Science and Splash: “My Eyes Couldn’t Rest for a Minute”

Today’s guest blog post was written by Carrie Hall, an optometric vision therapist at Washington Vision Therapy Center in Yakima, WA and edited by Benjamin Winters, OD, FCOVD, the clinical director of that clinic.

“I’m getting annoyed. I just feel like I didn’t get a break; everywhere I looked, things were distorted. My eyes couldn’t rest for a minute unless I closed them. Even faces, I’m trying to listen to what you were saying, but you know, I wasn’t there anymore.”

Many of us who work with children who are struggling in school might find the above sentiment familiar. Familiar not in the sense that children are able to express their concerns so clearly. But familiar in that as we look at their slightly overwhelmed, slightly vacant, slightly tired-seeming faces, we know that this is exactly what they’re feeling.

Believe it or not, the quote at the beginning of the story is not from a child with a vision problem, it is from a teacher who has just experienced what is like to have a vision problem.  This teacher and 3 other teachers were subjected to simulated vision problems and then given some school work to do.  The video, created by COVD member Dr. Chris Schell and Dr. Richard Maharaj captures what it is like for children that struggle with vision problems.  Even more,  they show that despite these vision problems, the teachers could easily pass a vision screening using the 20/20 Snellen acuity chart;  thereby, demonstrating how poorly we are able to catch these problems with the vision screening done in most schools.

The truth is that many of the children that we work with simply lack the capacity to voice this frustration. They have no idea that their eyes cannot “rest for a minute,” as they have never consciously experienced what that sensation would be like. They don’t know what normal vision feels like! All they know is their parents’ frowns as they peruse report cards. They know they sure do try to sit still and concentrate each time the teacher tells them to.  And they know they try so very, very hard to ignore it when their younger siblings can read the books they themselves struggle with.

It takes some contrast to truly experience how difficult it is to accomplish tasks with a visual impairment. If you weren’t born with amblyopia (a lazy eye)  or convergence insufficiency, it is nearly impossible to describe how difficult school or work can become. Just the simple task of reading becomes immensely challenging and exhausting when one’s eyes are not working together as the video so brilliantly demonstrates.  

The glaring truth of how very unfair it is to try to ask a child to read with a broken visual system becomes evident in this video: we see the looks on these teachers faces as they attempt to do simple tasks, such as reading and understanding children’s books. Dr. Schell elaborates, “the look on a parent’s face when they experience a moment of double vision or blurriness in one eye and how that interferes with function is priceless. The parent “gets it” for the first time.” Just like these teachers, the parents realize that their child’s slagging performance or poor behavior is utterly logical for the situation that they have been in. They experience the unfairness of it all first-hand and finally realize that they have completely misjudged their child. Often, they are overwhelmed with guilt. They feel it is their fault for not realizing what was really going on.

The simple truth of the matter is, it’s not their fault. They didn’t know.

It only takes one creative teacher searching for how to make concepts stick to realize that fixing the vision is the answer for multitudes of her students, from now till forever. It only takes one end-of-her-rope mom, worn to the bone by late-night procrastination marathons to see this video and know how to change the course of her child’s life. And it only takes one vision therapist, or optometrist, or student, or parent, to share this video with hundreds of people who desperately need to know that they are not doomed to the state they have always lived in. That there really is another way of seeing the world.

If you feel you or your child are struggling with a life-altering developmental vision problem, please contact a developmental optometrist near you by going to covd.org .

 

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The Plano Child Development Center

The Plano Child Development Center is the creation of Drs. Robert Johnson and Henry Moore.  Practicing in Chicago, these two optometrists were devoted to helping children, especially those with learning-related vision problems.  They were continually frustrated by their inability to provide services to economically disadvantaged children, especially minority children.  In 1965, their forward-thinking flash-of-brilliance solution was the establishment of a multidisciplinary not-for-profit organization: the Plano Child Development Center.

Today, as Plano’s Executive Director, Dr. Stephanie Johnson-Brown is building on the foundation that her father laid down and taking the Plano Center to new heights.  She embraces the philosophy that was always at the core of her father’s practice:  “Most people are born with the potential for good eyesight. However, vision — the ability to identify, process, and understand what is seen — is learned and developed, beginning at birth.  The Plano program is based on behavioral optometry, which entails the total vision information processing system and its relationship to learning and development. When problems are identified that relate to vision development, the cause may not necessarily be related to eyesight.”

