Vision and Learning at Hartsdale Family Eyecare
Did you know that 80% of everything a child learns, understands, and remembers is acquired through his or her visual system? Vision is very important in the learning process. What’s worse is that one in four children have undiagnosed vision problems that affect their learning. Sometimes the problem is misdiagnosed as ADD (attention deficit disorder), ADHD (attention deficit hyperactivity disorder), or dyslexia.
It is important that children receive comprehensive visual exams starting as early in life as possible. Vision screenings at school are not sufficient as a basis for diagnosing vision problems. A comprehensive exam may find a visual problem missed during screenings, and your eye doctor can recommend treatment.
Vision Therapy for Children in Hartsdale, NY
Many children have vision problems other than simple refractive errors such as nearsightedness, farsightedness and astigmatism. These “other” vision problems include amblyopia (“lazy eye”), eye alignment or eye teaming problems, focusing problems, and visual perceptual disorders. Left untreated, these non-refractive vision problems can cause eyestrain, fatigue, headaches, and learning problems.
Your child may suffer from a visual problem if they exhibit any of the following characteristics:
- struggles with reading
- grows tired or frustrated with reading
- can’t sit still or stay at a task for any length of time
- reverses words, numbers, or letters
- has difficulty remembering the spelling of words
- frequently loses their place, skips words, or skips lines of text while reading
- has poor reading comprehension
- has shown no improvement from medication or tutoring
What Is Binocular Vision Dysfunction (BVD)?
Binocular Vision Dysfunction or BVD is a condition where the eyes do not align with each other. This causes intense strain on the visual system and causes fatigue, stress, and eye pain after periods focusing. The three types of Binocular Vision Dysfunction are Vertical Heterophoria, Superior Oblique Palsy and horizontal misalignment. Symptoms are usually from either over stressing the muscles of the eyes or tilting the head which causes neck/shoulder pain and headaches.
This condition is a slight misalignment between each eye that is not noticeable at first glance. Vertical Heterophoria comes and goes and at times the person will be completely symptom free. Vertical Heterophoria’s symptoms of headaches and fatigue can be brought on by sudden movements or fast movements such as standing up rapidly or driving in a car. Many patients may experience other symptoms such as intense shoulder and neck pain, sinus pressure, severe headaches, and difficulty driving.
Superior Oblique Palsy:
Superior Oblique Palsy is a condition that is either from birth (congenital palsy) or due to external factors such as a traumatic brain injury or high blood pressure and cholestorol which causes poor blood supply.
Symptoms Binocular Vision Dysfunction:
Symptoms of BVD can be broken down into different categories.
- Pain- Headache, sinus and eye pain.
- Neck and Shoulder Pain.
- Dizziness-Balance, nausea, disorientation.
- Reading Issues-Losing place while reading, skipping lines, fatigue, difficulty concentrating.
- Binocular symptoms-Double or overlapping vision, difficulty with glare/contrast/light, covering one eye .
Treatment of Binocular Vision Dysfunction:
The commonly accepted treatment for Binocular vision dysfunction (Vertical Heterophoria or Superior Oblique Palsy and Horizontal Missalignment) is the use of prism glasses. Unlike regular glasses which correct for each individual eye and then the brain combines the two images, prism glasses correct the combined vision of both eyes. Patients using prism glasses for BVD see fast improvements in short and long term symptom reduction .
Problems Vision Therapy Can Correct
Vision problems being treated with vision therapy include:
- Binocular vision problems.
Subtle eye alignment problems called phorias that may not produce a visible eye turn but still can cause eye strain and eye fatigue when reading also can be minimized or corrected with vision therapy.
- Eye movement disorders.
Studies have shown vision therapy can improve the accuracy of eye movements used during reading and other close-up work.
- Accommodative (focusing) disorders.
Other research shows near-far focusing skills can be improved with vision training.
Also called “lazy eye,” amblyopia is a vision development problem where an eye fails to attain normal visual acuity, usually due to strabismus or other problems of eye teaming.
The success of vision therapy for strabismus depends on the direction, magnitude and frequency of the eye turn. VT has been proven effective for treating an intermittent form of strabismus called convergence insufficiency, which is an inability to keep the eyes properly aligned when reading despite good eye alignment when looking at distant objects.
- Other problems.
Other vision problems for which vision therapy may be effective include visual-perceptual disorders, vision problems associated with developmental disabilities and vision problems associated with acquired brain injury (such as from a stroke).
