Frequently Asked Questions
Although we do not need this information to perform an eye examination, it will help us to determine if a large change has occurred from one year to the next. It also helps us to find something more suitable if you are currently unhappy with your glasses or contacts.
No! Not all sunglasses are safe. Beware of cheap sunglasses as the UV coating wears off easily thereby exposing your eyes to even more UV than if you were not wearing any sun protection at all. Please call our office for more information on how to safely protection your eyes from harmful UV rays.
Almost all adults and children use computers throughout the day. Unlike reading text on paper, viewing a computer screen is not as easy on the eyes. The contrast between the words and the background is not as sharp and therefore much more difficult to focus on. The eyes are always trying to over and under focus thereby causing eye strain and fatigue.
Adults can make their computer station more comfortable by taking the following steps:
Look away from your computer screen every 20 minutes. This will cause your eyes to relax and force you to blink, thereby decreasing irritation and burning.
Make sure you computer screen is in the correct position. The computer screen should be just below your line of sight. If it isn't then either lower your screen or raise your chair.
Carefully check for glare and reflections on the computer screen. Position the monitor to minimize glare.
In some cases, these adjustments alone will not take care of computer vision discomfort. We always recommend a complete eye examination as some individuals need a prescription specifically for the computer. We offer an excellent office lens. Please ask us for more information!
Absolutely! Our staff is able to assist you in choosing the proper eyewear for your lifestyle. We also recommend this interactive tool to help you better understand all of the features available in today's products.
Bringing the most advanced technology to our patients, we recommend optomap ultra-wide digital retinal imaging as part of your comprehensive eye exam. For more information, please view the optomap brochure.
Questions about children:
Drs. Kelvin and Stacie are happy to fit children with contact lenses. There are many factors that go into deciding if the child is the right age; there isn't a certain age that makes a child eligible for contact lens wear (for example, the child can be as young as 11 or as old as 16). The following criteria must be met:
- They have a suitable prescription for contact lenses
- They are mature enough to understand the dangers of contact lens over wear and mishandling the lenses.
- They must demonstrate maturity during the examination.
- They are mature enough to follow directions and maintain good personal hygiene. Good questions for parents to ask themselves are "does my child regularly brush his teeth, shower, keep his room clean, etc". If not, he may not be ready to handle contacts, as they are a medical device that he is inserting in his body.
- The child (not the parent) must be interested in wearing contact lenses (if there is no motivation by the child, they will not have success with their training and with the care of their lenses)
- They must complete a training session on how to insert and remove the lenses from their eyes. The training also provides the child with information on how to take care of the lenses. It usually takes about an hour to complete the training and is usually performed on the same day as the eye examination.
- The child MUST have a pair of glasses with their current prescription. There are times where contact lenses cannot be worn (if the child has a red, irritated eye, for example) and for when the lenses are removed at night before going to bed.
At Prosper Family Eyecare, we recommend that you bring your child in for an eye examination before he/she enters school. We also recommend bringing your child in earlier if you notice any problems or if the child's pediatrician recommends an eye examination.
80% of the information that children learn in school is processed through their visual system. Unfortunately, it is hard for children to understand what it means to see something "blurry" because it looks normal to them.
The nurses in our area do an excellent job at screening the children for visual problems. However, there are some children that pass the screening but still have a need for glasses (far sighted children). These children can have the following symptoms:
- Difficulty in school (especially reading and math)
- Grades start to decline
- Avoid reading/Do not read for pleasure
- Suffer from headaches
If you notice any of the above, please bring your child in for a complete eye examination.
There are a few reasons that this may be true.
- Your child may be farsighted. Although he can read 20/20 on the eye chart, his muscles are working overtime and causing him to strain. This can lead to avoidance of work, headaches, decline in grades, etc.
- Your child may have problems perceiving what he is seeing. Approximately 15-20% of children with learning problems have visual processing (VIP)/perceptual problems that are significant to interfere with school performance.
