For some families, getting their child to read for 15 to 30 minutes a night can be a real struggle, if not an all-out battle. Some children have no problem identifying words on a flashcard but struggle to read a line of print on the page. Other children start to have difficulties when they attempt to transition into chapter books with smaller print. They are able to decode at a high level but continue to prefer graphic novels, larger print and/or books that are broken-up with pictures. Other children may do what is required but not one minute more. They may complain about their reading speed, lose their place or have to re-read information to comprehend.
All of these examples of avoidance of reading are unfortunate because studies show that the amount of time spent reading plays a large role in future academic success (Allington, 2014; Cunningham & Stanovich, 1998; Krashen, 2004 and 2011). What parents and teachers do not realize is that there is often an underlying cause behind why these children avoid reading, and that cause is related to their visual system. It might surprise you to know Learning-Related Vision Problems affect 1 out of 4 children. Even more surprising, is that many of these Learning-Related Vision Problems have nothing to do with the ability to see 20/20 on an eye chart.
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In most cases, distance vision has very little to do with reading performance and the desire to want to read. In fact, avid readers tend to have more difficulty with their distance vision (nearsightedness) then the general population. Below, I’ll outline the most common visual conditions that contribute to reading avoidance.
Refractive error generally refers to the lenses required to provide a clear image on the back of the eye. Nearsightedness (myopia), farsightedness (hyperopia) and astigmatism are all types of refractive error.
Nearsightedness is most often associated with decreased eyesight at distance and as mentioned above, may not interfere much with reading.
Farsightedness can require the focusing system in the eyes to work harder to clear words up close, but if severe enough, it can also interfere with distance vision. It is normal for infants and young children to be farsighted and then as the visual system develops, the amount of farsightedness decreases through a process called emmetropization.
Uncorrected astigmatism, if significant, can interfere with both distance and near eyesight and can also create increased visual strain to see 20/20.
Both uncorrected moderate to severe farsightedness and astigmatism have been associated with decreased pre-literacy skills in preschoolers and overall lower reading performance in older children. This makes sense because both of these conditions can cause the eyes to have to work harder to see print at near. Because children with uncorrected farsightedness and astigmatism often can pass traditional vision screenings, the American Optometric Association recommends that children receive a comprehensive vision evaluation between the ages of 6 months to 1 year (InfantSEE), between ages 2 or 3, before entering kindergarten and annually while in school.
When we look far away, the focusing muscles in each eye relax, when we look up-close, they constrict. The accurate and efficient use of these muscles allows us to focus on near-print for a sustained period of time and easily switch our focus from near to far and back again. This ability develops early in life and for most children, focusing should be easy and automatic.
It is at around age forty, when the lens inside the eye becomes stiffer and harder to move, that most people begin to have difficulty with blurry vision at near. Interestingly, while adults with age-related focusing problems tend to move the reading material farther away, children with focusing problems may move the book closer or turn their head to focus with only one eye.
Inefficient focusing skills can cause blurred vision at distance or near, visual fatigue, headaches, trouble copying from the board, reduced reading comprehension and of course, avoidance of detailed near tasks such as reading.
Saccadic eye movements are the ability to move our eyes between stationary objects, such as accurately moving the eyes along a line of print when reading. Inaccurate eye movement skills can cause loss of place when reading, skipping over words/lines, poor reading fluency and “careless” errors in reading and school work. All of these symptoms will make reading slower and reduce comprehension. This is especially true for smaller print and chapter books, where eye movements need to be more precise.
Eye teaming refers to the ability of the eyes to work together as an efficient, coordinated team to create a clear and single picture when looking near or far. There are different types eye teaming difficulties including convergence dysfunctions, strabismus (eye alignment/eye turn) and suppression of binocular vision also known as amblyopia.
Convergence insufficiency is by far the most common vision condition that affects reading. This type of eye teaming problem cannot readily be detected by an untrained observer; however, it can significantly interfere with the ability to efficiently process visual information, especially at near when reading and writing. Convergence insufficiency can cause numerous symptoms and adaptations including eyestrain, headaches and blurred, overlapping or double vision. It can make words run together when reading or appear to move on the page.
Some children will try to compensate by covering or closing one eye. They may also tilt their head or lay their head down on the desk. Fatigue can play a big role in performance, the more tired the child or the longer they have to sit and read or write, the more difficult it is for their visual system to compensate. When the visual system has to work harder to complete a task, it leads to difficulty sustaining attention on reading and reduces the ability to comprehend what is read.
Glasses are usually necessary to help children with farsightedness or astigmatism. Children with eye teaming, focusing and tracking problems often require Optometric Vision Therapy to develop these visual skills.
