A Major Reason Your Child Won't Want to Read 21 Jul 2020, 3:27 pm

When it comes to our children we always want the best. We research toys, food, activities, and educational programs that will give them the best advantage in this ever increasingly competitive world. So when our children begin to resist something that we know is good for them, it can be disheartening and anxiety-inducing. As I certainly haven’t held back from expressing the importance of reading, seeing patients of mine that are struggling in school, and seeing the frustration and concern from their parents, I greatly understand the anxiety that comes when a child doesn’t want to read or do their homework.

While there are many reasons why your child may not like to read, this article addresses a major one that is often missed and possibly worse misdiagnosed.

When in encouraging environments, most children truly seek to do well and succeed at whatever task is brought to them. When children are failing or falling behind, more often than not, there is an underlying problem that the child can’t control.

In my field as a behavioral optometrist, I’m rarely the first person that parents and children see to try to find a cause for the child’s academic struggles, and it is honestly quite disheartening. I understand that the reason is that the public isn’t aware of the complexity of vision and the many visual information processing skills, including perceptual skills, and how even the slightest thing wrong with this immensely complex system can cause a multitude of symptoms that can slow down every aspect of learning and that’s why myself and any other doctors are working to raise awareness.

By the time many children get to me, they have already seen some other type of healthcare professional, be it a psychologist, pediatrician, or family MD. Luckily, many in the health care field are keeping up with their education and are aware of the many vision disorders and actually refer appropriately to a behavioral or developmental optometrist. A great many professionals, however, are still behind and unaware of such conditions and these conditions are completely missed in the children or misdiagnosed as ADD, ADHD, or other mental and behavioral conditions and medications are prescribed that don’t help the problem at all.

After reading all of that, I know there can only be, at this point, a list of burning questions.

What is this visual problem that makes reading and comprehending and learning from what you’ve read seem near impossible? Why is it missed? Why don’t children complain? Why don’t they tell us they are having problems?

To the first question, the visual problems are those with how the brain and eyes collaborate together and unfortunately, it is not a single disorder that causes this problem, but a list of them. The disorders broadly break down to binocular vision disorders and those that affect how our brain processes vision.

Now knowing that there are several visual disorders that can cause visual symptoms that lead to extreme difficulties for reading and learning, it should be a bit easier to understand how these things can be missed. These vision disorders are present in children with visual acuity that is even better than 20/20, so school screening exams will never really catch the conditions.

Why don’t children complain then? Well, sadly, children think that everyone sees the world the way they see it, so children and teens aren’t able to distinguish that what they are experiencing is not normal. Many children do not know how to describe occasional blur when reading or occasional double vision.

When I was young, my mother said that the first time I had a headache, I said I had a tummy ache in my head. Children only really know what they are taught and teaching children about things that can go visually wrong so they can distinguish what is normal and what isn’t is not something that is really done.

Since these vision problems can all present with slightly different symptoms, diagnosis requires a trained behavior or developmental optometrist to test all of the visual skills and narrow down what is wrong.

For conditions where the eyes are not coordinated well together, symptoms can include blur constantly or occasionally, double vision constantly or occasionally, headaches, loss of place when reading, and more.

For conditions where the brain isn’t processing the vision properly, symptoms can include reversing letters, poor directionality, difficulty finding a word or place on a page, and more.

Both types of conditions can ultimately lead to poor reading comprehension, exhaustion when reading, homework taking longer than it should, falling several reading levels behind, and poor self-esteem.

Remembering that vision is MUCH more than just 20/20, as a behavioral optometrist, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read and that when it comes to learning, 80% of what children learn is take in visually. So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.

If you feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them).

Call our office today to schedule a complete and comprehensive eye and vision exam!

The Importance of Learning and Not Just Memorizing 21 Jul 2020, 3:22 pm

I personally couldn’t agree more with Natalie Portman’s quote, “I don’t love studying. I hate studying. I like learning. Learning is beautiful.”

I love learning. I love reading articles and research papers on visual function, visual treatments, psychology, and neurology topics. I get so into articles and find them so interesting that I torture my husband and make him listen as I reread to him every paragraph that struck me as fascinating. I could spend hours every day watching lectures from doctors and researchers and reading their books on topics that interest me as it is the closest I can get in the moment to sitting down with them and having a discussion with them.

I do, however, genuinely hate studying. I don’t like to force myself to memorize facts. While I love the usefulness of mnemonics when having to remember something I’m honestly just not that interested in, I loathe coming up with them and then scratching my head later to try to remember and make use of what I forced myself to remember.

So how did I make it through my undergraduate to receive a Bachelor of the Science in Biology with a minor in Chemistry and double concentrations in Microbiology and Molecular Biology and then go on to get my Doctorate in Optometry? Why did I shake my head when family members said, “Oh I wish I liked school like you do.” as I felt like a part of me honestly hated school sometimes?

Well, it’s because of what I stated above. I loved my science classes, most of them anyway, and loathed those that I couldn’t see applying to my profession. Some of the classes that I did the best in were genuinely my hardest ones that required the most studying and work… only I couldn’t imagine it as work. To me, the topics were and still are fascinating.

With other classes that weren’t nearly as difficult, it felt like genuine torture reading through the textbooks and memorizing the facts. I ended up always having to go to the library to study for those classes because if I was home I would rather do laundry or clean my bathroom than force myself to focus on the material that just didn’t pique my interest.

In the end, I obviously prevailed and made it through. But I always keep things very real and honest and do not hide that while part of it was incredibly enjoyable and perceivably “easier” as I was interested in my major, there was a lot of work and dedication put into getting my degrees and completing all of the required classes.

So how did I do it? When degrees require courses from various unrelated subjects, how does anyone get through them?

The simplest and most straightforward answer is that they see the bigger picture and have the patience to put in the work without reward (delayed gratification) until receiving it years later with the degree that can hopefully aid them in acquiring their desired career. But simple and pushing “delayed gratification” may not help you or your child at the moment, so here are some other ways to think about it.

So what is the value of learning over memorizing?

The value is honestly something that is already well understood and odds are, you already agree that it is more valuable even if you may not realize you do at the moment.

A great example of the value of learning versus memorizing is in mathematics. While we all memorize various simple equations that are incredibly important and time-saving, the greater picture and value of mathematics is learning and understanding the concepts so that we can apply those concepts to an infinite number of situations.

In medicine, while one may eventually memorize a great deal of information about the signs and symptoms of diseases, it would be impossible to memorize everything. Therefore, understanding what the disease does and how the body is damaged is much more useful as now one can derive the signs and symptoms and much more logically.

Engineering falls into the mathematic category when it comes to the importance of learning concepts, only with different and added elements added on top. An engineer could never memorize every measurement or parameter needed for building each structure that they are tasked with. However, understanding there mathematical and structural or electrical concepts, they can calculate and “engineer” what they need.

While the list could greatly continue for countless other careers, hobbies, sports, and situations. The true value of learning concepts over memorizing facts or numbers certainly isn’t difficult to understand, but it raises the next and most relative question.

How do we create the desire to learn something that we need to but, well, we really don’t find that interesting?

For me, if I’m being kind of honest, there were times where I just had to lie to myself to make myself interested. It was sort of a version of the “fake it ’til you make it”. While I certainly don’t recommend lying to yourself or anyone else ever, I did want to be honest with the somewhat ironic or interesting way that I came about my techniques to survive and thrive through my academics.

While my frustration led to a bit of a negative view of learning material I wasn’t interested in, the take-away is what should be focused on and what I focus on now in order to learn material that doesn’t seem to pique my interest at first.

