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What is Accommodative (Focusing) Dysfunction?

What is Accommodative (Focusing) Dysfunction?

May 9, 2018   /    Uncategorized   /    no comments


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.  

Image from

There are generally three types of accommodative dysfunctions:  

  • Accommodative Insufficiency- difficulty efficiently sustaining focus at near. This is the most common type of accommodative dysfunction. The increased effort required to maintain clear vision at near can decrease performance on near tasks.
  • Accommodative Infacility- difficulty efficiently switching focus between near and far and back
  • Accommodative Spasm- a spasm of the focusing muscle which prevents the focusing muscles from fully relaxing. This generally causes blurry vision both near and far.

Physical Symptoms of Accommodative Dysfunctions

  • Blurred vision at near
  • Intermittent blurred vision at distance after reading
  • Difficulty switching between near and far
  • Eye strain
  • Headaches- especially over the brow or temples
  • Eye fatigue
  • General fatigue, especially later in the day
  • Symptoms often are worse when tired, later in the day or during tasks

Behavioral Symptoms of Accommodative Dysfunctions

  • Avoidance of detailed near work (usually reading/writing, sometimes math)
  • Difficulty sustaining attention, especially on near work
  • Difficulty with copying from the board
  • Holding material too close
  • Requires frequent breaks to complete work
  • Makes frequent mistakes, poor attention to details
  • Poor reading fluency or comprehension


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

Vision and Autism Webinar

April 11, 2018   /    Uncategorized   /    no comments

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:

  • Poor Eye Contact
  • Difficulty Maintaining Visual Attention
  • Side Looking
  • Visual Stimming
  • Difficulties with Balance/Motor Coordination
  • Overwhelmed in Visually Stimulating Environments

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

Vision and Handwriting Webinar

February 27, 2018   /    Vision and Learning   /    no comments

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:

  • Peripheral Awareness
  • Visualization Ability
  • Eye Movement Skills
  • Eye Teaming Skills
  • Visual-Motor Coordination


Vision, Behavior and Attention: The Connection

January 15, 2018   /    Vision and Learning   /    no comments

Informative Webinar With Dr. Valerie Frazer

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.

What is Amblyopia?

January 11, 2018   /    Amblyopia   /    no comments

What is Amblyopia?

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

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.

Blurred Image (Amblyopic Eye) Normal Image (Non-amblyopic Eye)

Strabismic Amblyopia

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.

Is there an age limit for treating amblyopia?

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.


How is amblyopia treated?

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 with your questions.

Vision and Reading Webinar with Dr. Frazer

December 6, 2017   /    Vision and Learning , Webinar   /    no comments

Watch Dr. Frazer in this webinar to learn how tracking, focusing and eye teaming can interfere with reading fluency and the learning process.

20% of children lack the visual skills necessary to succeed in school. These necessary visual skills go beyond 20/20 vision. Dr. Frazer will review the most common symptoms of learning-related vision problems and the best methods of treatment.

Learning-Related Vision Symptoms:

  • Losing place on the page
  • Words run together when reading
  • Reversals of letters or words
  • Easily distracted or fatigued
  • Takes “hours” to do homework
  • Low reading comprehension or fluency
  • Poor or unevenly spaced handwriting
  • Uses finger to keep place
  • Eye fatigue or strain

Dr. Frazer’s Holiday Gift Guide 2017

November 22, 2017   /    Visual Processing   /    no comments

The holidays are right around the corner and you may be wondering, what kind of gifts can I give my child that will also help improve their visual skills. Games are a great way to develop skills related to how we process visual information. Visual perceptual skills help us bring meaning to what we see. Delays in these visual skills can significantly affect reading, writing, math and general learning.

These include visual skills such as:

Visual Discrimination– ability to pick out details

Which design is exactly like the one on top?

Visual Figure Ground– ability to find relevant information in a crowded background

The top shape is hidden in which picture?

Visual Directional Skills– the ability to understand concepts of right, left, up and down on ourselves and on others; a key skill for resolving letters/number reversals

Visual Motor Integration– ability to use the visual system to guide the motor system

Visualization– the ability to create a mental picture

Visual Closure– the ability to mentally complete an incomplete picture

If each design was completed and the lines were not moved, which one would look exactly like the design on the top?

Visual Memory– the ability to remember what we see

Remember the order of the shapes after you look away.

Without looking above, which row is the correct order?

Gift Guide

I’ve provided a list of games below that are fun and help work to improve one or more of the visual skills. Many of the 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.

Games for Young Children (3-5 years old)

Candyland, Sneaky Snacky Squirrel, Chutes and Ladders


What’s the Difference?, Hidden Picture Books, Spot It Jr.


