Before considering medication, you may want to know that children with AD(H)D symptoms are 3x more likely to have a common vision problem called convergence insufficiency that can interfere with a child’s ability to attend to reading and/or writing tasks.

Convergence Insufficiency (CI) is a vision coordination problem that affects about 10% of children. When the eyes look near, such as when reading and writing, they have to make precise eye movements together in order to keep things clear and single. CI is not related to eyesight, or the need for glasses or 20/20 vision. In some children, the coordinated eye movements needed to precisely converge the eyes do not develop properly. Concussions or other types of mild head injuries can also cause convergence problems. While some children (and adults) will try to work through their symptoms and get headaches or eye strain, others will find it too difficult to multi-task and their brain will struggle to keep attention on the material.

How Convergence Problems Interfere with Attention

A recent study found that children with eye coordination issues have a much more difficult time finishing schoolwork and paying attention in academic settings. Often children with convergence insufficiency will experience strain or discomfort while trying to read. Their eyes may not track across the page well, so they lose their place. Many times children are not able to identify that these symptoms are abnormal, so it is important to ask them about what they are seeing (Take the Convergence Insufficiency Quiz). But keep in mind that avoidance itself can be the biggest symptom as some children will often not focus their eyes on the page long enough to see the words as blurry or double.

With these symptoms, it is easy to see why children are incorrectly diagnosed with AD(H)D and started on medication. Convergence insufficiency cannot be found in typical school screenings or pediatrician vision exams that only test their ability to see 20/20 at distance, test each eye individually or look only at the need for glasses. Teachers, medical doctors and school nurses often do not attribute poor attention and behavior problems to functional vision problems such as convergence insufficiency. This causes the child to be mislabeled based on behavior problems or learning difficulties, when really the underlying difficulty is vision. Unfortunately, this frustration can lead to low self-esteem, anxiety or depression.

Solutions to the Underlying Vision Problem

What should you do if you suspect your child has ADHD or is showing symptoms of convergence insufficiency? Based on a recent National Institute of Health Study, vision therapy is the preferred treatment for this condition. The goal of Optometric Vision Therapy is to teach the child (or adult) how to properly coordinate the two eyes together, often using special lenses and filters. In addition to lenses and filters, the therapy may involve the use of special 3-D depth perception pictures as feedback for the patient to help determine if they are doing the activity correctly. We get our ability to see 3-D or fine depth perception (stereopsis) when the eyes are working well together. Often activities are integrated with other tasks to ensure that the process is easy and automatic.

Individual eye focusing skills, eye movement tracking skills and visual processing skills may also be treated in therapy to treat all aspects of the visual system that impact learning. The average length of treatment is about six months. Studies evaluating the success rate of treating convergence insufficiency with in-office vision therapy conclude the success rate is very high (over 75%-85%). The guided direction of a trained therapist appears to be key to success, as one study found that home-only programs were not much better than placebo in treating this condition. A 2005 study found that successful treatment of convergence insufficiency in children with AD(H)D symptoms had a significant improvement in their ability to concentrate on academics and a decrease in behavior concerns

How Do I Get Help?

Developmental Optometrists diagnose and treat functional vision problems including convergence insufficiency. They can determine if vision is the underlying cause of symptoms or refer to other professionals, such as neuropsychologists or occupational therapists, if no vision problem is found. Developmental Optometrists receive specialized training in the area of vision therapy and are qualified to diagnose and treat learning-related vision problems. Developmental Optometrists that are board-certified in this area will have the initials FCOVD to indicate they have advanced training.

In addition to vision therapy, FCOVD optometrists generally have a greater understanding of vision as it relates to child development, strabismus/amblyopia, developmental disabilities, autism and brain injuries/concussions. Their expertise is not limited to children, as adults can also have these conditions. Their understanding of visual processing goes beyond what is generally taught in medical or optometry school. The College of Optometrists in Vision Development website (www.covd.org) is a good starting point for finding a Developmental Optometrist in your area.

References

Academic Behaviors in Children with Convergence insufficiency with and without Parent Reported ADHD

Convergence Insufficiency Treatment Trial 

Improvement in Academic Behaviors Following Successful Treatment of Convergence Insufficiency

About The Author

Dr. Valerie 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 (Delafield) areas.

Contact us today for more information!
608-849-4040
www.newhorizonsvision.com
info@newhorizonsvision.com

Vision is Our Dominant Sense

More than just sight, vision is the process of deriving meaning from what is seen. It is a complex, learned and developed set of functions that involve a multitude of skills. It is estimated that eighty to eighty five percent of our perception, learning, cognition and activities are mediated through vision. The ultimate purpose of the visual process is to arrive at an appropriate motor and/or cognitive response. Research shows that more than 70% of concussion patients suffer from vision-related symptoms. These symptoms can linger weeks, months, even years after the initial injury if left untreated.

