Interview with Dr. Arnold Bierman, Optometrist
In response to a recent article of mine published in The Costco Connection magazine, “Untangling the Words: Dealing with Dyslexia,” I was contacted by Arnold Bierman, a behavioral optometrist from Lansdale, Pennsylvania (near Philadelphia). He wanted to share his observations over the last 49 years in successfully treating children and adults with reading and learning difficulties.
What does this have to do with dyslexia? I want to establish up front that dyslexia involves more than just difficulty with reading—it can affect hearing and speech, writing and motor skills, math and time management, memory and cognition, sense of direction and sequencing, and the list goes on. Dyslexia is caused by a difference in brain structure and processing of information and so there is no “cure” for dyslexia.
That said, the conversation I had with Dr. Bierman raised some interesting questions. Is it possible for a child to be diagnosed with dyslexia who may in actuality be suffering from a correctable vision performance problem, especially if they don’t have most of the other symptoms related to dyslexia? And for children that actually are dyslexic, could some also have a vision performance problem that, if corrected, could remove one obstacle to learning to read? In Dr. Bierman’s experience and observations, the answer is yes. So I asked Dr. Bierman if he’d be willing to answer some questions so we can explore this topic in more detail.
Don: What is your background, and when did you first get interested in eye function as a means to improve reading skills?
Dr. Bierman: I have been in private optometric practice for 49 years. During the first eleven years, I also taught at the Pennsylvania College of Optometry, which, for me, served as eleven years of continuing education. When I graduated high school, I had thoughts of becoming a child psychologist, as I always had an interest in children. During my teaching tenure, I tried to pick the brains of people who I felt knew more than I did in order to enhance my knowledge of visual function. I taught a course in case analysis and worked in the clinic overseeing student examinations of patients. My understanding of visual function as it relates to reading and learning ability increased over time.
Don: What methods do you use to determine eye issues? How is this different from the standard eye exam?
Dr. Bierman: I utilize a great deal of objective testing at close ranges, with me looking at eye movement skills and focusing reflexes, as well as subjective testing, with the patient responding to the demands of the test employed. I test for accommodative facility, which is the ability to shift focus from near to far, or vice versa. I also test the patient’s ability to both hold and relax focusing at near ranges. Conventional wisdom assumes that all one needs to do is to test for a prescription at distance, with near testing often totally overlooked within the confines of the examination.
Don: Can a person have 20/20 vision and still be suffering from a vision performance issue?
Dr. Bierman: Yes. The ability to see and the ability to perform visually are two separate entities. An individual can have 20/20 “sight,” and still suffer from the following:
- Difficulty with eye coordination—the eyes may be postured in an inward or outward direction. Eye coordination difficulties can cause an individual to frequently lose his or her place while reading, skip or substitute words, drop endings, or have problems with comprehension.
- Focusing ability—defined as the ability to sustain accommodation with the printed word. The inability to physically focus the eyes for prolonged periods of time will cause one to become bored or easily distracted.
- Focusing facility—defined as the ability to shift focus from near to far or vice versa. Children or adults with this problem will have problems copying from the board, following directions, or completing their work on time. This aspect of visual performance also affects one’s ability to take tests and answer the multiple answers provided.
- Laterality—a concept of “left” and “right”. People with poor laterality will frequently reverse letters and/or words; e.g. “b” for “d”, “was” for “saw.” Reversals may be common up to the age of seven, after which this issue would need to be addressed with visual training exercises.
- Visualization—the ability to “see” the word in the mind’s eye. People who cannot visualize words or letters are typically poor spellers. One can easily be taught to “visualize” with some simple exercises.
One exercise to teach visualization involves the following: Present the child (or adult) with a lined piece of paper and a pencil with an eraser. Say to the individual, “This paper is your chalkboard, and your back is my chalkboard. I want you to try to see what I am writing on my chalkboard.” At that point, the instructor inscribes an upper case letter on the student’s back. If the student writes the letter correctly on his paper, the instructor proceeds to write another upper case letter (in no particular sequence), and the student again writes the letter on his paper. If the student does not produce the correct letter, the instructor rubs the student’s back (as if the letter is being erased), and repeats the initial instructions. If the student is successful with upper case letters, the instructor continues with lower case letters. Success in this area can serve to easily eliminate reversals as the student becomes more efficient in visualizing the letters being written on his back. Words can then be written on the student’s back as well, enhancing the student’s ability to spell.