Plano’s mission is to identify, evaluate and treat economically disadvantaged children who have under-developed and/or inefficient vision information processing systems.  Last year, Plano provided in-office vision testing and vision therapy to over 220 patients. Although Plano’s customary fee for vision therapy is significantly less than average, they were able to provide services to about 23% of their patients on a sliding fee scale.  By participating in community-based programs such as Communities in Schools and VSP’s Sight for Students, Plano provided comprehensive vision exams to over 700 preschool and school aged students and vision screenings to more than 400 participants at various health fairs.  Community service vision awareness workshops reached over 250 persons.

One of Plano’s biggest fans is Larry Fitzgerald, pro-bowl wide receiver for the Arizona Cardinals!  Larry is the grandson of Dr. Robert Johnson, and the nephew of Dr. Stephanie Johnson-Brown, and he understands first-hand the power of Plano’s philosophy.  His grandfather recognized his visual problems and enrolled him in a vision therapy program.  Aunt Stephanie has also helped him enhance his visual skills.  Now you know the secret of his success as an elite athlete—VISION THERAPY!!.

Why is it called the Plano Child Development Center?  Plano is the designation of a lens with no power.  It is neutral.  It is not black or white, plus or minus.  Drs. Johnson and Moore conceived of Plano as a place where all people could be served– without regard to color, age, or economic status.

Plano Development Center will be celebrating all they have accomplished this past year and reaffirming their dedication to their mission tomorrow, October 18 at their 38^th Annual Vision Care Benefit.   Join me in saying thank you to the Plano Child Development Center and their tireless work on behalf of the children (and even the grown-ups) of Chicagoland.

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In Search of Hyperopes

Last week I brought a group of 1st year optometry students to an elementary school in Brooklyn .  We performed a vision screening on roughly 80 pre-kindergarten, kindergarten and 1st grade students.  I really enjoy taking 1st year students on vision screenings.  It’s their first real clinical experiences.  They get to practice what they have been taught on patients other than their classmates.  There are so many “teachable moments.”  It never takes more than 5 minutes before one of them notices something worthy of a referral for a comprehensive vision examination.  They begin to see the connections between various measurements and visual function in a classroom (and beyond!).  And who can resist smiling when you watch a 5 year old try to take apart a student’s  ophthalmoscope.

The purpose of a vision screening is to identify children with vision problems requiring intervention.  Sometimes these vision problems are easily overlooked.  A classic example is hyperopia (farsightedness).

When children are farsighted, they are able to compensate for the hyperopia by focusing their eyes.  They have to focus even more when reading or performing other near vision tasks.  The greater the hyperopia, the greater the focusing effort.  All that focusing can cause eye fatigue, intermittent blur, headaches, and inefficiency when using the eyes to gather information.  But it also allows the young hyperope to avoid blurry vision.  These children will pass the vision screening unless you search for the hyperopes.  That is one of the tests that we perform during a vision screening.  We include a certain procedure to look specifically for hyperopes with good visual acuity.

But a little bit of hyperopia is expected in children…….. so when do you refer?  How much hyperopia warrants a comprehensive eye exam and the possibility of an eyeglass prescription?

When discussing referring or prescribing for uncorrected hyperopia, I often point to an article written by Dr. Jerome Rosner in 1997:  The relationship between moderate hyperopia and academic achievement.  Rosner looked at the correlations between refractive error and performance on reading tests in a group of 782 elementary school children.  He found that the children with uncorrected hyperopia greater than +1.25 diopters were more likely to have lower reading scores.

Dr. Rosner drew a line in the sand — for children with hyperopia greater than +1.25, a comprehensive vision examination is indicated to determine if that child would benefit from lenses.  That was the number we used at the vision screening.  We referred many children for a variety of reasons;  that included several children who were able to read the letters on the chart 10 feet away, despite uncorrected hyperopia of greater than +1.25.

But identifying these children is only the first step in the battle against learning related vision problems.  These children need comprehensive vision examinations.  Hopefully that will happen and these children will be well on their way to successful performance in and out of the classroom.

Read more about vision screenings here and here.

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The Need (part 2)

Dr. Eric Borsting and colleagues are still investigating the diagnosis, treatment and consequences of convergence insufficiency.  The most current research from the Convergence Insufficiency Treatment Trial (CITT) which was presented at COVD’s annual meeting considers the behavioral and emotional problems associated with convergence insufficiency (CI).

