What if my child’s eyes are crossed? Strabismus 411.

HELP! It looks like my child’s eye is turning in, or out or I’m not sure. What do I do? What is strabismus anyway?

Photo courtesy of mjtmail (tiggy) on Flickr

Photo courtesy of mjtmail (tiggy) on Flickr

Strabismus, or crossed eyes, is a condition in which both eyes do not look at the same place at the same time. It occurs when an eye turns in, out, up or down. Strabismus is classified by the direction the eye turns:
• Esotropia = Inward turn
• Exotropia = Outward turn
• Hypertropia = Upward turn
• Hypotropia = Downward turn

There are six muscles attached to each eye that control eye movement. Normally, the eyes work together so both eyes look at the same place at the same time. An eye turn may be visible when there are problems with eye movement control.
The eye turn may be present constantly or only at certain times such as when the person is tired, ill, or has done a lot of reading or close work. One eye or both eyes may alternate turning.

Proper eye alignment is important to avoid seeing double, for good depth perception, and to prevent the development of poor vision in the turned eye.

What causes strabismus?

There are many causes, including:

  • Eye muscle problems.
  • Problems with the nerves that transmit information to the muscles.
  • Trouble with the control center in the brain that directs eye movements.
  • General health conditions or eye injuries.

What are risk factors for developing strabismus?

  • Family history – Those with parents or siblings who have strabismus are more likely to develop it.
  • Refractive error – Especially a large amount of uncorrected farsightedness (hyperopia).
  • Medical conditions – Including Down syndrome, cerebral palsy, stroke or head injury.

How is strabismus diagnosed?
Strabismus is diagnosed through a comprehensive eye exam. Testing may include:

  • Visual acuity, or vision – “Normal” distance visual acuity is 20/20.
  • Refraction – Determine the appropriate lens power needed to compensate for any refractive error (nearsightedness, farsightedness, or astigmatism).
  • Alignment and focusing testing – How well the eyes focus, track, move and work together.
  • Examination of eye health – This includes the front and back of the eyes. Eye pressure is also evaluated.

Because vision may change frequently during the school years, regular eye and vision care is important.

How is strabismus treated?
There are several treatment options to treat strabismus, including:

  • Eyeglasses or contact lenses – For some conditions, glasses alone will align the eyes.
  • Prism lenses – Prisms align the images seen by both eyes, so the eyes can fuse or see the same image, restoring visual clarity and depth perception.
  • Vision therapy – Vision therapy trains the eyes and brain to work together more effectively.
  • Eye muscle surgery – Surgery may be able to physically align the eyes so they appear straight. A vision therapy program may also be needed after surgery.

What can happen if the eye turn is not treated?

Photo courtesy of jmoneyyyyyyy on Flickr

Photo courtesy of jmoneyyyyyyy on Flickr

Potentially an untreated eye turn can lead to amblyopia, otherwise known as lazy eye. Amblyopia is permanently reduced vision in one eye.

When does a child develop strabismus?
Typically strabismus develops in infants and young children by age 3. It may be present in older children and adults. Children do not “outgrow” strabismus.

Most importantly…
If detected and treated early, strabismus can often be corrected with excellent results. Eye examinations are important for all children and adults, starting at 6 months of age. If any eye turn is in question, schedule a comprehensive eye examination immediately.

~Melissa Barnett, OD, FAAO
California Optometric Association
http://www.eyehelp.org
http://www.coavision.org

The vision problem affecting 1 in 5 school children

Chronic underfunding, overcrowded classrooms, run down schools, and shortage of textbooks and resources are some of the school issues that grab the headlines.

Yet, there’s a problem in our schools that affects an estimated 15-20% of our children and receives virtually no publicity. It’s a problem that is as acute in affluent communities as in the inner city.

The problem is our children’s vision. I’m saddened to report that there are millions of school-aged children in the U.S. who have vision problems that are interfering with their ability to learn. Unfortunately, the vast majority of them, their parents, and their teachers are unaware of the problem.

In too many cases, I have seen these undiagnosed vision problems create a cycle of despair. A child is labeled as a “slow learner,” receives special attention, yet shows little progress if the underlying vision problems are not treated.

