Posted by: Janet Hughes | August 31, 2009

AAP Vision Policy Gets NSF

j0284931Ever write a check only to have it returned NSF, Non-Sufficient Funds?

Banks issue NSF charges when account balances don’t cover the amount written on the check.

Today I’m issuing the vision policy by the American Academy of Pediatrics (AAP) my spin on NSF: Non-Sufficient Facts.

August 2009, the AAP updated their 1998 policy on learning disabilities, dyslexia, and vision.  The newly released policy statement made by top medical groups refutes vision therapy and the link between vision and learning for the fourth time in four decades. In other words, “Non-Sufficient Facts” abound here!

Here’s my list of the biggest “overdrawn” statements found in that AAP policy balanced by deposits:

1.) “Overdrawn” Statement: Children who exhibit signs of learning disabilities should be referred as early in the process as possible for educational, psychological, neuropsychological, and/or medical diagnostic assessments. (from Recommendations)

DEPOSIT: I’m surprised that in 2009, a possible vision problem isn’t ruled out first. It’s estimated that 80% of all learning comes through the eyes. Why aren’t complete eye and vision evaluations by vision experts such as those accredited with COVD included in this list with psychologists and neuropsychologists?

2.) “Overdrawn” Statement: Pediatricians and family physicians should perform periodic eye and vision screening for all children and refer those who do not pass screenings to ophthalmologists who are experienced in the care of children. (from Recommendations)

DEPOSIT: I’m surprised that in 2009, the AAP STILL recommends vision screenings in the medical home. The AAP 2008 Oral Health Policy recommends all children have a dental home by age 1, and that joint efforts be made with local dentists to support that dental home. The AAP is dedicated to the overall health of all children. Why doesn’t the AAP want to establish a VISION home for all children by age 1, and work together with the largest group of eye doctors—the optometrists?

3.) “Overdrawn” Statement: Other conditions may affect reading. Convergence insufficiency (CI) and poor accommodation, both of which are uncommon in children, can interfere with the physical act of reading but not with decoding. (from The Role of the Visual System and the Eyes)

DEPOSIT: Guess what. This policy also states: “The recommended vision screenings are unlikely to disclose near-vision problems such as convergence insufficiency, accommodative insufficiency, and significant hyperopia.” And the AAP recommends all children be screened in the medical home? The AAP policy references the latest study on CI from a medical journal but omits the publication from the Mayo Clinic. CI is uncommon in children? According to Mayo’s lead ophthalmologist and lead investigator in that study Dr. Brian Mahoney, convergence insufficiency IS common in children. Parents… KNOW that a vision screening is not a substitute for an eye examination. Read more about “Amy’s Law” here…

4.) “Overdrawn” Statement: Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavioral vision therapy, or special tinted filters or lenses, are not endorsed and should not be recommended. (from Abstract)

DEPOSIT: Oh my! Not endorsed and should not be recommended? It is unfair to the public to imply there is NO scientific evidence in support of vision therapy. Vision therapy does NOT claim to treat learning disabilities and dyslexia.  Vision therapy treats vision problems. Parents… there is evidence that vision therapy can improve a child’s vision. Check out these great success stories here…

5.) “Overdrawn” Statement: Ophthalmologists should identify and treat any significant ocular or visual disorder found to be present. (from Recommendations)

Deposit: Once more, why can’t the AAP work together with optometrists, too? I know pediatricians and ophthalmologists are medical doctors, and they refer to their own medical doctors but it’s the 21st century. Did you know the AAP enthusiastically promotes, supports, and protects breastfeeding? According to the 2005 policy, “the AAP firmly adheres to the position that breastfeeding ensures the best possible health as well as the best developmental and psychosocial outcomes for the infant.” Thanks to the AAP, I breastfed all five of my babies. The AAP did NOT do the breastfeeding. I did. Since the AAP partners with parents, and many parents value optometry and vision therapy, why can’t the AAP support optometric eye and vision care?

Fixing My Gaze by Susan R. Barry recounts fifty years of struggles with a vision problem until she discovered a behavioral optometrist. Thanks to a caring and competent eye doctor, vision therapy opened her eyes to a whole new world.

