Vision therapy for saccades improves reading

Dr. Dominick Maino has an excellent post on the blog of the College of Optometrists in Vision Development about a new study published in the journal Clinical Pediatrics by a group of researchers including one from the Illinois College of Optometry that shows that vision training (vision therapy) for saccadic eye movements improves reading in children. Read more

Vision therapy for vergence and accommodation

A new case report was published in the latest issue of the Journal Optometry & Visual Performance, which supports the effectiveness of in-office vision therapy for the treatment of vergence and accommodation dysfunctions.

Vergence is the simultaneous movement of both eyes in opposite directions to obtain or maintain single binocular vision.

Accommodation  is the process by which the eye changes its focusing power to maintain a clear focus on an object as its distance from the eye varies.

The case report discussed a patient who was 10-years and 10 months old and underwent 16 visits for vision-based therapy along with home reinforcement (vision therapy homework). The authors used several methods to measure accomodation and vergence before and after therapy, including the Convergence Insufficiency Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence range at near (PFV), accommodative amplitude, and accommodative facility. The measures taken showed decreased symptom severity following therapy.

The in-office vision therapy program used in the study was identical to that used in the well known Convergence Insufficiency Treatment Trial studies and produced measurable changes in vergence and accommodation in the case subject, who also had convergence insufficiency.

The results not only demonstrate the efficacy of vision therapy but also provide an illustration of the plasticity of the oculomotor system, which is not fully developed at 10 years of age and responds well to interventions like vision therapy.

Source

Optometry & Visual Performance
Objective Assessment of Vergence and Accommodation After Vision Therapy for Convergence Insufficiency in a Child: A Case Report Optometry and visual performance 2014 Feb 04;2(1)7-12, M Scheiman, KJ Ciuffreda, P Thiagarajan, B Tannen, DP Ludlam

Stereo vision (depth perception) in preschool children - what if my child can't see 3D?

One of the easiest ways to diagnose a vision disorder in a very young child is to test his or her stereo acuity or depth perception.  Poor 3D vision is often caused by a vision disorder, some of which may be serious disorders that are best treated in early childhood.  Poor 3D vision may even be the sing of life threatening diseases such as tumours, as in this famous story from Ontario.

A new study published in the journal Optometry & Vision Science examined the a large population of pre-school children and tested their depth perception using the Stereo Smile II test.  The researchers then looked at the association of poor 3D vision with vision disorders.

The study found that children with vision disorders had significantly worse median stereoacuity than that of children without vision disorders. Children with the most severe vision disorders had worse stereoacuity than that of children with milder disorders.

The researchers also found that testability was excellent at all ages of the children included in the study. The results support the validity of the Stereo Smile II for assessing random-dot stereoacuity in preschool children.  The results also point to the need to take children who have poor stereo vision to a developmental optometrist to be evaluated and treated for developmental vision disorders that may be the cause of the poor stereo vision.

For more information visit our 3D vision web page at http://www.visiontherapy.ca/3dmediaandvision.html

Stereo vision, vision therapy and the TED talks

Stereo vision and treatment of depth perception problems with optometric vision therapy has been the subject of TED talk featuring neuroscientist Dr. Susan Barry:

Related articles on children and depth perception

What is 3D Vision Syndrome? 

Don't like 3D movies? You may have 3D Vision Syndrome

Take your kids to see "Thor": doctor's orders!

Life threatening disease found in girls eye - lack of 3D vision was the clue

Fixing My Gaze - Can you imagine not having 3D vision?

TED - ideas worth spreading - Susan Barry on how vision therapy gave her 3D vision

Source

Stereoacuity and Vision Disorders in Preschool Children
Optom Vis Sci 2014 Jan 23;[EPub Ahead of Print], EB Ciner, G-S Ying, MT Kulp, MG Maguire, GE Quinn, E Graham, D Orel-Bixler, LA Cyert, B Moore, J Huang

Kids' eyeglass frames - the top three features to look for

Did you know? Only 10% of all eyeglass frames are made for children.

There are a number of child friendly features to look for in children's frames.  Here are the top three.  Read more...

RELATED ARTICLES

Which frames do celebrities choose for their children?

What is the best eye-wear for kids?

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Myopia control in children and spectacle lens design - how the right lenses can keep your eyes from getting worse

We have written extensively on the very big problem of mypoia and myopia progression.  Not only is it problematic that a child's vision gets more and more blurry as myopia progresses, it also puts the child at higher risk of developing glaucoma and retinal detachments, both of which can cause permanent vision loss.