Optometric Vision Therapy teaches the child how to coordinate their eyes allowing for a more efficient visual process. In addition, vision therapy can improve other visual processing skills important for reading and learning such as: visual discrimination skills for picking out details, visual memory for quick recognition of words and spelling, and visual-motor skills for writing and eye-hand coordination.
In-office vision therapy that is supervised by a trained Optometrist has a very high success rate. The National Institute of Health found (Randomized clinical trial of treatments for symptomatic convergence insufficiency in children) that in-office vision therapy is by far the most effective treatment for Convergence Insufficiency.
A related study, Improvement in Academic Behaviors Following Successful Treatment of Convergence Insufficiency, showed that academic behaviors and attention showed significant improvement in children diagnosed with convergence insufficiency and ADHD.
Don’t just take our word for it…. See what our patients have to say!
“During 1st grade Heidi’s teacher started to notice a few things. As the school year ended her teacher suggested we contact New Horizons for a second opinion. At this point Heidi was having trouble with b’s and d’s, left and right, and while reading would sound words out including letters from the words around the word she was sounding out. Heidi also complained of headaches and eye soreness.
Coming to New Horizons made a huge difference in Heidi’s reading and other school work! She worked with Beth on strengthening her eye muscles to be able to focus far and near. Beth also worked with Heidi on her left/right, making it visual, physical and mental. I really liked how the therapy was total body- knowing the parts all need to work together.
Heidi progressed on schedule and never complained about our weekly visits.”
-Amanda, mother of Heidi, age 7
Dr. Frazer is a board-certified Fellow of the College of Optometrists in Vision Development and specializes in vision therapy. She has over 15 years of experience with diagnosing and treating both children and adults with Learning-Related Vision Problems, binocular vision problems, strabismus (eye turn) and amblyopia (lazy eye). She also treats visual skill dysfunctions commonly seen in individuals with autism, other developmental disabilities and brain injury. Dr. Frazer owns New Horizons Vision Therapy Center and has two locations serving both the Madison, WI and Lake Country areas.
Call us 608-849-4040 or email at email@example.com for more information.
The holidays are upon us and you may be wondering, what gifts can I give that will be fun, interactive and a learning experience (without the kiddos even knowing it)?
Dr. Frazer has provided another great Holiday Gift Guide for your you this season! These games are a great way to develop skills related to how we process visual information… And they are fun!
Many of these games are very portable, which is great for taking on trips and keeping busy while waiting for food to be served. While some of these games are best played between 2 to 4 people, some of these games can be played as a one-person game.
Click here for last year’s Holiday Gift Guide and more gift ideas.
Happy shopping and Happy Holidays!
RSVP appreciated, but not required. Feel free to contact our office for more information!
Does your child have all the supplies he/she needs as they head back to school this year? Pencils, check! Crayons, check! Glue stick, check!
Comprehensive vision evaluation???
20% of children lack the visual skills necessary to succeed in school. These necessary visual skills go beyond 20/20 vision.
Learning-Related Vision Symptoms:
Watch the video below as Dr. Frazer, a Developmental Optometrist, reviews the most common symptoms of learning-related vision problems and the best methods of treatment.
If you’re curious how vision therapy can help with your child’s symptoms or difficulties, give us a call! We’d be happy to answer any questions you may have.
Accommodative Dysfunction is the medical term used to describe when a person has difficulty with their focusing system, unrelated to natural aging changes. Accommodation occurs by movement of the lens inside the eye. This movement is controlled by muscles that generally relax to see far away and contract to see clearly at near. This mechanism is separate from “refractive error” or the need for glasses at distance; however, uncorrected refractive error can influence this system.
Accommodative ability is generally well developed by 4 months of age and should continue to work efficiently until around age 40, when the lens begins to become less flexible and therefore harder to move. This is why the majority of older adults require reading glasses or bifocals as they get older.
There are generally three types of accommodative dysfunctions:
Treatment may include the prescribing of special lenses to help reduce eye strain at near and/or optometric vision therapy. Over-the-counter reading glasses are made for adults and are generally not advised for children, as they can create new problems. At our clinic, treatment of accommodative dysfunctions with optometric vision therapy has a very high success rate (greater than 90%) and often requires between 12 to 24 sessions, when combined with home support activities. Patients with additional visual diagnoses, autism, developmental delay or a history of traumatic brain injury/concussion may require a longer treatment plan.
Contact us today with your questions!
608-849-4040 or firstname.lastname@example.org
Functional vision problems are common in individuals with Autism, yet these vision problems are often misunderstood or overlooked.
Common behaviors in patients diagnosed with Autism Spectrum Disorder include:
Join Valerie Frazer, OD, FCOVD for this FREE interactive webinar where she will discuss how these symptoms are related to inefficient visual processing of information and how Behavioral Optometry can help.