Don: How can a visual performance issue be treated?
Dr. Bierman: An individual’s visual performance problem can be treated with lenses that relieve the visual stress on the eyes at near ranges. This can be accomplished through the use of single vision lenses, bifocals, or yoked prisms. Depending upon the severity of the problem, visual training (eye exercises) can be utilized as an adjunct to the lenses prescribed. Prescriptions will vary dependent upon the severity of the visual performance problem.
Unlike traditional lenses which are used to correct blurry vision in patients who are far- or nearsighted, therapeutic lenses and prisms help to improve eye alignment, perception, spatial localization, posture, eye contact and both fine and gross motor skills.
Note about yoked prisms: A prism deflects or shifts light. The yoked prisms can change the phase or timing of light. Prisms in glasses can “fool” a person’s eyes into thinking they are working together without strain, allowing the eyes to relax and the individual to take in printed information more readily.
Don: If readers suspect a vision performance issue, what type of help should they seek in their area?
Dr. Bierman: If readers suspect a vision performance issue, they should seek the services of a “behavioral optometrist,” because not all eye doctors look for the above mentioned issues. The use of drops called cycloplegics (which may be routinely used during a visit to most optometrists) negates the possibility of evaluating visual performance because these drops do two things—first, they dilate the pupils, making it easier for the practitioner to evaluate the patient’s eyegrounds, and secondly, they paralyze the focusing muscles within the eyes, thereby eliminating any chance of assessing visual performance.
The Optometric Extension Program is an organization comprised of practitioners who have a concern for visual function, and may be able to recommend doctors in a given geographical area.
Don: What have you observed as the benefits to your patients?
Dr. Bierman: There was a study done at the University of Houston where students were given tasks to do with and without therapeutic lenses, while being wired up electro-physiologically. The students wearing therapeutic lenses showed a marked reduction in heart rate, respiratory rate and galvanic skin response. So one of the biggest benefits of vision performance therapy is getting the patient to relax. The elimination of visual frustration changes the quality of an individual’s life, enabling them to process more information within a shorter period of time. Similarly, the use of special lenses allows one to function at their maximum capability, increasing their academic success. I have many patients who were formerly considered to be slow learners, poor readers, or even dyslexic who proceeded to become honor students as a result of treatment.
Don: Do these therapeutic lenses need to be worn for life? Or will they fix the problem in a certain amount of time? Is there an average time for treatment?
Dr. Bierman: I often use yoked prisms to resolve visual performance problems. These lenses act to relax the individual’s focusing muscles, and make it easier for the individual to perform for prolonged periods of time. If you give an individual a more efficient way to perform, they deal with less internal stress, their self-confidence increases, and the need for the lenses diminishes over time. Depending upon the emotional set of the patient, lenses may be withdrawn after one year, or it may take several years to totally eliminate their use. Typically, these lenses do not cause the patient to become dependent upon them.
Don: I’d like to thank Dr. Bierman for taking the time to be interviewed and for his passion for helping children and adults read better. I’d love to hear your thoughts, readers, on whether you are curious about vision issues as they pertain to your (or your child’s) reading challenges.
About Dr. Bierman: Dr. Arnold Bierman graduated with honors from the Pennsylvania College of Optometry. He is a fellow of the American Academy of Optometry and a member of the American Optometric Association and the Pennsylvania Optometric Association. He was a clinical instructor and associate professor at the Pennsylvania College of Optometry and served for some years as president of the Eastern Pennsylvania’s chapter of the American Academy of Optometry. Dr. Bierman also served as visual consultant for Montgomery County Intermediate Unit’s preschool screening program for physically handicapped children for eleven years and was a member of U.S. Healthcare’s Eye Care Quality Assurance Committee from 1991-1999. He has been in private optometric practice since 1968, specializing in visual performance-related remediation of reading and learning problems in children and adults.