Courtesy of MDGovpics on Flickr

Courtesy of MDGovpics on Flickr

In other less severe cases, I have seen problems linger as life-long “nuisances”- hindering the productivity and job satisfaction of successful executives, attorneys, actors, and other professionals.

How is it that so many of these problems can go undetected? There are three main reasons:

  1. Inadequate vision testing – The typical vision test given at schools (usually administered by the school nurse), and general eye doctors’ offices (that do not specialize in developmental vision) primarily only evaluate distance vision and eye health. Near vision tests, which determine if a child can read a book up-close, are often overlooked. More complex vision skills that are necessary to read effectively, such as eye tracking and teaming, are very rarely tested.
  2. Poor vision skills are “silent” ailments – A child cannot tell if he is seeing clearly because he cannot objectively compare his vision skills with others. By the same token, a parent or teacher cannot assess how a child is seeing because they cannot see through the child’s eyes.

No matter how poor a student’s vision skills, it is all that he or she has known. I have seen extreme cases where a child with double vision has never reported this to her parents because she thought everyone saw like this. Consequently, it is especially important that parents and teachers are aware of the behavioral signs that indicate a possible vision problem.

Signs of vision problems include:

  • School or sports performance below potential
  • Resistance to school work and homework
  • Slow reader or test taker
  • Clumsy catching a ball
  • Words go in and out of focus
  • Rubs eyes while reading
  • Covers an eye while reading
  • Uses finger to keep place reading after the 2nd grade
  • Moves reading material closer or further away to see it better
  • Short attention span on visual activities
  • Poor penmanship, doesn’t stay on the line
  1. Lack of public awareness-
    • The fact that proper vision is the learned mastery of variety of skills is not widely understood. Most people assume that visual skills naturally develop, when in fact, for approximately 20% of people these skills do not develop fully by themselves.
    • Fortunately, most people with these vision problems can be helped through a program of Vision training. A Vision training (VT) program builds and enhances deficient visual motor and perceptual skills step by step.

I am hoping that we will reach a time when poor vision skills are eliminated as a reason why many of our children are not performing to their potential in school and sports. This begins with one child at a time, and one developmental vision exam  at a time.

~Elise Brisco, OD

California Optometric Association

http://www.coavision.org

It’s just the FACTS: Vision & Learning Go Hand in Hand

August has been recognized as the Vision & Learning month.  It would seem appropriate since many children return to school in August or shortly thereafter.  In addition to getting new clothes and supplies for our kids, this yearly routine should spur us to take our children in for a comprehensive eye and vision examination.

Vision is a highly complex and intricate process.  So, it is not surprising that reading and learning is dependent on not only having excellent 20/20 vision, but also accurate eye movement, eye focusing, eye teaming, and visual motor skills.

It’s just the plain ole fact that there is a direct correlation between vision and learning.

Courtesy of woodleywonderworks on Flickr

Courtesy of woodleywonderworks on Flickr

Did you know that…

  • “25% of students in grades K-6 have visual problems that are serious enough to impede learning.” – American Public Health Association
  • Approximately “80% of children with a learning disability have an  undiagnosed vision problem.”– Vision Council of America
  • “1 in 4 children has an undiagnosed vision problem which can interfere with learning and lead to academic and/or behavioral problems.”  – College of Optometrists in Vision Development
  • Studies show that “children who had visual perceptual and eye movement difficulties did poorly on standardized tests.” – Dr. Lynn Hellerstein, FAAO, FCOVD, Past President of COVD
  • “When vision problems go undetected, children almost invariably have  trouble reading and doing their schoolwork.  They often a display fatigue, fidgeting and frustrations in the classroom – traits that can lead to a misdiagnosis of dyslexia or other learning disabilities.” – American Optometric Association
  • A “child with a vision based learning problem has excellent verbal skills, causing parent and educators to think the child must be lazy, have ADD/ADHD, or is learning disabled.”
    – College of Optometrists in Vision Development

A cursory vision screening is just not enough to detect vision-related learning difficulties.  Early prevention of a child’s vision problem is so important for school readiness, learning and academic success.  So make it an integral part of your child’s back-to-school preparations.  Buy school supplies, outfit your child with new clothes, and most important, take your child to see a doctor of optometry for a thorough eye and vision examination.

