"Twenty-twenty is not perfect vision."
Lessmann said that there is an important difference between sight and vision. Sight, as he defines it, deals with the health of the eye and the ability to see clearly. Vision, on the other hand, entails the individual's ability to understand what he sees in an efficient and meaningful way.
Behavioral optometry seeks to identify problems in visual understanding, then uses a variety of techniques to help people learn or relearn the skills they lack. Some of the techniques appear deceptively simple and almost old-fashioned.
With one patient, 8-year-old Jonathan Van Bremen, Lessmann uses a simple length of string with different colored beads placed along it. The Brock String, created by Dr. Frederick Brock, gives the eye practice in near and far focusing and in teamwork.
In other exercises, the second-grader from Ohiopyle practices depth perception with glasses with red and green lenses, and walks a balance board while attempting to encircle a rubber ball suspended above the end of the board. Lessmann has also prescribed bifocals for Jonathan to "settle his eyes down."
His mother, Debbie Van Bremen, who travels two hours each way for her son's weekly treatment, believes the time is well spent. Like most parents who seek Lessmann's help, Van Bremen is concerned about her son's poor performance in school and his problems with learning to read and write. She brought him to Lessmann about a year and a half ago.
"Jonathan has very poor eye coordination and in kindergarten could only learn his colors," said Van Bremen. "Now, he's in a learning support class and doing better. Dr. Lessmann has given me a lot of support."
Stamm, who worked as a mechanical engineer at Rockwell International for 23 years, described his life with poor vision as "a little hell."
Because his eyes could not focus properly, Stamm experienced extreme bouts of motion sickness. While a student at Carnegie Mellon University — then Carnegie Institute of Technology—he was unable to flip through a card catalog without becoming nauseated. He also suffered from chronic headaches.
A few years ago, partly as a result of his long struggle with reading and other visual deficiencies, Stamm was depressed enough to qualify as a subject in one of the University of Pittsburgh's studies on depression. His therapist there recommended that Stamm try behavioral optometry with Lessmann.
"The change is unreal," said Stamm, who finished his 13 months of treatment with Lessmann in December.
He no longer needs to take large doses of Dramamine when traveling, has improved his eye coordination enough to use the mouse on his computer, and no longer is troubled with the depression and frustration he felt in the past. Stamm said he continues to use at home the eye exercises Lessmann taught him.
Sandi Maloney of Swisshelm Park is a mother who refused to take no for an answer when dealing with her daughter's problems. A severe head injury at age 2 had left Sarah Maloney with a host of physical problems, including impaired vision in her left eye.
Two eye surgeries and repeated visits to eye doctors did little to improve the girl's poor vision. Her academic performance and self-esteem floundered.
When Sarah was denied entrance to Oakland Catholic last spring because of her low scores on the placement test, Maloney insisted that her child be re-evaluated. Maloney knew that it was a lack of vision, not brains, that caused Sarah to do poorly in school.
Sarah started biweekly therapy with Lessmann in June and entered Oakland Catholic in September. A few months ago, she was nominated by the school for the Courage To Come Back award given by St. Francis Health System.
"Sarah told me that she feels smart for the first time in her life," said Maloney. "She's never given up."
Lessmann said that while behavioral optometry can't repair the damage to Sarah's eye, it can make her aware of what she is actually able to see.
"Asking Sarah to do school work without tools — that is, proper visual techniques — was like giving her only a screwdriver when the other kids had all the other tools," said Lessmann. "Now, she has the tools and the knowledge to express her core intelligence. She now feels a part of the world."
"I got a test back with a 94 percent on it the other day," said Sarah, a shy, brown-haired freshman. "I was shocked!"
Lessmann works with a team of three trained visual therapists who have backgrounds in education. One, Donald Deets, teaches science at Shaler High School and has been involved with behavioral optometry for the past 29 years.
Treatment involves anywhere from 24 to 150 sessions, depending on the severity of the problem. Most major medical plans, including Blue Cross and Aetna, cover the cost of treatments; most health maintenance organizations, however, do not.
"People don't understand the impact vision has on human performance," said Lessmann. "You can tell a person they are smart, but you have to arrange for them to succeed."
Jonathan Van Bremen walks a balance beam as he tries to encircle a twirling ball with a ring at the end of a stick. This is one of the visual therapy exercises Lessmann uses in his behavioral optometry practice in Swissvale.
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