Vision and Learning: When 20/20 is not enough

1. Dynamic Child Event Presented by Carrie Sypherd, O.D. carrie@sypherd.com Office: 815-455-2800 February 20, 2010 Vision and Learning:When 20/20 is not enough

2. Goals for today's seminar • To teach the full meaning of vision a • To help you identify children with vision difficulties • To inform you of the people who can help retrain vision • To show simple modifications that can make your learning environment vision efficient

3. What is vision? • Vision answers four questions. • What is it? This is sight or visual acuity. • Where is it? This is depth perception. • Where am I in relationship to it? This is body awareness. • What do I do with it? How do I process the information that I have received? • Vision is a dynamic process that is altered by the information that is received. • There is no such thing as perfect vision.

4. Vision is a process • People who have a deeper understanding of vision understand that it is sensory just like taste, touch, smell, hearing, vestibular and proprioception. • People who have an even deeper understanding of vision understand that it is processed in the brain, not in the eyes. • People who have a full understanding of vision know that it is a process that goes through the sensory system, is processed and then there is a motor response.

5. What is vision? • Vision is sensory. • Vision is processing. • Vision is motor.

6. Examples • When you drive your car, do you look ahead to where you're going to go or do you look at your hands on the steering wheel? • Would you hike up a mountain with your eyes closed? • Have you ever read a note that you wrote in the dark or while driving or talking to your kids? • What happens when you stand on one foot? • Have you been in a stationary train and felt like you were moving?

7. Vision is developed • Watch infants as they learn how their vision system works. • A newborn can not focus at a large range of distances. The two eyes do not work together well and it has to turn its head to look. • Hand/eye coordination develops around months four to six, but the mouth is still used to explore. • Young children progress to make a tactile/visual connection before being able to process information only visually.

8. Conclusions • Vision is more than acuity. • Vision and balance are linked. • Vision and posture are linked. • Vision directs the motor system.

9. What does this have to do with autism and education? • Vision uses a lot of energy. 80% of all sensory fibers in the body are from the eye. The optic nerve has 10x more neurofibers than the entire auditory pathway. • 80% of what is learned in the classroom is visual. • Vision dysfunction is part of sensory integration disorders. • There is a link between convergence insufficiency and ADD.

10. Does teaching involve: • Recognition? • sight words, b/d, art, numbers etc. • Comprehension? • picturing in your mind what is happening in the story • Retention? • being able to recall visual information • Transfer of information? • being able to teach someone visually

11. What does someone with a vision problem look like? • Frequent eye rubbing or blinking • Avoiding reading and other close activities • Frequent headaches • Covering one eye • An eye that turns in or out • Tilting the head to one side • Putting head down to read or write • Bumping into objects • Swerve when walking

12. What to look for continued: • Holding reading materials close • Losing place when reading • Skipping words when reading • Reaching incorrectly • Pressing hard with a pencil • Poor spacing when writing • Difficulty remembering what he or she has read • Short attention span • Fatigue

13. How is vision tested? • Movement is assessed. • Posture is assessed. • Acuity, color vision and depth perception are assessed. • Eye alignment is assessed. • Convergence, divergence, pursuits and saccades are assessed. • Peripheral vision is assessed. • Accommodation is assessed. • Ocular health is evaluated.

14. How are lenses prescribed for vision? • Doctors who have a limited understanding of vision prescribe lenses for 20/20 acuity, often considering only a distance prescription for people under the age of forty. • Doctors who prescribe for vision look at the performance of the individual with the lenses. • Testing with lenses should involve looking at movement, assessing handwriting, observing hand/eye coordination, noting visual perception and listening to the patient read. • Patient feedback is also helpful.

15. What is the difference between a compensatory and therapeutic lens? • A compensatory lens resolves the symptoms when the patient wears them. • A therapeutic lens guides the patient's vision rehabilitation by using smaller amounts of prescription and prism. Tints may also be added. • Therapeutic lenses treat the underlying problem so that normal visual function can be restored.

16. What is vision therapy? • Similar to occupational therapy, physical therapy, speech therapy or developmental therapy, but treats the vision system. • It is designed to improve oculomotor skills, tracking, fixation, visual processing, visual memory and visualization. • Vision therapy can be administered at home, with a developmental optometrist, or with an occupational therapist under the guidance of a doctor.

