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2019-06-07Outline1. Vision vs Eyesight2. Testing for Learning Related Vision Problems (LRVP)VISION AND LEARNINGLisa W. Christian, OD, FCOVD, FAAOAssociate Clinical ProfessorUniversity of Waterloo, School of Optometry & Vision Science3. Vision and Learninga. Prevalenceb. Treatment4. School System5. Role of the OptometristVision vs EyesightEyesight – the ability to see something clearly 20/20VISION VS EYESIGHTDefinitionVision is LearnedVisual Skills in Reading

2019-06-07Vision vs EyesightVision is LearnedVision – the understanding of what is ailsKids.aspx?p 335&np 152&id 1730

2019-06-07Three Tiers of VisionTESTING FOR LRVPThree Tiers of VisionBinocular Vision TestingManagementHow does the brainprocess visualinformation?Can the information getinto the brain efficiently?Can the information get into the eye?Case HistoryChief Complaint: ParentChief complaint or concern Not performing up to potentialEducational history Frequent reversal errorsMedical history: prenatal, childhood Poor reading performanceDevelopmental history Frequent loss of place while readingPrevious assessments and treatment: visual history,psych-ed eval, audiology, OT/PT, neurology, otherBehaviour and attention Unable to finish written work in time allotted Distractibility or short attention span Difficulty copying from whiteboardFamily history3

2019-06-07Chief Complaint: ChildEducation Classroom setting Special interventions Specialized reading program? Academic achievement Speak with teacher tal History FormPlease check all that apply SupplementalHistoryReversalswhen reading/writingCOVD: Quality of Life ChecklistForm Blurred vision when reading or whenlooking from near to farReading below grade levelHeadaches associated with near tasksPoor reading comprehensionPrint moves around, or runs togetherLetter/number transpositionDouble vision at nearPoor/sloppy handwritingCloses or covers and eye whenperforming near tasksUses finger or marker when readingEye strain or pulling sensation with nearworkOften loses place, skips or rereadswords/letters when readingFatigue or sleepiness with near tasksAvoids reading, writing or other neartasksShort attention span, easily distracted,extensive daydreaming4

2019-06-07Full OVA BV AssessmentVisual AcuityAccommodative Distance and Near Amplitude (push-up or pull-away) MEM Accommodative FacilityOcular Alignment Cover Tests (distance and near)OculomotorWhat is Binocular Vision?Vergence Saccades and Pursuits Broad H NPC PFV and NFV Vergence FacilitySensoryRefractive Randot Stereopsis W4D Static CycloplegicOcular Health Pupils Direct OphthalmoscopyStereopsisHow is Binocular Vision Tested?Eye examination tests for important binocular visual skills:Accommodation focusingVergence eye teamingOculomotor eye tracking

2019-06-07Do All Optometrists Test for BV?Accommodation Eye FocusingYES!Tracking – Extraocular Motility (EOM)Fusion – Suppression (W4D)Stereopsis – Randot StereopsisConvergence – Near Point of Convergence (NPC) Eye TeamingOculomotor Eye TrackingObservations: Undershooting/overshooting Rhythmic timing Midline jump Jerkiness of movements Head and body movements Fixation loss Facial grimaces Meridional difficulties

2019-06-07Oculomotor: PursuitsObservations: Physical limitations (palsy,paralysis, OA/UA) Differences between eyes Quality of fixation Accuracy Quality of movement -Midline Jump Head/ Body movement,facial on and Learning one in six children has a vision problemVISION AND LEARNINGserious enough to affect their learning 60% of students identified as problemlearners have undetected vision problems 39% of adults understand that behavioral problems can bean indication of vision problemsEye See Eye Learn. Take the EyeQ Challenge. Ontario Association of Optometrists. Retrievedon May 6, 2013. -EyeQ-ChallengeComprehensive Eye Exams Particularly Important for Classroom Success. American OptometricAssociation. Retrieved on May 6, 2013.

2019-06-07Prevalence of Learning ProblemsPrevalence of LRVP 5% of all school children are diagnosed with a learning At least 20% of individuals with learning disabilities have adisabilities1,2prominent visual information processing deficit 3-7 Similarly, the prevalence of clinically significant visualefficiency problems is 15-20% 8-12 AI most common accommodative anomaly CI most common vergence anomaly1. Lyon GR. The Future of Children. Learn Disabil 1996;6:54-76.2. Altarac M, Saroha E. Lifetime prevalence of learning disability among US children. Pediatrics 2007;119 Suppl:S77-S83.Evidence: Christian et al (2018)Binocular Vision and Learning 80% ofn 121, age 6 – 14 yearsPurpose: review of binocular anomalies seen in elementaryschool children identified with a reading problemResults: 3/4 of the students had no significant Rx, but whentested for binocular vision 1/3 of the students scored belowwhat was considered normallearning duringa child’s first12 years isbased onvisualinformationThe Vision Council. Vision & Learning. College of Optometrists in VisionDevelopment. Retrieved May 6, 2013. Vision Learning8


2019-06-07TreatmentVision TherapyForms of treatment for binocular vision impairments:1. Lenses2. Prisms3. Surgery4. Vision therapy Series of eye exercises that help patients develop orPurpose of Vision TherapyVision Therapy Techniques Improvement of visual skills such as: lens sorting eccentric circlesrecover normal visual skills Unique for each patient Combination of in-office therapy and home reinforcement Done in 10 session “blocks” with reassessment after loose lens rock Hart chart rocko Stereopsiso Binocular Coordination Brock string tranaglyphs ando Binocular fusiono Eye trackingo Eye teaming skillso Fixation skills aperture ruleo Vergence disorderso Focusing /Accommodation Lifesaver cardsvectograms Home Therapy System(HTS)o Visual Acuity10

2019-06-07Letter TrackingPegboard RotatorMarsden Ball Pursuits11

2019-06-07Hart Chart SaccadesSCHOOL SYSTEM12

2019-06-07School SystemDevelopment of IEP Identifies students performing below chronological age Multidisciplinary staff works to:– Understand child’s problems– Determine educational needs– Eligibility for servicesand grade placement Assessment: Multidisciplinary team conducts formal evaluation and plansremedial programTeacher conducts informal assessment and resolves problemwithin the classroom– Dependent on: severity of condition, financial situation, availability ofservices and money in the school systemOptometrists do not treat learning problems.Primary role: to diagnose and manage vision problemswhich may prevent or interfere with the normal learningprocess.OPTOMETRISTS ROLERemediation (e.g. VT) allows children to benefit more fullyin the educational instruction.Role in education:1. Provide general information about vision disorders onlearning2. Provide specific information about the vision disordersof the educator’s student13

2019-06-07M. Taub:“In the field of eyecare, to put it simply, we help peopleto see. Whether dispensing spectacles or contactlenses, co-managing LASIK, or cataract surgery,treating diseases such as glaucoma or fitting a lowvision device, the ultimate goal is improved vision.Rarely do we get the opportunity to alter the outcomeof patients’ lives. Binocular vision allows you to take achild’s or an adult’s life and put them on a better path.”M. Taub. Binocular vision anomalies: What every optometrist should know. Optometry Today.Retrieved on May 8, 2013. 370 you!lisa.christian@uwaterloo.ca14

Reading below grade level Headaches associated with near tasks Poor reading comprehension Print moves around, or runs together Letter/number transposition Double vision at near Poor/sloppy handwriting Closes or covers and eye when performing near tasks Uses finger or marker when reading Eye strain or pulling sensation with near work

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