I Spy (preschool), Memory Matching, Alphabet Soup Memory, Zingo

Games for Children (5 – 7 years old)

Set Jr., Connect 4, Spot it!, I Spy Dig In


I Spy Eagle Eye, Twister, Sequence for Kids, Q-bitz Jr


Qwirkle, Left Right Center, Bug Trails (6 and up)


Games for Children 7 and up (great family games!)

Checkers, Chess, Battleship


Set, Kanoodle, Blink


Sequence, Qbitz, Jenga, Operation


Feel free to contact our office if you have any questions or concerns regarding your child’s visual skills.

Happy Holidays!

Dr. Valerie Frazer

Good Vision: Your Child’s Most Important School Supply

August 1, 2017   /    Vision and Learning   /    no comments

Summer vacation is coming to an end and the new school year is just a few weeks away. Your child may have survived last school year, but if you want them to thrive this upcoming year you might ask yourself the following questions…

  • Is reading/writing a struggle?
  • Does your child skip lines or lose his/her place when reading?
  • Does your child avoid reading or writing?
  • Do you find yourself battling to get your child to do his/her work?
  • Does your child seem tired, get headaches or complain about their eyes when reading?
  • Does your child have a short attention span for reading or writing?
  • Does your child struggle to complete the expected amount of reading minutes per day?
  • Are they unable to comprehend what is being read?
  • Is your child having difficulty transitioning into chapter books?
  • Does your child have 20/20 vision, but complain that he/she can’t see well?

If you answered yes to any of these questions, your child might be suffering from a learning-related vision problem. Many children with learning-related vision problems have 20/20 eyesight and will pass a traditional eye exam or vision screening. Parents are given a false sense of security that everything is fine; when in reality their child may have significant vision coordination problems that are interfering with their ability to sustain accurate, clear and comfortable vision for near tasks such as reading, writing and math.

There are 17 visual skills that make up “good vision” and only one of those skills include eyesight or the ability to see 20/20. It is estimated that as much as 80% of all learning during a child’s first 12 years comes through vision. The three most common causes of vision and learning problems are poor eye tracking, teaming and focusing skills. Below we’ll take a closer look at these three visual skills and how they impact learning.

If you are only checking this…

Snellen Chart- Checks visual acuity

You may be missing this…

How text may look to a child with eye teaming difficulties.

Eye Tracking Skills

Eye movement or tracking skills are the ability to accurately track and follow with our eyes. Inaccurate tracking skills can cause loss of place when reading, skipping over words/lines, poor reading fluency and “careless” errors.

Eye Focusing Skills

When we look far away, the focusing muscles in our eyes relax, when we look up-close they constrict. The accurate and efficient use of these muscles allow us to focus on near-print for a sustained period of time and easily switch our focus from near to far and back again. Inefficient focusing skills may cause blurred vision, visual fatigue, trouble copying from the board, reduced reading comprehension and avoidance of near-point activities.

Eye Teaming Skills

Eye teaming is the ability of the eyes to work together as an efficient, coordinated team to create a clear and single picture. Small eye teaming problems cannot easily be detected by the untrained observer; however, they do significantly interfere with the ability to efficiently process visual information, especially at near when reading and writing. Difficulties with eye teaming skills can cause numerous symptoms and adaptations including: eyestrain, headaches, blurred or double vision, words run together or moving around the page, difficulty with handwriting/spacing, covering or closing of an eye and decreased reading comprehension. These symptoms make it very difficult to maintain attention on reading and writing, especially for children.

Many times, difficulty will exist in all three of these visual skills areas. These children are labeled as learning disabled, attention deficit or just plain lazy. The good news is that these conditions are easily treated with vision therapy. The bad news is that even though they are fairly common (1 out of every 4 children), they are frequently misdiagnosed or overlooked completely in routine vision screenings.

Many eye doctors (ophthalmologists and optometrists) fail to include the battery of tests needed to identify teaming, tracking and focusing problems. Specialized doctors of optometry who are board-certified in vision therapy have the credentials FCOVD. This designates that the doctor has the training and experience to diagnose and treat vision and learning problems.

You can find more information throughout our website or to find a FCOVD optometrist in your area check out

Why Doesn’t My Child Like To Read?

