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Dr. Snider’s Blog Posts

Eye turns – Is it ever too late to correct without surgery?

Exotropia, a type of strabismus, is a binocular vision condition characterized by one or both eyes drifting outward (i.e. lazy eye). Surgery to clip the eye muscle(s) is the medically-accepted method of treatment to cosmetically straighten the eye(s). However, surgery does not address the reason the brain chose to allow the eye to turn in the first place. Since brain function is left out of the surgical treatment equation, subsequent surgeries to maintain cosmetic alignment are quite often necessary.

However, the vast majority of exotropes do not have faulty or damaged eye muscles! So why should surgery be the initial treatment option?

A more effective treatment involves the use of vision therapy, phototherapy, and lenses to retrain the brain so as to develop the eye teaming skills necessary for normal binocular vision. As the brain develops binocularity, the eyes straighten – without surgery.

Effective therapy involves a sequential approach to improving functioning visual skills. At Snider Therapy Centers, therapy for exotropia has been offered for close to thirty years with a success rate in the high 90 percentile range. And thankfully, the age of the patient has not been a limiting factor

Computer Vision Syndrome

Do you experience burning eyes, blurred vision, headaches, dry eyes, or neck and shoulder pain during computer use? If you do, you might be experiencing Computer Vision Syndrome.

Computer Vision Syndrome (CVS) or ‘digital eye strain’ describes a group of eye- and vision-related disorders that result from prolonged viewing of digital screens (i.e. computer, cell phone, tablets). CVS symptoms tend to occur when the visual demand of the digital task exceeds the individual’s ability and may occur due to poor print contrast, decreased print clarity, and/or the presence of glare and reflections.

In some cases symptoms associated with CVS can be alleviated by measuring the distance from the eyes to the computer screen and having the eye doctor use this measurement to design a computer-specific eyeglass prescription. Simple changes such as altering the angle of the computer screen, modifying ambient lighting, correcting poor posture, and/or the use of eyeglass lenses specifically designed for computer use can also be helpful.

Another modification is to implement the 20-20-20- Rule: Every 20 minutes look at a target at least 20 feet away for a minimum of 20 seconds. However, if an individual has problems with visual skills such as eye teaming, focusing, and tracking, these adjustments will not be enough. At Snider Therapy Centers, these specific visual abilities are evaluated during the initial Neuro-Visual Assessment. If found to be an issue, a therapy program utilizing phototherapy, lenses, and vision therapy can be designed to remediate the visual conditions and resolve the symptoms associated with Computer Vision Syndrome.

There’s More To Child Learning Than Just 20/20

Even if your child has “20/20” eyesight they may be experiencing vision problems. These problems may be causing learning problems and substandard educational results. A child’s visual acuity (how well s/he can see the wall chart) is an essential aspect of good vision but there are other factors which may prove more important. You may already be aware that a nearsighted child has little trouble reading or that good grades in school can be acquired even if much of the teacher’s board cannot be seen by the student.

Questions Related to Eyesight and Learning

Eye movement skills: Do your child’s eyes move across the page in a book smoothly and accurately?

Eye focusing abilities: Does your child change focus from near to far and back again – between reading text from a far-away white or black-board and writing on paper?

Eye teaming skills: Are your child’s eyes working together as a focus unit – do they come together for proper eye alignment for reading?

Binocular vision skills: Are your child’s eyes blending visual images from both eyes into a single, three-dimensional image?

Visual perceptual skills: Does your child identify and understand what s/he sees, co-relating importance, connecting with previous visual memorized information?

Visual-motor integration: Is the quality of your child’s eye-hand coordination balanced? Visual-motor integration is important not only for legible handwriting and the ability to efficiently copy written information from a book or board but also for sports. Deficiencies in any of these can be detrimental to a child’s learning ability and/or school performance.

Vision Problems Do Affect Kids Learning

Undetected learning-related vision problems in children are common. A child with an untreated vision problem may be misdiagnosed with behavior problems or ADHD/ADD when in reality they have a vision problem. Vision problems, in extreme cases, ignored or misdiagnosed, can become the true root cause of a child becoming the victim or aggressor in a school bullying tragedy.

Left untreated, vision problems will hinder your child’s learning in school. Studies have shown that at least 13% of children between the ages of nine-thirteen suffer from moderate to severe convergence insufficiency, the ability to bring one’s eyes together, which is crucial for good reading. Studies demonstrate clearly that 1 out of 4 school-age children suffer from at least one learning related vision problem.