Vision Therapy and Learning Disabilities
The relationship between vision problems and learning disabilities is a hotly debated topic and one about which optometrists and ophthalmologists often have different opinions.
Many optometrists support the use of vision therapy as part of a multidisciplinary approach to the treatment of certain types of learning disabilities. They contend that, in many cases, children with learning disabilities also have underlying vision problems that may be contributing in some degree to their learning problems. It's possible, they say, that these learning-related vision problems may be successfully treated with optometric vision therapy, which may improve the child's overall capacity for learning.
Many ophthalmologists, on the other hand, feel vision therapy is ineffective in treating any type of learning problem and say there is no scientific evidence to support the claim that the correction of vision problems reduces the severity of learning disabilities.
The First Steps
If you think your child has a vision problem that may be affecting his or her performance in school or sports, the first step is to schedule a routine eye exam to rule out nearsightedness, farsightedness and/or astigmatism.
If the basic eye exam suggests that no glasses are needed (or there is no change in your child's current eyeglasses prescription) and each eye has 20/20 visual acuity, be aware that a vision problem still may exist. The eye chart used in routine eye exams tests only a person's distance vision and does not test all critical aspects of visual performance.For a thorough analysis of your child's vision, including tests that evaluate vision skills needed for efficient reading, consider scheduling a comprehensive eye exam with an optometrist who specializes in binocular vision, vision therapy and/or vision development.
Examinations used to diagnose non-refractive vision problems differ from routine eye exams provided by most optometrists and ophthalmologists. Usually they are longer and include a number of tests of eye teaming, depth perception, focusing, eye movements and visual-motor and/or visual-perceptual skills.At the end of the exam, the eye doctor should give you a detailed assessment of your child's vision and visual skills. If vision problems are identified and a program of vision therapy is recommended, be sure to get information about the likely duration of the therapy and success rates for the specific type of vision therapy being recommended. Also, ask what criteria are used to define "successful" treatment.
What's a Pediatric Developmental Eye Exam
Children suffering from uncorrected vision problems may face many barriers in life – socially, academically, and athletically. Make sure your child’s vision is developing well. A child’s comprehensive eye examination should include the testing of the following visual skills which are aspects of normal, healthy vision:
Acuity-Distance: visual acuity (sharpness, clearness) at 20 feet distance.
Acuity-Near: visual acuity for short distance (specifically, reading distance).
Focusing Skills: the ability of the eyes to maintain clear vision at varying distances.
Eye Tracking and Fixation Skills: the ability of the eyes to look at and accurately follow an object; this includes the ability to move the eyes across a sheet of paper while reading, etc.
Binocular fusion: the ability to use both eyes together at the same time.
Stereopis: binocular depth perception.
Convergence and Eye Teaming Skills: the ability of the eyes to aim, move and work as a coordinated team.
Hyperopia: a refractive condition that makes it difficult to focus, especially at near viewing distances.
Color Vision: the ability to differentiate colors.
Reversal Frequency: confusing letters or words (b, d; p, q: saw, was; etc.)
Visual Memory: the ability to store and retrieve visual information.
Visual Form Discrimination: the ability to determine if two shapes, colors, sizes, positions, or distances are the same or different.
Visual Motor Integration: the ability to combine visual input with other sensory input (hand and body movements, balance, hearing, etc.); the ability to transform images from a vertical to a horizontal plane (such as from the blackboard to the desk surface).
What Is Vision Therapy?
Vision therapy is a doctor-supervised, non-surgical and customized program of visual activities designed to correct certain vision problems and/or improve visual skills.
Unlike eyeglasses and contact lenses, which simply compensate for vision problems, or eye surgery that alters the anatomy of the eye or surrounding muscles, vision therapy aims to “teach” the visual system to correct itself.
Vision therapy is like physical therapy for the visual system, including the eyes and the parts of the brain that control vision.
Vision therapy can include the use of lenses, prisms, filters, computerized visual activities and non-computerized viewing instruments. Non-medical “tools,” such as balance boards, metronomes and other devices can also play an important role in a customized vision therapy program.
It is important to note that vision therapy is not defined by a simple list of tools and techniques. Successful vision therapy outcomes are achieved through a therapeutic process that depends on the active engagement of the prescribing doctor, the vision therapist, the patient and (in the case of children) their parents.
