EXCELerated Vision

A look at convergence insufficiency and tracking problems...before and after vision therapy

Just as so many other children are affected (research shows 1 in 12) by this vision problem known as Convergence Insufficiency (CI), Josh also struggled. The impact on him was that he had double vision and loss of interest for reading. It also made it difficult for him to play baseball or most any ball sport. As a result Josh lacked confidence at school and on the playground. Now after successful completion of his office-based optometric vision therapy Josh no longer sees double when reading, his comprehension and reading speed has significantly improved and he is gaining skill and confidence in sports. Now that he has good binocular vision, Josh no longer struggles and is a happy kid!

Lindsey Stull, O.D., FCOVD - Congratulations for her Board Certification

Wow Vision Therapy would like to acknowledge our Clinic Director, Dr. Lindsey Stull (center) in her recent accomplishment of attaining Board Certification in Developmental Vision and Vision Therapy through the College of Optometrists in Vision Development (COVD) during the COVD Annual Meeting in Las Vegas October 26-29, 2011.  Congratulating Dr. Stull in this photo is our Resident, Dr. Nhin Nguyen (left) and Dr. Fortenbacher (right).

Dr. Stull is now a Fellow in COVD which is one of the highest honors and recognition in Optometry, specific to the specialty of developmental/behavorial/rehabilitative optometry. For more information about Board Certification through COVD you can go to the COVD website here.

We are all very proud of Dr. Stull who now has the distinction of placing FCOVD after her name! CONGRATULATIONS Dr. Stull!!

A Call for Advocacy on Vision and Learning

From time to time there is a patient advocate who steps up and says, “enough is enough”! …meaning, more has to be done to help recognize children with vision related learning problems!

In this video provided from Dr. Robert Lederman on YouTube, a family member speaks out about the importance of early recognition of children with vision related learning problems.

 

At Wow Vision Therapy we recognize the vital role that parents and patients make to help educate the public about the serious impact vision problems involving binocular vision (eye teaming), accommodation (eye focusing), oculomotor abilities (eye movement control) and visual processing can have on reading and learning. For more examples, check out Wow Vision Therapy on Facebook.

Dan L. Fortenbacher, O.D., FCOVD

Vision Therapy can give the competitive advantage!

Mack, who came into the office today for his vision therapy session, presented with some exciting news!

 

Mack is a bright young man who likes sports but (before vision therapy) was inconsistent in his batting. Mack struggled with a common binocular vision problem that affects 1:12 children and adults leading to headaches, transient blur and occasional double vision when reading. This common binocular dysfunction, known as Convergence Insufficiency, often affects the individual in many ways.

Dr. Len Press and I wrote a series for The VisionHelp Blog entitled: CI: The Private Eye Goes Public. To read more about this condition check out these posts:

CI: The Private Eye Goes Public – Part 1

CI: The Private Eye Goes Public – Part 2

CI:The Private Eye Goes Public -Part 3…who’s looking out for the kids?

CI: The Private Eye Goes Public – Part 4

CI: The Private Eye Goes Public – Part 5

Dan L. Fortenbacher, O.D., FCOVD

When visual dysfunction causes motion sickness

Do you know of a family member who is plagued with motion sickness when ever they go for an extended car ride? Recently I posted on The VisionHelp Blog the details of a visual problem that affects millions of people, coined The See-Sick Syndrome. Once diagnosed and treated, those with SSS can have life long resolution of motion sickness.  Dr. Lindsey Stull and I presented a lecture to area primary care optometrists entitled: The See-Sick Syndrome...Practical Diagnostic and Treatment Applications for the Primary Care OD.

 

 Hear a mom describe how her son has responded to treatment at Wow Vision Therapy.