The 2009 AAP vision policy is filled with inconsistencies and misleading messages about children’s vision.

It is my hope and goal that pediatricians and ophthalmologists will embrace optometry and put the visual needs of children first.

Join the Kids Eyes Count Campaign!

  1. KNOW vision screening is not a substitute for an eye examination.
  2. MAKE comprehensive eye and vision examinations by an eye doctor part of a child’s health care.
  3. KEEP eye care health and good vision habits a priority.

Be on the Kids Eyes Count email list! Sign-up here… it’s free and easy!

Helpful websites:

College of Optometrists in Vision Development COVD’s website.

Wright’s Law Here you’ll find thousands of articles, cases, and resources for accurate, reliable information about special education law, education law, and advocacy for children with disabilities.

Protecting students with disabilities Frequently asked questions about Section 504 and the education of children with disabilities.

Helpful articles:

Learning disabilities, dyslexia, and vision: a subject review About the 1998 AAP policy.

The Toolbox Analogy The nuts and bolts of what optometry knows, education needs.

CB068069More about the 2009 AAP vision policy:

News from the American Optometric Association
Here’s what they have to say…

A flawed statement on vision therapy, learning and dyslexia reissued.

Statement on vision therapy outdated, flawed.

Photo Fixing My Gaze Book CoverOrder your copy of Fixing My Gaze by Susan R. Barry!

Susan recounts her struggles with learning as a child. Discover how she takes the medical establishment to task for not giving her parents the option of considering the benefits of optometric care.

A must read for anyone looking for hope and inspiration!

Order from Amazon here…

Copyright (c) 2009 Janet Hughes. All rights reserved.


  1. Thank you Janet for everything you do to expand our knowledge of children’s eye care issues. You are a visionary in this field. Thanks to you, our children’s futures will be brighter with more smiles on the faces of parents and their children.

  2. Dear Janet,

    Your blog is wonderful. The statement by the AAP is inaccurate, and it is good of you to discuss it.

    Thanks again for all you do. We have an uphill battle but we’re making progress.

    Sue Barry

  3. Hi Janet! Your blog is terrific!

  4. Rachael is speaking here
    Rachael is a certified orthoptist (retired) who has lived with the lack of binocular vision for the past 88 years of her life. From personal experience 8 surgical (unsuccessful) (no orthoptic training which should have been available to her during her early childhood development years in order to teach and/or train her how to use her two eyes together as one).
    Rachael has learned the hard way, but today rachael is the happiest 88 year old (actively engaged as founder of the Orthoptic/strabismus endowment fund at Duke University Eye Center and founder of the Marco “Eye-land” Eradicate Amblyopia Foundation). Learn more about her dreams and wishes for all children who today and in the future who are challenged with the lack of binocular vision and its associated complications like “Amblyopia” and anomalous retinal. Correspondence go to or call rachael at 239 642 6657 and learn more about her life and experience with strabismus which (to repeat) should have been detected (early) and treated by means of orthoptic therapy by a certified orthoptist and/or a COVT. Had she been blessed with vision therapy as Susan has her life would have been completely different. But thanks to my god whose love and peace transcends all human understanding rachael is still here and advocating that Vision traning and/or orthoptic theraphy (along with surgery if necessary) is the one and only way to Rehabillitate Binocular Vision.
    Please go to my website at: Your comments and blogs will be ever so welcome. On behalf of all kids who lack binocular vision, I thank you because you care.

    Thanks for listening. Look forward to hearing from you.