~Judy Tong, OD, FAAO

(Special thanks to my colleagues Drs. Carmen Barnhardt, Eric Borsting, Ray Chu, and Rebekah Louie.)

Getting children ready to go back to school

Summer seems to have just started, but the new school year is only a month away. Many of us get ready for this time by making sure our kids have the right clothes, books and school supplies to start the year off right, but we forget to make sure that our kid’s eyes are working well so that learning in school is easy, comfortable, and fun!

The back to school season is a great time to schedule your child’s eye health and vision exam. Optometrists are able to make sure that not only is your child seeing as clear  as possible, but that all of their other visual skills are working properly to handle the demands of the new school year.

"Reading is Fun" Photo Courtesy of John-Morgan on Flickr

“Reading is Fun” Photo Courtesy of John-Morgan on Flickr

The following are some of the important visual skills necessary for learning in the classroom:

  • Visual acuity — The ability to see clearly at any distance. Seeing 20/20 is only one portion of all of the visual skills necessary for classroom success, but sometimes the only area that is assessed by typical “vision screenings.”
  • Eye Tracking — The ability to follow with the eyes a slow moving object such as the teacher moving around the front of the classroom and the ability for the eyes to follow along a line of print while reading without skipping or re-reading
  • Focusing Flexibility- the eyes ability to maintain focus on objects in the distance and at near as well as shift focus quickly from point to point.
  • Eye teaming — The skill needed to aim both eyes together at the same time.  This is a needed skill for lining the eyes up while reading across of page of print and also to have the very high level of depth perception needed for sports.
  • Eye-hand coordination — The skill needed to coordinate the visual system and the motor system when writing, copying, or playing sports.
  • Visual perception — The skill needed to sort, understand and remember information that is coming into the visual system.

Making sure all of these areas are working at the highest level will help ensure that your child has a successful school year.

~By Lisa Weiss, OD, FAAO

Vision therapy to improve academic & athletic performance

Image

Vision therapy (VT) is a high effective type of physical and perceptual therapy that works on improving eye muscle control and coordination, eye-hand and eye-body coordination, as well as visual processing/understanding and visual cognitive skills.

Seeing takes place in the brain instead of the eyes. The eyes are the instruments which transmit visual images to the brain. The brain then processes and integrates visual information with other systems such as the vestibular system to affect balance and spatial localization, as well as affecting understanding of what is seen or read. VT uses neuroplasticity to improve visual functioning and the activities that require vision.

When most people think of good vision, they think of seeing clearly– that is, having 20/20 vision. While seeing clearly is important, it is only one aspect of vision.

Having good vision involves much more than seeing 20/20. Being a good reader, a good driver, or a good athlete requires mastering a complex set of vision skills, such as eye tracking, eye teaming, visual perception and visual memory. Unfortunately, many children and adults have problems with these types of visual skills. Although they may see 20/20, they do not have good vision. They may have trouble reading or working on a computer. They may have difficulty driving or excelling in sports.

It is estimated that as many as 20 percent of people may suffer from these types of problems. Please click here to see if you may have a treatable vision problem that is interfering with your work, reading or sports performance.

Vision therapy can treat many problems including:

  • Strabismus
  • Amblyopia
  • Visually-related learning problems
  • Visual Impairment after Brain Injury (such as stroke, craniotomy)
  • Double vision
  • Sports Vision – to enhance athletic performance through faster and more accurate visual motor skills
  • Computer Vision Syndrome (headaches, eyestrain, decreased productivity)

Here are the most frequently asked questions about VT:

1. How do I know that I may need VT?

A: There are many symptoms that indicate a need for VT. Some of the more common symptoms are: eyestrain associated with reading or computer use, not performing to potential at school or work, poor eye-hand coordination with sports or handwriting, double vision, print that appears to “move” on the page, and losing your place while reading.

Special tests will determine if your specific vision problems can be treated with VT.

If you have two or more of the following symptoms, you can benefit from VT. It takes energy to compensate for a vision problem, which results in discomfort and loss of productivity. Improving your visual skills can improve your academic, athletic and executive performance.