So far, the best treatment for slowing and even stopping myopia progression is orthokeratology.  A number of studies have shown that orthokertology is effective:

Orthokeratology slows or stops the progression of myopia in children July 6, 2013

Study suggests that young children may benefit from orthokeratology February 14, 2013

New study confirms orthokeratology for slowing myopia progression January 30, 2013

Orthokeratology is shown to be safe for correcting myopia in chidlren Aug 11, 2012

Orthokeratology is shown to be effective in correcting astigmatism and myopia Jun 18, 2012

New study supports orthokeratology for myopia control and for astigmatism correction Jan 10, 2012 

As children's eye doctors we are very interested in treatments that can slow or stop the progression of myopia.

A new study published in July 2013 in the journal Investigative Ophthalmology & Visual Science suggests that the right spectacle lens design can slow the progression of myopia.   The study was titled "Peripheral Defocus and Myopia Progression in Myopic Children Randomly Assigned to Wear Single Vision and Progressive Addition Lenses".

The researchers looked at eighty-four myopic children between the age of 6 and 11 years with myopia that was measured between -0.75 and -4.50 diopters.  They were randomly assigned to wear single vision lenses or progressive addition lenses (often called "progressives" or "no-line bifocals").  The researchers then took measurements to investigate the association between peripheral defocus and the one-year change in central myopia.

The study concluded that the progressive lenses caused a myopic shift in peripheral defocus. Superior myopic defocus was associated with less central myopia progression. This suggests that lens designs like progressives that result in peripheral myopic defocus can potentially be used to slow myopia progression. 

However, orthokeratology is still the most effective way to slow myopia progression and is the only treatment that has been shown to stop myopia progression.

Citation:

Invest. Ophthalmol. Vis. Sci. 2013 Jul 09;[EPub Ahead of Print], DA Berntsen, CD Barr, DO Mutti, K Zadni

Source:
Investigative Ophthalmology & Visual Science
Peripheral Defocus and Myopia Progression in Myopic Children Randomly Assigned to Wear Single Vision and Progressive Addition LensesInvest. Ophthalmol. Vis. Sci. 2013 Jul 09;[EPub Ahead of Print], DA Berntsen, CD Barr, DO Mutti, K Zadnik

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Orthokeratology Stops or Slows Progression of Childhood Myopia

Orthokeratology is one of the specialized treatments we provide at our Vancouver eye clinic.  Naturally, we are please to see the continual flow of research studies that support its effectiveness.

The July 2013 issue of the journal Eye & Contact Lens published the latest in a long line of studies that have shown that orthokeratology is effective in stabilizing or slowing the progression of myopia in children.

Orthokeratology is a doctor-provided vision correction treatment that reshapes your cornea while you sleep so thatyou have perfect vision during the day. No glasses, no contacts, no surgery. Orthokeratology is also sometimes caled "corneal reshaping", "corneal molding", "overnight vision correction" or "ortho-K".

Eye doctors will tell you that some young people dislike going to the eye doctor because their eye-glasses prescription goes up at every visit. This phenomenon is known as myopia progression. Myopia is commonly called nearsightedness.

Not only does myopia progression mean increased inconvenience as the patient's vision worsens and thicker or more expensive lenses, high myopia puts a patient at risk of serious eye diseases that may result in blindness, such as glaucoma and retinal detatchment. Therefore, any treatment that can slow or stop the progression of myopia is welcome.

Myopia is quickly reaching epidemic proportions world wide:

• The World Health Organization predicts that there will be 2.5 billion nearsighted people by year 2020.

• Approximately 80% of elementary students in Singapore are myopic.

• 90% of college students in China are nearsighted.

• The National Institutes of Health reports that in 1972, the frequency of myopia was 25% in U.S. individuals aged 12 to 54. By 2004, it had increased to 41.6%. (Roan,2010).

• In 2004 approximately 26% of all people living in the U.S. and Europe were myopic.

• The incidence of myopia in "hunter-gatherer" societies where children perform little near work, is about 1%.

Orthokeratology has been shown to stop or slow the progression of myopia in children in a number of studies. The latest study, published in the July 2013 issue of the journal Eye & Contact Lens sought to determine whether overnight orthokeratology has an impact on a child's specacles prescription over a period up to 8 years. In the study, a group of kids with no orthokeratology treatment was compared with a group that received the treatment.