Fifty-three children with symptomatic CI were enrolled in the study.  For each child, the parents completed the Child Behavior Checklist (CBCL) and the teachers completed the Connors 3 ADHD Index.  The children were then enrolled in office-based vision therapy programs, and 44 of them completed 16 weeks of treatment.  The parents and teachers then completed the surveys again.

When scores at baseline (pre-therapy) were compared to normative data, the children with CI had more symptoms on both surveys.  On the Connors 3 ADHD Index, the symptoms most frequently reported by teachers were inattentiveness, distractability and giving up easily.  On the CBCL, the symptoms most frequently reported by parents were somatic, such as headaches and eye discomfort.  Children with CI exhibited more symptoms and behaviors associated with ADHD than children with no visual problems.  Following vision therapy, the children showed significant improvement on both scales.  Treatment of convergence insufficiency resulted in a reduction in the behavioral and emotional problems reported by both parents and teachers.

Here’s the take-home message:  if your child has been diagnosed with ADHD or exhibits many of the behaviors associated with ADHD, your child needs a comprehensive vision examination.  If vision deficits are revealed, then vision therapy might be the most appropriate treatment option.  This study is another contribution to evidence documenting the power of vision therapy in the treatment of learning-related vision problems.

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The Splash – From Ripples to Waves

Check out this video highlighting a child that has been helped with vision therapy.  In the feature story, the child says he went from C’s and D’s to A’s and B’s in a matter of months.  To me it is another great example of how these developmental life altering vision problems can impact school performance and beyond.

This child’s developmental optometrist is Dr. Carol Scott.  She is the reason I am a developmental optometrist today.  During my first year of optometry school, Dr. Scott came and lectured about children she was working with.  She talked with passion about how so many of these smart, intelligent children were struggling in school due to treatable vision problems.  She talked about the profound impact treating these vision problems had on these children – in many instances, completely altering the trajectory of their lives.  Unfortunately, in our society,  if you cannot read well and therefore cannot perform well in school, so many doors quickly close to your future.  I knew during that lecture that this was the part of my profession I wanted to practice for the rest of my life.

In thinking about that moment, it is amazing how Dr. Carol’s seemingly small act of lecturing to a group of first year optometry students had such a profound impact on my life.  Before attending her lecture, I had considered vision therapy to be one of the last things I wanted to do in my future practice.  Now as a developmental optometrist I see the lives of children change everyday.

And so it is with vision therapy.  The way we will reach the many people who can benefit from developmental optometry  will be the accumulation of many little ripples.  The ever-growing number of lives affected and the ever-mounting body of evidence supporting vision therapy are becoming the waves that will bring our brand of optometry to the mainland.

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Moms Need to Know

I participated in my first Twitter party last week.  As children go back to school, the party focused on children’s vision.  The Twitter Party was sponsored by 5 Minutes for Mom, an online community for moms (and people who love kids) and Eye Smart (American Academy of Ophthalmology). The party was 1 hour long, and every 10 minutes or so, the party host would pose a question for all the participants to consider.  Links were also provided to answer the questions and win prizes!  All the party-goers were tweeting questions and answers…. it was chaotic and very organized at the same time.  It was fun to read and respond to all the ideas that were being tweeted.  My keyboarding skills (and my synapses) got quite a workout in that hour!

Here are some of the ideas and questions that were presented during the party:

• Good vision is important to a child’s’ ability to succeed in school.
• What do you think is the most important thing you can do to keep your child’s eyes healthy?
• It is essential to check vision & eye health through their childhood, including school years.
• As your children head back to school, make sure they have the visual skills to be successful in the classroom.
• There are several important times for children to have eye exams: as newborns, during infancy, preschool age, and when entering school.
• The 3 most common “refractive” vision problems in children: hyperopia, myopia and astigmatism.
• As we head back to the classroom, it’s a great time to teach kids about eye health and the science of vision.
• Every year, a whopping 3 MILLION school days are missed because of Pink Eye.
• 90% of sport-related eye injuries could be prevented by wearing protective eyewear.
• If your child’s eyes are strained from too much screen time, practice the “20-20-20” rule: Every 20 minutes, shift your eyes to look at an object at least 20 feet away, for at least 20 seconds.

Don’t forget, good vision and eye health are key to your kids success in the classroom and safety on the playground.

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The Science: Performance-Related Symptoms

Convergence insufficiency (CI) is a common visual disorder that is characterized by great difficulty maintaining binocular eye alignment when looking at something close up (such as a book or a writing assignment).  This landmark study, funded by the National Eye Institute, provides strong evidence that office-based vision therapy is the most effective treatment for CI.  Treatment success can and should be measured 2 ways: objectively (looking at changes in measurements used in the diagnosis of CI) and subjectively (looking at changes in symptomology associated with CI).