 

  Dan L. Fortenbacher, O.D., FCOVD
 

Progress in Vision Therapy...Patients lives tell the story

Over the last 3 decades I have worked with thousands of children and adults with binocular vision dysfunction and other visual brain related problems. Some of the most common conditions I have treated are the visual problems that involve poor eye coordination and visual processing ability. The impact of these visual conditions on a patients life can be significant. The overall impact of poor visual abilities in some of the key areas of visual acquisitions skills such as binocular vision, accommodation and oculomotor function can be very stressful causing reduced individual performance and even emotional side effects.

I wrote about one such syndrome coined BAOD and published it on The VisionHelp Blog entitled: A new visual syndrome- BAOD...it's more than a feeling.

The emotional fallout of these visual conditions can take a significant toll on the child and the family. The following video by P.A.V.E. (Parents Active for Vision Education) describes the impact of an unaddressed vision related learning problem as well as the positive changes that occur when visual problems are identified and properly treated.

 

 

As a regional referral practice that specializing in developmental vision and therapy, most of our patients find their way to us through a doctor, occupational therapist, teacher, other professional or proactive parents who recognize and recommend us.

In the video below our patient Matthew was referred by his family primary care Optometrist with a binocular vision problem known as Convergence Insufficiency. Prior to treatment he was seeing double when trying to read or view anything within 20 inches. This caused Matthew, a bright boy, to struggle to keep-up in school. It was also beginning to have emotional side-effects on his self esteem.

This video shows how much better Matthew is doing within only 10 sessions of office-based optometric vision therapy in conjunction with home oriented activities...the evidenced-based proven standard of care for this diagnosis. Not only is Matthew no longer seeing double, his confidence is growing. Matthews response below sums it up!

 

Progress in vision therapy is not only about improving symptoms...it's about improving lives!

Dan L. Fortenbacher, O.D. FCOVD

Accommodative Dysfunction - The 3 A's of Eye Focusing that impact reading

The following is an abridged article written by Dr. Fortenbacher and recently published on The VisionHelp Blog. In the original post Dr. Fortenbacher describes a true story of one of his patients  "Jenny" who was referred for treatment for an Accommodative Dysfunction by her primary care optometrist.

Accommodation, otherwise known as "eye focusing",  is a vital visual function that provides the ability to adjust the lens system of the eye to see detail as an object is brought closer to the eyes.  To read this article requires your eyes to accommodate (focus) on the print. In addition, to read your eyes must stay "in focus" on the printed material for an extended period of time. What's more you must do this with a high degree of precision in order to see the print clearly. And let's not forget that we must periodically look away and then back to the printed material. Therefore,  for efficient reading and learning, a child's eyes must engage in the "triple play" of eye focusing or what can be called the 3 "A's" of Accommodation:

A # 1. Amplitude of Accommodation.This refers to the strength ability of focus. The greater the amplitude of accommodation means an object can be held closer to the eyes and sustained in focus for a longer period  of time.

A # 2. Accuracy of Accommodation: This refers to the ability to adjust the lens system of the eyes with precision to maintain optimal clarity of the viewed object.

A #3. Agility of Accommodation: This refers to the ability to adjust and change focus from near to far rapidly and without effort.

Symptoms of  Accommodative Dysfunction usually involves some of the following:

• Eye discomfort and/or headaches (often frontal headaches) with sustained close work like reading
• Squinting, blinking and rubbing eyes
• Trouble copying from the chalkboard
• Blurred vision when reading small print
• Vision becomes worse by the end of the day
• Reduced attention for reading
• Poor reading comprehension

 Accommodative Dysfunction has been studied and linked to an array of symptoms  associated with near visual work such as reading or computer based tasks.  It has also been linked to reading problems in children. Below are two interesting studies done within the last 5 years that shows there is scientific evidence to link Accommodative Dysfunction with serious negative consequences on the lives of children:

• Accommodative Insufficiency Is the Primary Source of Symptoms in Children Diagnosed With Convergence Insufficiency. Optom Vis Sci Vol 83, No. 5, May 2006 

 