The results shows that on the whole, the children treated with orthokeratology showed a significantly more stable specatcles prescription than the chidlren who did received orthokeratology treatment. An impressive 64% of the eyes treated wtith orthokeratology stopped getting worse all together. As the authors put it, they "demonstrated an apparent total arrest of manifest myopic refractive change."

The study's authors concluded that the study provides evidence that orthokeratology can reduce the rate of progression of childhood myopia over the long term.

Citation:
Eye & Contact Lens
Corneal Reshaping Influences Myopic Prescription Stability (CRIMPS): An Analysis of the Effect of Orthokeratology on Childhood Myopic Refractive Stability
Eye Contact Lens 2013 Jul 01;[EPub Ahead of Print], LE Downie, R Lowe

Related Articles

Study suggests that young children may benefit from orthokeratology
February 14, 2013

New study confirms orthokeratology for slowing myopia progression
January 30, 2013

Orthokeratology is shown to be safe for correcting myopia in chidlren
Aug 11, 2012

Orthokeratology is shown to be effective in correcting astigmatism and myopia
Jun 18, 2012

New study supports orthokeratology for myopia control and for astigmatism correction
Jan 10, 2012

Laser eye sugery makes you queasy? Orthokeratology is a safe and effective alternative
Jun 09, 2011

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If your child has reading problems, treatable vision and eye movement disorders may be the reason

The evidence on eye problems associated with reading difficulties and learning problems continues to accumulate.  At our Vancouver eye and vision clinic, we treat many students with eye movement and vision problems who are struggling in school and who read below grade lever.

We use ocular motor therapy, vision therapy and eye-brain rehabilitation to get both eyes working together properly.  Often the students who we treat experience a huge jump in their reading abilities, improving by 4 or five reading levels following therapy.

A new study entitled Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls published in the May 2012 issue of the journal Graefes Archives of Clinical Experimental Ophthalmology adds to the evidence of the connection between eye and vision problems and learning.

The researchers were struck by the fact that in Ontario, Canada, approximately one in ten students aged 6 to 16 in Ontario have an individual education plan (IEP) in place because of various learning disabilities.  May of those learning problems were specific to reading.   They wanted to investigate the relationship between reading vision problems and binocular vision problems.

The researchers measured the visual acuity and eye movement measurements of students that had an IEP and compared those results with students in a regular education program.

The researchers found that the IEP group had significantly greater hyperopia, compared to the control group on cycloplegic examination. Vergence facility was significantly correlated to (i) reading
speed, (ii) number of eye movements made when reading, and (iii) a standardized symptom scoring system. Vergence facility was also significantly reduced in the IEP group versus controls. Significant differences in several other binocular vision related scores were also found.

Here is the study's conclusion:

This research indicates there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination (including cycloplegia), in addition to a comprehensive binocular vision evaluation.

Girl goes blind when she failed to get to an optometrist for an eye infection

Here is a story from the Victoria Times Columnist that reminds us to go to the optometrist whenever we have eye or vision problems.  It might save your sight.  Here is an excerpt:

Bernadine Nielsen encourages her four children to get their eyes checked every year. The 41-year old Regina-based mother and student knows all too well the perils of neglecting eye health.

 Nielsen went blind after developing eye inflammation at the age of eight. Growing up on a Cree reserve in northern Saskatchewan with her parents and six siblings, there was no easy access to medical care. Driving to see a doctor of optometry took six hours, but Nielsen to this day wishes the local nurses had encouraged her to make the trek.

 When Nielsen started experiencing symptoms of iritis, a painful condition that causes an inflammation in the iris of the eye, she wasn’t taken to see a doctor of optometry until her vision got worse, despite the fact that the condition ran in her family.

 Without medical care, Nielsen’s eyes burned, her vision became cloudy and she became extremely sensitive to sunlight. When the little girl finally made it to see a doctor of optometry, it was too late to preserve her vision.

“By then [the inflammation] had spread all over my eyes and destroyed my eye area,” Nielsen says, adding, “I suppose if I was diagnosed earlier I probably would be able to see now.”

She’s right, according to Doctors of Optometry Canada (DOC) whose experts say iritis can be treated with eye drops if caught early through an eye exam by a doctor of optometry.

Read the entire article here. 