The take-away was really what I told myself. What I would do was create scenarios in my head where I would genuinely need the information I was learning. This was certainly more difficult for some subjects than others, but it really did work to help me to fuel the desire to really learn and understand the concepts, committing them to a longer-lasting understanding instead of just memorizing the details into my short term memory for the next test.

For various subjects, I would imagine myself in an intellectual conversation with someone and it would hit me that this may be a great topic to be well versed on. Not wanting to make a fool of myself, I would take what I was learning in class and relate it to that conversation and realized that simply memorizing facts wouldn’t last in a conversation.

In the same way that you would have to understand mathematical concepts in order to make use of them in the real world, you can’t have a conversation about a topic you don’t fully understand unless you are actively making note that the conversation if for you to learn about the topic. Conversing requires going back and forth with questions, comments, and viewing a topic from different perspectives. Simply memorizing facts won’t get you to that level.

So my main suggestion for shifting your mind from “having to memorize” new material to “truly learning” the new material is to create real-life scenarios of where you will need this information and you’ll quickly realize it’s value.

In adulthood, this task is much easier as the majority of things that we are learning, we are really only learning because we have already come across a situation where we needed the information or we see one coming. Learning the detail about our taxes may be daunting, but when we see the very real dollar signs, the motivation should come pretty quick.

For children, it would obviously be pretty difficult to get them to see far enough into the future to a real-life situation where they would really need or utilize the information they learn in school so try to work to create those situations in their everyday life.

If it’s math, use it at the grocery store to not only add totals or calculate the total with tax but use it to calculate the cost per ounce of something and see if buying a larger amount really is worth it. With other topics, go beyond asking them what they learned and continue with follow up questions that train them to really think about what they are learning instead of just memorizing the facts.

Asking questions with “why” and “how” instead of just “what” shift the child’s mind to think about the history, social studies, or literature topic on another level. Constantly shifting their way of thinking about a topic will train them to do this in the future and promote deeper understandings of everything they are learning leading to long-term memory storage.

As always, if your little one is struggling, never hesitate to get them examined so they can be treated for anything that may hold them back. There is a long list of visual conditions that affect the learning and reading ability of even those who have vision better than 20/20.

Always give your child the benefit of the doubt and know that they may not be a “problem student”, but may have an underlying vision condition and simply can’t understand or explain the symptoms. With countless children, teens, and adults being misdiagnosed with ADD, ADHD, and other learning disabilities and being put on medication that doesn’t even help their problem, a thorough vision exam should be the first thing on your checklist.

Remembering that vision is MUCH more than just 20/20, as a behavioral optometrist, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read and that when it comes to learning, 80% of what children learn is take in visually. So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.

If you feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them).

Call our office today to schedule a complete and comprehensive eye and vision exam!

Benefits of Playing a Musical Instrument 21 Jul 2020, 1:51 pm

The benefits of listening to and playing music have been preached about for years. Starting children young with simple piano lessons have been shown to impact numerous academic areas. Further studies have shown that music lessons have been correlated to much more as well.

Psychology Science published research back in 2004 that showed that full-scale IQ did measurably increase in children who took music lessons.  The article stated that

Playing a musical instrument and being involved in music has been debated to have effects on much more than just IQ. While it has been said to help develop various skills such as spatial awareness, fine motor skills, rhythm, observation, and improved social skills, it has also been linked more generally to help with higher-level careers.

According to research performed by numerous universities including the Maharishi University of Management in the US, Harald Harung, Oslo University College in Norway, and Yvonne Lagrosen, University West in Sweden, 

Music lessons have been shown in several studies to increase math scores and this study revealed that just a couple of years of piano lessons showed higher scores.  Considering that this study was performed over 20 years ago in 1999, the relationship between music and math performance certainly isn’t new.  The study states,

The benefits of learning a musical instrument don’t stop with just improving IQ, academic, and career performance, although I feel like that would be more than enough to convince someone to enroll their child in piano lessons. Another study revealed that lessons can also help with the aging mind and possibly even athletic performance.

A study in the U.S. journal Brain and Cognition stated that

The lead researcher, Simon Landry discussed the goal of his study stating,

As he revealed that the many benefits of learning to play a musical instrument go beyond just testing better in school and can have benefits in aging, he pointed out,

Considering some may play off the effects of studies showing an increase in IQ and still say it could be debated on a level that would examine the actual physiology of the brain, research has gone into that as well. 

Aside from mathematics improvements, the sheer fact that musicians’ brain waves show different reactions and reaction times, denies any claim that developing a musical skill doesn’t directly affect the brain.  A study over 25 years ago in 1994 revealed the neurophysiological changes as they examined the brain wave responses of musician and nonmusicians to 

While new research is always coming out and everything can still be debated on some level, showing that the responsive brain waves are different and measurable quicker

Remembering that vision is MUCH more than just 20/20, as a behavioral optometrist, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read and that when it comes to learning, 80% of what children learn is take in visually.

So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.

If you feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today for a complete and comprehensive eye and vision exam!

What is Convergence Insufficiency 20 Jul 2020, 9:30 pm

In it’s simplest definition, Convergence Insufficiency is when the two eyes do not converge (direct their aim inward together) strongly enough when someone is looking at something up close. This results in the eyes not being aimed at the same near target and the person seeing double.

The cause of convergence insufficiency, however, is not quite so simple. In order to understand why the eyes are not moving inward together as they should, we have to dive a little deeper.

The first thing to understand is that when we look at an object that is close to us, like a book, we must do two things in order to see it clearly. First, we must focus the lens inside of each eye in the same way a camera refocuses its lens when looking up close versus far. Second, we must move both eyes to aim at the exact same letter of each word together so we don’t see double and continue to keep them aligned as we read across a page.

If this sounds like a lot of work, it is. The immense amount of precision required to do this would be absolutely exhausting if we had to consciously focus on keeping things clear and actively lining up our eyes with each other. Luckily for us, most of this work is done autonomically (without us really having to think about it).

So what is going wrong in convergence insufficiency? Well, in short, the processing system (think of the brain as a computer) that normally coordinates these eye movements autonomically without us having to think about it isn’t working properly.

Each time we bring something closer to our eyes and our brain directs the lens inside of our eye to change it’s shape and focus (bringing clarity), the brain also gauges how close that object is based on how much the lens has to focus. Once the brain has a good idea of how close the object is, it then directs the eyes to move inward to aim at an object that it thinks is at the distance indicated by how much the lenses in the eye had to focus. Hopefully, your head isn’t spinning from this, because it is quite complicated and there are mathematical and optical equations that your developmental optometrist does to really dial in where the weaknesses are.

To simplify, the lens focuses, the brain judges how far the object is based on the amount of focusing power used, and the brain brings the eyes into the distance that it things the object is.

Now that we understand one of the main concepts of what goes on in a healthy and properly working visual processing system, we must ask again, “what is going wrong in convergence insufficiency?”

The error that occurs in convergence insufficiency is in the actually processing done by the brain. A very important concept to understand is that it is NOT a muscle problem with the muscles moving the eyes. It is a BRAIN PROBLEM with how the brain is signaling and directing the eyes.

The more complex, but truest answer to what convergence insufficiency is is that it is a problem with the brain not sending the correct signal to bring the eyes in a sufficient amount.

So what happens when the brain doesn’t send a correct or strong enough signal and the eyes don’t come in enough to look at a near target?

The eyes sit outward slightly and the person has to then work to bring them into the correct point so they don’t see double. And if you are thinking that this sounds exhausting, you are right again. It is literally a headache waiting to happen.