VIP is the ability of the brain to take and organize visual information from the environment and coordinate it with other sensory modalities and higher cognitive function. Development of this system is an ACTIVE process and the rate of development is faster at younger ages.
VIP is an important aspect of vision, particularly for children in grades 1-5. Just because a child can see clearly & comfortably does not guarantee that he/she will be able to make use of the incoming information. We believe that visual processing skills develop in most children without the need for any special attention or intervention. However, in some children the development of visual processing skills does not keep pace with the child's growth in other areas. This type of lag can lead to difficulty in the early grades.
Examples of behavioral signs and symptoms associated with VIP deficits:
- lack of coordination and balance
- working slowly compared to others
- skipping/re-reading lines
- difficulty learning R vs. L
- poor math skills
- sloppy handwriting
- difficulty learning the alphabet
- poor spelling skills
- difficulty finishing school work
- difficulty copying from blackboard
- not reading for pleasure
Because 80% of learning is derived from visual processing, it is extremely important that children who are struggling in school have their eyes examined. We first recommend a comprehensive eye examination. We may also recommend sensorimotor and perceptual testing, both of which are separate visits.
If your child experiences one or more of these symptoms, he or she should be evaluated by an optometrist specializing in vision therapy, to determine whether previously undiagnosed disorders of visual function may be interfering with your child's ability to learn:
- eyes strained or tired when reading
- print runs together when reading
- loss of place when reading
- reverses letters and/or numbers
- skips words when reading
- difficulty remembering words learned before
- uses finger to follow along when reading
- bright child, but does poorly on tests
- difficulty with copying from the chalkboard
- difficulty with tests using Scantron sheets
- complains of headaches after school
- avoids reading
- eyes tear or rubs eyes often when reading
- complains of blur or double vision
- holds books close to the eyes
- poor sports performance
- difficulty concentrating on homework
- diagnosed with ADD or ADHD
- distractible during homework
- diagnosed with dyslexia
- homework takes extremely long to finish
- reduced reading comprehension
- closes or covers one eye when reading
It is OK! Testing on toddlers is very different than testing on adults. We use pictures instead of letters and can check their prescription without ever asking them a question.
Beware of cheap sunglasses as the UV protection wears off quickly. With cheap sunglasses, your child's eyes are exposed to more UV light than if he/she were not wearing anything at all.
We proudly offer high quality, non prescription children and infant sunglasses with great UV protection. They range from $17-$25. You can also have sunglasses made with your child's prescription. Please call our office for more information.
Infant Milestones (courtesy of the Optometric Extension Program Foundation and the American Optometric Association):
- Sees in shades of gray at birth
- Distance vision blurry, primary focus is 8-10 inches from baby's face (the distance to their parents face)
- Stares at surroundings while awake
- Momentarily holds gaze on bright light or bright objects
- Blinks at camera flash
- Eyes and head move together
- One eye may seem to turn at times
- Eyes begin to move more widely with less head movement
- Eyes begin to follow moving objects or people (8-12 weeks)
- Watches parent's face when being talked to (12-16 weeks)
- Begins to watch own hands (12-16 weeks)
- Eyes move in active inspection of surroundings (18-20 weeks)
- Depth perception develops (20 weeks) (seeing the world in 3 dimension)
- While sitting, looks at hands, food, bottle (18-24 weeks)
- Now looking for, and watching more distant objects (20-28 weeks)
- Color vision fully developed (24 weeks)
- May turn eyes inwards while inspecting hands or toy (28-32 weeks)
- Eyes more mobile and move with little head movement (30-36 weeks)
- Watches activities around him for longer periods of time (30-36 weeks)
- Looks for toy he drops (32-38 weeks)
- Visually inspects toys he can hold (38-40 weeks)
- Creeps after favorite toy when seen (40-44 weeks)
- Sweeps eyes around the room to see what's happening (44-48 weeks)
- Visually responds to smiles and voices of others (40-48 weeks)
- More and more visual inspection of objects and persons (46-52 weeks)
12 -18 months
- Now using both hands and visually steering hand activity (12-14 months)
- Visually interested in simple pictures (14-16 months)
- Often holds objects very close to eyes to inspect (14-18 months)
- Points to objects or people using words "look" or "see" (14-18 months)
- Looks for and identifies pictures in books (16-18 months)
- Occasionally visually inspects without needing to touch (20-24 months)
- Smiles, facial brightening when views favorite object and people (20-24 months)
- Likes to watch movement of wheels, egg beater, etc (24-28 months)
- Watches own hand while scribbling (26-30 months)
- Visually explores and steers own walking and climbing (30-36 months)
- Watches and imitates other children (30-36 months)
- Can now begin to keep coloring on the paper (34-38 months)
- "Reads" pictures in books (34-38 months)
As optometrists, we are training to treat red eyes on individuals of all ages. Since the eye is our speciality, we recommend bringing your child to our office for any eye related issues.