Overall, the goal of vision therapy is to treat vision problems that cannot be treated successfully with eyeglasses, contact lenses and/or surgery alone, and help people achieve clear, comfortable binocular vision.
Many studies have shown that vision therapy can correct vision problems that interfere with efficient reading among schoolchildren. It also can help reduce eye strain and other symptoms of computer vision syndrome experienced by many children and adults. See below for more on conditions treated with vision therapy.
My Child is Nearsighted. Will Glasses Correct His/Her Learning Problem?
There is controversy in the exact relationship of vision to learning. For example there is a negative correlation between distance refractive error and reading ability. Myopic or nearsighted children who cannot see clearly at a distance without glasses are more commonly good readers. Children who spend tremendous amounts of time reading become nearsighted. Before Alaska became a state myopia was rare. After becoming a state, more than 50 percent of the children in Alaska developed nearsightedness. Thus, correlation is such that nearsightedness or poor distance vision is highly correlated with success in reading. Restated another way, poor distance vision is associated with better reading abilities. Farsighted children statistically are poorer readers than myopic children.
My Child Reverses Letters and Words. Does That Mean he Sees Backwards?
It has been presumed that children who reverse letters or words see them backwards. This is false. They have directional confusion. In the real world direction has no meaning. For example, a chair is a chair no matter which way it is placed. Changing direction does not change interpretation. In the world of language direction changes meaning. Connect the bottom of a chair and it looks like a "b". Turn it 180 degrees it becomes a "d", flip it upside down and it becomes a "q" and flip it again it becomes a "p". Thus, direction changes meaning. The difference between "was" and "saw" is direction.
What is the Relationship Between Eye Muscle Problems and Learning?
Some of the mechanical visual skills which are related to reading include focusing or accommodation, and eye teaming, or convergence. Fatigue of one or both the systems may interfere with reading. There is also a relationship between eye movement skills such as saccadics (whereby we change fixation from one target to the next) and smooth following movements known as pursuits and reading. Children who cannot make accurate eye movements are often found to skip lines and words while reading.
The visual system was originally designed so that the peripheral vision was responsive to motion detection (danger from the jungles) with a central portion for fine discrimination (to identify the source of danger; e.g., a lion.) In the school environment the child is expected to ignore the peripheral portion of their visual system and pay attention with the central portion. If the child can not ignore the peripheral portion, he/she becomes distracted. Improvement in eye movement skills often results in less distraction and fewer errors of skipping words while reading.
What are the Other Visual Components Necessary for Academic Achievement?
As mentioned previously, we should correct all optical errors of the eyes (glasses); eliminate eye muscle problems; and create smooth accurate eye movements. In addition, we should make sure that we properly interpret what we see and use it appropriately. These are known collectively as perceptual skills and include form perception, size and shape recognition, visual memory, and visual motor integration (hand-eye coordination.)
My Child Loses His/Her Place. Is That Related to the Eyes?
Reading requires very accurate saccadics, which are fixations from one spot to another. A second type of eye movement which involves tracking is, also, related to attention and reading. Children who have poor eye movements are easily distracted and loose their place. Remember, the eye movement system was designed so that peripheral vision detects motion and danger. Imagine what happens when the system works correctly in the class room. As soon as there is peripheral movement, the eyes move toward the source of movement. This results in the complaint of inattention. Thus, reflexive eye movement skills must be socialized so that they do not respond reflexively to peripheral information. In addition, speed and accuracy must be trained so that one does not lose one's place.The skills are easily improvable with vision therapy. Once the information is brought into the eyes, it must be sent back to the brain for appropriate processing. The information must be utilized and integrated with the sensory and motor areas of the brain. Defects in the perceptual (interpretation of visual system) and motor (the integration with output, e.g., hand-eye coordination) may interfere with the reading process. Perceptual motor skills are key in the early acquisition of reading skills. A deficit is important to identify very early on-- i.e., five to seven years of age. Remediation of the skills at a later date, such as age 12, will be less effective on reading. Thus, early identification and treatment is essential. It is evident that there is more to good vision than 20/20.
Dr. Arlene Schwartz
Our eye doctor, Dr. Schwartz is passionate about children’s vision and using the latest advances in technology to transform her patients lives. She is a member of the College of Optometrists in Vision Development or COVD and is one of the only eye doctors in Westchester County that provides advanced treatment for Binocular Vision Dysfunction, Myopia in Children, and Keratoconus/Scleral Lenses.