Accommodative Function in School Children with Reading Difficulties. Graefes Arch Clin Exp Ophthalmol (2008), 1769-1774

Therefore research shows that good eye focusing (accommodation function) is essential to reading, yet too often this area of visual dysfunction gains very little notoriety.   Currently the rave is all about 3-D vision, 3-D movies, 3-D  TV and 3-D games, but  there are no cool digital media devices like 3-D video games and movies that shed light on public awareness on Accommodation Dysfunction. What's more, school vision screenings will typically exclude testing of this vital visual function, even though it is one of the most important "players" in your child's "vision abilities team" for reading and learning.

What can be done to help children with Accommodative Dysfunction?The best approach is usually a combination approach of vision therapy to develop the visual brain learn which means the development of the essential "neural-software" for effective and effortless coordination of the accommodative system andproperly prescribed reading glasses.  The best practices in  vision therapy approach is office-based, doctor supervised optometric vision therapy. The best prescription for reading glasses are lenses with high-definition optics to maximize the patients ability to not only focus but also to expand peripheral visual awareness. The importance of  prescription lenses plus office-based vision therapy is to develop a patient's 3-As of accommodation so that visual-stress related side effects involving frontal headaches go away and the act of reading and doing classroom learning becomes a visually effortless process.

And yes with this approach, the patient will have a happy ending; but only when a child is first identified, usually by the primary care optometrist,  who then makes the initial determination that a referral for treatment is required. If left to the public provided visual screenings children all around the country will still have to endure the headaches and eye discomfort because an unidentified accommodative dysfunction.

What if these kids didn't have to struggle with an unaddressed visual deficiency of Accommodative Dysfunction? There is help available from doctors around the US and internationally, in private practice and University Clinics where optometric developmental vision and therapy services are provided.  But first,  the primary care eye doctor is usually where the patient with Accommodative Dysfunction is diagnosed and then referred for proper vision therapy care.

Will you help? If you are a doctor, occupational therapist or other professional who works with children and have ideas or suggestions to  increase public awareness I welcome your thoughts and comments on my post. If you are a patient, concerned family member, or public advocate who is  interested in getting involved with others on this cause of vision advocacy, I encourage you to join Sovoto- The Vision Advocacy Network, take a look and contribute your thoughts to the discussion groups. Your involvement could make the difference in a child's life!

Dan L. Fortenbacher, O.D., FCOVD

Hi-Tech provides the WOW... at Wow Vision Therapy

Effective vision therapy is not an eye exercise or an eye muscle strengthening procedure. Rather vision therapy  is a therapeutic process that develops the neuromuscular control of the visual brain through a process that is evidenced-based on neuroscience. The research shows that patients who engage in office-based vision therapy will develop lasting improvement in their visual function.

At Wow Vision Therapy a patient's therapy session is one to one, doctor supervised optometric vision therapy. During the session the patient is engaged in a variety of visual experiences that are designed to create a visual challenge and visual exploration between the patient and the therapist. The role of the therapist is to provide an experience that has just the right level of challenge, variety, increasing degrees of complexity as well as relevance so that the patient is exploring and building visual skills that become internalized and automatized.

Utilizing the latest technology and training is another reason why the patients at Wow Vision Therapy enjoy excellent outcomes. Plus it makes it fun too!

Here are a couple recent examples of the latest addition of new technology in treatment at Wow Vision Therapy...introducing the Sanet Vision Integrator.

In this example the patient is using the new Sanet Vision Integrator in an example of an oculomotor (visual tracking) procedure with visual motor reinforcement.

  

In this second example, the Sanet Vision Integrator incorporates saccadic eye movement (visual scanning) with word recognition, reinforced with visual motor integration.