17. Visualization Visual Discrimination Visual Circuit Teaming Eye Movements & Location Skills Visually Directed Movement (Fine Motor)‏ Visual Transport Skills (Gross Motor)‏ Now that we know what's wrong, how do we fix it?

18. What does this have to do with attention? • Granet D.B., Gomi C.F., Ventura R, Miller-Scholte A. The relationship between convergence insufficiency and ADHD. Strabismus. 2005 Dec;13(4):163-8 • There is a three fold increase in patients with convergence insufficiency who have ADHD compared to the general population.

19. What does a child do for relief? • Children are great at adapting. • They will move in close to read. • They will cover an eye. • They will shut out other stimuli. • Stress and trauma can cause maladaptations to the vision system. • Sensory deprivation affects vision development.

20. Let's talk more about the brain • The left hemisphere processes sequentially and is detail oriented. It understands symbols and representations. • The right hemisphere is global and scans the environment. It manages spatial relationships, depth, color, and shape discrimination. • Coordination between the two sides is important

21. Perception is reality • What do you see? • Clockwise? • Counterclockwise? • What if you look away? • Who is right?

22. A quote from education • “A child never answers a question incorrectly. He answers a different question.” • Perception is reality.

23. Does this remind you of a student?

24. A quote from neuroscience • “Along with other animals, we act in the world and then change ourselves in accordance with the impact the world has on our bodies following our actions.” Walter J. Freeman, 2000. How Brains Make Up Their Minds, Columbia University Press

25. Once vision is developed canit be changed? • ABSOLUTEY! • The brain is plastic. Neuronal function can change. This is true of amblyopia, strabismus and visual processing problems. • This is true of children and adults.

26. Vision is not hardwired at birth • The brain is plastic and nerve fibers need to be recruited for vision. • This is a developmental process that takes several years. • Just as with motor development there are expected milestones to be reached. • Vision therapy can guide visual development.

27. Vision is sensory • How many children have you seen who have been diagnosed with a sensory integration disorder? • Many of these patients are visually not ready for the sensory input that they receive. What they expect to feel or hear is not what is received. • This leads to poor body awareness. They constantly check to see where they are in space.

28. Based on what you see, what is your interpretation of the world around you? Vision is processed

29. What is your interpretation?

30. Try walking, reaching, and turning with prism glasses on. Try putting a stick in a straw. Try throwing a bean bag in a basket. Based on what you experienced, can you make a change with your motor system? Vision is motor

31. Temporary measures • Reduce visual clutter • Change lighting • reduce exposure to fluorescent lighting • increase lighting for near work • Increase font size • Use a slant board! • Improve posture for vision • Markers or highlighters for reading

32. Treating the root problem • Gaze stabilization • Head rotations • Activities for saccades • Alphabet plates • Thumb saccades • Activities for pursuits • Flashlight tag • Beanie • Activities for scanning • Highlights magazines/Word searches • Scanning boards

33. Vision therapy: a multi-sensory approach • Vision therapy needs to be done in four dimensions: x, y, z axis and time • awareness of time is off for patients with ADD, sensory integration disorders, and TBI • Incorporate the vestibular, auditory, and tactile systems as well. • Does this sound like education?

34. If you want more information • Resources • www.optometrists.org • www.vision-therapy.com • www.covd.org • Referral sources • Optometrists-refer for visual function evaluation • Ophthalmologists-refer for medical/surgical evaluation • Low Vision Specialists-refer for low vision devices • Occupational therapists-evaluate vision/body connection • There is no reason to wait!

35. Questions? • Do you feel that a vision deficit can affect your children? • Do you feel you can identify a child who might have a vision deficit? • Did your experience today change what you are going to think or do tomorrow?

36. Resources • Suddenly Successful Dawkins, Edelman, Forkiotis • Seeing Through New Eyes Melvin Kaplan • Without Ritalin Samuel Berne • The Suddenly Successful Student Ellis Edelman • The Out-of Sync Child Has Fun Carol Stock Kranowitz • The Gift of Dyslexia Ron Davis • Thinking Goes to School, Piaget's Theory in Practice Hans Furth and Harry Wachs