When someone has convergence insufficiency, they are constantly working to bring their eyes in enough to prevent seeing double. They have a limit and the eyes eventually pull back and the person will see double coming in and out until it is constant. This constant work can cause headaches and eye strain. Some people even report nausea as everything is going back and forth from single to double and it can be disorienting.

The sad part is that glasses do NOT help convergence insufficiency. So what do people do to relieve the symptoms? There’s nothing they can do really except to avoid the cause and that is near work.

Obviously avoiding near work isn’t a very helpful suggestion or route to take for a student who must read and study in order to succeed in school. It also won’t work for the majority of adults who’s jobs require some kind of reading or work at a computer. So the obviously better solution is to seek medical help to not just treat, but cure the condition.

What treatment is there for convergence insufficiency?

Vision Therapy. Vision therapy works to improve the processing system of our vision. As we went over earlier, convergence insufficiency is NOT a muscle problem and there is no way to increase the strength of the muscles that move our eyes anyways. Convergence insufficiency is a BRAIN and VISUAL PROCESSING problem and that is what vision therapy so amazingly treats.

Vision therapy is incredibly efficient and has cure rates of 85-95%. I often explain to my patients that vision therapy is like physical therapy, but for the visual processing system. We use customized parameters on each exercise to fine-tune how your brain processes the visional information it is receiving and direct the visual system (the eyes, muscles of the eyes, & processing in the brain) to more efficiently collect and process new visual information.

With the brain working more efficiently, patients no longer have to struggle to read up close. No longer is there the need to force their eyes together to keep things clear as their brain is now autonomically (performing without us having to think about it) doing it for them.

With the brain doing the work, patients and students treated and cured with vision therapy can now focus on the information that they are reading and learning and absorbing the material instead of focusing on preventing double vision and not even knowing what they’ve read.

How prevalent is convergence insufficiency?

According to the Convergence Insufficiency Treatment Trial, convergence insufficiency, or CI, “has a prevalence of 4.2% to 6% in school and clinic setting”.  That’s roughly 1 out of every 20 kids sitting in a classroom trying to keep up with their studies.

These numbers are alarming and the sad reason why the public doesn’t hear about it more often is because it is often completely missed. Because children think that everyone sees the world the same way that they see the world, children don’t know how to describe the visual symptoms of blur or double vision. They will still try to avoid reading, but will often sadly be misdiagnosed with ADHD, ADD, or other learning disabilities.

Remembering that vision is MUCH more than just 20/20, as a behavioral optometrist, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read and that when it comes to learning, 80% of what children learn is take in visually.

So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.

If you feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today and schedule a complete and comprehensive vision exam.

Adult Held Back in Life By Convergence Insufficiency 20 Jul 2020, 9:10 pm

As I type these posts, I am reminded of a 55 year old male patient that I treated in Philadelphia while I was working towards my doctorate.  He was soft spoke spoken and eager to try vision therapy as he said that he has had symptoms of head aches for his entire life if he did any work at near or attempted to read a book. 

He stated that he couldn’t read more than 2 pages of a book without getting a headache and it had been that way his entire life.

A detailed vision exam in our optometric clinic revealed that he had Convergence Insufficiency.  Convergence Insufficiency is the most common and well studied of the binocular vision disorders.  While his story was heart breaking, the good news was that his condition could be treated and most likely cured with Vision Therapy. After just a few months, he was completely cured and upon coming to his last session he stated that he read 40 pages of a book the night before with zero symptoms. He was in tears and my reporting doctor and myself were as well.  

He was so grateful that someone finally helped him with something that he had visited the best eye hospitals in the world to try to get help for, including Will’s Eye Hospital right in Philadelphia.  Everyone told him that his vision was fine since he could see 20/20 and there was nothing they could do.

The saddest part of his story was that it took until he was 55 for him to finally get relief from his disorder.  He spoke of how he had wanted to go to college when he was younger but had a hard time studying. He then said that in adulthood he would always be the last one to finish filling out a job application and felt like everyone viewed him as the dumbest person in the room.  His self confidence was damaged and he said that he always thought that he was an intelligent person and wanted to read books, but could never physically read them because of his headaches and double vision.  

And this entire time… he had perfect 20/20.  So what was wrong? Why was this kind, brilliant, and eager many unable to read even 2 pages of a book without getting headaches?  It’s because vision is so much MORE than 20/20.

To learn more about the many visual skills beyond 20/20, click here.

Some Common Causes of Double Vision 20 Jul 2020, 8:36 pm

While there are several things that can cause double vision, in this post, I’m going to just discuss one of the most common causes. In the simplest way of stating it, double vision is most commonly caused when the eyes are not aimed at the same thing. And while knowing that can be good, it doesn’t help us fix the problem, so let’s dive into what can cause the eyes to be misaligned.

Before we get too detailed, it’s important to note that no information presented in this post should be used for diagnosis or treatment. If you are experiencing double vision in any manner, constant, occasional, long-standing, or newly occurring, you should make an appointment with your primary care doctor and an optometrist immediately.

Let’s start with some of the basics of truly understanding our vision before we dive into how it can go wrong and lead to double vision. I often like to refer to our eyes as two individual cameras that are recording our world and sending the information back to our brain to be processed into an image. What is amazing about have two eyes is that, even though the eyes aren’t very far away from each other, they have different viewpoints of our world.

What does this mean for our vision if our brain is trying to process information from two different locations? It means that when our visual processing system and visual skills are properly functioning, we are able to see our world in 3D. This principle of having two offset eyes helps provide us more accurate depth perception as well as increase our peripheral vision.

So now that we know the purpose and benefit of having two individual views of the world, let’s move on to what can go wrong and prevent those two views from coming together in such a way that we see one clear world.

As stated above, the simplest way to explain one of the most common causes of double vision is that the eyes are not lined up at the same thing. If one eye is aimed at a ball and the other is aimed at a cup next to the ball, the brain is going to take the center of both of those images and try to place them on top of each other.

So one image with the ball in the center will have the cup to the side of it and that will be placed on top of an image with the cup in the center and the ball to the other side of it. When the brain attempts to make a clear image out of these two, the image ends up with two of just about everything.

Because each eye is sending information that the ball and the cup are in different places, the brain thinks that there are two of each.

What is causing the two eyes to be misaligned?

If we again start with the simplest answer, we would say that the muscles are not working properly to aim each eye at the exact same spot as the other eye.

Understanding the muscles of the eye takes us to another step in this process of understanding the causes of double vision. Each eye has 6 muscles. Each one moving each eye in a distinct direction.

It is obvious to see, that if there is damage to one of these muscles or the nerve supplying it, then there would be a decreased ability or inability for the eye to move in that direction.

So while trauma to the muscle or nerve supplying it are possible causes for the eye to not align properly, other causes involve problems with the visual processing system in the brain that sends signals to the eye muscles and direct them in their movement.

As vision is more than just 20/20 and requires several visual skills as well as visual information processing skills including visual perceptual skills, it isn’t hard to imagine that something could go wrong in one of the many tasks that the brain has to perform in order for us to have properly functioning vision. One of the most common conditions is convergence insufficiency, which can luckily be treated and often cured with vision therapy.

Disorders that cause the eyes to not line up properly are referred to as binocular vision disorders. They can include issues with the eyes not coming together properly when looking at something up close and causing double vision when reading, not moving apart properly when looking at something far away and causing double vision then, and various other issues.

Remembering that vision is MUCH more than just 20/20, as a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read and that when it comes to learning, 80% of what children learn is take in visually. So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.

Feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today to schedule a complete and comprehensive vision exam

Visual Information Processing Skills 20 Jul 2020, 8:31 pm

We are going way beyond 20/20 with this post! We are going past the eyes and into the brain and diving into the skills that are truly taken over and controlled by the brain.

