Vision and Learning

C.O.V.D. presents August is Vision & Learning Month

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Each year, the College of Optometrists in Vision Development promotes August as Vision and Learning Month. What’s this all about?

With school starting soon, it’s an excellent time for an eye exam. After all, up to 80% of learning comes through the visual system. The problem parents and their kids run into is that many kids have “20/20” visual acuity (meaning they can read the smallest letters on the eye chart) yet still have vision problems that can get in the way at school.

What type of eye doctor evaluates the 17 visual skills necessary for school success? A Developmental Optometrist specializes in testing and treating all of the visual skills necessary in the classroom. Seeing clearly and having healthy eyes (which is tested by your primary care optometrist or ophthalmologist) are important, but just a starting point.

Classroom tasks and required visual skills downloadable chart

  • Eye teaming problems can cause a person to skip words or lines when reading, or miss small details such as word endings, math signs, etc.
  • Trouble aligning the two eyes when looking at close objects can result in tired eyes, falling asleep reading, reduced reading comprehension, headaches, or just slow reading.
  • The two eyes not teaming well can make depth perception difficult, which can show up as trouble catching or hitting a ball. Poor depth perception can also make driving difficult (moms and dads!), especially making that tricky left turn across traffic lanes.
  • Kids with eye coordination problems can often look like they have ADHD– there’s a big overlap in symptoms. If your eyes hurt when you try to read or do written work, it’s common to be looking out the window instead!
  • Kids with visual processing (visual perception, visual motor integration) difficulties might struggle with reading comprehension; understanding graphs and charts; understanding math concepts– both arithmetic and geometry; or following instructions.
  • See a longer list of vision symptoms that can interfere with school.

Fortunately, nearly all of the visual skills necessary for learning can be developed and improved. Learn more about improvements kids have made here and here.

There’s still time– schedule your child’s back-to-school eye exam today!

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Vision Problems Masquerade as Learning Disabilities

It is important to understand that while our eyes take in visual information, that information is sent to the brain where it is processed. If the information that is sent to the brain is faulty, it can make learning very difficult.

While learning disability websites list a variety of accommodations that can help children with Visual Information Processing Disorders, it is important for parents and educators to understand that these are signs that a correctable vision problem is playing a role in a child’s learning challenges.

Many individuals with learning disabilities also have ADHD (Attention Deficit Hyperactivity Disorder). One of the signs that a vision problem may be contributing to one’s learning challenges is a short attention span when it comes to reading and near work. This behavior could easily be mistaken for ADHD.

A study published in the November 2013 issue of the Journal of Attention Disorders states that “attention and internalizing problems improved significantly following treatment for     Convergence Insufficiency.” Convergence insufficiency is an eye coordination disorder which can make reading difficult and cause symptoms such as eye strain, double vision, loss of concentration, and frequent loss of place when reading and working up close, all which play a negative role in learning.

The National Eye Institute of the National Institutes of Health recently funded a 5-year, 8 million dollar study called the Convergence Insufficiency Treatment Trial – Attention and Reading Study (CITT-ART).  This will be a national multi-center clinical trial that involves optometry, ophthalmology, psychiatry, and education in evaluating how this eye-teaming problem impacts a child’s attention and reading performance.

These studies are very exciting because we are sure they will prove what we have seen in our patients over the years: Vision problems, including eye coordination and eye movement disorders, can and do impact the ability to read and pay attention. We are able to help children and adults.

For more information visit our website: http://www.VisionTherapyDC.com

Does your child play soccer or football?

kid soccer headerWhen your daughter is on the soccer field heading a ball, she may help win the game, but she may actually be hurting her brain. While most parents know that their child is at risk of a head injury when playing football, a lot of people don’t know that head injuries can occur even with a helmet from the impact. Also, soccer is also one of the top sports that can also result in head injuries.

A recent study found that 85% of concussions go undiagnosed. Another study found that nearly 63 percent of varsity soccer players had symptoms of a concussion at some point, but only about 19 percent actually knew it. The reason this can happen is because you do not have to lose consciousness to have a concussion, so most players will experience a blow to the head and get right back into the game. However, repeated blows to the head can accumulate and cause just as much damage as a concussion.

When someone has a head injury they typically have vision problems that can be small boy footballtemporary or permanent. When a vision problem is causing or contributing to a problem with reading, balance or movement, the recovery process will move very slowly until the visual component is treated.

