Dr. K's Blog

The Subtle Child

18 November 2011

Let me describe a child to you. She struggles with school. Reading is slow and laborious. If mom or dad reads to her, her comprehension is a lot better than if she reads on her own. Homework takes a long time to complete. The biggest concerns are that she is starting to lose self-esteem and just doesn’t seem to be reaching potential.

She has had a psycho-educational evaluation at school and although some issues were found, they were subtle and didn’t warrant intervention. She also had an OT evaluation at school. Again, there were some concerns but, not enough to qualify for OT. Mom and dad have been told, “maybe your child is just simply a “C” student”.

A friend of her parents suggested she come to see me. After my evaluation it’s my turn to tell mom and dad the same thing everyone else has told them. The numbers don’t look so bad. But unlike the other professionals, despite the numbers, I definitely think that she should have Vision Therapy. I see the confusion in mom and dad’s eyes. “If it’s subtle, doesn’t it mean that it’s not much of a problem?” My answer is “No. In terms of vision, subtle does not equal a small problem.” Here’s why…

The subtle child is a child who hasn’t adapted to their inefficiencies. If the visual system is not efficient it interferes. So, a “small problem” is a problem that hasn’t been solved and interferes. Imagine driving your car and you suddenly get a flat tire. You pull over to the side of the road. Maybe you can simply put some air into the tire and quickly drive to a service station. Maybe you can put a spare tire on and then get to the service station. Maybe you need a tow. Any one of these choices will work to solve the problem. They’re not necessarily efficient adaptations, but they’ll do the trick. On the other hand, imagine instead of pulling over, you just keep driving on that flat tire. You’d have to drive slowly, you’d have to be real careful because it’s not safe, and it would be a bit uncomfortable to be thumping along down the road. In fact, continuing to drive seems pretty silly doesn’t it? It makes a lot more sense to fix the problem. Yet that’s the subtle child. Slowly, thumping along down the road, not able to adapt to the problem, but able to get to the destination. She has four tires, one of them is flat, but three out of four is good enough. Right? Not in my book.

The subtle child needs help just as much, if not more, as the obvious child. If we’re not careful the subtle child will perpetually fall between the cracks, not getting any help because they are not the squeaky wheel and at the same time never reaching their full potential. If you have a subtle child, don’t leave any stones unturned in trying to find professionals who “get it” and are willing to work with you. It’s that important.

Learning Lenses Part II

08 February 2011

There are several different kinds of lenses that fall into the category of learning lenses. One type of lens is called prism. Prisms can be prescribed in many different ways, but when they are used in a "yoked" fashion they have a particularly powerful affect on how we perceive and organize space. At it's most basic level, vision is our spatial sense and we can manipulate this spatial sense by the use of prism.

We all have a midline that runs vertically through the center of our body. Some of us, perceive this midline to be displaced. It can be displaced in any direction (forward, backward or to one side). We then balance our body around this perceived midline. If our perception is inaccurate we will have shifts in our body posture and in our movement. For example, some children are toe walkers. For some, (not all) their toe walking is a consequence of a misperceived midline. I can then put a pair of prism glasses on this child that will change how they perceive space and the relationship of their body to space and you can see an immediate shift in how they walk. In other words, no more toe walking.

Just last evening I saw a patient who I prescribed yoked prism for. His parents were concerned because he had difficulty with his gross motor skills. He couldn't catch a ball, he couldn't ride a bicycle, and he was a bit "clumsy". There was an immediate improvement in these areas after he started wearing his yoked prism glasses. Now he can ride a bike. Now he loves to play basketball. Now he is more coordinated. Now he does better socially. Now he is reading more fluently. All these improvements from a simple pair of glasses.

So, if you have a child who doesn't seem to interact in their spatial world very well, if you have a child who seems to have difficulty organizing space, if you have a child who is having difficulty with spatial concepts such "it to me" "it to it" "me to it" concepts - please go to a Behavioral Optometrist who can perform an evaluation an potentially prescribe this very powerful type of lens.

Snow days and Eye Safety

03 February 2011

With the country getting pummeled by snow I wanted to give a quick reminder to be safety conscious when playing outdoors. Every year I see a few cases of children being hit with snowballs in the eye. This can cause very serious injuries such as retinal detachment. Wear protective eyewear when playing in the snow.