As you read through these skills, remember, NONE of these will be caught on a vision screening at your school or your check-ups with a pediatrician or even most likely not even at your annual eye exam with an Optometrist. These are skills that will need to be examined in a more detailed and specific exam by a developmental Optometrist, like myself. Knowing about these and symptoms that can arise from problems can help prevent misdiagnosis with ADD or ADHD and can catch often missed conditions like convergence insufficiency.

If you are concerned about your child having any issues with any of these skills or any of the 17 Visual Skills, call our office today to schedule a complete and comprehensive vision exam.

Visual-motor integration: the ability to process visual information and direct movements coordinated to the instructions based on the visual information

• you will read many developmental optometrists and occupational therapists who work together often use the phrasing eye-hand coordination instead of the incorrectly implying hand-eye coordination. This is because the limb goes where they can see.

• Problems here may include poor handwriting and drawing and poorly coordinated fine motor skills and/or gross motor skills.

Laterality: the ability to be aware of the middle of your body and know which side is right and left.

• This sense of laterality starts in infancy with crawling and then walking as both sides of our both are working together in synchronized motions.

Directionality: the ability to understand the concept of left and right in the world around you.

• Those with directionality issues often mix up a letter like p & q and b & d.

• They may have a hard time understand what right and left are on another person or object that is not a part of themselves.

Visual Perceptual Skills: These include several higher-order skills that the brain uses when processing information and greatly affect how well one can read, learn new material, and function in their everyday environment. Skills include:

• Visual Discrimination

• Visual Memory

• Visual-Spatial Relation

• Visual Form Constancy

• Visual Sequential Memory

• Visual figure-ground

• Visual Closure

• Learn more about each of these by clicking here.

Visual-Auditory Integration: this is how well our visual and auditory systems work to process information together. Locating something based on the direction the sounds are coming from and increased reaction time to a sound or command are good examples of this integration.

• Problems can result in delayed reaction time to a sound and poor localization of an object when trying to listen to the direction it is coming from.

Eye Movements: the eyes move quickly and autonomically based off of several factors. These highly specific and coordinated movements include much more than looking up and down and side to side with each other, but also include diverging (aiming away from each other) when looking at something in the distance and converging (aiming more toward each other) as you look at something in closer proximity to yourself.

• problems can lead to double vision, poor depth perception, appearance as though the world is unstable, headaches, and many other visual disturbing symptoms.

Remember also that vision is MUCH more than just 20/20. As a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read. And when it comes to learning, 80% of what children learn is take in visually.

So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills here on this page including the visual perception skills.

Feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today to schedule a complete and comprehensive vision exam.

Misdiagnosis of ADD, ADHD, Autism, and More 20 Jul 2020, 8:26 pm

Time and time again developmental eye doctors (developmental optometrists) are having parents bring in their children who have been misdiagnosed with ADD, ADHD, and a list of other disorders and are still struggling in school despite being on, sometimes, several medications. Their child will still be complaining of headaches or poor reading comprehension, or won’t be complaining at all, but will just avoid near work completely.

Granted, there could be other symptoms than just those related to reading up close. Maybe they have terrible handwriting. Maybe they can’t copy from the board because of the board’s clarity back and forth between being blurry and clear.

The parent never thought of vision problems as their child passed the vision screening at school with flying colors and can see even better than 20/20 and is capable of seeing all the way down to 20/15. Their little one can spot things at distance that few are able to and the parent has been sadly misinformed that there is nothing wrong with their vision because their child is able to accomplish that one skill.

Unfortunately, the general public and many pediatricians, child psychologists, general MDs, and ophthalmologists are unaware of the many visual skills that are required beyond just the ability to see 20/20 and the many visual information processing skillsincluding visual perceptual skills that our brains must have the ability to do effortlessly in order for us to live and function comfortably.

So how did this misdiagnosis occur? What happened down the line to lead to the mistake and subject this child to invasive medication that is not needed and isn’t even solving the problem? When we look at the overlapping symptoms, it is sadly not very difficult to see how this, unfortunately, happens all the time.

The first and possibly most important thing to remember when it comes to vision disorders and the laundry list of symptoms that they inflict is that most children are NOT able to describe the symptoms.

A child can’t even describe blur, double vision, or losing their place when reading as an adult might be able to, so there is certainly no way that they could describe problems with visual information processing including the visual perceptual skills when an adult, including myself, probably couldn’t even tell if that is their issue.

These are skills that can only be identified through specially calibrated testing performed by a developmental eye doctor (developmental optometrist) whose diagnosis and treats problems with the brain’s ability to properly process visual information.

I bring up this first point because as you read over all of the symptoms, you may find yourself saying that your child has never complained of such issues, but remember that your child thinks that everyone sees the world the way they see it and doesn’t have the sense of awareness to know what is normal and not normal, so be the advocate for them.

When it comes to the many symptoms of the many vision disorders that lead to misdiagnoses, the misdiagnosis is often made because of simply observing the child’s reaction to their symptoms and adaptation of ways to avoid the symptoms.

This means that if the child sees double when they are reading and gets headaches, they will adapt by simply not reading. It seems rudimentary, but it makes sense. They don’t understand what double is and they don’t want to have pain in their head, so they avoid the action.

The scenario below is all too common with the most common binocular vision disorder that plagues about 5% of all children and arguably adults since it is not something that you outgrow, convergence insufficiency. I treated a 55-year-old patient with vision therapy who was in tears after being cured as he felt like his whole life could have been different. Even though he didn’t want to think he was of lower intelligence, he said that he always felt stupid when he was the last one to finish reading a passage or finish a job application.

When a student is a poor reader and suffers from symptoms of these vision disorders, they most likely do not want to read during “quiet reading time” in school. They may suffer from headaches, double vision, and self-esteem issues and they feel stupid not remembering anything they’ve read anyways.

With these symptoms, they may get bored as all of their classmates are reading away and look around the classroom to relax their vision and relieve headaches, tap their pencil or poke their neighbors because they’re bored. Any good and observing teacher would relay information to their parents that their child is “having a hard time paying attention to their material” and “appears to have extra energy as they are fiddling around during quiet reading time”. When this is relayed to doctors by parents trying their best, doctors miss the mark by making a diagnosis of ADHD without further researching other possibilities.

Considering ADD and ADHD are diagnoses made from symptoms and observations and there is not yet a blood test or genetic test that can definitely prove the diagnosis, we must ask our doctors to be more vigilant in their continued education and learning about other disorders with the same symptoms.

An example I like to use is that if someone had a limp, no doctor would dive in and replace their hip. They would do further testing to narrow down exactly what the issue is and would start with the least invasive treatment first. The symptom of a limp could be caused by problems with the patient’s foot, ankle, knee, hip, or neurological signaling to any of these points.

There is no debate that advanced medicine is always working to the least invasive techniques to first “do no harm” and then working with more invasive treatments only if they are necessary and the benefits outweigh the risks.

Though this principle has somehow not been applied when just a few of the symptoms of ADD and ADHD are mentioned. Instead, the most invasive treatment is started first, a medication that is capable of crossing the blood-brain barrier and altering the chemistry of a child’s developing brain.

What is the solution for avoiding a misdiagnosis?

In short, proper research and social awareness. Before anyone can properly diagnose, they must be aware of the possibilities. Raising awareness and educating the public and parents as well as the professionals (teachers, nurses, doctors, psychologists, pediatricians, etc.) in our child’s life is certainly the first step.

With better awareness, professional should be eager and excited to have an option that is non-invasive with better cure rates (85-95%) for the vision disorders than medication has for actually properly diagnosed ADD and ADHD.