Post-Trauma Vision Syndrome (PTVS)

Post-Trauma Vision Syndrome describes the visual symptoms and findings commonly associated with a concussion/brain injury. Typically, exam findings will show abnormal eye movement skills such as eye teaming, focusing and eye tracking. There is a relationship between these visual symptoms and a “fight or flight” stress reaction, which in severe cases creates symptoms similar to a panic attack.

Symptoms commonly associated with Post-Trauma Vision Syndrome include:

• Intermittent blurry vision, especially at near
• Double or overlapping vision
• Eyestrain
• Headaches, especially during visually demanding tasks such as reading or computer work
• Seeing objects appear to move that are known to be stationary
• Seeing words in print run together
• Patterned floors may appear tilted or distorted or difficult to look at
• Difficulties with crowds or moving environments
• Feeling overwhelmed, nauseous or dizzy in big stores (grocery stores or department stores)
• Balance difficulties or dizziness
• Light sensitivity

Two Visual Systems- Focal and Ambient

Recent research has documented the brain pattern disruptions that occur when someone has Post-Trauma Vision Syndrome. To understand these symptoms, it is important to understand how the visual system is organized. Our visual system is actually divided into two separate but integrated visual pathways, the focal (central or “what”) visual pathway and the ambient (dorsal or “where”) visual pathway.

The Focal Pathway (what) is slower and is designed to process details at a conscious level. Most of the central part of our vision and what we think of as “sight” is a part of the focal pathway. This is how we achieve 20/20 eyesight. Most eye exams are geared toward evaluating this focal pathway.

The Ambient Pathway (where) is faster and the information from this pathway is often processed at a subconscious level. Most of the information that is processed by the ambient pathway is gathered by our peripheral vision. It connects with other areas of the brain such as vestibular (inner ear) and proprioceptive (the information we get from our muscles and joints) to help direct our movements and maintain our balance.  The ambient pathway is sensitive to motion and low light conditions and does not concern itself with details. This pathway also helps direct our visual attention and eye movements.

Because the ambient pathway travels through more primitive parts of our brain located in the brainstem and midbrain (near the base of the skull and neck), it is more susceptible to concussion type injuries including whiplash. When most people think about good vision, they think about good eyesight or 20/20 visual acuity. But many any concussion patients are able to pass standard eyesight tests, while still feeling like their vision is “off” because it is the ambient pathway, not the focal pathway, that is dysfunctional. When the ambient pathway is disrupted, everyday activities that should be automatic, like reaching for a cup, going into a store, riding in a car or reading a book, require more effort. This increased effort can often lead to headaches, fatigue and decreased energy leaving less energy for completing cognitive tasks and remembering. This difficulty in cognition is often described by patients as “brain fogginess”.

Optometrists who are trained in Neuro-Optometric Rehabilitation and Optometric Vision Therapy, understand how to test, diagnose and treat the ambient (where) visual pathway. They can prescribe therapeutic lenses, prisms, filters and therapy that can significantly improve ambient visual function, measurably reduce symptoms and significantly aid in recovery. For more information about brain injury and Neuro-Optometric Rehabilitation, please visit www.noravisionrehab.org.

About Dr. Valerie Frazer

Dr. Valerie 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 info@newhorizonsvision.com for more information.

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.

If you’re only checking this…

You might be missing this…

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.

Common causes of Learning-Related Vision Problems:

1. Uncorrected Farsightedness or Astigmatism

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.

2. Eye Focusing Skills (Accommodative Dysfunction)

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.

3. Eye Tracking Skills (Dysfunctions of Saccades)

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.

4. Eye Teaming Skills (Convergence)

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.

Finding the Correct Treatment

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 treated for convergence insufficiency and ADHD.

Success Stories

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

About Dr. Valerie Frazer

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 info@newhorizonsvision.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.

Games for young children (3-5 years old)

Animal Pattern Block Set, Catch and Count Fishing Set, Three Little Piggies

Games for Children (5 – 7 years old)

Quick Cups, Tangoes Classic, Grabolo

Thumbs Up!, Spot It! Packers Edition, Snappy Dressers, Fast Flip

Games for Children 7 and up

Roll for it!, Dr. Eureka, Tangoes Brainiac, Thinkfun Gravity Maze, Thinkfun Laser Maze

Click here for last year’s Holiday Gift Guide and more gift ideas.

Happy shopping and Happy Holidays!

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:

• 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

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.

608-849-4040

info@newhorizonsvision.com

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 http://biology-igcse.weebly.com/-accommodation.html

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

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 info@newhorizonsvision.com

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.

RSVP TODAY!

608-849-4040 or info@newhorizonsvision.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:

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

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 info@newhorizonsvision.com with your questions.