The connection between vision and learning

Experts estimate that 80% of learning is obtained through our visual system.   That is why thorough eye exams and treatment for eye and vision problems are essential for academic and life success.  Some vision problems can be treated with corrective lenses (glasses and contact lenses) while others that have to do with eye movement or the connection between the eyes and the brain require vision therapy  - which is like physical therapy for the eyes and the brain and is delivered by a developmental optometrist like Dr. M.K Randhawa.

Just how important is vision for success?  Here is what some scientists have found about the connection between vision and learning.

• studies found significantly lower achievement test scores, as well as reduced letter and word recognition, receptive vocabulary, emergent orthography, and verbal and performance intelligence quotients among children with uncorrected hyperopia.
• children with learning disabilities exhibit a greater prevalence of vision-related problems than the entire population.
• most vision problems that may affect learning are related to refractive error, so vision examinations may provide helpful information in the management of children with learning disabilities.

Source:

Vision Problems of Children with Individualized Education Programs, Walline et al., Journal of Behavioral Optometry, Volume 23/2012/Number 4

Related Articles:
More visual symptoms means lower academic performance

Vision therapy for convergence insufficiency improves academic performance

82% of teachers report an improvement in students after vision therapy

Binocular vision dysfunctions ate my homework

Study proves that vision problems interfere with learning

Children's eye exams

Did you know that a child should have their first eye exam at the age of six months and then annually thereafter?  Like most medical conditions, eye health and vision problems are much more treatable when caught early.

Good vision in infants is also critical for visual, brain and overall development.  A child with poor vision is prevented from effectively exploring and understanding the world and deprived of valuable brain stimulation.  Studies have also proven what eye doctors already know, that vision problems that persist lead to adult problems such as joblessness, incarceration, lower income and behaviour problems.  Life threatening diseases can also lurk in the eyes of young child.  Read more...

 

Here is a video of Dr. M. K. Randhawa talking about a patient story from our Vancouver eye clinic involving a five-year-old girl who had been legally blind her whole life - until she came in for an eye exam:

Image courtesy of arztsamui / FreeDigitalPhotos.net

Vision and learning

At our Vancouver optometry clinic one of the most professionally and personally rewarding things we do is to help children reach their full academic and intellectual potential by treating vision problems that interfere with learning.  There are a number of vision problems that interfere with learning beyond the obvious one that can be fixed with glasses or contact lenses and need to be treated by a developmental optometrist using vision therapy.  These include visual information processing and binocular vision disorders, convergence insufficiency and accomodative insufficiency. These disorders are sometimes the result of traumatic brain injury.

That's because these are not problems with visual accuity,which means that even if a child has 20-20 vision as measured with the eye chart, the child's vision could be substantially deficient if she has one of these visual problems.


For who want to learn more about vision and learning, here are some informative articles:

More visual symptoms means lower academic performance
Feb 29, 2012

Vision therapy for convergence insufficiency improves academic performance ...
Jan 16, 2012

82% of teachers report an improvement in students after vision therapy
Jun 16, 2012

Binocular vision dysfunctions ate my homework
Mar 31, 2012

Study proves that vision problems interfere with learning and cause dyslexia
Apr 25, 2012

60% of students labled "learning disabled" students failed two or more binocular vision tests
Oct 20, 2012

Symptoms of some vision problems are a lot like ADHD - make sure your child is not misdiagnosed and unnecessarily medicated.

To find a doctor visit www.covd.org

What is the best eyewear for kids? It's what eye doctors choose for their own kids.

Our sister blog, KidsVision.ca asks, "What is the best eyewear for kids?"  The eye wear that eye doctors choose for their own children  reflects a doctor's concern for health, safety and effective vision correction.  Find out what eye doctors choose for their own kids. Read more...

Brain injuries and vision problems - vision therapy and developmental optometry

Brain injuries Brain injuries can result from impacts during sports, car accidents or falls and they can also result from events like a stroke, aneurysm or due to degenerative diseases that affect the brain. A brain injury caused by an external trauma to the head is called a “traumatic brain injury” or “TBI”.

Brain injuries and vision

It is estimated that 20%-40% of people with brain injuries suffer vision related disorders.  

At our Vancouver developmental optometry clinic, we have treated patients with brain injuries resulting from car accidents, viral brain infections, sports related injuries such as concussions and more with vision therapy.