Almost all children use computers throughout the day. Unlike reading text on paper, viewing a computer screen is not as easy on the eyes. The contrast between the words and the background is not as sharp and therefore much more difficult to focus on. The eyes are always trying to over and under focus thereby causing eye strain and fatigue.
More about children and computer vision can be found here: http://www.aoa.org/x5379.xml
Questions about Vision Therapy:
We learn to use the visual process over time. They develop as a result of meaningful life experiences that children have prior to entering school and are thereby a product of the environment we grow up in. Visual skills and abilities are learned primarily through movement and interaction with our three-dimensional world.
A child with a limited set of experiences should not be expected to acquire skill merely as a result of surviving a certain number of years on this earth. Time alone does not cause development. Good development is the result of the appropriate meaningful experiences occurring at opportune times in a person's life.
Learning how to fixate on an object, shift visual attention from one point in the visual array to another, precisely align both eyes with ease for sustained periods of time, and shift attention from distance to near and back again are all developed skills. A child who has not had appropriate life experiences in meaningful ways may come to school without these requisite skills.
A behavioral optometric evaluation can be compared to taking an inventory of these visual abilities and skills and finding which are present and which may not yet have emerged. The lack of the emergence of these visual abilities does not represent a physical or physiological or mental deficit. The vast majority of what we see in clinical practice are visual development problems.
There is no simple answer to this vital question. Parts of it will be found in many areas and blaming one exclusively will not lead to a resolution of the problem for large numbers of children. The following is a list of some of the potential culprits and a bit about what types of problems they may be causing.
- Not enough self-directed movement while young: In our modern fast-paced society, families seem to always be on the go. So we transfer our young child from the baby carrier to the car seat to the stroller and we move them around for much of the day, rather then having them exploring the world around them with their own visually directed mobility.
- Attention demands too short: So many of today's television shows geared for children are so fast-paced that they seem to flit from one thing to another, barely giving the child the opportunity to learn to sustain attention.
- Too many pictures supplied rather than constructed by the child: When a child gets to listen to a reader who orates in an interesting manner, using descriptive prose, the child gets the chance to learn to make, modify and recall visualizations and visual imagery, which will become the basis for spelling and reading later in life. When a child is given a steady diet of graphics and cartoons they become passive viewers of "interesting" content but they don't get the opportunity to develop the necessary mental imagery skills.
The Toolbox Analogy
This analogy was beautifully written and provided by the Optometric Extension Foundation
Imagine that we have delivered to a plot of land all of the necessary raw materials needed to build a house. Piles of wood, nails, screws, drywall, cinder blocks, plumbing supplies, electrical supplies, cabinets, doors, windows, roofing materials, etc. are all present in abundance. The child brings to that work site each day their toolbox. The tools in that toolbox have been acquired over the years based on the life experiences that child has had. Some children enter the worksite with a rather complete set of tools to cover most needs, while others have only the essentials or may in fact be missing even a core or fundamental tool. Fundamental or required tools might be considered to be a hammer, a saw, a screwdriver or a tape measure.