  • My eyes feel tired or uncomfortable while reading
  • Headaches while reading or studying
  • Reading or computer use makes me sleepy
  • I, or my child, is not performing to my potential in school or work
  • I have difficulty remembering what I have read
  • Frequent loss of concentration while reading
  • Words move, jump, or appear to “swim”
  • Double vision
  • I am a slow reader
  • “Pulling” sensation around eyes while reading
  • Words blur, or go in and out of focus
  • I often lose my place, or jump over letters & words
  • I often re-read the same line over and over
  • I do not like to read for pleasure
  • I have a short attention span while reading compared to other activities
  • I have poor eye-hand coordination while playing sports
  • I have poor depth perception
  • I learn better visually than verbally
  •  I get dizzy reading in the car
  • I have difficulty judging distances such as parallel parking or stopping a car
  • I have difficulty making visual judgments such as the depth of stairs, pouring coffee into a cup

2. What is involved with vision therapy?

A: A vision therapy program incorporates many different exercises that train deficient visual skills. Learning visual skills is like learning to play the piano, or a new sport. VT exercises are performed in our office under the supervision of a vision therapist. We also prescribe home therapy to reinforce and accelerate the development of newly learned skills.

The length of the VT program depends on the nature and severity of your vision problem.

3. What results can I expect?

A: You can expect your vision to improve significantly or completely if you stick to the program as prescribed by the doctor. The amount of your improvement depends on the type of vision problem(s) you have, how well you follow doctor’s orders and how regularly you practice your vision exercises.

4. Will my insurance cover vision therapy?

A: Few insurance plans cover VT, but it depends on your particular insurance coverage. The California Optometric Association has several doctors who specialize in vision therapy who would be happy to help you determine if you have any allowance for vision therapy.

5. What kind of vision problems can be treated with vision therapy?

VT can treat a variety of vision problems including:

  • Strabismus (eye turn)
  • Amblyopia (lazy eye)
  • Oculomotor dysfunction
  • Focusing problems
  • Double vision
  • Convergence insufficiency or excess

Visually-related learning problems

Visual motor or visual perceptual problems can interfere with the input and processing of visual information. This decreases a student’s performance on reading and writing tasks, which are highly dependent on visual skills (see symptom checklist below).

Visual motor problems can occur in these skills: tracking, eye teaming, or focusing.

Visual perceptual delays can occur in: visual-motor integration, visual memory or sequential memory, visual discrimination, visual figure ground, visual form constancy, or speed of visual processing.

Sports performance enhancement therapy

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Photo courtesy of DeusXFlorida on Flickr.com

VT can be used to improve athletic performance through increasing visual accuracy, speed of visual reaction time, depth perception, tracking speed (to follow a target quickly), increasing the span of recognition, and improving eye-hand and eye-body coordination.

Enhancing Executive Performance

VT can be used to improve work productivity by increasing visual stamina, decreasing symptoms such as eyestrain or headaches associated with desk or computer work, improving speed of scanning and reading.

Visual Rehabilitation after Brain Injury

80 percent of the brain is related to visual function; therefore, after an injury to the brain (such as stroke, craniotomy, aneurysm or trauma) visual skills and activities dependent on visual skills (such as walking and driving) are often impaired. VT can be used to train the non-damaged part of the brain to do what the damaged part used to do.

Symptoms of brain injury-related visual impairment include double vision, poor judgment of distance while driving or reaching for objects, hemianopsia or loss of side vision, frequent loss of place while reading, skipping words, sensitivity to light, vertigo, fluctuating vision, bumping into objects, decreased depth perception, leaning to one side, and eyestrain.

Please refer to the section on Brain Injuries for more information.

6. Can Adults benefit from VT?

A: Vision therapy benefits adults. In fact, Dr. Brisco went through VT as an adult, and it has tremendously contributed to her improved reading speed and comprehension, as well as her tennis game!

Vision problems that were not corrected during childhood often persist through adulthood, thus interfering with efficiency and productivity on visual tasks. The majority of vision problems are treatable at any age, but it is better to catch problems early to maximize your potential during your academic and executive career.

~By Elise Brisco, OD, FCOVD, FAAO