Posted in Binocular Vision, Child Development, Science and Splash, Vision Therapy, tagged "vision therapy", childhood development, college of optometrists in vision development, FCOVD, fellowship, vision development on November 12, 2013 |
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Well, I certainly must say that I’ve missed the blogosphere. My absence from this blog has not been without reason though. If you look really close, you’ll see I now have the letters FCOVD after my name. It stands for Fellow of the College of Optometrists in Vision Development. You may have seen these letters after the names of the other doctors that are authors of this blog. So, it’s gratifying to be able to join their ranks.
I must say though that many of the congratulations on my accomplishment have been accompanied by some blank stares. Most notably was that of my sister who posted her congratulations as “Very cool. Not sure what it means, but I’m proud of ya.”
Most of us are pretty familiar with the Fellowship of the Ring, from J.R.R. Tolkien’s Lord of the Rings which involves a harrowing, death-defying tale of two small Hobbits. While some may think my size resembles that of a Hobbit (I’m 5’6” on a good day), that’s about where the similarities end between my quest for fellowship over the last year and that of Frodo and Sam.
While my fellowship did not involve any encounters with any large orcs, talking trees, or dark lords, I did have to write 9 papers, take a grueling 3-hour test, and withstand being grilled by some of the best doctors in our field in an oral exam. Wikipedia defines a fellowship as a period of medical training in the United States and Canada that a physician may undertake after completing a specialty training program. You may have heard of fellowships in fields like cardiology and oncology.
Fellows of the College of Optometrists in Vision Development are specialists in vision development and in the practice of vision therapy. They have not only completed a doctorate process that qualifies them as doctors of optometry, but also have received at least 100 additional hours of training and at least 3 years of clinical practice specifically dedicated to the field of vision therapy. The designation FCOVD means that the doctor has met the rigors of competency set by others in their field of expertise and has their peer’s full endorsement to treat patients with vision problems impacting school, work, and life.
It was a tough but gratifying process that has made me a better clinician. I do kind of wish that my fellowship experience could have ended by having a large eagle carry me home, but I am happy nonetheless the process is over and to be back to blogging about vision.
Dr. Winters practices in Yakima, Washington and is the clinical director of Washington Vision Therapy Center. To find a doctor who specializes in vision therapy near you please go to covd.org.
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Lack of eye contact, staring at spinning objects or light, fleeting peripheral glances, side viewing, and difficulty attending visually are behaviors typically associated with autism. Yet these can also be signs that there is a visual component to your child’s challenges. This April, the College of Optometrists in Vision Development (COVD) is participating in Autism Awareness Month and releasing a Public Service Announcement to help educate parents on the visual component to Autism.
As COVD President, Dr. David Damari notes, “Visual problems are very common in individuals with autism. Children on the autism spectrum often have eye coordination and eye movement disorders. For example, when asked to follow an object with their eyes, they usually do not look directly at the object. Instead, they will scan or look off to the side of the object. They might also have difficulty maintaining visual attention. At least one study suggests that more than 20% of those with autism have strabismus (eye turn) and 10% have amblyopia (lazy eye). Other studies support this high incidence of functional vision problems as well.”
Most people don’t realize our eyes are actually part of the brain. So it stands to reason that if someone has a neurological disorder that impacts the brain, their vision would be compromised in some way. Children with ASD and other neurological disorders don’t complain verbally when their world doesn’t look right; they show us with their behavior. When vision disorders are treated, one can see improvement in the child’s behavior and how he interacts with the world.
Here is one example of how a child’s behavior changed dramatically once the vision problem was treated. As a pediatrician, Zach’s mother was aware of the symptoms of autism. While he had many symptoms of autism, he did not meet enough criteria for that diagnosis. It wasn’t until she took him to a developmental optometrist that she understood how an undiagnosed vision problem could impact his quality of life.
Dr. Janna Jennings shares, “Zach begged me to bring him a loaded gun so he could shoot himself in the head … Since he started wearing the bifocals prescribed by the developmental optometrist a little over two years ago, he has never said another suicidal thing again. After a few months of vision therapy, he stopped saying he was stupid.” While it took more than bifocals and vision therapy to help Zach fully recover, you can see the impact bifocals and vision therapy can make when there is a visual component to a child’s challenges.
To learn more about how vision disorders can impact a child with ASD or to find a developmental optometrist near you, visit COVD’s website: www.covd.org.
“For this April’s observance of Autism Awareness month,” Damari continues, “we invite everyone to take a few minutes to view our Public Service Announcements and share them with your friends and relatives.” The Autism and Vision PSA is airing on Insider Exclusive and can also be seen on COVD’s YouTube channel.
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There’s an interesting discussion in the New York Times “Room for Debate” series concerning finding appropriate reading material for children. The “debate” centers around whether to allow children to read whatever they want, even if the book they select may present themes and issues that may be difficult for the child to understand. Is Harry Potter appropriate for a precocious 6 year old? What about other “chapter books” that expose children to evil, war, death, and intolerance? or diversity, love, and overcoming adversity?
There are 8 “debaters” that present their ideas on this topic. Most center around whether it is a good or bad idea to allow children to read books when they may not be emotionally mature enough to grapple with these issues. Here are some of the opinions:
- “But because reading is such a collaboration between the reader and the storyteller, young readers are likely to “self select” when it comes to the maturity level of their choices. If a child doesn’t have what’s required for a particular book, they’ll put it down.” (Matt de la Pena)
- “It is a disservice to children to introduce them to books they are not emotionally ready for or to books that they do not yet have the narrative, historical or cultural scaffolding to understand. They may read the words, but it will not be the emotionally consuming, imaginative, unforgettable pleasure that readers seek.” (Janice Harrington)
I especially like the opinion of Deborah Pope. She frames the question differently. She writes of the trend away from picture books, especially for gifted children. Why rush? She feels there is much to be gained from spending time enjoying picture books: visual literacy.