In general, schools assume two things. The first is that most children enter with the set of tools that will carry them through their academic career and that the fundamental set of tools that a child brings to school is fairly set or immutable. The child is placed into a series of courses such as Carpentry 101, Plumbing 101, and Electrical Systems 101. In Carpentry 101 they may begin with the simple tasks of measuring and marking lumber to be cut to length, how to start, drive, and set a nail, and making a cross-cut saw cut safely, accurately, and square. To a child coming to the workplace with a basic framing hammer, a handheld crosscut saw, and a Stanley 25 foot tape-measure these beginning classes may come rather easily. To a child missing one or more of these basic tools, failure to achieve basic "educational" goals may become evident rather early on.
Generally in the education system a child comes to the attention of their teacher before testing for a problem is initiated. To qualify for services their performance must have fallen to a certain measurable amount.
Many resourceful and smart children who are missing fundamental tools may find ways to get the job done although they are not using the proper tool. They might find a rock to use as a hammer or they might use a monkey wrench to hammer in the nails. The job gets done but it takes longer, the job isn't done as well and there may be some wear and tear on the child that would not have been present had the child used the proper tool for the job. However, the child, due to a lack of the appropriate developmental experiences is/was lacking the tool. This degree of compensating can often serve to mask the discovery of a missing fundamental tool for quite a while in a resourceful child.
Once the teacher realizes the child is having a problem, the school system will initiate a series of tests to identify the problems. Psychological educational testing often correctly identifies the general category of the problems, such as carpentry or plumbing but may fail to recognize that the lack of a tool may be the problem. Here is where a false assumption dooms the child to an intervention program that will actually work to embed the problem even more. How?
A hammerless child is labeled as "hammerless" or "hammer compromised." The system then looks for special education materials that have been shown to be able to be mastered by those without hammers. The idea has been that the child who does not have a hammer should not be penalized for not having a hammer and we should not ask them to do things that require hammers. Therefore a program has been conceived and produced in, for and by the school, which addresses hammerless children's needs.
The hammerless child will be given activities, which will not require them to use a hammer. Either they will now use screws and screw guns for everything or they will switch to learning to assemble prefab home kits. The child will advance through the rest of their courses but a fundamental tool and basic skill necessary to nearly any home building project will be missing, the ability to use a hammer. The false assumption was that once hammerless, forever hammerless.
The education system is not in the business of tools. They are in the business of tool usage. "Missing tool? Oh well you'll just have to learn to accept your hammerless condition and arrange things differently so that you don't encounter hammering demands in school life." Real life then becomes another matter.
The key factor in behavioral vision care is that our assumption is that the presence of a missing tool is only evidence of not having had the appropriate meaningful experience to have developed or acquired that tool. We are in the business of identifying the missing tools and then putting together treatment protocol. The purpose of which is to provide the child with the necessary meaningful experiences to acquire the tool.
In essence, we take the child shopping. We know that hardware stores exist. We know the fundamental classes of tools. We know the order which people generally acquire tools. One would not start their saw collection with learning how to use a coping saw or a compound miter saw. One starts with a handheld crosscut saw and learns by cutting basic lumber to length. A rip saw may follow. Then a circular saw, jig saw, table saw, band saw, coping saw etc. each experience being built on the prior knowledge base all which came from the handheld crosscut saw. This process of tool acquisition and attaining fundamental competence in the use of the skill is the domain of optometric behavioral vision care. We turn over to the school system a child who now possesses the correct array of tools to perform the tasks required of them. When the school system moves on to fundamentals of balloon framing houses or the proper method of trussing up a floor the child will have the tools necessary to execute the demands of the class, understand the concepts, and to use the proper tools for the proper job.