The Convergence Insufficiency Symptom Survey (CISS) was developed to quantify the frequency and severity of symptoms reported by patients with CI.  The 15 symptoms on the CISS can be divided into 2 categories: performance- related and eye-related.  There are 6 performance-related symptoms evaluating visual efficiency when reading and/or performing near work:

• Loss of place
• Loss of concentration
• Having to re-read
• Reading slowly
• Trouble remembering what you read
• Getting sleepy when reading

The 9 eye-related symptoms include blur, headaches, double vision, tired, sore, uncomfortable eyes, words that move and jump, and pulling sensations around the eyes.

This study evaluated the symptomology of children with Convergence Insufficiency before and after optometric vision therapy.   Before vision therapy, the six most frequently reported symptoms were the six performance -related items. Fifty percent of all the children in the study responded “fairly often or always” when asked if they lose their place when reading.  Similarly, 45% of the children reported loss of concentration and having to re-read; 40% read slowly; 38% have trouble remembering what they read; and 37% get sleepy when they read.

Children with parent-reported ADHD (attention-deficit hyperactivity disorder) had significantly higher symptom scores on the CISS and the higher score was almost entirely attributed to an increase in the frequency and severity of these performance-related symptoms.

The good news is that ALL the children who responded to treatment reported a decrease in ALL their symptoms.  And while this study did not look at academic performance, the authors do note this relationship when they state: “the treatment of symptomatic CI may have a positive impact on reading performance and attention.”

What is the take home message?  If your child has a convergence insufficiency, it is important to consider both eye-related and performance-related symptoms.  Your child may not be complaining of blurred or double vision, but they still might have performance-related symptoms.  Loss of place, re-reading, poor reading comprehension, slow reading, sleepiness, poor concentration….. am I describing your child’s symptoms?  Have you considered a vision problem as a possible explanation?

Read more about convergence insufficiency here.

Reading more about vision and ADHD here.

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Success Stories for Children’s Vision and Learning Month

Children’s Vision and Learning Month is coming to a close today.  Have you seen the success stories that were posted on Facebook?  So inspiring!

Developmental optometrists are helping children succeed by treating their learning related vision problems.  Here are just a few of them:

Ryed  from Kansas

Nick from Pennsylvania

Kyle   from Massachusetts

Morgan  from Michigan

Ytzel  from Oklahoma

Autistic children from Barbados in Michigan

Jacob  from  Utah

August may be over, but these success stories are being written every day all over the world.  Give your children the gift of a comprehensive vision examination as they head back to school.  Start writing your child’s success story today!

Find a doctor here.

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The Splash – Persistent Parents

Our guest blogger this month, Carrie Hall,  is one of the very talented vision therapists at my practice. She brings a unique perspective to the blog since she works with patients every week often times for many months.  Because of this,  she often gets to know the patients and their families on a very personal level and truly gets to know the struggles, trials, and triumphs patients go through.  At the conclusion of COVD’s National Vision and Learning month, I think her perspective into one of our patients is a perfect addition to what has been a great highlight of many inspiring vision therapy success stories.

As a vision therapist, I often see a theme among the parents that I encounter. Though they are of various ages, personalities, beliefs and styles, they often share one certain characteristic that sets them apart as vision therapy parents. They are incredibly persistent. They have been told many times in their lives that their children may not be capable of certain things. Perhaps by a doctor intending to give them a realistic expectation of the future, or perhaps by a teacher who is frustrated by a lack of success in their child. Whatever the source, I encounter parent after parent who has been informed that their child will not be capable of a certain level of ability, be it athletic,  academic, or just general life skill development.