    Ever ever so sincerely

    rachael PIETRINI klein (orthoptist) retired

    e mail is
    2000 royal marco way
    hideaway beach
    marco island, florida 34145
    phone (239) 642 6657

  5. I took my son for his annual exam this summer, one year post diagnosis with CI and 6 months post vision therapy. The pediatrician asked if there were any changes in medical history and I told her of our “year of vision.” Over the years of struggling in school I had repeatedly asked for her advice and never had a referral for vision, even though one of his biggest problems was tics – blinking, eye pulling, restlessness in school. She had never heard of CI. How many parents, like me, turn to their pediatrician when their child is struggling? The AAP must need a vision intervention of its own (or fewer lobbyists from insurance companies that don’t want to pay for VT – I’ll bet the Mayo Clinic report sent a few of them running for the AAP). AAP – your stance on vision and learning does not provide your pediatricians with a complete picture on which to make judgements about children’s health. Just as some pediatricians choose to give multiple vaccinations in a visit and some spread them out, some will choose ophthalmologists and some optometrists for referrals. Both should be in your vision policy.

  6. Very direct!! Now if only everyone would work together for the children.

    You are an inspiration.

  7. Hi Janet,

    I am just amazed at the AAP’s updated policy. It is just unbelievable to think, that this is where they stand here in 2009. And then to think that they say “Ophthalmologists” should identify and treat any significant ocular or visual disorder found to be present.

    My daughter was referred to a Pediatric Ophthalmologist when she was in the 3rd grade. The ophthalmologist was extremely arrogant and then proceeded to tell me in a very condescending manner that my daughters eyes were perfect.

    Yet, when she was a Junior in High School she was diagnosed with a vision disorder where her eyes were operating at a 7 year old level… she was 16! She went through vision therapy, however, her struggles continue. I truely believe that if she would have seen an optometrist when she was in the 3rd grade, school would have been easier for her.


    We continue the fight here in Minnesota to change laws related to childrens vision, however, as you know, it is a very slow and arduous task.

  8. I enjoyed your take on the NSF acronym and the story is a good one.

    I would think that you could take an item like this and write it up for one of the optometric publications (Optometric Management, REVIEW of Optometry) where you would get a more widespread audience of optometrists to hear your message.

  9. I loved your article!

    Don’t give up the fight!

  10. Hi Janet, you have a fantastic blog. I really thank you for all that you do,

    happy weekend

  11. You go girl!! I appreciate your thoughtful and well thought out response to the continuing &*$%%*(&%^ from organized medicine. It sure would be great if we could all work together for the benefit of our patients….instead of a particular profession….

  12. Janet,

    Your info for parents is excellent as ever.

    I would like to add though that when it comes to the field of visual status and learning, ophthalmologists have little to no training in this area. Their specialty is in surgery and trauma.

    Pediatricians have even less background in this area. It’s no wonder then that these professionals don’t ever discuss this treatment option. They really have litte to no background to give accurate information to parents. Therefore, they just avoid the subject to the disadvantage of the patient.

    The true type of doctors these patients really should be seeing is a COVD affiliated optometrist. They’re the only type of doctor who is required to take continuing education in this field.

    Hopefully with the work you’re doing the public will learn what is best for their families.

    Keep up the great work!

    Dr. Tom Poswilko

    • I agree. I took my child to the opthamologist for 5 1/2 years and was told he could see fine. After starting school in the middle of first grade he finally was prescribed eye glasses because he had almost no binocular vision (from an optometrist). He has exotropia and strabismus so his eyes just do not work together. He has prisms in this glasses but they do not completely straighten his eyes. If the eye doctor had been on the ball at age 6 months he would have been prescribed glasses or at the very least eye exercises or equipment to start straightening his eyes.

      Another problem I have now is with the teachers many of whom refuse to realize his binocular vision is poor so he doesn’t see clearly. He can’t see but apparently many he encounters don’t care so it is a double whammy. The last time he had his eyes checked at age 8 he had some binocular vision which gives me hope that someday he may be able to see clearly. Imagine the results if this had been addressed in his first year of life?

  13. Janet — The AAP needs to be renamed — how about
    the American Academy of Pinheads? — sounds like some elite-ism going on here — doctors vs. non-doctors — well, one thing you can say about the AAP
    is that they’re consistent — hang in there!

  14. i do agree with your statement. but sir ophthalmologist is not ready to accept this thing in india. they do refrection dispencing and other thing which is not done.