Behavioral vision care optometrists do not teach carpentry, plumbing, or wiring. Behavioral vision care optometrists do not teach reading, writing or mathematics. Behavioral vision care optometrists do identify missing tools and take the child shopping to acquire and gain competency with the new tools. Then, and only then, will the school system find a child who is ready to be taught using conventional methods and who will achieve in a variety of educational settings and following a variety of teaching methods.
The answer to this question certainly depends on a number of variables, including what groups of children we are talking about and at which aspects of visual development we are looking. A study was done by the New York State Department of Education in conjunction with the New York State Optometric Association, in which they did testing on random samples of children in all socioecomic groups throughout New York State. It was found that around 23% of the general school population had visual development problems that were affecting learning in a significant way.
In this study, when you looked only at those children identified under public law 94-142 as needing extra help in school, the percentage climbed to 93%. In a study done in Baltimore with juvenile delinquents at the Hickey School in the late 1980's, I found the number of these 14-18-year-old boys with visual development problems to be in the mid-90's percentage wise. In another study in the late 1990's in several Baltimore City public schools, it was found that over 80 percent of the children had primary visual development problems. Without the visual problems being addressed, simply reducing class size, getting better text books, finding better teachers, or changing the pay system to a merit system will not result in significant gains. The visual problems need to be addressed so that the children can then benefit from their education.
The primary method of treating a visual development problem is to arrange conditions to provide the person with the necessary meaningful experiences to acquire these needed skills and abilities. The method whereby this is done is called vision therapy.
During the early phase we will be building foundation skills and abilities, which may not translate immediately into observable changes in the classroom. These early changes will involve gross motor abilities along with acquiring the fundamental visual skills and abilities. The child may exhibit a decrease in symptoms such as headaches or blurred distance sight after doing close work.
Once the core skills are established, the therapy will focus on elaborating on those skills and abilities so the child can apply them to real life demands. These real life encounters may be similar but actually require slightly different skill sets than used earlier in therapy. The child will need to learn how to use these new skills by shifting from one application to another with ease.
The last phase of treatment has two major purposes. The first is to automate the newly acquired skills and abilities so that the new skills are simply called on when needed without any conscious thought. The second is to help the child generalize the new skills so that as life throws new challenges, they can immediately call on what they have learned and make the necessary adjustments, again almost without conscious awareness of having done so.
The time-frame for seeing change will vary with the degree of the problem, the age of the child, the intensity and regularity with which the home practice sessions are completed, and many other factors. Generally, by the eighth week of visual therapy changes are beginning to be noticed by all. At first, these may only be that the child is staying on task a bit longer or doesn't have to be restarted on homework assignments so many times. Often the child is beginning to notice things in their environment, many of which may have been there all the time but are just being recognized.
A major visual development step is the ability to track and fixate with eyes only. In cases where this was not present, I see this emerging by the 8-week progress evaluation. The visual therapy begins in free space with real physical objects and moves to working in the two-dimensional plane of paper or a blackboard at about this time. Since visual development follows this course one of the early signs of change is often in sports. The child with emerging spatial competency is more aware of where they are in space in relation to others and to objects and as a result of this they interact with these things more accurately and more consistently.
Reading is a complex process that is dependent on many visual abilities as well as a host of other skills. Much of the early emphasis in the visual therapy programs is aimed at the fundamental visual abilities. These foundational skills are necessary to build on, but often do not have an immediate effect on improving reading performance. Early on, the major effects might be that the child can stay on task for a longer period of time before tiring.
A major developmental hurdle is learning to move the eyes only when shifting visual attention from one place in space to another. Once this has been achieved we often see renewed interest in near tasks that involve sustained use of vision for deriving meaning. The fact that the child can now do this kind of task often helps them feel better about themselves, and early changes in reading may not be directly from the actual visual therapy, but indirectly from the changes in the child's self-image and feeling that they are not dumb, that a real problem had been found and that it is being addressed.
