EXCELerated Vision

Early intervention critically important in children's vision problems

When is it OK to "wait and see" if the problem goes away on it's own?

What if your 6 year old child has been diagnosed with a binocular vision problem that appears to be interfering with her learning to read? You are seeing behaviors that look like she can't concentrate on books. Her teacher is spotting some signs of trouble but can't be sure that it is "her eyes". You take her to an eye doctor who makes the diagnosis of a binocular vision problem called convergence insufficiency but dismisses treatment "for now" and opts for monitoring the problem. But, is it really ok to just wait and see?

As strange as it may sound, an outdated approach often recommended by many eye doctors when faced with a young patient (often 4-7 years old) diagnosed with certain forms of eye coordination problems, such as convergence insufficiency, is to simply monitor the condition and see if it goes away it's own. In other words, no treatment is recommended.

In response to this and other vision problems in children, the University of Oregon Brain Development Lab has just produced this video on vision and the developing brain. See what the neuroscientists and the research is showing about the importance of early intervention.

Then check out the story of a mom (below) who wouldn't accept "NO" for an answer when told that her 6 year old daughter (with convergence insufficiency) was too young to be treated.

Find out how a persistent mom dealt with this problem with her own 6 year old daughter. Read the heartwarming and inspirational story from Paige Melendres in Albuquerque, who was not comfortable with the "wait and see" recommendation by her first doctor.  Her story can be found by clicking on  CI:The Private Eye Goes Public -Part 1 and scroll down to comment #8. Her story has a happy ending and good advice for parents who may have a child who is struggling.

CI: The Private Eye Goes Public is a  VisionHelp Blog investigational series written by Dr. Leonard Press and Dr. Dan Fortenbacher dedicated to uncovering the important public health and patient care issues surrounding convergence insufficiency.

Dan L. Fortenbacher, O.D., FCOVD

Developmental Games and Activities for the Nine to Eighteen Month Old

  This article is brought to EXCELerated Vision as a continuation of the infant vision development activities provided by Dr. Gary Etting of Encino California.

1.         Give your baby the opportunity to look for his favorite toy in another room.                                                 

2.         Give your baby opportunities to crawl under and over objects. Vary the distance of the spacing and the objects.

3.         Give your baby objects that he can push or pull. Pushing a ball or a box cannot only be great fun, it helps him to learn to coordinate his body and control objects.

4.         Provide objects that can be placed in a container, such as beads or buttons in a box. (Because these objects are small and can be swallowed, this activity has to be carefully supervised.)

5.         Provide opportunities to stack objects such as pillows, blocks, etc.

6.         Provide opportunities to judge distances. You can use a small stick with a magnet attached to it. Teach your baby how to fish for objects with a magnet.

7.         Provide fat crayons and paper to scribble on.

8.         Provide opportunities to play alongside another child his age. A good distance for the other child to be is between 2 to 4 feet.

SUGGESTIONS AND GUIDELINES FOR TOYS AND GAMES

A.         General Motor and Bilateral Development

1.         Creep through, around, over and under a family furniture obstacle course.

2.         Hold your baby's hands and encourage jumping off a small step. Jump over a very low object.

3.         Play nursery games like Pat-a-Cake and Ten Little Indians.

4.         Play games of identifying body parts as you dress your baby.

5.         Provide your baby with a kiddy-car that he has to drive around obstacles in the family room.                                                                   

6.         Provide him with pull and push toys that make sounds.

7.         Allow him to climb a safe set of stairs.

B.         Visual Focusing

1.         Identify objects in large baby books.

2.         Make up a two-piece puzzle with a circle and a square cut-out. Identify each space.

3.         Provide toys of different shapes and design, and label each one verbally.

4.         Sort pictures of different family members. Ask your baby to identify each one verbally.

5.         Provide a grab-bag of objects to identify by reaching in, guessing what it is, and then pulling it out to see if he's correct.