608-849-4040 or email@example.com
Poor handwriting is a common problem and may be helped by improving visual skills. View Dr. Frazer’s webinar below to learn more.
The visual skills needed to improve handwriting are trainable through a well-designed vision therapy program. In this webinar, Dr. Frazer will also present the many helpful modifications available.
Children who have difficulty with good handwriting may struggle with these vision-related skills:
The number of children and adults diagnosed with AD(H)D has increased significantly over the course of the last decade.
Did you know that many of the characteristics used to diagnose AD(H)D are also symptoms of vision related learning problems?
Symptoms for AD(H)D diagnosis that are also seen in learning-related visual problems:
* Making careless mistakes in schoolwork
* Not listening to what is being said
* Difficulty organizing tasks and activities
* Losing and misplacing belongings
* Fidgeting and squirming in seat
* Interrupting or intruding on others
Watch Dr. Frazer’s webinar that explores common signs of vision-related attention problems and strategies to improve these skills.
Ambly-what? Let’s sound it out… am-bly(blee)-o-pia… amblyopia. Great! Now we can all say it fast 5 times, but what does it mean? You may be more familiar with the term “lazy eye” even though neither one of the eyes are actually lazy. Amblyopia is a condition affecting 2-3% of the population, where one eye has reduced visual acuity (i.e. can’t see 20/20 even with correction) because the brain ignores or suppresses information from the eye. The two most common causes of amblyopia are refractive amblyopia, large differences in the refractive error between the two eyes, and strabismic amblyopia, a condition where the eyes do not align with each other.
Refractive amblyopia develops when the difference in prescription between the two eyes makes it difficult for the brain to merge the two images together. If the brain is faced with one blurry picture and one clear picture, it will give preference to the clear picture and ignore information from the blurry one. The amblyopic eye isn’t actually lazy, it is just being overpowered, or bullied, by the better seeing eye. Over time the suppression of information from the amblyopic eye leads to reduced visual acuity.
The second most common cause of amblyopia is strabismic amblyopia. Strabismus is a misalignment of the eyes. When the eye muscles have trouble coordinating with each other and are not pointing in the same place at the same time, double vision can occur. As we discovered above, the brain gets confused when it cannot merge the two images together. Rather than seeing double, the brain will ignore information from the turned eye, which can lead to decreased visual acuity.
It was once thought that if amblyopia was not treated before a certain, usually age 7, that nothing could be done. These assumptions were based on the belief that the brain did not retain neuroplasticity (or the ability to make new connections) after this “critical” period of development. Interestingly enough, the “critical period theory” was based on research done on cats in the 1960s and 1970s under very artificial conditions. While early intervention and treatment is always best, the National Institute of Health now recommends age not be the determining factor when deciding to treat amblyopia. Click this link to learn more: (National Institute of Health Study).
In her book, Fixing My Gaze, Dr. Sue Barry, a neuroscientist, explains how vision therapy can help patients with strabismus well into adulthood. She draws from her own experiences as a patient; as well as her neuroscience background. Optometric Vision Therapy places an emphasis on binocular (two-eyed) vision, rather than relying on traditional patching only methods. Patients of all ages can see improvements in both visual acuity and more importantly, depth perception, using this method.
In the not so distant past, treatment for amblyopia was limited to patching of the better seeing eye. For patients who are not compliant with patching, a newer method of treatment uses eye drops to blur the better seeing eye. Neither of these options are very practical for school aged and older patients, whose daily functions include high visual demands. Recent studies have shown a different approach which uses Visual Perceptual Learning can be very effective in treating amblyopia well into adulthood.
Remember, successful treatment of amblyopia is ultimately about being able to use both eyes together as a “team”. Quality depth perception only occurs when the brain is able to fuse two images into one three-dimensional image. At our office, we combine Optometric Vision Therapy techniques, along with new advanced Visual Perceptual Learning techniques, to successfully treat patients of all ages.
We are particularly excited about our new virtual-reality based vision therapy program. In this program, we are using the latest virtual-reality technology combined with a video game that is specifically designed for patients with amblyopia and strabismus. This system is both fun and functional. For many patients, this program has allowed them to experience three-dimensional (3-D) depth perception for the very first time! While this program is not a stand-alone treatment for amblyopia and strabismus, it has become an important tool in our office. You can find out more about Vivid Vision here.
As research and our understanding of amblyopia is rapidly changing, not all doctors are aware of or are utilizing these new techniques and technology. It is important to find a doctor who specializes in Optometric Vision Therapy and Visual Perceptual Learning techniques.
Dr. Valerie Frazer practices Developmental Optometry and specializes in Optometric Vision Therapy near Madison and Milwaukee, WI. Contact us at 608-849-4040 or firstname.lastname@example.org with your questions.