- “Children learn certain critical comprehension skills from picture books that cannot be taught through chapter books: interpreting imagery based on the information given in the text; understanding that there is more to a story than what the words alone convey; and visualizing a story in their own mind’s eye. Mastering visual literacy is fundamental to success with more advanced material.”
She then goes on to conclude that if we want our children to be successful, independent and motivated learners, we must share the experience of reading with them.
I remember a conversation I had with a woman I met while traveling. She had 2 children, and when they were very young, their father began to read to them every morning during breakfast. Ten years later, that family tradition continues, because the children continue to ask him for this simple gift.
When my parents moved to Florida, my father would make his own “books on tape” for my children. He started with simple picture books when they were very young, and eventually moved up to children’s classics. When those books conjured up images and memories of his own childhood adventures, he would include them in his rendition. The tapes were not tied to any birthdays or holidays. When he finished, he would mail the tapes and the book… my children loved receiving those packages. And now, though my father is gone, his storytelling is still with us.
So start a family tradition, pick a book, one with lots of pictures, and read it to your child. You will be building your child’s visual literacy, and so much more.
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Posted in Child Development, Research, Science and Splash, tagged child development, DNA, epidemiology, epigenetics, genetics, inheritance, research on December 4, 2012 |
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Did you happen to see this article in the New York Times: Why Fathers Really Matter. This article introduces the concept of epigenetics. Epigenetics can be defined as “the set of modifications to our genetic material that change the way genes are switched on or off, but which don’t alter the genes themselves.” ¹ Epigenetics helps to explain the relationship between a person’s genotype (the genetic makeup as defined by DNA) and phenotype (physical appearance and traits). The classic example of this is identical twins. Identical twins have identical genotypes but different phenotypes. Their differences become more apparent as they age, because the environment plays an important role in epigenetic modifications. Research in this field is exploding, because herein lies a key to the relationship between an individual’s genetic code, the environment, aging and disease.
It is now known that epigenetic modifications or marks consist of chemical groups that are stuck onto DNA without changing the DNA. They sit on top of the genetic code and control the activation and deactivation of genes. This explains why neurons are so different from skin cells, even though they all contain the same genetic code. If skin cells divide, they become new skin cells. All the genes are deactivated except for the ones needed for the skin cells to look and behave like skin cells.
But epigenetic modification can also be very fluid. These chemical switches on DNA govern protein production—which ones will be produced, when, for how long, how much, etc.
- Think enzymes that control metabolic processes and their impact on health.
- Think hormones and their profound influence on child development.
- Think neurotransmitters that impact learning and the growth of synapses.
In the New York Times article, the author, Judith Shulevitz, describes why she has become obsessed with epigenetics: “because it strikes me as both game-changing and terrifying.” Here are two reasons why:
- Epigenetic mechanisms of gene expression and suppression are influenced by the environment. Our phenotype is not written in the stone of our DNA. Physical traits, mental status, and the development of disease can be shaped by environmental factors such as the food we eat, the air we breathe, our exposure to traumatic events, and our age.
- Epigenetic modifications are heritable. A recent journal article cited over 100 examples of epigenetic inheritance, in both animals and humans.
One of the best known example of both of these principles of epigenetics in humans is an epidemiological study of the people living through the “Dutch Hunger Winter” of 1944-45, during which over 20,000 people died of starvation. Scientists were able to evaluate the long-term effects of the famine among the survivors, including pregnant women and their children. If a woman was well nourished during the first portion of her pregnancy but malnourished for the last few months, her baby was likely to have a lower birth weight. On the other hand, if the baby was conceived towards the end of the famine and the mother was malnourished only during the first trimester, she was likely to have a normal birth weight baby. This is not surprising, because babies do most of their growing during the last months of a pregnancy. But long-term effects were very surprising. The babies that were born small stayed small for the rest of their lives, with lower obesity rates than the general population (Audrey Hepburn was one of these babies). The normal birth weight babies who were poorly nourished during the first trimester were more likely to become obese as adults. A major environmental event (the famine) changed the epigenetic programming of the developing fetus. The epigenetic modifications of the babies that were malnourished during the first trimester enabled them to survive by making the most of a bad situation. But this reprogramming remained in effect long after the famine that caused it. It is thought that epigenetic modifications to the genes regulating metabolism resulted in a greater likelihood of becoming obese. Even more extraordinary was the presence of these effects in future generations. The grandchildren were more likely to be skinny or obese. Something that happened to a population of pregnant women affected their children and their children’s children!
While Shulevitz has chosen to describe epigenetics as “game-changing and terrifying,” others view epigenetics as the new frontier in fighting disease. Epigenetic therapies are already being used to fight various cancers. The role of epigenetics in depression, autism, Alzheimer’s disease and addiction are being explored. An understanding of epigenetics may prepare us to face the global obesity epidemic. The epigenetics revolution is underway, and the implications for patient care today and tomorrow are profound.
1. Carey N. The Epigenetics Revolution: How Modern Biology is Rewriting Our Understanding of Genetics, Disease and Inheritance. Columbia University Press: 2012.
[i] Carey N. The Epigenetics Revolution. 2012
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