Tree branches can be another source of injuries to the eyes. Particularly if you like to snow shoe or cross country ski watch for those branches. Again, protective eyewear is important to protect against a corneal abrasion.

Also, over the years I've seen several cases of head injuries from sledding. Although, I focus on vision and learning issues, head injuries can cause major breakdowns in the ability to execute visual skills. There's a general awareness that children should wear helmets when skiing and snowboarding, but a lot of parents forget about using helmets when sledding.

Have fun out there but please be careful by taking some simple precautions.

Learning Lenses-The Reading Miracle

23 December 2010

I often write about the power of Vision Therapy, but today I want to tell you about another powerful tool that Behavioral Optometrists have at their fingertips. This tool is easy to use and often gives immediate results. I've seen non-readers become readers literally within seconds.

I call this tool "learning Lenses". Everyone is familiar with the idea of using lenses to make things look clearer. If you're having trouble seeing clearly, putting on a pair of glasses that compensates for this blur will give you better clarity. Learning Lenses have a different application. They are not necessarily used to create better clarity, although that may be one of their perceived effects. Learning Lenses make it easier to execute visual skills such as eye teaming, eye focusing, and tracking.

My favorite Learning Lens story involves a 15 year old boy named Brad who hated to read. He wouldn't do his homework, and he was doing poorly academically, because he would not read. I prescribed reading lenses for him and asked him to come back for a progress evaluation in a few weeks. At this visit, his mom told me on the evening they picked up Brad's new glasses she was calling Brad to the dinner table. He didn't come to the kitchen. She looked for him all over the house, but couldn't find him. She finally found him in the backyard, sitting at their picnic table, with his glasses on - reading! She couldn't believe it. He didn't want to put the book down, he didn't care about dinner!

The other day I saw a 6 year old who was having difficulty learning to read. Mom had noted that he skips around and loses his place when he tries to read. Sure enough, his eye movements were not smooth and he had trouble holding his fixation on what he was trying to look at. I put a set of Learning Lenses on him and rechecked his eye movements. His mom nearly fell out of her chair. There was an immediate, obvious improvement in his eye movements.

Even though Integrative Vision Skills is all about Vision Therapy, you should be aware that glasses play an important role in helping a child to read better. So, if you have a child struggling academically find a local Behavioral Optometrist by clicking here to explore the possibility of Learning Lenses!

The Vision and Reading Disconnect

16 November 2010

It's been awhile since I last posted. This time of year is real busy for me. School is in full swing and all those children who are showing signs of visual problems are coming in for evaluations. It's also peak season for the lecture circuit. I'm speaking at a number of schools for staff development day. All in all, there's just not been a lot of time for writing.

I'm often asked, "why so many people have difficulty using their visual skills when reading?". Behavioral Optometrists call reading and other near point tasks "biologically unacceptable and socially compulsive". In other words, our biological evolution has not kept up with our social evolution.

Literacy requires visual skills that have not evolved to handle the task. Therefore, reading (and computer work) places stress on the visual system. We call this near point stress. When a system is stressed, it must adapt. There are many adaptations that people make to near point stress.

The first adaptation is to avoid the task. Why stay in the kitchen if it's too hot? You wouldn't - you'd get out. So, if reading is too stressful, avoidance is a reasonable strategy.

Another adaptation is to cover an eye when reading. This takes one eye out of the equation and now there's no energy needed to coordinate the two eyes together. That removes stress. It creates a new problem in that it disrupts depth perception, but it does solve the immediate issue of near point stress on the system. As an individual evolves their stress response they may learn to have the brain ignore input from one eye. This accomplishes the same thing as physically covering an eye except it's occurring at the level of the brain.

We can also work hard to push through the near point stress. Again, this allows us to accomplish the near point task, but we use a lot of energy in the process. This causes fatigue. The person may feel symptoms of fatigue such as headaches and eyestrain.

The take home messages are:

1) If a child is avoiding close work, covering an eye when reading, or exhibiting symptoms such as headaches and rubbing eyes when reading - suspect vision issues.

2) Manipulate the environment to make close work easier. Good lighting and good posture help. Using a slant board when reading also helps. Take frequent breaks when doing close work. I often recommend the 10x10 rule. For every 10 minutes of close work take a break by looking far away for 10 seconds.

I don't know that I'll be able to get another post in next week. I hope every one has a great Thanksgiving. Enjoy your families!

Dr. K