Seeing Clearly To Think Clearly

Theresia Goeppner of Jasper held out two pencils, each with a column of letters on it, at different distances to work on accurate eye movements as development and behavioral optometrist Dr. Joan Bauernfiend observed in her office at the Vision Development Center in Jasper on May 22. Bauernfiend offers vision therapy, which instead of focusing solely on an individual’s clarity of eyesight also focuses on the individual’s ability to interpret information from the environment. An individual with a dysfunctional visual system in which the brain isn’t properly interpreting what the eye sees suffers from the amount of extra effort and energy it takes to get her visual system just to function. Bauernfiend works to help individuals correct the system and use their energy more efficiently.

Story by Claire Moorman
Photos by Dave Weatherwax

They seemed like simple enough tasks — reading a line of sheet music, taking a test at school, walking through the mall with friends — but they had the capacity to send Theresia Goeppner to the emergency room.

The Jasper High School senior, now a freshman at Vincennes University Jasper Campus, had nearly run out of options by the time she and her mother, Judy Heller, walked through the doors of Dr. Joan Bauernfiend’s office this past spring. Heller had spent the past several months taking her 18-year-old to family doctors, chiropractors and even cardiologists, all just to find out what was causing her frequent panic attacks and serious headaches.

“I actually took her into the hospital because she was having an anxiety attack,” Heller said. “She was a real mess.”

It wasn’t until Goeppner told the family doctor, Norma Kreilein, what she had been doing right before her most recent panic episode — trying and failing to comprehend the questions on a pop quiz at school — that the light bulb went off.

It was her vision.

And it wasn’t just any vision issue. Theresia had complained of blurry eyesight earlier in the year and optometrists had made small adjustments to her contacts prescription. She made sure to wash her hands before touching her eyes to avoid contaminating the lenses with oils. Nothing had helped, and the blurry eyesight symptoms eventually had given way to the larger health concerns.

Now, Theresia and her family had at least the beginning of an answer. It seemed as if she had an ineffective visual system that was the likely culprit behind her lifelong struggle with reading comprehension.

While participating in Jasper High School marching band, Theresia often noticed that her eyes would move and blink a lot as she tried to focus on the notes on her sheet music. This often would cause her to tire quickly and even feel dizzy. Then a senior, Theresia rubbed around her temple as she tried to play with the band May 14.

“I noticed back in middle school that she didn’t comprehend like she should, so I would read out loud to her and then she would read out loud,” Heller said. “If she hears it, she can process it, but she can’t do it with her eyes.”

Kreilein referred the family to Bauernfiend, a 31-year-old doctor specializing in a field that many in the area don’t yet know about. She has been working in the Gunderson Eyecare office since September 2009 after a yearlong residency at Nova Southeastern University in Fort Lauderdale, Fla.

The Southridge High School graduate, formerly Joan Harpenau, knew right away she wanted to work in optometry, but it wasn’t until she began studying for her undergraduate degree at Indiana University in Bloomington that she truly found her passion for the relatively unknown field of vision therapy. It was one young patient she treated during school who gave her the final push.

“I was going to put drops in his eyes, and he asked me, ”˜Are those drops going to make me smart?’ I wasn’t quite sure what to say,” Bauernfiend said. “I thought about him and I thought about how he understood that his vision was keeping him from being successful. He was already a step ahead of me as far as knowing really what vision is.”

Now, as a vision therapist, Bauernfiend evaluates her patients — who range in age from about 5 years to adults and come from as far away as Evansville and Paoli — with a typical eye test. But instead of simply checking for blurred vision, she watches closely as patients attempt to move their eyes together to follow an object and observes their range of vision before an object becomes blurry or doubled. Someone who cannot track with his eyes likely suffers from an defective visual system, which can create a whole host of other problems.

“When you have an inefficient system, you have to put a lot of energy into just the basics of seeing something clearly, seeing it singly and being able to interpret that information efficiently,” Bauernfiend explained. “Because of the amount of effort a person has to waste on getting their system working right, it’s an incredible amount of stress. There are certain behavior signs: meltdowns after school, battles with homework.”

Helping these children, many of whom have been called stupid for much of their lives or are erroneously put on attention-deficit medication to curb their outbursts, is Bauernfiend’s ultimate goal.

On the wall of Bauernfiend’s office are optometric Hart Charts, which are used to work on tracking ability. She has the patient call out the letters and numbers in specific patterns of increasing complexity. This helps train the individual in organization and self-monitoring for correctness. Making a mistake, realizing it and correcting it shows a higher ability of visual processing than making a mistake and never realizing it.