Visual rehabilitation is vital, as soon as possible. There are a variety of symptoms which are involved in Post Trauma Vision Syndrome, including:

  • Blurred vision, especially when reading
  • Headaches
  • Double vision
  • Pain in the eye or eyes
  • Poor reading comprehension
  • Sensitivity to light
  • Loses place when reading
  • See a complete checklist of symptoms

boy footballIt should also be noted that sometimes symptoms of a concussion might not even appear for days, even weeks after the accident. Some symptoms may last only seconds, while others linger much longer, months and even years. Additionally, some symptoms might disappear after time, such as eye pain or headaches, and yet other symptoms remain, i.e., blurred or doubled vision. Keep in mind, that when someone is experiencing any of the above symptoms they could also have difficulty with reading and learning, as well as physical activities.

Head injury patients with resulting vision problems are very similar to patients we see at our office who have vision problems that interfere with reading and learning. Vision therapy is very effective at eliminating blurry and/or double vision, focusing problems, poor concentration, and reduced comprehension, to name a few, when they are due to a vision problem.

If you or your child have had a blow to the head, or suspect Post Trauma Vision Syndrome, call us today at 301-951-0320 to schedule a vision evaluation and get on the road to recovery.

More Reasons Your Child Needs an Eye Exam, Not a Vision Screening

The most recent Review of Optometry has three news items emphasizing the importance of infant and child eye and vision evaluation– not just a screening done by the pediatrician or school nurse.

The first describes how retinoblastoma, a rare but potentially fatal eye cancer found in children, can be detected by the appearance of a white pupil in baby photos. It used to be thought that early stage eye cancer couldn’t be detected this way, but a recent study found that early disease in a child as young as 12 days can be visible as a white pupil.

When treated early, retinoblastoma is often curable.

Next, a new study shows that in children with autism, changes in visual behavior can be

Using eye-tracking technology, researchers found that infants later diagnosed with autism showed a decline in attention to others’ eyes by two to six months of age.

detected in the first few months of life. The children that were later diagnosed with autism started out showing normal eye contact with caregivers, but over the next several months their eye contact decreased. Decrease in eye contact began somewhere between two and six months of age. Since the social interaction (eye contact) started out intact, it suggests that there may be another opportunity for early intervention in autism.

Finally, researchers in Sweden discovered that children born before 32 weeks gestational age had a much higher– up to 19 times– risk for retinal detachment by adolescence or young adulthood. The risk for retinal detachment increased with age. So for children born prematurely, it’s very important to have annual dilated eye examinations. It’s also critical to know the signs and symptoms of a retinal detachment: sudden onset or sudden increase of floating spots in the vision, which may look like hairs, cobwebs, or debris in the visual field; flashes of light in the affected eye; and what may look like a curtain or shadow over part of the visual field. If a person notices any of these symptoms, it’s critical to contact an eye care provider immediately. A retinal detachment is an emergency, and the sooner it can be repaired, the more likely the person’s sight can be saved.

If you have any concerns about your child’s developing vision, the first step is a comprehensive eye and vision evaluation. The American Optometric Association sponsors a public health initiative called InfantSEE, which provides no-cost examinations to children between 6 and 12 months of age. Infantsee.org can help you find a participating provider in your area. Yearly eye examinations are also now covered by all insurances as an essential benefit for children under 19 as a part of the Affordable Care Act.DSC_0294

At the Vision & Conceptual Development Center, we provide evaluation and non-invasive, non-surgical treatment for a variety of vision disorders, including Convergence Insufficiency, Strabismus (eye turn), Amblyopia (lazy eye), problems with tracking, Visual Perceptual disorders, and visual anomalies secondary to developmental delay, autism, concussion, stroke, or brain injury. We are also InfantSEE providers.

Is it a Behavior Problem? Or a Vision Problem?

I recently had a discussion with a parent about behavior and vision problems. A mom of

photo from Newsbusters.org

one of our patients told me that the biggest change she has noticed is that,

“It’s not nuclear war anymore,”

when she tells her daughter it’s homework time. This makes perfect sense to me, and we hear similar stories all the time. If you, as an adult, were asked to do something frustrating,

arduous and painful, on a daily basis, you would eventually refuse. You might even throw a temper tantrum.

Maud at AwfullyChipper wrote to me that

“I really want to make others aware of vision therapy because I know there must be many children out there who’ve just been labelled slow readers (or disruptive, ADD, etc.) when in fact they have vision difficulties. I hope I can help spread the word.”