As the therapy progresses we often see a pick up in the fluency of reading at their current instructional level. Mechanically we see the child begin to take in a larger perceptual chunk, resulting in them not needing to stop so many times with their eyes per unit of text. Because less effort is needed to keep their place, to keep the print clear, and to plan where to go next, as well as keeping both eyes directed accurately so that their inputs are complementary, more of the child is left to learn from the experience.
Over time we see a consolidation of gains at a level of reading material followed by a non-linear jump to a new demand level. When that happens there is a short period of time when the mechanics seem to make a downturn. This is because it takes more thought, reflection and some conscious effort to decode new words and to find the appropriate meaning in more complex contexts at the new level. Over time this too becomes consolidated, with a commensurate period of time of improvement in the mechanics again. This continues cyclically during the course of treatment as well as continuing for many months after treatment has been completed. This can also be seen in normally developing readers at the appropriate developmental time.
To recap, we first often see improvements that are more secondary to attitude differences than to actual treatment effects. Once the "eye movement free of the rest of the body" target has been achieved there is often a new ability to sustain near centered visual attention, which can be seen in renewed interest in close work. Then begins a cycle of change; beginning with improved mechanics at the current demand level and followed by a jump in the demand level that can be understood. During the early part of the jump to the new level the mechanics typically suffer for a finite period of time.
Difficulties in copying from the blackboard come in two flavors. The first is problems secondary to clarity problems. A child who is nearsighted sitting in the back of the room without glasses or contact lenses may not be able to see the letters and differentiate them well and therefore may make lots of mistakes or copy the wrong thing entirely. Generally no amount of treatment will address this. Some form of eyewear, glasses or contacts, are needed to address this problem.
The second and more common problem affecting copying from the blackboard is the problem with fixation and tracking already noted. The child may be incapable of remembering where they were as they shift from one place to another. So when they return to the blackboard after writing down the last portion seen, they may be unable to relocate where they were. This ability to leave a mental marker from the last fixation point is taught in therapy and often comes in between the 8th and 10th week of treatment and certainly should be present by the 16th week. So problems related to fixation and tracking respond to treatment rather quickly. In the meantime it might be helpful to give a child with this type of problem a copy of their assignments so that they can have it at their desk and they are not penalized for making copying mistakes.
Many children with learning related visual problems fall apart when put in timed situations. The added pressure of having to work fast may be the straw that breaks the camel's back, causing many of these children to "melt down". During the first 8-10 weeks we are working to build fundamental visual abilities. From that point on, although more skill building and elaboration are being done, we shift emphasis to being able to multitask and to perform under pressure.
This aspect of treatment is aided by the use of a stop watch. A number of activities are timed and emphasis on some activities is shifted away from perfection to speed. Some errors are accepted in order to get the child moving. Once moving, then the emphasis shifts back to increased accuracy and then back to faster speeds. These cycles are built into many of the visual therapy activities all the way to using guided reading in the last 8-10 weeks of treatment. Here a moving window flies over text to be read about 20-30 words per minute faster than the speed at which the child is currently reading. These sessions of being pulled over text a bit faster than is comfortable pay great dividends. It also reduces the number of regressions in text (going back to the left within a line of text to reread a section) because the window only moves forward and does not allow for regressions to be of any help when reading.
So the bottom line here is that many of these children have trouble with completing work on time and when time pressures are added they may crumble. However, vision therapy specifically targets this and most children make very quick changes here. Generally from 4-6 months into treatment timing issues are no longer a concern.
|Patient performing circles on the chalkboard. This is an activity that works on creating bilateral symmetry in gross movements along with eye movements.
|Patient working with the rotating peg board. This exercise develops spatial organization, eye control, eye-hand coordination and visual attention.
|Patient on the walking rail tracking a swinging ball. The purpose of this activity is to guide the patient in developing her internal rhythm. This is important in learning how to guide behavior while moving through space.
|Patient performing convergence therapy with the Brock String.