In many brain injury cases, eye muscles or the nerves controlling the eye muscles are damaged, resulting in problems with teaming, movement and focusing of the eyes. These disorders include binocular vision problems, visual information processing disorders, convergence insufficiency and accomodative insufficiency.

A number of published research studies support vision therapy as a and effective treatment for vision disorders caused by brain injuries.  One study presented  4 cases of pediatric brain injury patients aged 6-18 years who were examined at an optometry clinic of a local hospital.  The author found that the children suffered from a variety of ocular and visual disorders and three of them were having difficulties academically. Academic problems are no surprise since 80% of our learning happens through our visual system.  The patients benefited from vision therapy.

Symptoms of brain injury caused vision disorders

The most common vision related symptoms of brain injuries include the following:

• Double vision
• Poor eye tracking ability
• Difficulties with shifting gaze quickly from one point to another
• Focusing
• Loss of binocular vision (eye alignment)
• Eye strain
• Fatigue
• Glare, or light sensitivity
• Inability to maintain visual contact
• Headaches
• Blurred near vision
• The extent of the injury can also impact a person’s visual information processing ability.  This can cause the following symptoms:
• Spatial disorientation
• Shifts in ability to judge location of objects
• Difficulties with balance and posture
• Poor depth perception
• Memory loss
• Poor handwriting

Studies on the treatment of vision problems caused by brain injury

For more information on the treatment of vision problems caused by brain injuries, check out the following published scientific studies on the topic:

Brodak, M.I. Pediatric acquired brain injury. Optometry 2010 81: 516-527. DOWNLOAD.

Green, W., Ciuffreda, K.L., et al. Accomodation in mild traumatic brain injury. Journal of Rehabilitation Research & Development. 2010. 47: 183-200. DOWNLOAD.

Ciuffreda KJ, Ludlam DP, Kapoor N. Clinical oculomotor training in traumatic brain injury. Optom Vis Dev 2009;40(1):16-23. DOWNLOAD.

Cockerham, G.C., Goodrich, G.L., et al. Eye and visual function in traumatic brain injury. Journal of Rehabilitation Research & Development. 2009. 46: 811-818. DOWNLOAD.

Julie L., Julie, B-T, et al. Deficits in complex visual information processing after mild TBI: Electrophysiological markers and vocational outcome prognosis Brain Injury.March 2008; 22(3): 265–274. DOWNLOAD.

Stanley, Paul. Effects of computer assisted visual scanning training on visual neglect: three case studies. Physical & Occupational Therapy in Geriatrics,1996 Vol. 14(2) 33-44. DOWNLOAD.

Sharieff K. From braille to quilting: a neuro-optometric rehabilitation case report. Optom Vis Dev 2010;41(2):81-91. DOWNLOAD.

Schlageter, K. Gray, B. Incidence and treatment of visual dysfunctoin in traumatic brin injury. Brain Injury. 1993, 7:439-448. Download.

Brosseau-Lachaine, O. Gagnon, I. et al. Mild traumatic brain injury induces prolonged visual processing deficits in children. Brain Injury.August 2008; 22(9): 657–668. DOWNLOAD.

Leslie S. Myopia and accommodative insufficiency associated with moderate head trauma. Opt Vis Dev 2009;40(1):25-31.DOWNLOAD.

Gottlieb, D.D., Fuhr, A., et al. Neuro-optometric facilitation of vision recovery after acquired brain injury. NeuroRehabilitation. 1998. 11: 175-199. DOWNLOAD.

Mandese M. Oculo-visual evaluation of the patient with traumatic brain injury. Optom Vis Dev. 2009;40(1):37-44. DOWNLOAD.

Raymond, M.J., et al. Rehabilitation of visual processing deficits following brain injury. NeuroRehabilitation. 1996. 6: 229-240. DOWNLOAD.

Proctor A. Traumatic brain injury and binasal occlusion. Optom Vis Dev 2009;40(1):45-50.DOWNLOAD.

Tong D, Zink C. Vision dysfunctions secondary to motor vehicle accident: a case report. Optom Vis Dev 2010;41(3)158-168. DOWNLOAD.

Tassinari JT. Vision Therapy for sensory fusion disruption syndrome: two case reports. Optom Vis Dev 2010;41(4):215-221.DOWNLOAD.

Hellerstein L.F., Freed S., Maples, W.C., Vision profile of patients with mild brain injury. J Am Optom Assoc. 1995; 66: 634-39. DOWNLOAD.