Learning-Related Vision Problems

Signs and Symptoms

Some of the most common roadmap symptoms of learning-related vision disorders are:

  • Double vision, particularly during or after reading
  • Poor handwriting
  • Hyperactivity or recklessness during class
  • Word and letter reversals
  • Easily distracted during reading
  • Poor reading comprehension
  • Poor overall school performance
  • Circumventing of reading
  • Blurred vision, especially after reading or working closely
  • Eye Strain or frequent headaches

Call us to schedule a comprehensive child’s vision exam if your child exhibits one or more of these signs or symptoms and is exhibiting these types of problems in school.

Comprehensive Child Vision Exam

A comprehensive child’s vision exam includes tests performed in a routine eye exam, plus specific additional tests for detecting learning-related vision problems.

Extra tests would include accommodation, binocular vision, and ocular motility testing. In addition to these, depending on the type of problems your child is displaying, we may recommend other testing, either in our office or with a child’s vision and/or vision development specialist.

Vision Therapy

Special reading glasses or vision therapy may help your child if s/he has a learning-related vision problem that cannot be corrected with regular glasses or contact lenses. Vision therapy entails eye exercises and other activities specifically tailored for each patient to improve vision skills.

Learning Disabilities and Vision

Although children with learning disabilities may also have vision problems that are contributing to their difficulties in the classroom, vision therapy is a treatment for vision problems; it does not correct a learning disability. A child’s learning ability and school performance may indicate learning disabilities and/or vision problems.

Once your child’s comprehensive vision exam is completed, our doctor will advise you about whether a program of vision therapy could be helpful. We will refer you to a children’s vision or education/learning specialist if we do not provide the specified additional services your child needs.

Anxiety and The Autonomic Nervous System

What’s a body to do? Fight? Flight? Rest? Restore? What determines which way to go?

The answer to all of these questions lies in the Autonomic Nervous System (ANS) . The ANS is the branch of the nervous system that is responsible for control of the bodily functions not consciously directed. It consists of two branches – the sympathetic (fight or flight) branch, and the parasympathetic (rest and restore) branch. Using an automotive analogy, the sympathetic system acts like the gas pedal and the parasympathetic acts as the brakes.

Life is good when these two systems work in harmony. However, when they are out of balance, symptoms such as insomnia, anxiety, depression, and even suicidal thoughts manifest. Peripheral awareness decreases or even disappears. Sports performance may deteriorate while school and work performance becomes more taxing.

The Neuro-Integrative Evaluation conducted at the Snider Therapy Centers (STC) includes tests to assess ANS function. Two areas which provide information include pupil testing and functional visual field testing.

1. The normally functioning pupil is an example of the ANS in perfect balance. However, a percentage of otherwise healthy patients may have larger-than-normal (‘dilated’) pupils which is a direct indicator of an out-of-control sympathetic system. These individuals are in fight or flight mode, which generally indicates chronic stress.

2. Reduced functioning visual fields are also an indicator of an imbalanced ANS as a response to stress.

Stress? “What kind of stress?” you might be wondering. Here at STC, we are checking for sensory processing stressors – specifically visual, auditory, and vestibular. However, patients may also have a history of physical and/or emotional trauma, toxin exposure, TBI, or food sensitivities, to name a few. The good news is that our bodies have been designed to handle stress. When uncontrolled stress impacts the ANS, we at STC have been blessed to know which tests to conduct and which treatments to offer to restore balance to the ANS.

What’s a body to do? Function in balance and harmony

Spotting Hidden Vision Problems

Do you have a child with an undetected vision problem? Experts estimate that up to 25% of school-age children have vision problems significant enough to interfere with learning. Among children with learning disabilities, that number jumps to 30% to 60%. Yet many of these same children easily pass their annual vision screenings and eye exams.

How is this possible?

Eye exams evaluate the ability to be able to see letters on the 20/20 line of a chart placed 20 feet away. But vision is much more than this one aspect of eyesight.

A child’s ability to perform visual tasks such as reading and athletics depends on the ability to synchronize thinking and seeing. If visual skills such as aiming, turning the eyes as a team, following moving objects, focusing, depth perception, and other abilities are inefficient or poorly integrated, the child will be unable to cope with the demands of school and/ or sports.

When a child’s attention is divided between trying to make the visual system work and trying to understand the material, one or both tasks suffer. With an inefficient visual system, a child works harder to gain meaning from what he is trying to see or understand.

