a snapshot…

In our office – as in most Vision Therapy clinics – Visual Perceptual testing has become a necessary step of the overall diagnosis.  The goal of testing seems to be analyzing the visual perceptual skills necessary for learning and living, in hopes of discovering areas of strength and weakness.   Conventional wisdom says this process provides a window into a patient’s perceptual world, which in turn, allows us to guide their treatment program while also providing benchmarks for overall developmental levels.  But is it really necessary?

Generally speaking, I’ve never been a big fan of perceptual testing.  Most probably because test taking was one my greatest academic struggles. While it’s agreed that testing remains the best available method for demonstrating progress in Vision Therapy, those results (good or bad) should be kept in perspective.  My argument for this is simple: testing is a snapshot, nothing more.

Whether one hour or three, perceptual testing batteries provide a minute cross section of a lifetime spent learning, calibrating and re-calibrating. Mitigating or aggravating factors during testing could be the patient’s mood, how much they’ve eaten and slept, personality conflicts between tester and patient, and how well they can perform at a doctor’s office while working with a complete stranger for a few hours looking at pictures and duplicating drawings.  There are also the intangibles to consider, such as sub-vocalization. Many patients have become so good at compensating by way of sub-vocalization, that their test results may produce false positives or other misleading results.  Some will argue that testing results (good or bad) provide information on how patients normally function, and I agree. Still, lots of kids I’ve met have literally talked their way through the tests, and done quite well. As therapists, we always try to factor in these compensations, but we’ve got our own set of filters to contend with while trying to remain objective.

You’re probably wondering if I’m about to provide a better solution, and I’m not.  I don’t have one.  My thought here is simply to remind myself (and the world) that testing is a snapshot, and should not be considered the end all, and be all.  Keep the results it in perspective. After all, if  insurance companies  judged our driving abilities on the snapshot of  our driver’s license testing at 16 years old, there would be no good drivers in the world.

More important than any test results are the patient’s quality of learning and quality of life.  Those are the areas they care about most.  Not the test results.


Posted on June 11, 2013, in From My Perspective.... Bookmark the permalink. 4 Comments.

  1. Hi Robert:

    I’m on the fence as far as testing goes…I see each of your points. The funny thing is, I’m the one in my practice that does the testing as well. We are a small office, so it’s just me. And what I like best about the testing isn’t the scores I get, but the two hour chance to observe a person doing the best they can in this situation. The insights I get for the VT I’ll eventually do with them – learning style, behavior or sensory issues, methods of organization….it’s all pretty fascinating. I sort of think of it as “pre-VT analysis”. Are there other, better ways to get this information? Undoubtedly, and I don’t have the answer either. I also find that the “numbers” really matter to a lot of people, especially parents and school systems. Probably most of us that do this work would fall on the other side of valuing observation more heavily. Thanks again for your blog. Jenni Roeber, COVT


    • Robert Nurisio COVT

      Thanks, Jenni. I too enjoy the observational pieces of testing. Certainly there is value there. My concern is more when too much emphasis is placed on test results, because truly even the perceptually solid kids can, at times, test poorly. We should always keep those results in perspective, since we are a profession built more on process, and less on product.


  2. Hi Robert and Jenni
    I agree with both of you. I admit to having distrust of testing results, and prefer to see the snapshot of what happened on a particular day at a particular time.
    When I was a senior in high school I wanted to take the SATs early – it was common at that time to take them more than once and submit the best results on college applications. They were being offered in a school district close to mine. On the day I took the tests I had a 102 fever, it was hot and humid (no air conditioning) and I got lost several times on the way to the testing site (you know how wonderful I am under stress!) Well I did very well, but I wanted to take them again in case I could do better. The second time I took them it was in my own school, a beautiful day, and I felt great. My scores were several hundred points LOWER. It’s hard for me to believe that I got “dumber” when the fever went away!


  3. Robert Nurisio COVT

    Thanks for sharing that story, Linda. You never fail to bring a smile to my face 🙂


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