Lynn was one such parent. Her daughter Shelby was simply not blooming in school like her older sister had. Reading was inexplicably difficult for this 8 year-old. Always a fight, often involving tears, Shelby simply would not take to reading. Lynn was baffled. Shelby was obviously bright and determined, a spunky and enthusiastic girl. It just didn’t add up. The pieces did not fit. Her eye doctors confirmed that Shelby’s vision was fine. She had 20/20 acuity, so the only reason why she shouldn’t be learning to read was if she simply wasn’t as smart as Lynn thought.
Perhaps some parents are more inclined to take the words of professionals at face value than others. Perhaps some parents simply refuse to be satisfied with an underwhelming determination of their children’s potential. Whatever is the mitigating factor, Lynn could not and would not be satisfied with this evaluation of her daughter. She persisted in her search. When she eventually found Washington Vision Therapy Center whose symptom checklist of vision-related learning problems read like a specific description of Shelby’s struggles, Lynn knew she had found her answer. When confronted with the financial strain that therapy would mean for her family, her persistence did not waiver. She would make whatever sacrifices were necessary: she would ensure her daughter’s chances for success in school and life no matter what.
Maybe persistence is a genetic trait as well. I certainly saw the same attributes in little Shelby that her mother demonstrated. Months after beginning therapy, after countless lifesaver cards and hart charts, Shelby was burnt out with it all. Who can blame her though? When the goal of all the work is just to get better at doing homework, it hardly seems a fair thing to ask of a girl of 8 who would rather be playing outside than getting better at reading any day of the week.
But like I said, maybe persistence is a genetic trait. Or perhaps it’s more nurture than nature. Whatever the case, Shelby persevered. Not only did she make it through therapy, she did great at it. She learned to be able to coordinate the use her two eyes like the best of them by the time it was all said and done. She and her mother developed a balanced working relationship in regards to this specific area in order to attack vision therapy head-on and accomplish every last bit of what Dr. Winters wanted to see from her clinically. Neither one of them would quit. Lynn pushed Shelby, and Shelby pushed right back in order to finish well. That little girl was the definition of persistence.
It’s the characteristic that marks out the parents, and the patients as well, for success. They are all up against diagnoses and school evaluations that make the future look bleak. They have been told repeatedly that they can’t, that they won’t. But they refuse to listen. Little fighters, they are, coming in and out of our offices defying the odds stacked up against them.
The other day, Shelby came up to her mother after doing some reading and said, “You know Mom, I think I like this reading thing.”  She is now at grade level in reading.  That is the payoff for any persistent mother.  Lynn has continue to fight to get Shelby’s story of hard work and persistence out to the public and she is now being featured on COVD for National Children’s Vision and Learning month. http://www.cisionwire.com/college-of-optometrists-in-vision-development/r/mom-of-struggling-reader-finds-help-and-speaks-out-for-college-of-optometrists-in-vision-development,c9283372 Imagine that. A homeshooling mom from Yakima, Washington who believed her child’s struggles with reading were more than a resistant attitude or just that her daughter wasn’t smart enough. Persistence is a powerful thing.

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Building a House With Dr. Amorita Treganza

Amorita Treganza as “Miss Lemon Grove”

Dr. Amorita Treganza received the Skeffington Award  in 1986 .  She was another GIANT in developmental optometry.  She was instrumental in the birth of COVD as the national (and now international) organization of developmental optometry.  In fact she served as COVD’s first president, in 1971.   When I typed her name into Google, I was delighted to find this story about the celebration in Lemon Gove, CA, honoring her life and legacy , 100 years after her birth.  Dr. Treganza continues to be  an inspiration and role model for women pursuing optometry, especially those of us specializing in developmental vision.  Dr. Treganza is the co-author of Optometric Evaluation of Children with Academic Dysfunction, published by the Optometric Extension Program, from 1977-78. 

In her case presentation to parents, Dr. Treganza would often begin by separating the vision problem and the reading problem.  She would use the analogy of building a house.

Vision is the foundation.  Vision provides the platform, the stability and the strong beginning on which the remainder of the house will be built.  Reading is the structure of the house; the framing, walls, ceiling and finishing work.  The visual dysfunction affects reading efficiency.  It eliminates or puts crack in that foundation that is supposed to provide stability and strength.  Learning to read and reading to learn are both more difficult.  Attempts to teach that child to read may add a few boards to the walls of the house, but what might we expect if the foundation is unstable and weak?  The pieces won’t fit together and won’t function properly.  At best it will be disorganized, and at worst, it will be unusable!  In order to treat the academic dysfunction, it is necessary to start at the beginning, by rebuilding the foundation.  This can be accomplished with optometric vision therapy.  Then, it is possible to address the reading problem with the appropriate educational intervention.  The framing, walls, ceiling and finishing touches can be built.  Just as building a house requires a team effort (contractor, plumber, electrician, carpenter, etc) so does treatment of the academic dysfunction.  Optometrists, parents and educators must work together.

–August is National Children’s Vision and Learning Month–

So let’s build some houses, from the ground up.   If your child has academic problems, please schedule a vision examination today! 

Find a developmental optometrist in your area.

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