Freed, S. Hellerstein, LF, Visual electrodiagnostic findings in mild traumatic brain injury, Brain Injury. 1997, VOL. 11, NO. 1, 25-36. DOWNLOAD.

Rowe, F. Visual perceptual consequences of stroke. Strabismus. 2009 Jan-Mar;17(1):24-8. DOWNLOAD.

Han, E., The role of the neuro-rehabilitation optometrist. DOWNLOAD.

Suchoff, I., Gianutosos, R., Rehabilitative optometric interventions for the adult with acquired brain injury. DOWNLOAD.

Take your kids to see "Thor": doctor's orders!

One of problems in diagnosing vision disorders in children is that children who have never had normal vision have no way to know that there is anything wrong with their vision.  They have always seen that way and they think that everyone else sees that way too.

Most optometrists can tell you a story of a young child, perhaps 5 or 6 years old who goes to the eye doctor because she is not picking things up in school and a visual problem is suspected.  It turns out that the child is severely myopic and has likely never even seen the faces of her parents beyond identifying them as a particularly shaped blurr.  It is a heart warming moment when the child sees her mother clearly for the first time!  Here is a video of Dr. Randahwa telling this story about what happened with a five-year old girl in our Vancouver opometry clinic:

The same is the case with patients who have strabismus or ablyopia.  While the former may present itself in the form of a noticeable eye turn, amblyopia (or lazy eye, as it is is sometimes known - a condition where one eye is not working properly and may even be legally blind) is not obvious.   Patients with these conditions suffer from binocular vision problems (when the two eyes do not work together properly) and will often have stereo vision problems that make it impossible for them to see in 3D.  The problem is that such a child will not be able to tell you that there is anything wrong with her vision, because it has been that way for her entire life.  Read my older post about the book "Fixing my Gaze" to learn about a famous case of 3D deficiency and how an optometrist used vision therapy treated the problem.

Lack or depth perception and 3D vision could be a sign of a potentially life threatening disease.  It could be caused by eye cancer shutting off communication between one eye and the brain.  Cancer such as this should be caught early before it causes noticeable vision changes - that is the key to successful treatment and the reason why annual eye exams for children are so critical.

3D movies (like Thor, pictured to the right) and video games are an opportunity for parents to test 3D vision.  If a child does not experience the sensation of objects coming out at her from the screen, she may have a binocular vision problem.  You can ask your child to reach out for an object that is popping out of the screen.  If she does not reach out or does so at inappropriate times, you should take her to the optometrist for clinical testing.  

You can also ask your child to describe what the 3D movie or game is like.  Be careful not to ask vague questions like, "is this movie different from an ordinary movie?"  The child will be wearing 3D glasses, which can alter color and so the movie will be different for those reasons alone. 

While 3D media offer parents an opportunity to catch a visual problem, parents can always, and should regularly visit their optometrist where visual disorders like strabismus and lazy eye are routinely tested and diagnosed. 

Properly functioning binocular vision is not just necessary for enjoying the latest entertainment but it is vital for learning, sports, driving and it is necessary for many careers (you can't be an eye surgeon without good binocular vision, for example).

For more information of children's vision, eye care, and children's optometry, please visit www.kidsvision.ca.

Related articles:

What is 3D Vision Syndrome?

Don't like 3D movies? You may have 3D Vision syndrome

Life threatening disease found in girls eye - lack of 3D vision was the clue

Fixing My Gaze - Can you imagine not having 3D vision?

TED - ideas worth spreading - Susan Barry on how vision therapy gave her 3D vision

Visual function development: behaviors to watch out for in your children

Developmental optometry and ophthalmology

Dr. Lea Hyvarinen is one of the worlds few developmental ophthalmologists.  Usually, if you or your child has a developmental vision problem you will see a developmental optometrist like Dr. Randhawa  who is a member of the College of Optometrists in Vision Development (COVD).  Dr. Lea has just commenced a blog on children's vision development, which you can visit here and was a well-received speaker at the COVD annual meeting last weekend.

Dr. Lea Hyvarinen

In a recent post about infants with normal visual development, she provided the following table, which summarizes the development of visual functions that are easy to for parents and teachers to observe.  The table and the related post give an excellent indication of the quality of her new book called "What and how does this child see?" 