In fact, studies have been published showing that, indeed, “adverse academic behaviors” decrease following successful treatment for Convergence Insufficiency, one of the more common binocular vision problems we see. The behavior questions used in the study were:

  • How often does your child have difficulty completing assignments at school?
  • How often does your child have difficulty completing homework?
  • How often does your child avoid or say he/she does not want to do tasks that require reading or close work?
  • How often does your child fail to give attention to details or make careless mistakes in schoolwork or homework?
  • How often does your child appear inattentive or easily distracted during reading or close work?
  • How often do you worry about your child’s school performance?
weighted symptom checklist

weighted symptom checklist

It’s important to note that there are other symptoms that may point you to a vision problem. For a more comprehensive list, see our Weighted symptom checklist.

Scientific Basis for an Accommodation Already in Use in VT Practices

books

Image courtesy of adamr/ FreeDigitalPhotos.net.

Amanda Zeller Manley, O.D., F.C.O.V.D.

It’s always nice when research proves the benefit of what we’ve already been doing in clinic.

For the last several years, as e-readers have become more prevalent, I have been recommending them to many of my patients. In our clinic, we have found that by increasing the font size (which also increases letter/word spacing and decreases the number of words per line), many of our vision therapy patients report that they can read more quickly, with better comprehension and less fatigue.

So I was quite pleased to hear an NPR story a few days ago about a study described in the journal PLOS ONE.  Researchers had dyslexic students read on specially formatted iPods or printed text. For many of the students, reading on the iPods (limited to about 3 words per line) greatly improved their reading speed and fluency.

The lead researcher, Matthew Schneps, director of the Laboratory for Visual Learning at the Harvard-Smithsonian Center for Astrophysics, postulates that the mechanisms involved include visual attention span; saccades (the small word-to-word eye movements we make when reading); and visual crowding. By limiting the amount of text per line, deficiencies in those areas don’t have the same effect as when a person reads a normally printed page.

What I find interesting is that in the article, there was no mention of whether these students had had a comprehensive vision examination to look for oculomotor dysfunction, convergence problems (excess or insufficiency), or other binocular vision disorders. In numerous other publications, there have been links between dyslexia and eye movement disorders and binocular vision problems. In many studies of learning disabilities and vision disorders, it has been found that up to 70% of students who have been diagnosed with a learning disability have a vision problem that may be causing or exacerbating that learning difficulty. It would be interesting to see whether the population described in Dr. Schneps’s study has a similar incidence of vision problems.

Fortunately, vision therapy has shown to be a very effective tool in eliminating the underlying visual problems that interfere with reading and learning. And in the meantime, an iPod fits neatly in your pocket.

Are you mad as hell?

There is a lot of opinion on the internet, some good, some bad, and a lot that is completely confounding. I recently came across a post on mothering.com in which the original poster describes her daughter’s success in vision therapy and the significant positive changes that have occurred in her life as a result. Great! We have patients in our office every day who tell of the improvements they see in school, work, hobbies, and many other areas of daily life. I always love hearing more.

But in this case, another mom replied that VT has only been proven effective for strabismus and convergence insufficiency.

Where does this idea come from? There is an abundance of data showing otherwise, that in fact vision therapy is an effective treatment modality for numerous other visual dysfunctions. For an incomplete yet impressive listing, see the COVD website. It is frustrating to me and the rest of the community of developmental optometrists, educators, and others who care for children that the science gets swept aside and replaced with opinion. The opinions are repeated again and again until they seem to be true.

Just last week a mother brought her son in to see me. He had numerous symptoms consistent with a binocular vision problem. Sure enough, testing showed he had convergence insufficiency. The mother was relieved to find out the reason for her son’s symptoms, but worried that her mother and others in the family would ridicule her for seeking treatment in the form of vision therapy. So opinion not based in fact may stand in the way of this boy’s academic, sports, and life success.

Dr. Len Press posted this morning about a patient with double vision from convergence insufficiency whose ophthalmologist told her that vision therapy was bogus. Yet the Convergence Insufficiency Treatment Trial was published in the Archives of Ophthalmology. Not the archives of Optometry. Biases (opinions) get in the way, even when it’s published in ophthalmology’s own literature. And these biases prevent children from getting the care they need, and result in children suffering needlessly. Which is something that should make us all mad as hell.