C.        Visual Tracking

1.         Provide a basketful of different colored clothespins or similar objects to find.

2.         Provide water toys that float in different directions.

3.         Play ball on the floor. Occasionally use balls that have unpredictable movements.

4.         Provide a toy merry-go-round. Place toy objects on it and watch them go around and fall off.

D.        Eye-Hand Coordination

1.         Stacking toys

2.         Nesting toys

3.         Blocks and pegs

4.         Form boards

5.         Spurt and squirt toys for the bath

6.         Objects to fill and pouring toys

7.         Hinges

8.         Toy xylophone

9.         Toy telephone

E.         Binocular Coordination: Two Eye Teaming

1.         Have your baby line up large pegs in a row as if they were soldiers marching toward him or marching away.

2.         When your baby is on a swing, stay in front of him and maintain eye contact.

3.         Have him use a large wooden or plastic hammer with large pegs

4.         Have your baby pour water into a container. As his skill improves, let him use containers with smaller openings.

5.         Have your baby throw a ball or a beanbag into an area on the floor or into a basket.

6.         Try a balloon catch.

F.         Size, Shape, Spatial Concepts

1.         Try having your baby put things in order by size or length.

2.         Have him put different objects in a line and describe their positions: one, two and three.

3.         Have him place objects together that belong together, like all cups or all spoons, plates, cars or dolls.

4.         Hide an object and have him find it.

5.         Have him place objects into their proper containers.

6.         Scramble a stack of chips and then have your baby pick out only one type of chip. For  example, have him pick out all the blue ones, although there are red and blue scattered  together or have him pick out all the chips that look alike (all the circles or squares).

More Playful Games to Help Your Baby's Vision Develop - Age 4 to 8 Months

 This article is a continuation of the infant vision development activities provided by Dr. Gary Etting of Encino California

1. Allow your baby time every day to lie on his stomach with his field of view unobstructed so that he can watch the comings and goings of things. Make sure there are interesting things to see at the 2 to 3 foot distance.

2. While he is on his back, provide an eye-hand gym for him to reach out and explore. It should have objects he can pull and objects he can control. Each day place it so he can explore it with his feet as well as with his hands.

3. Provide your baby with objects of different textures, sizes and weights.

4. Occasionally place an object so that it is partially hidden by a blanket or by another object.

5. Label by verbally naming each object that he plays with and ask him to find it by

calling it by its name.

6.Allow him to experience crawling under objects as well as climbing over them.

SUGGESTIONS AND GUIDELINES FOR TOYS AND GAMES

A.General Motor and Bilateral Development

1. Holding your baby's hands, gently lift him up from the crib and then slowly lower him.

2. Place your baby face down with his abdomen across a round bolster. Gently roll him over until his  hands touch the ground, and then roll him back until his knees touch the ground.

3. Put wrist and ankle bracelets on the baby so that he becomes aware of the movement of the two sides of his body.

4. Make climbing and sliding equipment out of stiff and smooth pillows and bolsters.

5. Place a kickable mobile at the end of the crib.

6. Place small objects within his reach so that he can practice grasping and holding abilities. (Make sure they are large enough that he cannot swallow them.)

B. Visual Focusing

1. Place a plastic mirror (without sharp edges) in a place where your baby will catch a view of himself.

2. Place stuffed toys of different sizes and shapes and patterns around the room for him to look at.

3. Roll a patterned ball toward him as he sits on the floor.

4. Play peek-a-boo with your baby.

5. Hang a three-dimensional face on the crib for your baby to look at.

C.  Visual Tracking

Call your baby's attention to you as you creep behind a piece of furniture and then emerge  from the other side.         

1. Walk in front of your baby pulling a desirable pull-toy, such as a dog on a string.

2. Jingle a set of toy keys approximately 12 inches in front of his eyes to stimulate his eye-following abilities. Do this from left to right and back and then up and down and so forth.

3. Roll objects down an incline in front of your baby so that he can watch what they do.

D.Eye-Hand Coordination- The following toys and objects provide multiple opportunities for exploring eye-hand coordination possibilities.

1. Nesting toys

2. Pots and pans

3. Banging objects, such as a drum or pounding pegs, especially large ones.

4. Tie objects onto the side of the highchair so that the baby can throw them to the floor and you can retrieve them more easily. Make sure that they make different sounds as they reach the end of the string.

E.  Two-Eye Teaming

1. Attach toys to strings so that your baby can pull them toward himself. (Be careful that he does not get the string around his neck.)

2. When bathing the baby, provide toys that float toward and away from him.

3. Play a choo-choo game with some food as it goes into the tunnel of his mouth. Have him watch the train all the way into the tunnel.

4. Have your baby sit on the floor with his legs apart and gently roll a ball toward him.

5. Provide wind-up toys that walk toward and away from him as he watches.

As your baby contnues to grow, always look for opportunities for him or her to explore their enviornment in three dimensional play.