Vision problems can be divided into three categories:

1. Refractive errors include nearsightedness, farsightedness, and astigmatism.

2. Visual processing disorders include poorly developed left/right awareness, faulty visual memory, imperfect visual form perception, inadequate eye/hand coordination, and tunnel vision. Common signs include letter reversals, difficulty learning the alphabet, poor spelling, and sloppy handwriting.

3. Visual efficiency disorders include eye teaming (binocular vision), focusing disorders, and tracking disorders. Common signs include closing or covering one eye, loss of place, headaches, rubbing eyes, poor reading comprehension, and short attention span.

Refractive errors are easily detected during routine eye exams. However, Developmental Optometry is the field of vision care with the expertise to test for both visual processing and visual efficiency disorders.

Since nearly 80% of what a child perceives, comprehends, and remembers depends on the competence of the visual system, an undetected vision problem may have a serious impact on academic or athletic performance.

Can Concussions Cause Reading Issues?

For individuals who sustained a mild concussion this year, one in three will become part of the silent epidemic of the brain-injured. And here at the end of football season, many young players have just joined this epidemic.

A concussion is defined as a trauma to the brain which alters mental (physical or cognitive abilities) status. It may or may not involve a loss of consciousness. Many athletes experience “seeing stars” or “having their bell rung” during play and never realize that they just sustained a concussion.

Concussions disrupt the normal functioning of the brain. Common visual symptoms associated with concussions include reduced reading skills, headaches, double vision, fatigue, sensitivity to light, and sensitivity to motion. These are just part of a constellation of problems termed Post Trauma Vision Syndrome (PTVS).

Binocular vision problems may develop which cause the print to appear to move and may contribute to frequent loss of place. Tracking dysfunctions may develop and also contribute to reading errors and fatigue. Young head injury patients may experience decreased focusing ability. Since doctors don’t expect this to occur until about age 40, it is often missed during a routine exam.

Since the effect of head injury tends to develop with time, many parents or caregivers do not relate the head injury with the later development of reading problems, emotional disorders, and even attention problems.

Symptoms associated with PTVS may be significantly improved with the use of Neuro-Optometric Rehabilitation, a new branch of vision therapy for individuals with a brain injury.

The Best Visual Systems are Made – Part 2

As discussed in the “The Best Visual Systems are Made – Part 1”, the best visual systems develop over time with the achievement of specific developmental visual milestones. This article will discuss activities parents and caregivers can provide to aid in the optimal development of the visual system. What can parents and caregivers do to encourage the development of an infant’s visual system?

Play, play, play!
Provide three dimensional play activities for the baby as soon as he/she is able to sit up.

Do not rush to walking. Crawling is important in the development of future handwriting skills as crawling develops bones in the hand, upper arm strength, and stimulates receptors in the hand.
Encourage daily outdoor play. Provide a lot of gross motor activity.

No television! In an ideal world, there would be no television viewing before the age of 4 as the more TV that is watched, the less time is available for the development of eye-hand coordination.

Nutrition! Many nutritionists believe that children who do not get enough protein in utero and during the first four years of life may be intellectually compromised forever. A child needs 2 grams of protein for every 2.2 pounds of body weight.

Children with visually-related learning disorders often have a history of antibiotic use (think chronic ear infections). Antibiotics destroy the normal flora in the gut and foster the overgrowth of yeast. Yeast releases alcohol into the body as a by-product of consuming sugary and high carbohydrate meals. Parents have to provide a healthy diet for the child.
Supplements frequently recommended include Omega-3 fatty acids, Vitamin D3, probiotics, and JuicePlus.

Specific activities for motor and perceptual development
As soon as the baby can sit up, provide eye/hand training toys. Around age 2, begin to teach self-care and art. Introduce puzzles and beads. These activities involve movement and require eye-hand coordination and binocular vision.

Around ages 3 and 4, teach concepts of quantity, patterns, and shapes to develop manipulation and creative thinking skills.

Around 5, see if the child can develop a 3D object from a two dimensional drawing with Legos, K-nex or Lincoln logs. Encourages building with simple blocks and parquetry blocks to aid visual perceptual skills.

Preschool children must learn how to use vision to guide other learning experiences.

Is it Attention Deficit Disorder or Is It Auditory Processing Disorder?