With proper education, the professionals will know to first refer to a developmental optometrist where the child can receive a comprehensive exam that not only examines their ability to see 20/20, but dives deeper and examines how well their brain is working to coordinate their eyes together and process the visual information.

For my fellow colleagues and myself as well as parents, the biggest fears are missing a diagnosis or misdiagnosing and we firmly believe with proper education, parents, educational professionals, and medical professionals will make the right decision to get proper examinations that can reveal treatments for that are less invasive and have higher success rates.

Remembering that vision is MUCH more than just 20/20, as a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read and that when it comes to learning, 80% of what children learn is take in visually.

So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.

Feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today for a complete and comprehensive vision exam.

Symptoms of Vision Disorders 20 Jul 2020, 8:19 pm

As I’ve pointed out in other posts, it is always important to reiterate that it is incredibly important to remember that when it comes to vision disorders and the laundry list of symptoms that they inflict is that most children are NOT able to describe the symptoms.

A child can NOT describe blur, double vision, or losing their place when reading as an adult might be able to. Considering other problems involving visual information processing including visual perceptual skills would be difficult if not impossible for an adult to be self-aware of and describe, there is certainly no way that a child could tell you something is wrong with those skills either.

I start by bringing up this point because as you read over all of the symptoms, you may find yourself saying that your child has never complained of such issues, but remember that your child thinks that everyone sees the world the way they see it and doesn’t have the sense of awareness to know what is normal and not normal, so be the advocate for them.

These are skills that can only be identified through specially calibrated testing performed by a developmental eye doctor (developmental optometrist) whose diagnosis and treats problems with the brain’s ability to properly process visual information.

As I go through the possible symptoms, I’ll only break them down into their two main groups in order to simplify things.

The first group is the binocular vision disorders. You may hear or read this term a lot and it is referring to disorders that involve problems with the two eyes working well together.

Problems here can arise when the two eyes are not aimed at the same thing, are not clearly focused at the same point, are not performing properly coordinated movements together, and are not maintaining their aim and focus together.

Symptoms that your child may experience can include but are not limited to the following:

• Blurred vision (constant or occasionally coming and going)

• Double vision (constant or occasionally coming and going)

• Headaches

• Losing their place when reading

• Skips lines, accidentally rereads lines when

• Difficulty focusing on the board after looking down at their paper

• Difficulty looking down at their paper after looking at the board

• Difficulty reading for an extended period of time

• Difficulty comprehending what they are reading

The second group of vision disorders is visual information processing skill deficiencies or disorders including the many visual perceptual skills. These processing skills are not necessarily involving the eyes but are instead view as higher-order visual skills as these are performed by the brain as the brain makes use of the visual information that is taken in.

Symptoms that your child may experience can include but are not limited to the following:

• Reverses letter like “b” into “d”

• Double vision

• Difficulty understanding what is read

• Difficulty remembering what is read even if the material is understandable

• Difficulty finding material on the board

• Difficulty finding material on a page

• Difficulty reading quickly and keeping up with those their age

Reinforcing what is stated above, while your child may be suffering from these symptoms, it could be near impossible for them to have the sense of awareness to understand what is going on and then explain it to you, therefore it is important to advocate for them that this could be a vision problem when they display symptoms, not limited to, but including the following:

• Displays trouble concentrating while reading

• Displays trouble with reading comprehension (understanding what is read)

• Doesn’t remember what was read

• Dislike of reading in general

• Short Attention Span with reading and schoolwork

• Fatigue while reading

• Homework takes much longer than it should

• Acting out at school or at home​

Learning new material involves a myriad of visual skills.  A child’s two individual eyes must work together as a perfect team to master the 17 visual skills and their brain must be properly processing the visual information so that children and adults can understand and remember what they have read.

Given the many unique abilities required to simply read an article, my fellow colleagues and I implore you to be an advocate for your child. Children DO NOT OUTGROW these conditions. A large percentage of the adult population suffer from these conditions as well and have been held back in life because of thiem including a 55-year-old patient I treated who suffered his entire life from convergence insufficiency.

Give your child the benefit of the doubt. There have been countless children that are absolutely brilliant and yet several reading levels behind their classmates simply due to a completely curable vision disorder.

After struggling with reading and having their other subject suffer due to lack of being able to read and study efficiently, these children quickly catch up and often surpass their peers after undergoing vision therapy that cures their disorder and relieves them of their once handicapping disorder.

Remembering that vision is MUCH more than just 20/20, as a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read and that when it comes to learning, 80% of what children learn is take in visually.

So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.

Feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today to schedule a complete and comprehensive vision exam.

Most Important Skill for Success 20 Jul 2020, 8:07 pm

What do Warren Buffet, Elon Musk, Oprah Winfrey, Mark Cuban, Bill Gates, Walt Disney, and so many other wildly successful people agree upon without debate? The importance of reading and that it is one of the most if not THE SINGLE MOST important skill to obtain.

A good reader is an efficient and comprehensive reader free from the many symptoms of various vision disorders. After all, what good is flying through pages if you don’t remember what you read or you weren’t able to understand it?

While it may not appear to be so on the surface, reading is actually no simple task. It actually actively requires 7 distinct visual skills of the total 17 visual skills to be constantly working throughout an entire reading session without symptoms of problems. Knowing about these and symptoms that can arise from problems can help prevent misdiagnosis with ADD or ADHD.

That's certainly no easy task indeed and missing or being deficient in any of these can really hold someone, child or adult, back in reading and kill any desire to crack open a book or sift through a newspaper. Luckily, if you or someone you know has concerns, vision therapy has an 85-95% success rate for treating the vision disorders that can hinder reading, so thank goodness for that.

So why reading? Why is reading arguably more important than math skills? I mean, with my husband having his MBA in finance from USC, all I hear about is how everything is numbers, and I really do see it too. And yet, reading still takes the cake.

Bill Gates has said, “Reading is still the main way that I both learn new things and test my understanding.” And many of the most successful people in the world agree and prove it with their actions of hours of reading every day.

It is arguably the most important skill because it is a skill that broadly reaches over to every other topic, subject, and skill. If you want to learn about cooking techniques, mechanics, coding, philosophy, economics, engineering, biology, medicine, you name it, the better you are at flying through material AND comprehending and remember it, the more information you will obtain.

Warren Buffet gave a lecture to investing students and advised, “Read 500 pages like this every day,” Buffett said to the students while reaching toward a stack of manuals and papers. “That’s how knowledge works. It builds up, like compound interest. All of you can do it, but I guarantee not many of you will do it.”

On top of the many books that Warren Buffet reads, it has also been reported that he reads 6 newspapers a day, The Wall Street Journal, The Financial Times, The New York Times, The USA Today, The Omaha World-Herald and American Banker. It doesn’t leave much time for youtube videos of facebook scrolling I guess, but it all depends on where your priorities lie.

While I love breaking open a good book, I also personally love reading blogs and articles online and have learned so much from doctors in my field and others in areas of expertise that I simply want to learn more from. With so many free sources, it is an amazing time to be a good reader and have a thirst for knowledge.

Mark Cuban pointed out that “Everything I read was public,” in his blog. “Anyone could buy the same books and magazines. The same information was available to anyone who wanted it. Turns out most people didn’t want it.” So since access isn’t a problem to reading, making sure you and your children’s 7 main visual processing skillsthat are required to be avid readers are healthy and efficient have never been more important.

Viewing knowledge building up like compound interest is truly a brilliant thought. After all, if you come across an opportunity that requires a quick and yet educated decision, you are going to have a major advantage over anyone else in the same situation if you have obtained more knowledge from reading and have the tools already stored in your knowledge base to make the right decision.

One of my favorite sayings is that luck is when preparation meets opportunity. I have had several situations where, from the outside, many people could have said that I got lucky. The truth is that each of those situations I was able to prosper from or utilize because I had obtained knowledge in the past or worked hard to improve my situation with a degree or career that appeared to serve a minimal purpose at the time, but was crucial to have when an opportunity arose.

One could say that Mark Cuban got lucky with the sale of his internet company, but the truth is that the buyer came across countless others in their lifetime, but when they came across Mark’s site, he had done the work and was prepared when the opportunity came about. He stated, “I remember reading the PC DOS manual (I really did), and being proud that I could figure out how to set up startup menus for my customers,” and “A guy with little computer background could compete with far more experienced guys, just because I put in the time to learn all I could.”

So how does one better their situation, open their minds to new possibilities, obtain the tools they need to expand their capabilities?

They read!

Elon Musk made his first really large success selling PayPal to eBay for $1.5 billion in 2002 and then later decided to make a car company. To say that going from a payment company to a car manufacturing plant is a bit of a change in industry is a drastic understatement.

Elon’s next move was then to make rocket ships. When asked in an interview how he learned to build rockets, he replied simply and to the point, “I read books.”

Mark Cuban also attributed reading to being able to learn about different businesses and industries stating, “To this day, I feel like if I put in enough time consuming all the information available, particularly with the net making it so readily available, I can get an advantage in any technology business.”

And Oprah Winfrey expressed how reading allowed her to expand her mind and hope for possibilities stating, “Books allowed me to see a world beyond the front porch of my grandmother’s shotgun house… [and] the power to see possibilities beyond what was allowed at the time.”

So, of course, this all makes sense. I don’t believe that it takes much convincing of the stream of logic that knowledge is key to success and even happiness (due to having better emotional intelligence and being better able to handle life’s stresses) and that knowledge can be greatly and freely achieved through reading, therefore reading is key to success and happiness.

So the next thing one might wonder is if it matters what you read? Well to some extent content and quality are obviously very important, but the topic really depends on your goal.

As stated above, Elon wanted to switch industries to making rockets, so that’s what he read about. But am I saying that there is only a benefit of reading if it comes from textbooks, instruction manuals like what Mark Cuban read, or the 6 newspapers a day that Warren Buffet reads? Not at all. Reading can be for gaining emotional intelligence and peace and for improving and expanding our outlooks and creativity.

So the main take-home message is that the benefits of reading are virtually endless in our day and age with access to so much material. Between having access to hundreds of years of literature to research articles that have just been published, you can learn about and expand your knowledge about anything that you can think of.

So make sure you have all the reading specific skills needed to be the best reader you can be and don’t hesitate to get vision therapy if any of your total 17 visual skills or visual information processing skills need some help.

If you or your child are having a hard time reading or just haven't felt like reading was for your favorite thing to do, there may be a visual processing problem occuring in the background that is holding you back like convergence insufficiency held back a 55-year-old patient of mine his whole life. Call our office today and schedule a complete and comprehensive eye and vision exam and we will get you on the right track if anything is wrong.

How does Proprioception work? 20 Jul 2020, 6:14 pm

Proprioception is our sense of awareness of where our bodies are in space, as well as our senses of resistance or tension on our limbs and joints such as pulling or pushing an object. If you close your eyes and reach your arm out, even if it isn’t touching anything, you can “feel” where is it being held. We can tell where that arm is in space due to mechanoreceptors, also called stretch receptors, that are located in our muscles, tendons, and joints.

How various nerve receptors work is through something changing them physically leading them to then send a signal to the brain that something has occurred at their locations. Touch receptors have gate-like structures that send a signal to the brain when there is pressure put on those gate-like structures almost as if they are opening up to start the signal. Temperature receptors obviously change with the temperature that they under. The eye has light receptors that chemically start their signal upon receiving a ray of light.

Proprioceptors work in the same way as all of the other receptors in that they send their signal based on a change to their structure. The change that they detect is a physical one rather than a chemical or temperature-induced change. They are often called “stretch receptors” because, in a sense, they detect how far a joint, muscle, or tendon is “stretched out” in its location.

Proprioceptions is incredibly important in virtually everything we do. As it is involved in our eye-hand and eye-foot coordination, when we reach forward to pick something up, those mechanoreceptors are constantly measuring how far our arm is reached and sending signals back to the brain to provide a type of mental picture of where our arm is in space.

It’s important to note the development of proprioception is very vision dependent. Because our bodies and limbs are different sizes, shapes, and weights in adulthood than they were in our youth, our brain has to reprogram what each degree of “stretch” that these nerves experiences really means.

In youth, you dial in proprioception through visually seeing where your limbs are in space and equating that to the “feeling” of stretch that those mechanoreceptors or “stretch receptors” are sending back to the brain. While this may seem fairly easy to do, it is important to remember that in youth, the length and weight of your arms, legs, and other parts of your body are constantly changing and growing. This means that just when your brain may have things dialed in pretty well, everything changes and it has to keep fine-tuning.

In order to paint a better picture of this process, I can’t help but think about my younger brother and observing him in his youth.

I am often reminded of the many times when my younger brother, even though he was very athletic, would be rather clumsy just after he would go through a growth spurt. One thing, in particular, was when he would all of a sudden start accidentally knocking over glasses at the dinner table. Every time he would go to reach for his water glass his hand would get there before his brain had dialed in that it should according to the mechanoreceptors (stretch receptors) because his arms were now longer. Now that they were longer, he had to either consciously think more about where his arms were in space or look at exactly where they were so he knew to stop as he approached the water glass. Until he fine-tuned his proprioception with his now longer arms, he could not as easily reach for his water glass without looking and bring his had to just the right distance.

With this story in mind, it is now easier to start to get a glimpse of the complexity of proprioception. In the same sense that we understand the difference between our gross motor (movement of larger limbs and our torso) and fine motor (more detailed movement such as the movement of fingers) movements, the sense of proprioception is capable of being incredibly detailed and its signaling can be instantaneous.

In professional athletes, fine-tuned and flawless proprioception is absolutely necessary. In soccer, a player must be able to look up and scan the field while knowing the exact angle and location of each foot in relation to the ball they are kicking without having to look down at it. In basketball, players are also required to scan the court while simultaneously dribbling a ball with their hand that it momentarily or continuously for a longer moment of time out of their field of view.

In everyday life, proprioception aids us in tasks such as walking, carrying an object, pushing or moving around objects, and countless tasks that we aren’t even aware of. Proprioception is sort of the “hidden” sense that is constantly working in the background.

Those that can help with proprioceptive issues depend on the conditions of the case, but great places to start are occupational therapists, behavior optometrists, and physical therapists. Feeling and knowing where you are in space is obviously incredibly important for your mobility and safety. Any issues should be addressed with a professional right away.

As a behavioral optometrist, I can tell you from my field that vision is MUCH more than just seeing 20/20. I can’t help but always want to educate people on the 17 Visual Skills and how they are all needed to function in our everyday lives and especially in academics.

Such skill as visual information processing skills including the visual perception skillsare required to live comfortably and safely and to succeed in your endeavors.

If you feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them).

Call our office to schedule an evaluation.

17 Visual Skills 20 Jul 2020, 5:15 pm

Many people have heard that there is more to vision than just 20/20, but it is still greatly underestimated how complex “vision” really is. After spending 4 years of a doctorate program where I studied not only eye anatomy and physiology, but also how the entire vision system worked throughout the brain, I knew that even I had underestimated the vast complexity of our visual system.

While 20/20 is very important, the 20/20 component is really the only component that many screening exams look at and children are left with many visual problems that leave them plagued with symptoms that hold them back in school.

The worst part is that children do NOT OUTGROW these disorders that cause the other visual problems. So there is a large percentage of our population that is still. It never ceases to amazing me how many adults are still plagued by disorders they have had their whole life.

Their stories are heart breaking because they often include the fact that the adult struggled in school, most likely never went to college, has found their job difficult and is concerned that they will never promote because certain tasks can just be too difficult for them, and there are still countless daily activities that are a struggle for them and have been their entire life.

As I type this, I am reminded of a 55 year old male patient that I treated with Vision Therapy for convergence insufficiency in Philadelphia while I was working towards my doctorate who had a vision disorder that held him back his entire life. (To read about his story, click here)

And the entire time… he had perfect 20/20. So what was wrong? Why was this kind, brilliant, and eager man unable to read even 2 pages of a book without getting headaches? It’s because vision is so much MORE than 20/20.

When you think of vision, I want you to think of it as recording and processing a 3D movie because that is basically what our eyes and brains are doing. Our eyes are the two cameras and our brain is the processing system or computer, that then takes those 2 incredibly detailed images and pieces them together AND then created the perception of our 3D world in our brain AND integrates it with our other senses and cognitive processing skills.

So wow, yeah, a lot more than 20/20. Optometrist spend 4 years studying this process from eyes to brain. Dialing in a prescription to 20/20 is already incredibly complicated, but then what goes on behind the eyes is even more so.

Before we go through the skill though, there just 2 key parts of the eye that I want to mention and explain.

The first is the retina. The retina is the sensory tissue in the back of the eye. This is made up of several difference types of nerves that detect light, decipher a bit of what is seen, and send the information back to the brain. I often tell patients that you can think of the retina as the film in a camera.

The second part I want to point out is the lens. The lens is adjustable like the lens in a camera and allows us to see clearly at different distances. (To learn more about the focusing system in our eye, click here)

So let’s break down all of the other skills that everyone needs.

1. Eye Movement Control: The ability to move both eyes together to point at an intended target or follow along a path, like a line of text. This is checked at every comprehensive vision exam with an optometrist as there.

2. Simultaneous Focus at Far: Forming a clear image of something in the distance. This is our ability to relax that lens inside of our eyes and bring objects in the distance (street sign, tree, board in a classroom) into crisp and clear focus.

The complexity of this is more than many realize though as this is more than just bringing distance into focus. It is important to remember that our brain has to coordinate two cameras (eyes). So the lens in each eye has to be relaxed or focused at the exact same distance as the other eye. If one is even slightly different from the other, the you would see blur and possibly the perception of double vision. With this issue, your depth perception would be off and you could suffer from many other symptoms including headaches.

3. Sustaining Focus at Far: Keeping an image of something in the distance clear and being able to effortlessly hold that focus and keep those lenses in our eyes relaxed.

This may seem like at easy task by the sounds of it and I must admit that I would have never thought that this could be an issue until I was in my doctorate. For those who suffer from accommodative (when the lens focuses at near) spasms, sustaining distance vision is very difficult and can lead to many visual disturbances and symptom like blur, double vision, headaches, and more.

4. Simultaneous Focus at Near: Forming a clear image of something close to the eyes. This is obviously the opposite of relaxing our focusing system and instead requires us to adjust the lens at a near object.

While we have spent time talking about the work that they eye has to do in adjusting the lens, it is important to remember here again that the brain is behind the scenes pulling a lot of strings and directing the coordination between our two eyes. Just as the brain has to coordinate the lenses in both eyes at distance, it must do the same at near.

5. Sustaining Focus at Near: Keeping a clear image of something close to the eyes such as reading a book or working at a computer and keeping the typed font clear and in focus.

Nowadays it is incredibly important to be able to sustain near as our word and work is so near. Whether you are reading a book, studying for an exam, or doing working on your computer, our eyes and visual system must be able to do this effortlessly so we don’t interfere with our work.

6. Simultaneous Alignment at Far: Lining up both eyes at the same point the distance just as a director would need to line up two 3D cameras at the exact same point but just from different angles.

This ability to pull our eye apart is called divergence. (To learn more about

Keeping the eyes aimed at the same thing is incredibly important in preventing double vision. Some patients can have delays in the coordination of their eyes and this can greatly slow down their ability to judge the distance of an object in front of them, see it clearly, comprehend and read notes on a board at school, and countless other things.

7. Sustaining Alignment at Far: Holding both eyes lined up at the same point in the distanced maintaining that alignment while the person absorbs the information they want at distance.

Whether you are driving or looking across a classroom at a distant board. There is a great need at countless times during our day to be able to maintain our eye alignment at distant objects.

8. Simultaneous Alignment at Near: Lining up both eyes at the same point up close to keep the item single and prevent double vision.

When a student changes their gaze quickly from the board to their paper to take notes or someone driving glances quickly at their dashboard to look at their speedometer, this skill is crucial. A delay will cause instant double vision. In school, this could lead to missing information in a lecture. When driving, this could lead to an unsafe situation. Either way, our brains incredibly ability to so flawlessly line up our eyes so instantly is a skill that we shouldn’t take for granted as a deficiency in this skill is sadly common and can be life changing.

9. Sustaining Alignment at Near: Holding both eyes lined up at the same point up close with ease and without symptoms of strain.

Just because someone can be given a reading card and read 20/20 in and instance, doesn’t mean that they could then read that card for an extended period of time comfortably.

10. Central Vision (Visual Acuity): This is where “20/20” vision comes in!

The ability to see 20/20 is a good indicator that the eye is most likely healthy. Again, I say “most likely” because there are several vision threatening conditions that can lead to complete blindness that still allow someone to see 20/20 in early phases of the disease. This is why it is incredibly important to see an Optometrist for a comprehensive exam every year. When cause early, many conditions can be treated and even cured. When cause too late, there is sadly often times no way to recover vision that is lost.

11. Peripheral Vision: Being able to see what’s on either side of you while your eyes are pointed forward.

This skill is obviously in credibly important in countless situations. Any time someone is moving, the wider their peripheral vision range, the safer their movements can be. Glaucoma is a disease that progresses with vision loss starting on the outside and works it’s way inward. It is a perfect example of why you should see an Optometrist every year. Optometrists can diagnose and treat glaucoma conveniently at your annual eye exams. The importance of finding glaucoma early is that the vision lost can NOT be restored, so it is incredibly important to catch it early and slow down or hopefully stop the progression.

A fun note about peripheral vision is that although it can’t be increased, our brain’s awareness in our peripheral vision can be increased with sports vision training.

12. Depth Awareness: Being able to tell that things are further away or closer up than each other (also know as depth perception).

This is a great example of one of the brain’s processing skills. In order to judge depth, so many things have to be going perfectly. Multiple skills above must be occurring in order for the eyes to be aligned at the exact same point and be focused (lens focusing) on the same point for clarity. Then, the brain still has to have the ability to take these two images (we’ll consider them videos because, in life, we are always moving) and decipher and process them in order to tell how far away something is from us.

Interesting fact, the skill of proprioception is learned heavily from vision and responses to our environment. To learn about our sense of “proprioception”, click here.

13. Color Perception: Being able to tell different colors apart (if you are not color-blind).

Our ability to tell color is an amazing skill. Those who are sadly lacking it are luckily still able to decipher most colors, but have problems distinguishing between a phew.

14. Gross Visual-Motor: Moving yourself through space without bumping into things by using information from your vision.

Here’s where proprioception and motor skills can really come into play. When we talk about gross visual-motor skills, we are talking about walking, swimming, jogging, riding a bike, and performing tasks that are , more or less, moving are larger limbs.

15. Fine Visual-Motor: Writing, sewing, texting, and doing other small and close-up activities with accuracy by using information from  your vision.

We attach “vision” to “gross-motor” and now “fine-motor” because all of these actions, in a non-visually impaired person, start with the sense of vision and the visual processing of that information. As I type on my keyboard now, my fingers know where to go without me looking because I have seen the keys enough times to memorize their location and because, even if I close my eyes, my visual processing is still working hard to create the visual world that I am in. This is why it is more logically appropriate to call a skill eye-hand coordination instead of hand-eye coordination. Using this proper naming shows that you have a better understanding of the actual neurological process that is underway as the neurological reactions all start with the eye taking information and end with the hand completing a task that the brain has made the decision to tell it to do ONLY after processing the visual information.

16. Visual Perception: Being aware of your environment and what is going on around you in your visual field (the area you can see).

Sadly, just because someone is physiologically (meaning no damage to their actual eye) capable of full peripheral vision, doesn’t mean that the visual processing system in their brain is capable of perceiving the information delivered to it and using it in a meaningful way.

17. Visual Integration: Bringing together your vision and your other senses to accomplish complex tasks, like reading while walking a balance beam.

This is certainly a higher level of visual processing that is a skill that everyone should master in order to better navigate through they every day activities in the most comfortable manner.

This is another area that can be enhanced with sports vision training for athletes looking to improve on their visual processing.

Remembering that vision is MUCH more than just 20/20. As a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read. And when it comes to learning, 80% of what children learn is take in visually.

So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills.

Feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today to schedule a complete and comprehensive eye and vision exam.

Most Important Skills for Reading 20 Jul 2020, 5:15 pm

Ah, the skill of being a good reader. The ability to be a good reader has been argued to be one of the most important skills by the wealthiest and most successful people in the world.

Every time we read from a book, a sheet of paper, a computer, or a mobile device, we are performing a visual task using 7 of the 17 vital visual skills. 7 skills. Just to aim our eyes and read?! Yes! Listed below are all of the reading-specific skills we need. Knowing about these and symptoms that can arise from problems can help prevent misdiagnosis with ADD or ADHD or missing a diagnosis of the most common binocular vision disorders, convergence insufficiency, and being held back your entire life like a 55-year-old patient of mine was as children DO NOT OUTGROW these conditions.

As you read through them and feel like you may be struggling with any of these skills of have symptoms of eye movement or visual skill deficiencies, if so, know that there is hope with vision therapy!

When we aim two eyes at the same point simultaneously and accurately, we use:

Skill #1 Eye Movement Control

Skill #8 Simultaneous Alignment at Near

Skill #9 Sustaining Alignment at Near

When we focus both eyes to make the reading material clear, we use:

Skill #4 Simultaneous Focus at Near

Skill #10 Central Vision (Visual Acuity)

When we continue to sustain clear focus, we use:

Skill #5 Sustaining Focus at Near

When we move two eyes continually as a coordinated team across the line of print, we use:

Skill #1 Eye Movement Control

Skill #9 Sustaining Alignment at Near

Skill #15 Fine Visual-Motor

Remembering that vision is MUCH more than just 20/20. As a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read. And when it comes to learning, 80% of what children learn is take in visually.

So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills.

Feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today to schedule a complete and comprehensive eye and vision exam.

Visual Perceptual Skills 20 Jul 2020, 5:15 pm

One of the many areas of vision that I learned about and studied is the visual perceptual skills. These skills are a subcategory of the Visual Information Processing skills and can be thought of in a similar relationship to “vision” like in the sense that these are controlled by the brain.

Just like every processing skill that we develop and need in our daily lives, it is always possible to have a deficiency. So it is important to understand what each skill does and why it is important so if a child or adult is struggling, we can work our way back to the skill that is lacking or deficient and work on it and avoid misdiagnosis with ADD or ADHD.

And when I say “work on it” I mean to treat with vision therapy which has an incredibly high success rate for many disorders without the use of any surgery or medication.

So here’s the list of Visual Perceptual skills and a few examples of the role that they play in your daily life.

Visual Discrimination: the ability to see and notice fine details and discriminate between very similar looking items.

• May have problems distinguishing letters or words and this can slow down reading and decrease comprehension.

• Problems can lead to difficulty distinguishing between p and q, or b and d. This can slow reading and decrease comprehension and learning or new material.

Visual Closure: Allows one to perceptually close an incomplete object, letter, or word. This is a vital skill to have for quick and efficient reading as we often don’t “read” or “decipher” every letter in a word. Those with good visual closure can “scan” a word, know what it is by closing the rest of the information in their mind, and take in the information faster as they are able to move on to the next bit of text quicker.

• Problems can present in children being slower readers and/or less comprehensive readers, as well as having difficulty with writing and math.

Figure Ground: ability to find and maintain focus on a single item when it is within a busy background

• May have problems finding a desired topic on a school board and may miss notes. Copying from the board could be affected as the child would have difficulty finding where they left off on the board.

• May feel overwhelmed by or have trouble finding an item in a grocery store or shopping isles.

• May have problems finding a tool or item in a busy area, even if the area is clean and organized.

• Problems can lead a child to have a difficult time finding something specific on a page.

Visual memory: The ability to recognize or recall previously presented visual information.

• Trouble visualizing what is read – Poor reading comprehension and poor spelling

• May have trouble with mathematical concepts.

• May have poor comprehension and recall of material that is visually taught or presented.

• Problems can lead to a decrease in comprehension from what is seen in a lecture in class to problems remembering what they have read in a book or calculated in math or science classes.

Visual sequential memory: the ability to remember what is seen in a specific order.

• May have problems taking notes from the board and problems with comprehension with reading.

• May also have problems in various areas of mathematics.

• Problems can also affect reading speed, and reading comprehension.

Visual-Spatial awareness: Ability to know the positioning of other items in space in relationship to each other.

• May arise as problems with relating two objects to each other. Copying information and drawing can be affected.

• Handwriting may be poor and may not stay on the lines or be an appropriate size for the space provided.

• Sense of directions may be difficult as well when discussing up, down, right, left, to the side of, on its side, and other direction relating terms or phrases.

• Problems can lead to difficulty judging how far something is from oneself and from other objects. This can also be problematic even if something is verbally described to them or if it is read.

Form Constancy: the ability to recognize a figure for what it is even if there is a difference in its presentation’s size, shape, or form.

• A good example of this is knowing that a letter is the same letter even if it is in a different font or even orientation. Problems could arise is a student is taking notes from the board as they may have a hard time quickly distinguishing was is written.

• They may also have problems understanding basic math concepts of size, magnitude, and position.

Visualization: the ability to recall visually presented material and manipulate these images mentally – basically creating mental pictures. This skill required visual memory and takes it to the next level of applying and manipulating what we’re seeing visually.

• This skill plays a large role in writing, spelling, math, and music.

• Before a child can write anything, they must first visualize the letter of the word. Having a difficult time even seeing what it looks like in your mind makes every following task difficult as well.

Visual sequencing: Ability to put things in a certain order and maintain that order

• May have problems with the concept of ordering items such as first, second, third, and last.

• May have problems with repeating or creating patterns.

• May have problems with daily activities as they face challenges explaining what they are doing in order.

I hope this helped break them all down and provides some examples of their importance and things to look out for. Remember, if you or someone you know is having problems with any of these areas, they are all treatable by a developmental optometrist who performs Vision Therapy.

Remember also that vision is MUCH more than just 20/20. As a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read. And when it comes to learning, 80% of what children learn is take in visually. So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.