  15. Dear Janet,

    So very many, many times I wanted to write you to absolutely congratulate you and encourage you in your attempt to upgrade vision screening and examinations…… so let me tell you why I have not done so.

    Over 50 years ago, as a member of the prestigious health council in Park Forest, I suggested adding just one test to the school screening….besides the monocular Snellen eye chart, a test to give us a clue how the 2 eyes coordinate.. the stereo test. It was immediately challenged and rejected. And the elite group were the pediatricians and the family doctors. They suggested a meeting with the local ophthalmologists which I encouraged and never took place. That discussion rested in limbo. That was 50 years ago.

    The good news rested in my newspaper column on eye care. It appeared week in and week out and resulted in the success of my local practice…it challenged the status quo over and over again. But the change in the vision screening never took place.

    That’s why I was and am overwhelmed at your perseverance and dedication to improve the vision screening. And the fact that a school entry form for vision has come about is remarkable… especially circumventing the pediatricians and family practitioners.

    When I came to your house at your last meeting, I felt I entered the twilight zone… like a rehashing of a discussion that took place 50 years ago. It proves that the discussion needs new blood,.and constant repetition…. and you’re doing it!

    You’re welcome to any of my writings.
    Keep up the good work.

    Dr. T.

  16. […] ago!  Blessing to my daughter Amy for passing her vision screenings.  Read more here… AAP Vision Policy Gets NSF August 31, 2009 Another post with many great comments. Read my list of  ”overdrawn […]

  17. […] wellness check-ups by a pediatrician should not be confused with eye care by an eye doctor. Even though the American Academy of Pediatrics recommends vision screenings for all children, parents need to know that a vision screening is not be a substitute for an eye examination. Vision […]

  18. […] Unfortunately, the American Academy of Pediatrics recommends all children have vision screenings. Read “AAP Vision Policy Gets NSF” here… […]

  19. Well, I am surprised that so much friction and antagonism persists. To demonstrate that there is a more collegial path: Many optometrists and ophthalmologists are working together on a multi-center, prospective, randomized study on treatment options for convergence insufficiency, building on the encouraging results of the CITT study. This study, sponsored by the National Eye Institute / National Institutes of Health is currently being designed by respected ODs such as Mitch Scheiman and Sue Cotter along with pediatric ophthalmologists under the PEDIG (Pediatric eye disease investigator grouo) organization.

    The attitude is: Whatever works can be proven to work. The AAP corollary that what hasn’t been adequately proven shouldn’t be supported will likely evolve once better evidence and more definitive clinical trials are available.

    The time and effort directed toward rigorous scientific investigation will pay off with better standardization of diagnosis and treatment. By having MDs and ODs work together, we’ll reach common ground.

  20. […] Unfortunately, the American Academy of Pediatrics recommends all children have vision screenings. Read “AAP Vision Policy Gets NSF” here… […]

  21. janet it is a real pleasure for me to take time out of my busy , but ever so self gratifying and more self rewarding passion (similar to yours) to continue on with our joint efforts to “eradiicate Amblyopial. god is with me all the way and results are phenomenal. in fact your will be delighted to know that rachael at the age of 91 is being blessed with the ability to see the world as you see it in three dimensions. please do not ever underestimate the miracles that god performs. Pray and have faith and ask and you will receive at the moment it is only intermittent. however i am applying the techniques that are explained in my patent with the us governmental “rachael pietrini visual training instrument and also working daily improving the strength and flexibility of my gross body muscles. miracles do happen and i will explain mine further when i hear from you. praise the lord “hallelujahs” it has all been a real challenge and an unbelievable experience. that is why i am blessed to “discover” early ” any problems of the neuro visual system that will place children at risk to develop amblyopia i earned my living treating it successfully as a professional orthoptistl. now it is my greatest pleasure to prevent “amblyopia” when are you comeing to hide-a-way and enjoy a little bit of heaven with me. you are welcome at any time and all the time.

    in the name of jesus\\(my friend who has blessed my past 91 years of life and still is blessing me in ever so many ways. praise the lord: HALLELUJAH’

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s


%d bloggers like this: