VisionMechanic.net https://visionmechanic.net Vision Rehabilitation - No Filler. Mon, 07 Sep 2020 23:54:07 +0000 en-US hourly 1 https://wordpress.org/?v=5.5.1 https://visionmechanic.net/wp-content/uploads/2020/01/cropped-VM-Logo-Square-32x32.png VisionMechanic.net https://visionmechanic.net 32 32 171196465 Protected: Vision Mechanics: Core Four https://visionmechanic.net/vision-mechanics-core-four/ https://visionmechanic.net/vision-mechanics-core-four/#respond Mon, 07 Sep 2020 23:54:07 +0000 https://visionmechanic.net/?p=562

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Is visual perception testing worth the time? https://visionmechanic.net/is-visual-perception-testing-worth-the-time/ https://visionmechanic.net/is-visual-perception-testing-worth-the-time/#respond Mon, 07 Sep 2020 13:41:29 +0000 https://visionmechanic.net/?p=544 Continue reading "Is visual perception testing worth the time?" ]]> The Test of Visual Perception skills (TVPS) is a common part of a school-based occupational therapists evaluation process. Performance on this test has been used to infer visual processing problems. These “visual processing problems” are then thought to be related to letter reversals or reading problems. The good OT will be working to improve these visual perception skills. These therapists often get frustrated with a lack of progress with these visual perception skills and the lack of progress with the related academic problems.

So whats the best visual perception task?…

…is a very common question we answer frequently, but often not with the answer expected. Let us explain:

Vision can be described as a multi-step process. Step one is referred to as Visual Signal Acquisition. Here, visual information is collected by the eye. The accuracy of this visual information is dependent on things such as refractive state, binocular visuals skills and other cognitive factors such as attention and engagement with the test. When the information is not collected by the eye accurately, then the next step visual signal processing will suffer as the brain did not start with the correct information. The student fails the visual perception test and is perhaps labeled with “visual processing disorder” and in some school systems, referred to teachers of the visually impaired, who have little background to understand these problems when they find the child has no acuity problems.

What does the science say?

In a 2005 article in the American Journal of Occupational Therapy, the authors point out the high incidence of visual deficits in children with reading and learning problems. They further suggest the need for any child with difficulties in visual perception or visual motor integration be assessed for ocular motor and binocular vision problems(1).

An article in the Irish Journal of Occupational Therapy (2), authors found that only results on two of the seven areas of the assessment correlated to problems reported by teachers, further bringing into question the useful of the assessment. Interestingly, the areas that correlated, visual discrimination and visual memory, both rely upon and assume good visual signal acquisition. The article cites several studies showing a lack of correlation between the TVPS and other tests of visual perception such as the MVPT or DTVP.

Clinical Pearls

So when a therapist feels that a processing problem may be occurring, the first step should be a comprehensive eye exam to insure that the stimulus is being seen accurately. Also note the behavior of the student during the test: Are the engaged and attentive and giving their best effort?

References

(1) Goldstand, S., Koslowe, K. C., & Parush, S. (2005). Vision, Visual-Information Processing, and Academic Performance Among Seventh-Grade Schoolchildren: A More Significant Relationship Than We Thought? American Journal of Occupational Therapy, 59(4), 377-389. doi:10.5014/ajot.59.4.377

(2) Sullivan, C., Lynch, H., & Kirby, A. (2018). Does visual perceptual testing correlate with caregiver and teacher reported functional visual skill difficulties in school-aged children? Irish Journal of Occupational Therapy, 46(2), 89-105. doi:10.1108/ijot-03-2018-0005

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Easy Steps to Strong Child Vision https://visionmechanic.net/easy-steps-to-strong-child-vision/ https://visionmechanic.net/easy-steps-to-strong-child-vision/#respond Tue, 25 Aug 2020 19:58:44 +0000 https://visionmechanic.net/?p=521 (The goal of VisionMechanic.net is to provide science-based clinically relevant resources about humans, for humans. All humans. This series highlighting International Vision and Learning Month (August) is more focused on those humans who are in formal learning programs, most notably, younger humans. If you yourself are a learner, or if you teach them, guide them, care for them or provide therapy for them, then this series will be of interest to you.)

This article details some basic steps to take to correct the most common problems with vision. Even if you feel your child / patient / student is unaffected by vision problems, until you can check off a list of ‘knowns’, you simply don’t know and are subjecting the child to unnecessary risks. A further post will consider what else can be done to ensure children with Visual Impediments to Learning and Development (VILD) can make an attempt at life and learning on a level playing field, visually speaking.

While the picture is somewhat more complicated than this, this series on Vision and Learning is designed to highlight core principles of how vision works, and to also underline how we ignore vision and the costs associate with this. If you’re serious about vision, and if you care for children you should be, the Vision and Learning series will get you started with the key pieces to protect what is important and to avoid common pitfalls.

Even if you feel your child / patient / student is unaffected by vision problems, until you can check off a list of ‘knowns’, you simply don’t know and are subjecting the child to unnecessary risks.

The following list of steps to be taken is adapted from the paper ‘Visual Impediments to Learning‘ which offers much more detail regarding how vision impacts on child performance and health. Don’t forget this entire series is also devoted to exploring these topics.

  1. All children need an eye exam. Start there.
    • Read this before you begin so you know what to look for – not all ‘eye tests’ are going to uncover all Visual Impediments to Learning and Development.
    • Read this to know whom to see. If you need a general comprehensive eye exam, a surgeon is not the one to see.
    • Exams for children are covered under most health systems and plans.
  2. Be sure to review the notes that follow to have a baseline for understanding.
  3. At the exam, ask for an explanation of the status of eye movements:
    • Saccades (jump eye movements).
    • Pursuits (smooth eye movements).
    • Vergence (moving eyes inward and outward in a coordinated fashion).
    • Fixation (holding both eyes steady on a target at 40cm).
    • Any restrictions or limitations can and should be addressed through physical/visual training. This is a complex topic covered in other posts in visionmechanic.net and drboulet.com among others.
  4. Ask for a copy of the glasses/optical prescription. All children/people have such a measurement – it’s the optical calculation or recipe to make distant light rays focus on the retinas with zero effort. Everybody has something, and it’s important to know what the values are in every case, period. As a general rule (must be assessed individually depending on circumstances and visual tasking requirements):
    • Myopia / Nearsightedness: This is expressed as a ‘minus’ prescription with minifying, diverging lenses. Myopia up to -2.50D can be helpful for near work and so glasses are often discouraged if the child is comfortable working without. Myopia of -0.50D or more should be compensated for during distance viewing activities. Myopia should be closely monitored in growing children.
    • Hyperopia / Farsightedness: Hyperopic prescriptions are ‘plus’ prescriptions with magnifying, converging lenses. Children with hyperopia less than +1.75 don’t need compensation for most activities – and can simply be monitored during near tasking for fatigue and other signs of frustration or headache. At +1.50 and above, a reading lens is recommended for digital platforms in particular where text is emphasized. At +2.00 and above, a full time lens is recommended and will be appreciated.
    • Astigmatism: As a rule, astigmatism of more than 0.75D should be compensated for anyone managing any text-based tasking. Engineers and accountants will appreciate the difference this low-level compensation provides. Children with astigmatism over 1.00D should wear compensating lenses most of the time while awake to prevent headache, fatigue, irritability, reading concerns. Uncompensated astigmatism over 1.50 will lead to depressed vision, even blindness (amblyopia).
  5. For the long hours of near-digital learning strain imposed by COVID-related instructional design changes, a ‘low plus‘ approach is recommended for any child needing to work in front of the computer. The same applies to adults: We are, on average, most comfortable gazing off to a distant target, eyes relaxed, and a low plus prescription achieves this same result. What low plus means to any individual will vary, but the same result is achieved by relaxing the focusing and targeting systems for near work. Your optometrist will help you with the math, but it’s pretty straightforward. ‘Plus’ of anywhere from +0.50 to +1.50 can offer any one (under 40) a great boost for extended and comfortable near work.
  6. DO NOT SUBJECT A CHILD TO PSYCHO-EDUCATIONAL TESTING prior to assessment of visual status and before problems identified have been addressed.
  7. Filters: Filters and overlays will have limited impact on reading. For the most part, children who struggle with reading will have other identifiable visual impediments.
  8. Blue Light: Do not worry about filtering out blue light from computer screens. In fact, encourage plenty of blue light exposure through outdoor exploration and play.
  9. Exercise and Play: Active movement, including guided targeting with fingers and hands improves fine visual targeting. Work also major body muscle systems and balance through activities such as swimming, climbing, yoga, and martial arts.

Following the above steps will cost next to nothing to do and save most cases from falling through the cracks. Educators, doctors, psychologists all need to spend more time in reviewing core concepts so that they might better understand how to address problem behaviours related to vision, but more importantly, how to guide parens in preventing these entirely.

In an upcoming post we’ll identify some of the gaps in the system whereby, for some reason, most kids who need the help keep falling through – and how the current COVID-19 environment is making things worse. Simple solutions will be recommended, cost-effective solutions, to help prevent needless suffering and waste of tax-payer dollars.

Expand your understanding:

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COVID-19: Learning without a seatbelt. https://visionmechanic.net/covid-19-learning-without-a-seatbelt/ https://visionmechanic.net/covid-19-learning-without-a-seatbelt/#respond Tue, 25 Aug 2020 16:45:11 +0000 https://visionmechanic.net/?p=516 (The goal of VisionMechanic.net is to provide science-based clinically relevant resources about humans, for humans. All humans. This series highlighting International Vision and Learning Month (August) is more focused on those humans who are in formal learning programs, most notably, younger humans. If you yourself are a learner, or if you teach them, guide them, care for them or provide therapy for them, then this series will be of interest to you.)

In 2007, the Government of Alberta introduced mandatory seatbelt laws. This was not openly received by everyone. Nowadays, it seems a critical error in judgement to allow children, or indeed anyone, to take a high speed ride in a sea of 2 tonne vehicles without some sort of restraint to prevent unneeded death and injury. Most people avoid accidents during the day, the law is designed to protect against unforeseen cases, and to protect children who stand to lose the most over a lifetime.

Most people avoid accidents during the day, the law is designed to protect against unforeseen cases, and to protect children who stand to lose the most over a lifetime.

Applying the same logic to the way we manage early childhood education would also go a great distance to reduce healthcare and education costs. The benefits to the economy, and to individual and public health, of mandating vision assessments for children are greater even than those of seatbelt laws.

It doesn’t take a vision scientist to recognize that if a person is affected by visual impediments, much of life can be out of reach, from education to work opportunities. It is not so widely known or obvious that visual difficulties can also often lead to some common medical concerns, like headache, dizziness, double vision, and a variety of child behaviour concerns.

Alberta currently has no requirement for mandatory vision exams for children, and yet we all pay the price for ignoring the problem. Vision concerns are often attributed to underprivileged people in far-off lands, that is, people without access to essential care. The fact is, from 1/6 to 1/3 of children in our own community schools are seriously affected by visual impediments. Ironically, our success in managing these concerns is similar to success in the third world, especially so, I’ve found, on First Nations reserves.

What Happens When You Check All Children? The Kentucky Experience

In 2000, the Kentucky preschool exam law, House Bill 706, was enacted to address high rates of vision problems severely limiting young Kentuckians’ ability to learn and succeed in school. One goal of the law was to ensure children had no significant physical or sensory impediments that would prevent them from succeeding. The bill’s proponents recognized that not only do many children struggle with easily corrected obstacles to learning, but that some populations, such as Native Americans and Hispanics, are much more disadvantaged this way than other ethnicities.

HB706 requires schools officials to secure evidence that a comprehensive eye exam has been performed by an optometrist or ophthalmologist prior to Jan. 1 of the first year a child turning 3, 4, or 5 years old is enrolled in a public school or Head Start program. The goal is to ALL children are ready for education, and that no child will suffer the long term effects of uncorrected visual impediments. In general, children from more informed and affluent homes are more likely to undergo vision assessment, and this leads to losses in opportunity for those affected but never tested. These unchecked visual impediments alone, it is said, account for billions in lost productivity and unneeded healthcare costs in the US every year. Differences in economic, social, and education achievement between ethnicities is also magnified by the relative differences in rates of visual impediments between them. (To be covered in an upcoming article.)

Analysis of the first seven years of data from Kentucky reveals that, as expected, a great number of children were identified as having significant visual impediments that had not otherwise been corrected. Correcting vision in the highest risk cases alone meant:

  • The number of Kentucky children proficient or distinguished in core scholastic success measures showed significant improvement only a few years after the preschool exam law was implemented.
  • Children proficient or distinguished in reading rose from 57 percent in 2000 to 68 percent in 2005.
  • Students proficient or distinguished in science rose from 36 percent in 2000 to 55 percent in 2005.
  • Students proficient or distinguished in writing rose from 23 percent in 2000 to 53 percent in 2005.

Alberta Does Not Mandate Vision Assessment, and Loses

The statistics in Kentucky’s experience do not reflect the increases in productivity from the treated children over their lifetime, nor do they describe the savings to health and education authorities due to prevention of apparent learning and health concerns caused by difficult vision. It is also true that proper vision management can improve performance in children who are otherwise fine: They know how to play hockey, they just have to ‘play with dull skates’.

In Alberta, few schools have the training or direction to properly manage children’s vision needs prior to subjecting them to years of intensive book learning. For some children, this neglect amounts to abuse.

In Alberta, few schools have the training or direction to properly manage children’s vision needs prior to subjecting them to years of intensive book learning. For many children affected by visual impediments, this neglect amounts to abuse – though it is hard to define who is responsible, and it is likely not important. It is a parent’s responsibility to ensure they are aware of any vision needs the child might have and this requires they see a professional for assessment. The schools for their part have an important role to play in ensuring high capture rates for vision exams, and to facilitate the process.

Sadly, most schools in Alberta and across Canada are oblivious to the need, so it is really the Wild West, or a crap shoot, as to whether an affected child succeeds or not. Children are, effectively, learning without seatbelts.

All Children Must Be Checked – Especially In Light of COVID-19

Alberta came close to achieving the same common-sense approach to child development as Kentucky (and other jurisdictions, see also here) through near adoption of Bill 203 in 2014, something I am proud to have fought for. This Bill passed second reading unanimously, then was forgotten when government changed over. It seems child health issues were of secondary concern for the governments that followed.

Now, with a headlong rush to change how we deliver education to a much more computer-centric model (more than a child-centric one), more an more problems will rise to the surface in a more obvious way. Visual disturbances that impact on learning and behaviour are much more likely to be encountered when the visual tasking is overloaded, such as with greater and extended amounts of near-distance digital presentation of text.

Healthcare provides essential and advanced vision assessment service through optometry and ophthalmology, but since there is no mandate for exams, only about 15% of children are ever checked before it’s too late. It is not good enough to avoid comprehensive testing saying ‘this kid doesn’t appear to have a problem with vision’ or ‘vision is not contributing to the problem’. In fact, ignoring vision is logically and properly categorized as child neglect, even abuse in some cases.

It is not good enough to avoid comprehensive testing saying ‘this kid doesn’t appear to have a problem with vision’ or ‘vision is not contributing to the problem’. In fact, ignoring vision is logically and properly categorized as child neglect, even abuse in some cases.

Opinions vary on this issue, but those who work in child development, such as optometrists, vision science researchers, ophthalmologists, occupational therapists, and a growing number of teachers and psychologists, recognize the the clinical facts. Some feel this is a political issue where costs to healthcare and business interests are at play. Meanwhile, for clinicians, it is clear that children who are affected by visual impediments will struggle needlessly for years and cause extra burden to public services. For taxpayers, it is a simple matter of proper resource management and cost reduction through prevention (an exam and a pair of glasses is cheaper than and MRI scanner when looking for the reason a child gets headaches and can’t read.) As Canadians, we must remember that when a child is denied strong vision for learning, he is denied a lifetime of freedom, productivity, and self-sufficiency: We are denying his rights according to the Canadian Charter of Rights and Freedoms.

The day is coming when teachers, family doctors, and psychologists will have at least some notion of a child’s vision needs as a basic piece of information necessary for managing their care, similar to knowing their age and gender. Vision is invisible. You have to look for it, like blood pressure or heart rate. Currently, most professional programs in child development, including pediatrics, psychology, and education include little to no practical training in the nature of child vision, and it matters. All children must be checked; not doing so is negligent – towards the child, but also regarding the provincial and national economies.

When taking your children to school, make sure they are secured by a seatbelt, and make sure you know what their vision needs are, if any. Child vision exams are covered by the Province.

Ignoring vision needs of young learners costs us all, but the greater cost is borne by the child over a lifetime – and these costs are incalculable. Still, the Kentucky example does provide us with a clear view of some of the many benefits to education that follow from ensuring basic learner needs, such as easy and accurate vision.

Expand your understanding:

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Dalton and Dane https://visionmechanic.net/dalton-and-dane/ https://visionmechanic.net/dalton-and-dane/#comments Tue, 18 Aug 2020 01:41:12 +0000 https://visionmechanic.net/?p=175 (The goal of VisionMechanic.net is to provide science-based clinically relevant resources about humans, for humans. All humans. This series highlighting International Vision and Learning Month (August) is more focused on those humans who are in formal learning programs, most notably, younger humans. If you yourself are a learner, or if you teach them, guide them, care for them or provide therapy for them, then this series will be of interest to you.)

Dalton and Dane are twins from a nearby First Nations community. Given a lack of local supports for vision and appropriate training in the local community and school, these boys have a long road ahead: My estimation is that they have almost zero chance of finishing high school – even though they are now only 12 years old (loads of time to intervene) and quite capable.

Schoolwork for these boys is not only impossible without essential vision help, it’s uncomfortable, toxic, even threatening. Without supports, school is inaccessible, even though the doors are open and the latest tech is in place. The fact is even the tech adds to the obstacles for many, yet another barrier.

The image attached is a ‘strip’ from their autorefractor readings, right eyes on top, left eyes on the bottom. Confusing to the untrained eye, but very revealing to the Vision Mechanic. Bottom line: Both boys have sufficient farsighted astigmatism that reading is impossible, and they live with nearly perpetual headaches and blur. The readings also suggest that the strain to try to focus is so great, the brain has virtually given up trying (indicated by the lack of variability in the readings). Schoolwork for these boys is not only impossible without essential vision help, it’s uncomfortable, toxic, even threatening. Without supports, school is inaccessible, even though the doors are open and the latest tech is in place. The fact is even the tech adds to the obstacles for many, yet another barrier.

While completing degrees in neural science then in education, there was plenty of discussion around basic psychology and a review of some classical thinking on ‘learning’ (you owe it to yourself to read Piaget, Kelly, Rousseau, among others). On the large stage, these ideas were helpful in putting the students at the centre of the process, tailoring programming to meet group needs according to age, milieu, and content/curriculum. There was however zero discussion related to how vision works – even though the education world was on the verge of a major paradigm shift to an electronic in-your-face mode of instruction, literally speaking. It was the same in other schools like in psychology and medicine and remains the same today.

Kids can learn and should learn in different ways, using a multitude of approaches that appeal to all senses and their motor needs. Given an already high reliance on vision in traditional learning, the shift to eLearning formats in the 1990’s further limited the options for multi-sensory instruction and put an even greater emphasis on strong and fluid visual skills. So, we proceed blindly, making increasing demands on basic visual function. Still, nowhere in education in Alberta, or in Canada, is there any requirement to ensure a child can even handle the visual demands of the neo-traditional (aka ‘computer-based) classrooms. Now in the COVID-19 era, visual demands have increased exponentially.

In Dalton’s and Dane’s case, the over-reliance on computer screens due to COVID-19 related changes to instructional delivery means they are now even more on their own as this approach is uncomfortable, if it’s even possible for them to do the tasking at all. Nobody is asking about these guys, or the thousands of others across the province who are suffering in plain sight. For many of these kids, Dalton and Dane included, they have effectively now been excluded from the rolls of those who deserve an education. Schooling is no longer accessible to them.

we proceed blindly, making increasing demands on basic visual function and yet nowhere in education in Alberta, or in Canada, is there any requirement to ensure a child can even handle the visual demands of the neo-traditional (aka ‘computer-based) classrooms.

For many of these kids, Dalton and Dane included, they have effectively now been excluded from the rolls of those who deserve an education. Schooling is no longer accessible to them.

Dane and Dalton struggled from day one and various people turned a blind eye to their needs – this vision blindness, the inability or unwillingness to see vision as important in learning and development, is a major factor in why schools lose so many like these twins. The problem is particularly onerous in remote communities, and in First Nations communities where there seems little Provincial or National interest to provide adequate care, and where (in some cases I’ve seen), the local community itself disadvantages their own children by refusing care, period.

The problem is particularly onerous in remote communities, and in First Nations communities where there seems little Provincial or National interest to provide adequate care, and where (in some cases I’ve seen), the local community itself disadvantages their own children by refusing care, period.

Furthermore, in an age of bully-awareness and anti-bullying campaigns, Dane and Dalton feel like wearing glasses is a punishment – the teasing today is far more important than future life prospects. To be effectively blind is one thing, to be teased about it is another story entirely. Vision problems affect as many as 1 in 4 children, most fly under the radar, and they do not discriminate according to race or gender. Children need to learn that vision is important, something to be respected.

My hope is that these boys find a school that better understands their physical visual disabilities and makes room for them before it’s too late. Their amblyopia (poor visual acuity, so-called ‘lazy eye’) is detectable early and fairly straightforward to treat – but there is still no funding to do this and parents must pay out of pocket.

When schools, psychologists, and family physicians finally attend to their own vision blindness, boys like Dalton and Dane will have a fighting chance. In the meantime, expect these children will be ‘coded’ so the school might receive additional funding for instructional support – which will not include any money for vision rehabilitation, nor will the school be required to even make note vision issues, or whether there is a report of a vision exam on hand.

This current series on Vision and Learning highlights many issues around ‘vision blindness‘, in other words, the ease with which we all dismiss vision as both a problem in learning and behaviour, but also the cause of many children’s apparent developmental concerns. Dalton and Dane are two examples where mom agreed to have the story published so that others might wake up. I would not expect a mom to have my background and she like most moms blamed herself when she first learned the full story. Still, in their community not far from my clinic, like the other First Nations communities around, the lack of attention to vision leads to serious community and individual tragedies that are fully ignored. This responsibility falls squarely on the shoulders of any one who cares for these kids and gets paid for it, but especially those who make decisions for them.

It’s the same everywhere. Our blindness to vision means we never get to drop the ball because we simply never picked it up. So, how do we know we’re neglecting our kids if we don’t know? A great question for a future post.

When it comes down to it, we’re failing thousands of kids every year. The programs are in place to detect and manage these common problems, but the infrastructure is not there, nor the will. Nor is there a requirement to have a child’s vision assessed.

It’s time to take vision seriously, it’s well overdue in fact. The move to siloed isolated learning environments (erroneously and cruelly called ‘sugar cubes‘ in one jurisdiction because of all the ‘sweet kids’ who are stuffed into these enclosed spaces), will lead to increased broadening of the gaps for the children who for reasons of vision alone are incapable or unwilling to manage such extreme visual tasking for hours daily. It’s hard to put numbers on it, but expect that COVID-19 will see the following outcomes, mostly among kids whose vision concerns (Visual Impediments to Learning and Development or VILD) have yet to be diagnosed or addressed:

  • Lowered outcomes/performance, so lower grades.
  • Greater number of classes dropped, not completed.
  • Greater intensity and frequency of emotional outbursts.
  • Greater admission to attend medical diagnostics, including brain imaging, due to unwanted behaviour such as inattention, and increased fatigue and headache.
  • Increased prescribing of medication for attention/unwanted behaviours..
  • Increased suicidal ideation and criminal activity.

The nearsighted kids with decent muscle control will do well in comparison.

When it comes down to it, we’re failing thousands of kids every year. The programs are in place to detect and manage these common problems, but the infrastructure is not there, nor the will. Nor is there a requirement to have a child’s vision assessed. The common reaction to this is ‘Oh, I didn’t realize that, that’s doesn’t make any sense.’ And this is precisely what drives my writing and advocacy.

There are relatively simple solutions for all stakeholders and a future post will address these simple cures for vision blindness.

Expand your understanding:

Vision is critical to learning and development, period. Learn more about astigmatism here and learn more about vision, like what glasses prescriptions mean, by following the content here on VisionMechanic.net and on YouTube. You’ll be especially interested in spending time with us if you’re a parent, a teacher, therapist or doctor working with reading, developmental, and learning disorders, and of course brain injuries. Loads of good practical information and advice.

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Visual Impediments to Learning and Development – Putting the Pieces Together https://visionmechanic.net/vild/ https://visionmechanic.net/vild/#respond Sun, 16 Aug 2020 17:16:00 +0000 https://visionmechanic.net/?p=433 Subscribe to Vision Mechanic on YouTube.com

(The goal of VisionMechanic.net is to provide science-based clinically relevant resources about humans, for humans. All humans. This series highlighting International Vision and Learning Month (August) is more focused on those humans who are in formal learning programs, most notably, younger humans. If you yourself are a learner, or if you teach them, guide them, care for them or provide therapy for them, then this series will be of interest to you.)

The fact is that we don’t look at vision, not seriously, and most kids who struggle with Visual Impediments to Learning and Development fall through the cracks

It’s reasonable to acknowledge that the lack of attention to vision in a meaningful way constitutes an abrogation of the basic rights of these children.

To understand how vision affects learning and development we first need a foundation in some basics, and that’s what was covered in earlier posts in this series. Importantly:

  1. Vision is more than simply just eyesight, and so measuring vision means more than simply using an eye chart.
  2. Using eye charts alone as ‘tests of vision’ is a problematic pursuit, even discriminatory: It most often fails the children who don’t need help and leaves out those who really do need help.
  3. Refractive States (nearsighted, farsighted, astigmatism) are common causes of reading and behaviour problems in the classroom. Most people are unaware of their own refractive states, most doctors don’t ask about refractive state before prescribing medications for unwanted behaviours.
  4. Blur is important in driving accommodation (the focusing reflex), and if an image cannot be made clear (for instance in the case of farsightedness or astigmatism) the eye’s focusing system will continue to struggle to try to make it as clear as possible. This is felt as eye strain (asthenopia, of which there are different kinds).
  5. There are different kinds of ‘blur’ including differences in image sizing (so ‘ghosting’ of images, a condition called aniseikonia), differences in refractive state between the eyes (one eye a little nearsighted, the other very nearsighted – one example of a condition known as anisometropia).
  6. Muscle movements are also very complicated. Our eye muscle movements offer us a sort of short-hand, or quick way of gathering a lot of information in a very short time with minimal effort.
  7. Impaired or restrictive muscle movements can and will result in impediments to learning and development such as reading disorders.
  8. Most Visual Impediments to Learning and Development (VILD) are detectable early and can even be used to predict who will succeed and fail in school with a fair degree of accuracy.
  9. VILD may be addressed often through simple therapeutic means at a relatively low cost.

Studies abound in the world of research in how vision function affects the three pillars of childhood: Development, Behaviour, and Learning. The fact that most child development professionals are unfamiliar with the basics of vision science is a problem for education and health budgets, and for families. The saying goes that if your only tool is a hammer, then everything will look like a nail is applicable, but so is this related notion: If you don’t know what a screw is, you will also likely ruin it trying to pound it in with that hammer.

A growing number of researchers are paying attention to the basics of human vision in child learning and development, including in psychiatry…

A growing number of researchers are paying attention to the basics of human vision in child learning and development, including in psychiatry such as this work from the Journal of Attention Disorders from 2018: The Underestimated Role of Refractive Error (Hyperopia, Myopia, and Astigmatism) and Strabismus in Children With ADHD or this one from Dr. Patrick Quaid in Medical Ophthalmology from 2013. Two papers of hundreds pointing to what should otherwise be obvious – obvious but for the simple fact that we, as a population of adults and developmental professionals, simply do not have a common background in the basics of human vision.

In my own case, I was trained in neuro-psychology and neural science, then in educational psychology and instruction – this included work in designing standardized testing, curriculum design. My students saw good success and were well supported – it was a relatively affluent community with a healthy tax base. At no point did I ever consider that vision could ever be a problem for my students – some had glasses, that was it. I later learned, during studies in human visual function in my optometric studies, that I had been in fact blind to the very intricate and important details of how we work as visual beings, and more importantly, how it shapes who and what we become.

I later learned … that I had been in fact blind to the very intricate and important details of how we work as visual beings, and more importantly, how it shapes who and what we become.

Even in that well-supported classroom with the best technology available, there were likely 1 in every 4 kids that struggled with a visual impediment of some kind, something about how their their eyes struggle to focus on near targets or to align properly, or to track lines of text. My own clinical experience, corroborated by studies in similar populations, shows extremes in some populations, namely First Nations communities where up to 50% of children in one survey showed enough astigmatism to interfere with reading and cause strain when dealing with text and computers. What makes matters worse is that these communities are the most poorly supported on visual function – even though they might have the very best computer technology on the Planet (which ironically is often especially toxic for those affected with visual impediments).

With vision, the impediments themselves can cause anything from mild blur and difficulty finding focus, to extreme discomfort and disability. The sad truth is even the extreme cases are most often missed and there is a price to be paid.

Vision is at the root of how we behave – our core inputs to life: If we struggle with simply perceiving something, if looking at something is painful, arduous, tedious, we will resist, fight it, and our performance will take a hit. With vision, the impediments themselves can cause anything from mild blur and difficulty finding focus, to extreme discomfort and disability. The sad truth is even the extreme cases are most often missed and there is a price to be paid.

It is still surprising to find medical and psychological clinics that make no reference to actual visual function in a meaningful way – like even considering the basic refractive state, for example.

In moderate and extreme cases, VILD are mis-labelled as anything from ADHD to dyslexia to even autism and other emotional disorders. Still, vision is not even on the radar for public health, or in pediatric clinics where medications are a common catch-all for therapists who want to try something and where the testing seems driven to justify use of medications. It is still surprising to find medical and psychological clinics that make no reference to actual visual function in a meaningful way – like even considering the basic refractive state, for example. There are reasons for this, not least of which is the DSM-V makes no requirement to note or assess visual function – so by default, vision cannot have anything to do with what is observed. This blind spot is dangerous and costly.

The fact is that we don’t look at vision, not seriously, and most kids who struggle with Visual Impediments to Learning and Development fall through the cracks: This includes kids who succeed in spite of real physical disabilities rooted in poor visual function – so study might be unnecessarily painful, for example, or reading belaboured, but for treatable reasons. Mostly kids who have significant visual impediments will see improved function (reading, athletics, comfort) and emotional balance when they are not bothered by the core element to learning, what most people take for granted – clear, fluid, effortless visual function.

For the price of one psychoeducational testing series with a report, the going rate is somewhere in the neighborhood of $7000 – per child. Most mild to moderate visual impediments to learning and development can be managed over the school life for less than $3k, including glasses and training. This provides a path to a solution, rather that a shot in the dark as to what the problem might be. Testing results always improve when vision is addressed first, and this makes perfect sense. Still, most psychological testing and medicating is done in the blind when it comes to vision.

…it makes no rational sense to use a vision-centric testing battery on a child whose visual functional status is unknown.

We all have reason to pay attention to VILD because it costs, all of us. The ones who suffer most are those who struggle in pain, or through needless testing and treatment only to find no solace because the hammer does not work on the screw. The worst part of this story is certainly the lost opportunities of these affected and labelled children who are forced to endure needless testing and treatment. Likewise, it makes no rational sense to use a vision-centric testing battery on a child whose visual functional status is unknown.

It’s reasonable to acknowledge that the lack of attention to vision in a meaningful way constitutes an abrogation of the basic rights of these children. With this in mind, and the consideration of additional costs to taxpayers and families of not treating basic vision issues, it’s time we reconsider our approach to dealing with learning and behaviour concerns from a nuts and bolts perspective first, with vision as a primary concern.

In an upcoming post in this series, we’ll have a look at how instructional design and health policy can be used to prevent harm from unmanaged visual impediments, and ultimately save millions annually.

Expand your understanding:

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Eye Movements – A Second Look https://visionmechanic.net/eye-movements-a-second-look/ https://visionmechanic.net/eye-movements-a-second-look/#comments Fri, 14 Aug 2020 19:30:00 +0000 https://visionmechanic.net/?p=429 Subscribe to Vision Mechanic on YouTube.com

(The goal of VisionMechanic.net is to provide science-based clinically relevant resources about humans, for humans. All humans. This series highlighting International Vision and Learning Month (August) is more focused on those humans who are in formal learning programs, most notably, younger humans. If you yourself are a learner, or if you teach them, guide them, care for them or provide therapy for them, then this series will be of interest to you.)

Think about this for a few moments: How often do you move your eyes? Even as you’re reading this, or driving down the road – how many times per second are your eyes darting here or there, how long do they sit on one target in particular? We don’t simply spend our time looking straight ahead and we don’t spend our days turning our heads to find new targets – that would be a burden that would surely stop us in our tracks. Instead, we turn our eyes to locate targets because it’s much faster, much more energy efficient – and it allows us to take in the maximum amount of information with quick snapshots of hundreds of unique targets every single minute of the waking day. Were we to suddenly rely on our necks to move our eyes, human activity would grind to a virtual halt.

…these metrics, like others mentioned in this series (even so basic as refractive state), are virtually never considered when children are referred for standard pediatric assessment of behaviour and learning/reading concerns – even though they are known to have significant impact on child learning, development, and behaviour.

You’ll understand more after reading this brief outline of the different kinds of eye movements we rely upon – but never even think about. We’ll consider very briefly how these can affect child development and behaviour. Bear in mind as you read that these metrics, like others mentioned in this series (even so basic as refractive state), are virtually never considered when children are referred for standard pediatric assessment of behaviour and learning/reading concerns – even though they are known to have significant impact on child learning, development, and behaviour. This represents a major failing in professional colleges in education, psychology, and medicine/pediatrics.

Start with this, a simple experiment: Try to not move your eyes. If you need to see something, or scan text for example, try to only move your head while keep your eyes pointing straight ahead. You’ll soon find this impossible to do for any period of time.

Step 2: Hold your head perfectly steady and continue reading. Pay attention to how many very small eye movements you are making. Now look straight ahead and while holding your head still, practice moving your eyes to different targets in all extremes of your visible field of view. Notice how much easier it is to do this rather than to move your head to accomplish the same task.

https://theophthalmologist.com/subspecialties/art-of-eyes-2020/
Click the link or the picture to learn more about how are visual systems have layers of complexity. A great part of the visual system, about half of it, is geared towards targeting objects and moving the eyes.

The above graphic is one of many in the collection ‘Art of Eyes‘, a series of detailed and imaginative illustrations about the human eye and all that supports it. Partly pictured here are some of the pieces of the eye movement system. The nerve networks, muscles, and muscle sensors that are responsible for moving the eyes and holding the eyes in place are complex, no less complex than the nerve tissue and brain connections that capture light and turn it into a usable signal we call ‘sight’.

Muscle movements of the eyes can be broadly classified as follows. Obviously the details are a whole lot more … detailed, so refer to Adler’s Physiology of the Eye, or Principles of Neural Science, or Neurology of Eye Movements for more.:

  • Fixations: Holding a target steady. This is actually maintained by a series of minute movements that we do not perceive. When we think we are holding fast on a single target, the reality is the eye is making countless micro-movements to keep the target freshened on the retinal receptors, and for other reasons. Fixations allow us to verify targets and to study them in more detail. Fixations develop relatively early in life.
  • Pursuits: Smooth targeting of targets like birds in the sky. This sort of smooth tracking is only rarely used in daily life for most people, that is, relative to other forms of eye movements. Pursuits take a little longer to develop and, like other eye movements, become stronger and more accurate with use. Pursuits have an important role to play in maintaining balance (and helping to avoid nausea) when we are moving and objects around us are also moving.
  • Saccades (pronounced ‘suh-kades’ or ‘suh-kawds’): Next to fixations, saccades are our most important type of eye movement. When we are young, we move our bodies and heads to find targets. In time, we learn to do ‘short hand’ by moving the eyes instead – this saves time and energy, a lot of energy. Speed and accuracy comes with practice with moving in the environment and interacting with objects in it. Saccades also become more refined with an evolving brain and mind and are driven by attention. Jumping from one visual target to another with quick and easy accuracy is the foundation to reading – so much so that you can predict a child’s reading outcomes by assessing saccadic skills alone. Thankfully, these skills like other visual motor skills can be trained. Aside: One of the first things to suffer after a concussion is saccadic function.
  • Vergence: Technically, vergence is the ‘opposing movement of the eyes’, so eyes moving in opposite directions to one another. There are two examples of this – crossing the eyes inwardly (convergence), and moving them outwardly away from the nose (divergence). Both eyes must maintain contact with the target at all distances, and so vergence is important for many reasons and will be the foundation for all other types of eye movements. When convergence fails, children feel this as strain when reading – the eyes struggle to pull inwardly, so muscle strain and double vision. This condition is associated with ADHD and reading concerns. When the eyes struggle to diverge, distant objects can appear doubled or blurry. Sticky vergence (reduced vergence range and facility) can also lead to difficulties targeting targets near then far, or far then near – so copying from a board will be difficult. Again, like other visual motor skills, vergence can be trained. Like saccades, vergence is often affected after stroke and this causes trouble with near work, like on computer screens.
  • (Accommodation: This is another muscle ‘movement’ of the eye but it’s invisible – accommodation is the action of the ciliary body to change the shape of the lens to focus light. So, it’s a movement that can affect other eye movements, but does not itself move the eyeball. Reduced range and ease of accommodation is often associated with reading trouble, or after a concussion.)

The experts out there will complain that I’m leaving out a million things, but that’s fine. The goal of this series is to underline and highlight common elements that commonly contribute to learning and developmental concerns. You can always find more in books like the wonderful Adler’s Physiology of the Eye, or Neurology of Eye Movements. Or, for when things go awry, Eye Movement Disorders (among others).

all chairs need at least three legs, and accurate visual targeting requires vision/sight, balance, and body sense to be in proper working order.

Things get even more complicated when you consider there are two other main inputs to targeting, other than vision, that is: Balance (what is known as vestibular sense) and Body Sense (aka somatosensation). When either of these is troubled or burdened by illness or developmental trouble, visual targeting will be affected – all chairs need at least three legs, and accurate visual targeting requires vision/sight, balance, and body sense to be in proper working order.

Finally, to really complicate things: All these muscle actions can be controlled voluntarily by learning and through experience, and they can also be activated by reflexes. Sometimes these can come into conflict in some interesting ways – like when you feel you’re moving at a stop light when it’s really the car beside you that’s moving. (See Vestibulo-ocular Reflex and Optokinetic Reflex)

More to come on this and how it all applies to learning in upcoming posts.

Expand your understanding:

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Eye Care Professionals (ECP’s) https://visionmechanic.net/ecps/ https://visionmechanic.net/ecps/#comments Wed, 12 Aug 2020 17:24:00 +0000 https://visionmechanic.net/?p=436 You wouldn’t take your car to be repaired at a lawyer’s office, not my lawyer anyway. Then again, if you need a great lawyer, he’s your guy. The point is this: Find the expert you need and benefit from their years of study and experience. Or fool yourself wasting your time with half-baked solutions.

Eyes, vision, glasses… it’s all very complicated and we’re just not taught about it in school, and most of us get zero training in these areas during our professional training. Still, vision remains the most important tool we all rely on to make it through our lives. This short series is designed to get you going on your awakening to what vision is and why is matters to children especially, and especially now during the confined times of COVID-19 computer-based learning.

This post offers a brief outline of the various ECP’s, or Eye Care Providers, and which one will best answer your needs. Across Alberta, Canada, North America, your best first stop will be your family optometry clinics who can do the measuring and diagnosing of primary disorders and offer immediate solutions.

your best first stop will be your family optometry clinics who can do the measuring and diagnosing of primary disorders and offer immediate solutions.

Eye Care Professionals: Whom Should You See?

One of the greatest mistakes a person can make is to see a surgeon for a common eye concern, a functional vision problem, or a child learning concern that is suspected to be eye or vision related. ‘Specialists’ are just that – really good at some things – and they will not often be able to consider a broader view for the money charged. On the other end of the spectrum, a basic vision screening offered by some discount optical shops will also cost a lot more in time if even basic concerns are not addressed properly – even garden variety farsightedness (hyperopia) can become a serious problem if not adequately addressed. Here is a brief summary of ECP’s, Eye Care Professionals, and why you might want to see them. 

Optometrist: Optometrists are doctors with ‘OD’ degrees, having at least a four-year degree in biological or health sciences, and then four more years in optometry school studying eye health, disease, and visual function. An optometric physician is akin to a vision mechanic and assesses eye health, the health of your visual pathway, and manages the details of visual function. Optometric studies in leading schools emphasizes various aspects of neurology, ophthalmology, optics and human visual physiology, orthoptics, and human behaviour. Optometry has a number of sub-specialties that help people improve visual performance for sport or high-performance tasks such as flying jet aircraft, and there are developmental optometrists who work with visual rehabilitation for pediatric populations or for brain injury patients. Optometrists will do minor surgical procedures locally and refer more complicated disease and surgical needs to ophthalmology. If you have an eye or vision concern, family optometrists are your best bet to start for both service, costs, and referrals. Beware: Not all optometrists have a full complement of service offering, so ask about specialities before you proceed. 

Developmental (Behavioural) Optometrists:  These are optometrists (OD’s) with additional training during and after doctoral studies. “VTOD’s”, or doctors in optometry who practice Vision Therapy/Rehabilitation, offer advanced diagnostics and treatment options for troubled visual function and development. Like a mechanic who listens to and measures different aspects of a car engine to diagnose and fix a problem, developmental optometrists break vision down into its various elements to fix whatever might be in disorder. This starts with looking for eye or nervous system disease, then moves on to look at the finer points of how the eyes work and how the brain perceives. VTOD’s help with many different problems ranging from reading/learning disabilities, to problems with balance and focus after brain injury, reading concerns, myopia progression, and more. Currently, there is no more effective treatment for reading and learning problems than a full sensory reading program combined with visual neuro-rehabilitation. Search for ‘COVD.org’ or ‘noravisionrehab.org’ or simply ‘optometry vision therapy’ to locate a VTOD near you. 

Ophthalmologist: These are doctors with ‘MD’ degrees, having at least a four-year degree in biological or health sciences, and then four more years in medical school studying general human health and disease. Ophthalmology is a specialty with a minimum of 2-4 years training in surgery and advanced management of eye disease, including principles of ophthalmology, some optics and aspects of visual function. Ophthalmologists provide therapeutic and rehabilitative help to people who are having trouble with eye disease and injury. Ophthalmologists will be either generalists or specialists, such as for retinal diseases, problems with the front parts of the eye (‘anterior segment’ specialists, like for cataracts), or problems with the visual nervous system (neuro-ophthalmologists). Ophthalmology aims to ensure good eye health and maintain eyesight but is not generally interested in the finer aspects of visual behaviour or rehabilitation beyond the functional basics of acuity and alignment. Pediatric ophthalmologists will study child vision assessment and surgical techniques for pediatric cases but will rarely consider non-surgical approaches to treatment. If you need surgery or have a serious degenerative eye disease, you likely need an ophthalmologist. 

Orthoptist: Applies optical principles and devices in the measurement and correction of visual function, as directed by a doctor. Orthoptists are primarily interested in measuring deviations of the eyes and measuring these in preparation for surgery or for specialized optical needs. Their rehabilitative role will be limited and consists primarily of patching. Optometrists are trained in orthoptics as part of their general training, and developmental optometrists can often realign the eyes and correct functional visual concerns without surgery.

Optician: Opticians study for one or two years in order to be knowledgeable and proficient with fitting and making prescription glasses and lenses. Lenses must be aligned to within a millimeter, and this is not something you can do over the Internet. Only someone with optician’s training can ensure your glasses fit well and are perfectly aligned.  When you buy glasses, you will likely be dealing with an optician to select, make, and then fit the glasses. As a rule, you should avoid taking medical advice from an optician. Opticians associated with chain stores will often be required to offer the deal-of-the-day and pay little heed to what might be best for the client. See notes on Refractive Technician below. Opticians have no medical training or training in human visual function.

Ophthalmic Technician: Ophthalmic Technicians have a one-year training program to operate equipment for diagnostic testing, to assist in surgery, and determine basic glasses prescriptions. You will work mostly with ophthalmic technicians when you go to see an ophthalmologist and spend only a few minutes with the doctor.

Optometric Assistant: Assists optometrists with gathering information about patient cases. Optometric Assistants are the doctor’s right hand, and they perform a number of diagnostic tests on patients before the doctor sees them. Optometric Assistants might also assist with glasses and with minor surgical procedures in the examination room. In Canada, the Optometric Assistant program is 9 months in duration.

Refractive Technician: Checks for refractive error, that is, determines the glasses prescription. Training is variable and can be as short as a few hours. Refractive technicians typically work under the guidance of a doctor. Beware any ‘eye exam’ that consists of a simple machine-centered refraction, or where the refraction is the entire examination. Some opticians are refracting opticians, but beware: Best advice is to not fill a glasses prescription issued by someone who isn’t also trained in human visual physiology. Corollary: You can’t fix what you don’t understand. 

Vision Therapist: Vision Therapists work with developmental optometrists to deliver therapy to patients experiencing visual dysfunction. Vision Therapists can be either trained on site in Vision Therapy clinics, or undergo more formal training through approved organisations such as COVD (College of Optometry in Vision Development, www.covd.org), or NORA (Neuro-optometric Rehabilitation Association, noravisionrehab.org). 

In an upcoming post, we’ll put all the pieces together and try to make better sense of how defective elements of vision (Visual Impediments to Learning and Development) can and will interfere with our best hopes for our children. Knowing who to turn to will be of critical importance.

Expand your understanding:

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Eye Tests Are a Waste of Time https://visionmechanic.net/eye-tests-are-a-waste-of-time/ https://visionmechanic.net/eye-tests-are-a-waste-of-time/#comments Mon, 10 Aug 2020 17:28:00 +0000 https://visionmechanic.net/?p=421 Subscribe to Vision Mechanic on YouTube.com

(The goal of VisionMechanic.net is to provide science-based clinically relevant resources about humans, for humans. All humans. This series highlighting International Vision and Learning Month (August) is more focused on those humans who are in formal learning programs, most notably, younger humans. If you yourself are a learner, or if you teach them, guide them, care for them or provide therapy for them, then this series will be of interest to you.)

Of course, I’ll explain the title: If all that’s being done to test eyes is to use an eye chart only, then it’s a waste of time. Mostly, that’s what people call an eye test: Check eyesight. This notion is way off the mark, and a good example of the Dunning-Kruger Effect in action: What we do know, which is often very little, makes us believe we know a lot more than we do and this leads us to some pretty awful conclusion at times. As a rule, those who are expert in their fields will be the first to say they need to learn more. In this case, taking a child’s vision seriously means we can treat many common conditions and avoid unnecessary testing and treatment.

Of course, I’ll explain the title: If all that’s being done to test eyes is to use an eye chart only, then it’s a waste of time. Mostly, that’s what people call an eye test: Check eyesight. This notion is way off the mark, and a good example of the Dunning-Kruger Effect in action: What we do know, which is often very little, makes us believe we know a lot more than we do and this leads us to some pretty awful conclusion at times. As a rule, those who are expert in their fields will be the first to say they need to learn more. In this case, taking a child’s vision seriously means we can treat many common conditions and avoid unnecessary testing and treatment.

taking a child’s vision seriously means we can treat many common conditions and avoid unnecessary testing and treatment.

This brief post covers the basics of what should be in an eye health and vision exam – that is, if we are at all interested in understanding what is going on. Some of it gets a little technical, but that’s ok, it’s best to give more than less.

Again, eye tests in this sense are not only of no use – a real waste of time – they are actually discriminatory.

Elements of a Comprehensive Vision Exam

The following is a listing of visual functional elements that can and should be considered as part of a comprehensive assessment of function. That is, this is what should happen during an eye exam you pay for for yourself, or one that you offer your children. 