Visual information processing

The book covers many of the topics discussed on this blog, including as visual information processing, a topic that North American ophthalmologists tend not to be familiar with.  For example, see this 1996 study from the field of rehabilitation medicine published in the journal NeuroRehabilitation by Raymond et al., where the authors say that patients with potential visual information processing deficits "should be referred to a behavioral or neuro-optometrist" and noted that  "referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only."  Of course, Dr. Lea is an exception to this and would likely provide excellent assessments of her patient's visual information processing skills.

Visual development behaviors to watch for

Parents can refer to this table when trying to assess their child's visual development.  But understand that trained professionals should be consulted for reliable assessments and diagnoses.  As noted by Dr. Lea, the table "summarizes the main steps of the visual development. These milestones are used in many countries in the follow-up of normal development of visual functions and in detecting symptoms and signs of deviations from the norm."

Age (months)	Behavior
0–1	•       turns eyes and head to look at light   sources  •       horizontal eye tracking, tonic focusing
2–3	•       intense eye contact at 6-8 weeks  •       vertical and circular tracking •       interested in mobiles •       interested in lip movements
3–6	•       watches own hands  •       reaches toward, later grasps hanging objects •       observes toys falling and rolling away •       shifts fixation across mid-line •       visual sphere of attention widens gradually •       very active in visual interaction
7–10	•       notices small bread crumbs, touches them  •       adjusts the grasp to the size of the objects •       interested in pictures, also stereo images •       recognizes partially hidden objects •       recognizes family members by facial features
11–12	•       knows places at home  •       looks through window and recognizes people •       recognizes pictures, plays hide-and-seek •       can predict adult’s goals of motor actions

For more information of children's vision, eye care, and children's optometry, please visit www.kidsvision.ca.

Related articles:

Study proves that vision problems - visual information processing deficits -  interfere with learning to read and cause dyslexia

The former First Lady of the United States on her daughter's developmental vision problem and how vision therapy worked for her

Mom of struggling reader speaks out

Vision problems can have drastic effects on brain development and learning

How to choose a children's (pediatric) optometrist

Binocular vision dysfunctions ate my homework 

TED: ideas worth spreading - Dr. Susan Barry on vision therapy and depth perception

Patient story - Five year old girl sees her mom's face for the first time in our Vancouver eye clinic

Convergence insufficiency symptoms - doctors need to pay attention to performance related symptoms such as reading performance, attention and ADHD-like symptoms

In a study published in October 2012 in the journal Optometry & Vision Science, researchers set out to to investigate the symptoms that children with convergence insufficiency experienced and to determine whether certain categories of patients (grouped by age, sex, ethnicity, children who's parents reported that they had ADHD  etc.) experienced symptoms in a common way.  In short, the study sought to figure out whether there was a pattern to convergence insufficiency symptoms.

The study is a validation of the approach we take in our Vancouver optometry clinic, where we always assess performance related symptoms. it is performance related symptoms that make convergence insufficiency a problem in the first place and the reason why patients with convergence in sufficiency need treatment.

Here is how the study was conducted.  The researchers conducted a a randomized clinical trial in which they administered the convergence insufficiency symptom survey before and after treatment.  There were 221 children aged 9 to 18 years with symptomatic convergence insufficiency who participated in the study. Performance-related vs. eye-related symptoms for was compared.  Performance-related symptoms are symptoms such as having difficulty reading or concentrating on school work.

At baseline, the score for performance-related symptoms was greater than that for eye-related symptoms  regardless of age, sex, race/ethnicity, or presence of parent-reported Attention Deficit Hyperactivity Disorder (ADHD). Symptom severity increased with age. Children with parent-reported ADHD were more symptomatic than those without parent-reported ADHD. This study adds to the literature linking ADHD to convergence insufficiency.

There was a significant improvement for the performance- and eye-related symptoms in the children who responded to treatment for convergence insufficiency. It was found that girls had significantly lower performance-related symptoms than boys, and black children reported less eye-related symptoms than white children. Children without parent-reported ADHD had significantly less symptoms overall and less eye-related symptoms than children with parent-reported ADHD.

The study authors concluded that because of a high frequency of both performance- and eye-related symptoms, eye doctors should perform a targeted history that addresses both types of symptoms to help identify children with symptomatic convergence insufficiency. In other words, doctors who ignore performance related symptoms and just focus narrowly on the eye are liable to miss patients who have convergence insufficiency.  The study focuses attention on the important relationship of convergence insufficiency and symptoms and their potential influence on ADHD, reading performance, and attention.

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