Looking Ahead – Vision Therapy as a Related Service in WA Special Education Law

Cedar Law, PLLC, recently won a case on – among other issues – a novel question of whether vision therapy can be required for FAPE in Washington state. Although new to our jurisdiction, other states have historically recognized vision therapy as a related service if a student’s visual impairment has an adverse effect on the student’s education.

FACT SUMMARY

In our case, the parents had been concerned about the Student’s vision since she was in first grade. When she was in second grade, the student did not pass the school vision screening, and consequently, the Parents obtained an outside vision evaluation at Alderwood Vision Therapy Center. At the evaluation, the student presented with blurry vision, farsightedness, and astigmatism. Further, her eyes were not tracking properly. (“Tracking” refers to the eyes’ ability to follow along with the words on a page.) The student also experienced stereopsis, which resulted in her left eye intermittently turning off and on, which occurs when the brain suppresses input from one eye in order to avoid double vision. Additionally, the student had convergence insufficiency, which meant her eyes had difficulty turning, aiming, and focusing on the same point. She would often look at words with her peripheral vision, rather than looking straight on, resulting in additional blurring.

The Student was prescribed glasses, and weekly vision therapy to train her brain and eyes to work together, with the goal to teach her eyes how to focus and learn to see with both eyes.

Dr. Torgerson, a Doctor of Optometry, and owner and director of Alderwood Vision Therapy Center, opined at the due process hearing that vision is more than just eyesight; it is the intake of information, processing of information in the brain, and action that comes from that. Components of vision include depth perception, eye teaming, and focusing.

The finding of facts includes additional statements by Dr. Torgerson:

After one year of vision therapy, the student’s progress was “unreal” according to Dr. Torgerson. The student was able to read a horizontal listing of numbers faster and with many fewer errors than when she started. Her vision was much closer to normal after the treatment than before. When she left treatment, the student’s vision skills regressed, and Dr. Torgerson recommended nine months of further treatment in order for her vision to improve and stabilize.

Of note, Dr. Torgerson was not aware of school districts in Washington that work with vision clinics to provide vision therapy to students. However, her colleagues in California do see districts working with clinics to provide vision therapy services to students.

Starting in second grade, the Student received vision accommodations from the District, including a slant board and large-print worksheets. The District did not offer to provide SDI in vision and the Parents did not know to ask for such a service. The Mother did ask the District if it could pay for vision therapy, but was told it was not something the district would pay for. The District responded that they were not sure what else the student could need, or how they could serve, as the student was achieving 20/20 vision and did not require the use of braille.

The Parents also provided the District with the student’s vision records prior to an IEP meeting. The “team considerations” noted:

This was the first mention of vision therapy in the Student’s IEPs.

The District’s assessments included in the 2020 reevaluation were conducted virtually. The medical/physical evaluation was conducted by the school nurse who gathered information from a conversation with the parents. The Student’s vision and hearing were not screened as part of the medical/physical portion of the evaluation. The nurse noted, under vision diagnoses that the Student had passed a District vision test in November of 2018.

She also noted:

The nurse also noted that the student’s other diagnoses caused her to pose a risk of “self-directed violence,” as well as frustration, self-doubt, and discouragement, among many other potential adverse impacts on educational performance.

The District Teacher for Students with Visual Impairment assessed the student in the area of vision. The assessment was based on reports from the student’s vision doctor’s report. The assessment noted that the Student’s glasses work well and noted the recommendation to continue vision therapy, in order to work on the Student’s eye-teaming, tracking, and focusing to support easier near-vision for writing, reading, and screen time.

LEGAL ANALYSIS

In her Findings of Law, Judge Becker held that once the Student qualified for special education services in reading, vision therapy became a necessary related service.

Under WAC 392-172A-03090, an IEP must include a statement of the special education and related services that are to be provided to a student to enable the student to advance appropriately toward attaining annual goals, to be involved in and make progress in the general education curriculum, to participate in extracurricular and other nonacademic activities and to be educated and participate with other students, including nondisabled students.

Judge Becker cited to In re: Student with a Disability, 24 IDELR 612, 24 LRP 3894 (SEA VT 1996):

Judge Becker stated that the determination of related services that are required for a student with a disability, including vision therapy, depends on the unique circumstance of the child. In this case, “the evidence that the Student required and continues to require vision therapy in order to access her education is persuasive and uncontroverted.” Judge Becker ultimately ordered the District to provide compensatory education, vision therapy, vision examination expense reimbursement, and in-person SDI to include prospective vision therapy to be provided at Alderwood Vision Clinic.

CURRENT

The Student is currently receiving (District paid) Vision Therapy at Alderwood Vision Center in Lynnwood, WA and is making weekly progress in continuing to strengthen her eyes and process information.  Parents have already reported growth in the student’s academic ability and personal confidence.

ABOUT VISION THERAPY

Vision therapy can be recommended by a doctor as an individualized treatment program designed to correct visual-motor and/or perceptual-cognitive deficiencies. Depending on the deficiency, the therapy may include procedures designed to enhance the brain’s ability to control eye alignment, eye tracking, eye focus and movements, and visual processing.

Under WAC 392-172A-01155, a related service means:

Transportation and such developmental, corrective, and other supportive services as are required to assist a student eligible for special education to benefit from special education, and includes speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, early identification and assessment of disabilities in students, counseling services, including rehabilitation counseling, orientation and mobility services, and medical services for diagnostic or evaluation purposes. Related services also include school health services and school nurse services, social work services in schools, and parent counseling and training.

However, the specific services listed in the WAC are non-exhaustive, and related services “broadly encompasses those supportive services that may be required to assist a child with a disability to benefit from special education.”[1] Further, the decision reinforced and supported that vision therapy is sufficiently research based to be ordered, in an appropriate case, as a related service for a child with a disability.[2] It is worth making the distinction that a school district will not pay for eye related medical services, including vision examinations relating solely to the student’s glasses or the cost of glasses. However, as a necessary medically and educationally related therapeutic service, districts can add vision therapy to a student’s IEP, if the student requires vision therapy to access their education. Parents are encouraged to work with their District IEP team to determine if this service could strengthen their student’s visual processing skills and/or to contact Cedar Law with any questions or concerns.

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[1] Cedar Rapids Community School District v. Garrett, 526 U.S. 66, 119 S. Ct. 992 (1999)

[2] Maine School Administrative Dist. #72, 53 IDELR 207 (SEA ME 2009)