All the following can be done in most modern clinics but may not be available in general optical or chain clinics: 

  1. Health and History
    1. General personal and family health and eye health history
    2. Assessment of work and lifestyle needs, including any current concerns.
    3. Visual acuity (how clearly you can see with and without glasses, right eye, left eye, both eyes together).
    4. Depth perception / stereopsis.
    5. Color perception.
    6. Intraocular pressures (fluid pressure inside the eyeball itself, this is unrelated to blood pressure). 
    7. External exam: Lids, lashes, conjunctiva, tear ducts, cornea, facial structure and alignment, facial muscular function, general neurological function and development path (at least history).
    8. Internal examination (ophthalmoscopy, others such as Optical Coherence Tomography (OCT), photography)
    9. Neurological screening with visual field (screening is sufficient)
  • Physical Elements of Vision – ‘Hardware’
    • Alignment (aka posture): 
      • Resting posture and alignment. (Do the eyes turn away from straight-on fixation (the ortho position)?)
      • Lateral and vertical alignment range and facility. (Vergence)
    • Focus (accommodation) range (depth of available focus range) and facility (how easily can the eyes shift focus).
    • Refraction / Refractive State: Looking for myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and anisometropia (marked difference in prescription between right and left eyes). 
      • Is prism indicated to help align images with the eyes? 
      • Is there a need for a ‘near boost’ or other specialized optical intervention?
    • Visuomotor skills
      • Pursuits: Following a smoothly moving target across the midline.
      • Fixation: Maintenance of gaze on an unmoving target.
      • Vergence: Movement of the eyes inwardly or outwardly to target near and distant targets, respectively.
      • Accommodation: Is the accommodative system responsive and with good range, or is focus range and facility more restrictive (or absent)? 
      • Range of comitant movement: Are there any restrictions or misalignment as the eyes try to hold a target in a full range of movement? 
      • Vestibular testing is indicated if visuomotor skills are deficient.

There’s also a whole realm of visual perceptual testing and visuo-motor skills testing that could be put into action to look at even more detail, but this is beyond the scope of a basic comprehensive eye health and vision exam.

If your provider does not know what these tests are, you’re likely in the wrong place.

If any of these elements above is deficient, it will show up in predictable way and should be easy to detect in clinic. In most provinces and states, these vision assessment services are covered for parents and should be used, with exams at least every two years. If your provider does not know what these tests are, you’re likely in the wrong place. Likewise, if the doctor prescribing medication to your child for classroom and learning concerns is unfamiliar with the child’s visual profile, get another opinion before filling that prescription.

Aside: Eyesight is most often tested at a distance of around 10 feet, if you go by school settings and family practices. If your eyes happen to be nearsighted, that is, tuned to the near distance, they will have no issues seeing near targets – especially if they are younger eyes with some focusing range. In fact, seeing near targets is not only easy for nearsighted kids, it’s also very comfortable. Nearsighted children succeed in academics over their farsighted classmates because their eyes are tuned to the task. The great tragedy is that the farsighted child will pass the eye test (visual acuity test) while the nearsighted child will fail it. In this way, the ‘eye test’ is really screening out those who are already suited to the task of near work, while passing through (false negative) those who struggle with near tasking. Again, eye tests in this sense are not only of no use – a real waste of time – they are actually discriminatory.

Parents need answers based on science: Vision science is one of the most studied domains, period. Understanding the basic mechanics of how a child’s vision works is a fundamental guide post in setting directions fro care and treatment. More on the different kinds of eye care providers in an upcoming post.

Expand your understanding:

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Meet More Than The Eye https://visionmechanic.net/meet-more-than-the-eye/ https://visionmechanic.net/meet-more-than-the-eye/#comments Sat, 08 Aug 2020 16:42:00 +0000 https://visionmechanic.net/?p=423 Subscribe to Vision Mechanic on YouTube.com

(The goal of VisionMechanic.net is to provide science-based clinically relevant resources about humans, for humans. All humans. This series highlighting International Vision and Learning Month (August) is more focused on those humans who are in formal learning programs, most notably, younger humans. If you yourself are a learner, or if you teach them, guide them, care for them or provide therapy for them, then this series will be of interest to you.)

An upcoming post will take a quick tour of what a full vision assessment should include – that is, should include if we’re truly interested in identifying visual impediments to learning and development (VILD). The notion of testing vision with an eye chart alone is woefully inadequate for those are on the receiving end of the assessment. Vision is complex with the eyes providing only one leg of a three-legged chair. In this post, we’ll look at what the major inputs to vision are, and very briefly at how they can create havoc in children’s learning lives if things are not properly in balance.

As mentioned earlier in this series, vision takes inputs from different body systems, and feeds into still other brain and muscle command functions. It’s complexity is obscured by what we see: Our eyes. The picture behind the eyes is much bigger, however, and if the core elements are not healthy and strong, trouble with vision will ensue. (See Adler’s Physiology of the Eye, or Principles of Neural Science, or Visual Perception: A Clinical Orientation for starters.) Let’s have a quick look at the three primary inputs to human vision, the three-legged chair of visual localization and targeting.

  1. The Eyes: Obviously the eyes capture images for us and if they cannot do this due to blur, this leg of the chair starts to fail. The scanning of space adds to our spatial mapping of the world around us.
  2. The Inner Ear: Called the vestibular organ, the inner ear is very closely linked to the systems that guide eye movements in the brain and is responsible for what we call balance. It tells us, and our guidance system, if we are moving our heads or if our target is moving, or if the world is moving or if we are moving in the world. As an example of how this works, if the head is not moving but the target moves across our retinas, then we calculate that the object is moving, not us.
  3. Body Sense: Called somatosensation, body sense has different elements to it, like touch, pressure, pain, temperature, and importantly – detection of joint movement. Body sense maps against our visual inputs to create a sense of where we are in space.

If one of these elements is unbalanced or dysfunctional due to injury, disease, or development, then visual targeting and fixation will be affected. Children who show deficits in balance will for example almost always show shortcomings in visual targeting skills which can look a lot like a reading disability when the child is faced with the demanding targeting requirements of reading. In the end, a child must have a good sense of where they are in space before they can launch new muscle movements to direct feet or fingers with any accuracy.

When children present with learning and reading difficulties, the eyes are the first place to look, then a good vision mechanic will also probe deeper through investigations of how well the child can control their eye movements. This can include a variety of tracking tests while seated or while standing, in addition to other tests of eye muscle function. Understanding the eyes is just one part of getting the full picture on vision, but understanding the forces that drive eye movements tells a whole other story. Eye movement control depends on a strong foundation of eye function, balance/vestibular function, and body sense – it follows that addressing all three will help to overcome related shortcomings in the classroom.

Eye movement control depends on a strong foundation of eye function, balance/vestibular function, and body sense – it follows that addressing all three will help to overcome related shortcomings in the classroom.

Accurate targeting and target fixation are another complex topic in understanding human vision. Observing these in children opens windows into their world and why they struggle with reading, for example. There is more to the eye movement story and we’ll review some of this in the next article. The bottom line is that vision relies heavily on accurate and reliable target location, fixation, and maintenance. When these fail, children fail. An upcoming next will explore even more aspects of visual motor control and how things can fall apart for young learners right under our noses.

For another look at computer-based learning and COVID-19, have a look at this:

https://visionmechanic.net/the-real-danger-of-screen-time-and-covid/

Expand your understanding:

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