Dan L. Fortenbacher, O.D..FCOVD

Founder, Wow Vision Therapy

Activities to Help Your Baby Develop Better Vision- Activities in the First 3 months of Infancy

What can you do to help your baby develop his or her vision? This article is part 1 of a 5 part series that I will be presenting. These come directly from renouned lecturer and clinician, developmental optometrist, Dr. Gary L. Etting, Encino, California.

Activities in the first 3 months of infancy:

1.Give your baby the opportunity to use both eyes by having an unobstructed view out of both sides of the crib. If the crib is against one wall, change his position so that each eye has a chance to see out through the crib bars.

2.Make sure your baby has a chance to view patterns, especially changing patterns. Sometimes a light behind a moving mobile will cast some interesting shadows upon his wall for him to inspect. Black and white patterns on mobiles are best.

3.Speak to your baby no matter where in the room you are.

4.When you are dressing or feeding your baby make sure that he has a lot of opportunities to focus his eyes on your eyes. Remember that he can see your eyes clearly if you are approximately 8 to 10 inches away from his face.

5.Give him plenty of opportunities to follow you with his eyes, to his right, to his left, upward toward his head and downward toward his toes.

SUGGESTIONS AND GUIDELIES FOR TOYS AND GAMES

A. General Motor and Bilateral Development

1.Playfully move your baby's arms and legs, at first each limb separately and then in various combinations.

2.Raise and lower your baby while you look into each others eyes.

3.Bounce your baby gently on the bed or on your knee.

4.Gently and playfully massage the baby's body with baby lotion or powder.

5.Place multicolored mitts on the baby's hands. Make sure the material is safe for him to put in his mouth.

B. Visual Focusing

1.Place a picture of a face 8 to 12 inches from the baby's eyes. The face should be about 10 inches in diameter and the eyes in the face should be about one inch in diameter. Place the face on one side of the crib and change sides regularly until the age of approximately two months. Then hang it above the middle of the crib. Make sure that you place the face so that the baby has an opportunity to look toward each side of his body.

2.Hang a patterned piece of material on the crib with a bell attached to it.

3.Provide multicolored objects for your baby to look at. Place the objects in various

positions within his view. Give him opportunities to look in different directions.

4.Leave a night light on at night, so your baby will have something to look at if he awakens.

5.Make sure that he doesn't face only one side of his crib or a wall thus using one eye all

the time. Change his position or that of the crib occasionally.

6.Hold your baby on opposite sides of your body while feeding him so that he gets a chance to look with each eye.

C. Visual Tracking

1.Hold your face about 8 to 12 inches in front of your baby and talk and sing to him while you slowly move to one side of his body and then the other.

2.Take a large patterned object (such as a doll or a balloon) with a bell attached, and move it

in front of his face, approximately 8 to 10 inches in front of his eyes. Move the object 

slowly from side to side.

3.Make a bridge between the two sides of the crib and attach a multicolored object to it that can be made to swing.

4.Place a roly-poly doll approximately 8 to 12 inches in front of your baby's eyes and set it moving.

D. Visual-Auditory Coordination

1.Place noisy rattles with different textures in his hands so that he can shake them and then place them in his mouth.

2.Put squeaky rubber toys in his hands.

E. Eye-Hand Coordination

1.Make a bridge between the two sides of the crib and hang objects there that will invite swatting. Make sure that the objects change patterns or make noise as they move.

2.Hang a cradle gym across the crib.

3.A good mobile to hang over the crib is a picture of a smiling face.

4.Black and white mobiles provide greater stimulation than colored mobiles at this stage of development.

You can also learn more at the College of Optometrists in Vision Development.

Dan L. Fortenbacher, O.D, FCOVD

Infant Vision...The First Step to Your Child's Learning Future

   How important is it to have your baby's eyes examined? The answer is,it can be critical not only to their health, but also to their ability to learn when they are older. To find out more, I invite you to listen to Dr. Andrea Thau, Trustee of the American Optometric Association and one of the founding members of the AOA InfantSee program, interview on WBAI-FM 99.5, NYC, talk about the importance of infant vision examinations.

Also, you can read about the how to help your baby's vision development by checking out, "Learning to See" from the College of Optometrists in Vision Development.

Dan L. Fortenbacher, O.D.,FCOVD