May 11, 2017   /    Vision and Learning   /    no comments

Why doesn’t my child like to read? A common question parents find themselves asking. For some kids, it isn’t that they just don’t like it, they actually hate it and they will avoid reading at any cost. But why the strong aversion? Here are five reasons why many children (and adults) dislike reading:

Reason #1- Reading is uncomfortable

If your child gets headaches or complains about their eyes hurting with reading or doing near-work, they may be having difficulty with their eye teaming system. Eye teaming (also called convergence) is the ability to coordinate both eyes together. Our eyes have to converge with each other accurately at near to maintain clear and single vision. If the eyes struggle to converge, or sustain that convergence, they will have to work harder to compensate. This will create tension in and around the eyes, forehead and temples. Only the most motivated readers will keep reading when things become uncomfortable. Other signs of convergence insufficiency include: double vision, words appear to move on the page, decreased comprehension (related to the increased effort) and a slow reading rate.

Symptoms like those just listed make it more difficult to attend to reading and near-point tasks, which may cause symptoms that mirror attention deficit disorder (ADHD) symptoms. In fact, in a recent study, children diagnosed as having ADHD were 3x more likely to have convergence insufficiency. These children saw a significant reduction in their ADHD symptoms when their convergence insufficiency was successfully treated with vision therapy.

Reason #2- Words are blurry or hard to look at

Kids do not understand that how they’re seeing is not quite how everyone else sees. A child may have 20/20 eyesight and pass a regular vision examination, but still have poorly developed eye focusing skills (also called accommodation). When our eyes look far away, the eye focusing muscles relax to see clearly at a distance. When we look at something closer, the eye muscles contract to move the lens in the eye to see clearly at near. As we age, this lens itself becomes less flexible, which is why most people begin to need reading glasses after age 40. For a child, this skill should be easy and automatic.

Eye focusing skills allow the visual system to maintain clear and comfortable vision at near. Other signs of poor eye focusing skills include: blurry vision at near, occasional blurred distance vision after prolonged near-work, eyestrain and headaches. Some children complain that the words are hard to look at, that there are colored spots around the words or that the print is distorted. Others will have difficulty maintaining attention on reading or just avoid reading altogether.

Reason #3- They lose their place on the page frequently

To read efficiently, our eyes have to be able to make very precise eye movements, independent of head and body movements. If eye movement skills are delayed or never fully develop, it can significantly affect reading fluency and comprehension.

Reason #4- They think they are a slow reader

It isn’t hard to understand why a child with poor eye teaming, focusing and/or tracking skills might take longer to complete reading assignments. Another reason for slow reading speed can be poor span of visual awareness. Span of visual awareness refers to the amount, and speed, with which visual information can be taken in and processed. Children who are stressed about reading will often have difficulties with this and the end result is a child that seems to never “sit still”. Getting the wiggles out through movement activities and/or deep breathing exercises before sitting down to read can help combat some of the internal stress which may be making the problems worse.

Reason #5- They can’t visualize what they’ve read

Reading is more than decoding words, it is about creating a picture in your head to help you understand the author’s thoughts. Visualization, or the ability to make pictures in your head, is a skill that is often developed when children use their imaginations or play make believe. Parents can foster this skill by reading aloud to their children and then asking them questions to see if they understand what was just read.  Visualization is important not only for good reading comprehension, but also influences a child’s spelling and writing skills.

If you or your child identify with any of these five common reasons people avoid reading, you’re not alone. One out of every 10 children have an undiagnosed vision problem that can interfere with learning. The good news is there is hope! These visual skills are all learned skills that can be developed with proper guidance at any age. Developmental Optometrists specialize in the diagnosis and treatment of these common visual skill problems that can affect reading and learning. Treatment for vision-related learning problems may include therapeutic glasses designed to improve visual efficiency and/or optometric vision therapy. To learn more, check out our website, To find a Developmental Optometrist near you, visit the College of Optometrists for Vision Development website at

Valerie L. Frazer, OD, FCOVD

Click here to learn more about Dr. Valerie L. Frazer.


Amblyopia: Myths, Truths, Treatments

April 21, 2017   /    Uncategorized   /    no comments

Advances in Amblyopia Treatments

Watch Dr. Frazer’s webinar that explores the ins and outs of amblyopia, dispel common treatment myths and uncover innovative treatment options including Vivid Vision virtual reality!

According to recent studies, over 12 million people in the United States alone are diagnosed with amblyopia… that’s about 3.5% of the US population.

Standard treatment options generally include endless hours of patching or Atropine drops, which have many visual and emotional consequences and low prolonged success rates.

Good news! There are advanced treatment options that are evidence-based and can be effective at any age.

During this webinar, Dr. Frazer explains:

  • Why amblyopia develops.
  • Why patching alone is not always effective.
  • The importance of binocular vision in treatment.
  • New advances in amblyopia treatment including Vivid Vision.

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