This blog post earned its author a $500 Travel Grant for the COVD 2018 Annual Meeting! Students and residents–the application period for 2019 is open thru November 30th, 2018! Apply now and see your COVD Family in Kansas City next April 9-13!
by Dr. Lorig Sildiryan (Waterloo ’17)
Dr. Rochelle Mozlin was awarded the A.M. Skeffington Award in 2014. She is an avid COVD Mindsight contributor, with many thought-provoking articles on vision and learning. She approaches her editorials from a behavioral aspect, which COVD members can appreciate through her work. As an optometry resident, I have definitely learned a lot from her with respect to how much vision and behavior tie into a child’s learning process. This type of approach is growing very quickly in the optometric community, and there’s a huge potential for COVD members to make a difference in these children’s lives.
Dr. Mozlin published an article called “The Use of Behavioral Parameters for a Visual Perceptual Evaluation” in the 1995 edition of the Journal of Behavioral Optometry. This article encourages optometrists who do visual perceptual examinations (VPEs) to consider their patients as a whole, emphasizing how a child’s behavior can guide the doctor towards creating a problem-oriented management plan. Dr. Mozlin begins by describing how certain behaviors can cause poor performance on testing by negatively affect the way a child processes visual information.
Before designing a management plan for a patient, it is important to take into account their case history. I like to sit down with the child’s parent/guardian before administering a VPE and I encourage them to talk about how school and other activities are going. They can tell you what specific areas that their child may be struggling in at school and whether there is a learning disability present. Although optometrists cannot diagnose learning disabilities, this article explains how they can affect a child’s performance on a visual perceptual exam. Treating visual perceptual deficits can help children with learning disabilities improve their academic skills by working on certain visual perceptual skills, such as reasoning, visual-spatial and visual-motor integration. This can improve the way the child approaches mathematic problems (visual-spatial) and their handwriting (visual-motor).
A VPE test battery contains multiple standardized tests that an optometrist designs based on their experience and preferences. These tests yield reliable results based on the child’s scores, but it is important to consider the behavioural observations that were made during the testing as well. This includes the way that the patient approaches and solves problems, which can help the doctor tailor their management plan.
I find that observing behavior on VPEs can show if a child is weak in certain developmental areas, and that parents will appreciate that you can identify those deficits and include activities in their vision therapy that helps build those skills. Dr. Mozlin’s article includes developmental models on motor skills, cognitive skills, and perceptual speed. They are summarized below:
Birch states that early in life, motor skills predominate and the feedback that the infant gets from motor movements drives their visual development. As an infant continues to grow and learn, their vision begins to drive their motor skills. If this feedback loop is poor, a child’s visual-motor coordination will be weak and this can be seen on a VPE. The optometrist administering the test can observe if the child is relying on their motor abilities to process visual information, such as using a trial-and-error approach to completing a Circus puzzle.
Kagan describes that children can be impulsive or reflective in their decision-making. Impulsive children will attempt to complete the VPE activities quickly, but they will be inaccurate. This type of behavior is not ideal for good academic performance. Vision therapy for an impulsive child emphasize activities where they have to slow down in order to accurately process information to complete a task.
Bender postulated that there is a time factor involved in processing and integrating visual information. A child with weak perceptual speed will be a slow responder on tasks and scores poorly on eye tracking tests, such as the DEM. There appears to be a link between perceptual speed and reading skills, and improving speed could help with a child’s academic performance. Vision therapy activities should eventually be timed in order to continually develop this skill.
Dr Mozlin’s article is a great clinical tool for optometrists that are considering performing VPEs and treating children with visual perceptual deficits in their practice. Along with test scores, a child’s behavior during a VPE can give the examiner a multitude of information on how a child learns and how to best approach and improve their skills during vision therapy. It is important to realize that these children do not have an inferior intelligence, but that they learn differently than others and would definitely benefit from a personalized vision therapy plan.