When trying to determine why an individual is exhibiting attention or focusing problems, it is important to check for the presence of an auditory processing disorder (APD). An auditory processing disorder can be defined as a breakdown in the brain’s ability to process sounds and words. An individual with APD may be able to hear well but be unable to perceive sound correctly. A breakdown in any of the areas listed below may cause an individual to display attention/focusing problems:

  • Auditory Figure-Ground– Problems happen when an individual is unable to pay attention due to the distraction of back ground noises (i.e. an echo in a building, the hum of an air conditioning unit).
  • Auditory Memory– Problems arise when an individual has difficulty remembering information such as directions, lists, or study materials. It can occur immediately or be delayed (i.e. inability to remember known information at the time of a test).
  • Auditory Discrimination– Problems ensue when an individual has difficulty hearing the difference between similar words or sounds (i.e. ‘coat/boat’ and ‘ch/sh’).
  • Auditory Attention– Problems occur when an individual is unable to concentrate on listening long enough to complete a task or requirement (i.e. listening to a lecture).
  • Auditory Cohesion– Problems manifest when higher-level learning tasks are difficult (i.e. drawing inferences from a conversation or comprehending verbal math problems).

The following symptoms are indicators of APD:

  • Difficulty blocking out background noises
  • Struggling to pronounce age appropriate words correctly
  • Difficulty following conversations
  • Hypersensitive to sounds
  • Difficulty following directions
  • Discriminating between similar sounds
  • Difficulty with spelling and reading

If you suspect the presence of an auditory processing disorder, have the auditory processing system tested. We at Snider Therapy Centers recognize that auditory processing disorder is a common issue. As a result, a test for APD is Included in the initial Neuro-Sensory Assessment. If an APD is noted, further testing can be administered to determine severity and appropriate treatment measures. Don’t guess – take the test.

The Best Visual Systems are Made – Part 1

Good visual systems are not inborn, they develop over time. A healthy infant is born with a complete visual system but must learn how to see. As a baby matures, developmental milestones are achieved. These include skills such as rolling over, sitting up, crawling, and walking. Many parents, however, are unaware there are also developmental visual milestones to be attained.

The first developmental visual milestone is focusing. Focusing should develop around the age of six months, along with eye contact.

The infant learns to communicate by imitating. If eye contact does not develop by 8 weeks, a referral to a doctor of optometry is indicated.

The second developmental visual milestone is ocular motor control which should occur around three months of age. Ocular motor control is essential for the eyehand coordination needed for reaching and grasping skills which develop at around 5 to 6 months.

The third developmental visual milestone is facial recognition of family members which begins to develop around 5 to 7 months of age. Failure to recognize a family member by sight by 11 months of age may indicate a serious problem, and an exam is indicated.

The fourth developmental visual milestone is that of depth perception which begins to develop around 9 months of age. Depth perception allows the child to explore his spatial world.

As a result, during the first two years of life vision is central in development of the following skills: communication, motor development, body awareness, spatial concepts, orientation of a body in space, and language.

Therefore, all infants should have a comprehensive eye exam with a doctor of optometry (not the pediatrician) by the first birthday to ensure that the attainment of developmental visual milestones occurs in a timely manner.

Join the Sports Vision Revolution

To the average person, 20/20 vision is just fine; but for an athlete, a myriad of visual skills are needed in order to excel. These skills include:

Dynamic Visual Acuity – visual acuity while in motion

Eye Tracking – the ability to “keep your eyes on the ball,” no matter how fast it may be traveling

Eye Focusing – changing focus quickly and accurately from one distance to another

Peripheral Vision – seeing people and objects “out of the corner of your eye”
while concentrating on a fixed point

Fusion Flexibility and Stamina – the ability to keep both eyes working together while engaged in high speed, physically stressful situations

Depth Perception – quickly and accurately judging the distance and speed of objects

Visualization – picturing events with your “mind’s eye” or imagination

Eye-Hand-Foot Coordination – precise coordination between the visual and action systems

Visual Reaction Time – the time needed to process and respond to what is happening

Visual Concentration – the ability to screen out distractions and stay focused on the ball/target

Athletes, both professional and amateur, have found that these visual skills play such an important part in sports performance that many are turning to Sports Vision Training to stay on top of their game. Sport Vision Training, a branch of Optometric Vision Therapy, provides specialized therapy to develop visual skills to a peak level to improve the athlete’s ability to follow a ball, react more quickly, judge depth accurately, and improve hand/ eye coordination.