“I want people to know that before I am a corporation or a company or a doctor, I’m a person and a mom and we’ll figure it out,” Bauernfiend began, tears welling up in her eyes. She and husband Adam have a 1-year-old daughter and another baby on the way.

“It’s not that the kids are lazy, that they don’t try, that they’re unmotivated, that they just don’t like to read, that they’re just not good at school and that’s how it is. All of these kids are intelligent kids, they just have specific certain struggles. ... That is their normal, and it’s hard for adults, teachers or parents to put together that it might be something visual and it’s not attention or any other learning issue.”

And that’s why it was important for Bauernfiend to bring her services back to her home county where many children with vision problems have gone untreated as a result of the lack of therapists in the area. The nearest specialists are located in Evansville, Owensboro and Indianapolis.

“Kids here need it just as much as the kids in big cities,” she said.

Theresia and Heller had to travel only a few miles to Bauernfiend’s office for their frequent morning appointments. They started their 32-session process with a preliminary evaluation. Theresia tracked a pen with her eyes while Bauernfiend rapidly fired questions at her.

“What time did you get up today?”

“Seven,” Theresia said quickly.

“What did you have for breakfast?”

A short pause, and then, “A Nutri-Grain bar.”

“What is eight plus five?”

Before Bauernfiend begins a therapy session with a patient, she has to conduct an initial evaluation to assess the patient’s needs and severity of visual problems. Bauernfiend conducted an initial evaluation with Theresia on May 6. Theresia’s mother, Judy Heller, sat in on it.

A much longer pause. Theresia let out a nervous giggle as she tried to keep her eyes focused. Finally, she whispered, “Thirteen. That was hard.”

“That was supposed to be hard,” Bauernfiend responded.

Bauernfiend often begins her biweekly sessions with patients by having them read off a list of letters or numbers. Then, she increases the difficulty by asking them to read the list to the beat of a metronome.

“You can’t imagine how hard it is for them now to do the exact same thing they already did,” Bauernfiend said. “They have to get that mental organization done every beat. They’ll call N’s for nines.”

She can tell if a patient is improving based on how often the patient is able to catch and correct his mistakes in future sessions.

“Seeing a mistake, correcting and continuing takes more of a determination, more of a confidence than doing it all perfect and never doing it wrong,” Bauernfiend said.

Each day for a few months, Theresia would return home from school to do her class homework as well as 15-minute vision homework from Bauernfiend. One of her assignments was to hold a pencil straight ahead at a normal reading distance and align it with a small target that was at least 11 feet away. She then had to alternate looking from the pencil to the distant target and back again as quickly as possible, while slowly moving the pencil closer to the eyes. When the pencil began to double, she would move it out to a normal reading distance again and repeat the procedure.

Another was to look at a series of pictures of dogs, cats and ducks, and instead of calling out the name of the animal, Theresia would call out the sound it makes.

In between at-home practices with her mother, Theresia would return to Bauernfiend’s office a couple of times per month to perform the activities in front of the doctor. A ball hanging from the ceiling of the office swung in front of her head. It was Theresia’s task to read symbols from the side of the ball as it moved closer to and farther away from her.

Between regularly scheduled appointments, which are typically once or twice a week depending on the patient, Bauernfiend often asks her patients to work on specific activities at home. Theresia worked on an activity with the help of her mother in the family’s living room July 29.

After weeks of therapy, Bauernfiend could not be completely sure that a visual problem was behind all of the health struggles Theresia experienced throughout her senior year of high school. She told the family she was pleased that the patient began performing better on her schoolwork and controlling her anxiety as she started her college coursework in the nursing program. Theresia said she and her mother were relieved that at least most of her pain and panic had subsided.

“This last anatomy test, I got a 94 (percent) on it,” Theresia proudly told Bauernfiend of her VUJC coursework at her final evaluation in September. “I know I can critically think deeper and work through the answers. I can memorize a lot better. Before, I would forget it when I saw the test. I guess I just get the hang of it more easily.”

For Bauernfiend, her battle to gain acceptance and awareness of her practice will continue, but the results are worth the work.

She told Theresia, “I just wish there was somebody there for you when you were younger to figure this out for you so it wouldn’t have had to get where it did.”

Bauernfiend’s office is tiny, filled to the brim with equipment to exercise the eyes, but she is proud of what she has built in an effort to help her fellow Dubois County residents. She will soon move to a larger suite on the lower level of the office.

“When you look at these kids and the disparaged look on their faces and the parents who are like, ”˜I don’t know what else to do,’ it’s just a big struggle for them. When I see certain things and I know exactly how to help, everybody just takes a breath,” she said. “It’s really powerful. It’s really amazing.”

Contact Claire Moorman at

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