   

Asking the right questions critical to the right care in children's vision

Have you ever wondered if what you see is really the right way of visually seeing the world? If you find all of your visual tasks to be pretty easy to accomplish, then you may never have thought that there is anything besides just being able to "see clearly". Now, imagine being a child who in fact sees print overlap or move while reading and yet not knowing that "doubling letters" is not the right way of seeing. A child wouldn't  know that overlapping print is a sign of a problem since they have no reference to what is actually normal vision.

My name is Amanda Hodge, 4th Optometry Student at Michigan's College of Optometry at Ferris State University  and I have just completed my 2nd rotation with Dr. Dan Fortenbacher and the team at at Wow Vision Therapy. As a doctor in training, this experience has opened my eyes to many aspects optometric care that I was literally not aware of until I saw the vision therapy patient in action.  For example, I have heard several children say, "I didn't know I wasn't suppose to see like that." What occurred to me is that this may be the main reason why younger children often do not have complaints about their vision. What I've learned is that a child can have a significant visual problem but never announce anything to their parents because they don't know any different.

This is true for doctors too!  Doctors who work with children's vision must be aware of the behaviors which can be signs and symptoms of a problem that requires the necessary testing to make the right diagnosis. Often a parent may see a behavior in their child and just assume that it is something else, but in fact be a sign of a significant vision problem.

Some examples of questions parents can ask their children or themselves are:

• Do you notice one eye turns in or out, up or down?
• Do you squint trying to see things?
• Do you close or cover one eye?
• Do you avoid near work such as reading?
• Do you use your finger to keep your place when reading?
• Do you have a short attention span?
• Do you have sloppy handwriting?
• Do you have trouble with reversals such as bdpq's?
• Do words appear double or move while reading?

Other symptoms can be found on the College of Optometrists in Vision Development (COVD) website Vision and Learning Symptoms checklist. Another good resource for children and vision is the American Optometric Association (AOA) Good Vision Throughout Life. This section breaks down what to be aware of for different age groups.

If you as the parent or your child answered "yes" to any of the above questions (or those on the COVD or AOA website) it is important to make the time to schedule  your child for a comprehensive vision examination. Make sure you tell the doctor what your concerns are and specifically ask the doctor if he/she offers vision therapy or has a referral protocol with a vision therapy provider if your child requires VT care. Simply ask, "Do you ever recommend vision therapy for your patients?" If the answer is no, then your doctor may also overlook the vision problems that are only detected by running the correct vision tests.

Now you might be saying to yourself, I don't have a doctor and don't know where to begin? Well a good place to get started would be to visit the Doctor Locator via the COVD website and/or the AOA website  by locating an optometrist who works in pediatrics.

Don't let your child fall through the cracks of having to deal with an undiagnosed vision related learning problem. Schedule a comprehensive vision examination for your child if you are concerned that vision may be playing a part in your child's struggles. But, most importantly be sure that you ask the right questions.

Amanda Hodge

4th Year Intern, Michigan College of Optometry

MFBF treatment for amblyopia shows patching alone is not enough

MFBF is a technique we use to accelerate vision development through office-based treatment of our patients with amblyopia. This latest research (October 2010), from Current Biology, shows that this MFBF(monocular fixations in a binocular field) treatment methods are evidenced based in Neuroscience. Read more in this interesting VisionHelp Blog post written by Dr. Leonard Press.

Research Support for MFBF Amblyopia Optometric Vision Therapy

The significance of this research is that occlusion therapy (eye patching) the "good eye", when utilized as the sole treatment, does not address critical aspects of binocular vision development for patients with amblyopia.

Dr. Fortenbacher has previously blogged on this topic and explains why eye patching alone is not enough to treat amblyopia. Parents need to be aware of this advancement in amblyopia treatment which is based on solid research. If you have a child who has amblyopia and the only treatment recommended is an eye patch, consider finding a doctor who will provide office-based vision therapy and the MFBF technique.   

Read Dr. Fortenbacher's previous VisionHelp post here: Amblyopia treatment – Eye patching alone is no longer the standard of care