What did my doctor just say? Common terms your eye doctor will use and what they mean

Courtesy of riekhavoc (caughtup?) on Flickr

Courtesy of riekhavoc (caughtup?) on Flickr

Have you ever felt like you were not quite sure what just happened at your optometrist’s office? It is difficult enough to answer the “which is better, one or two?” questions and then at the end of the exam to try and understand the doctor’s explanations with difficult optometry terms without secretly worrying that you might have said something wrong!

Hopefully this blog will help you better understand some of the more common terms we use in our examinations.

1) First of all, most comprehensive exams will include a detailed case history. The doctor will want to know your family medical and ocular (eye) history. Some terms you may hear include the most common eye diseases – cataracts, glaucoma and macular degeneration.

  • Cataract is the term used when the natural lens of your eye becomes cloudy, causing blurred and distorted vision.
  • Glaucoma is the eye disease that causes your eye to have excessively high pressure, which can lead to long-term damage of the nerve in the eye.
  • Macular degeneration is a disease that affects your central or straight ahead vision.

Not only will the optometrist ask you about a family history of any of these conditions, they will also assess your eye health and your possible risk for developing any of them.

2) Next, the optometrist will perform a refraction to get you the best possible glasses or contacts that will correct your vision.

  • A refraction is just the process of determining for each individual what are the best lenses to give you maximum visual clarity and comfort at both distance and near.
  • Myopia – nearsightedness or the ability to see better at near than at far.
  • Hyperopia or farsightedness, really means that it is more difficult to focus at near and at far distances.
  • Astigmatism: this refers to the shape of the front surface of the eye being more football shaped rather than basketball shaped.

3) There are a few terms you might hear specifically in an child’s exam.

  • Pursuits: slow, smooth eye tracking.
  • Saccades: fast reading eye tracking.
  • Accommodation: focusing.
  • Binocularity: the ability of the eyes to work together as a team.

4) Finally, there are some terms regarding glasses that it might help to define.

  • Progressive lenses are the kind of “no line bifocal” that you might hear about on TV. But, unlike a bifocal, where there are two areas of vision, near and far, progressives have an unlimited amount of areas as you look from distance to near in the lens.
  • Transition lenses are the kind that change to dark outside. They undergo an anti-reflective treatment, which eliminates all glare and allows for crisper vision, especially at night.

Hopefully, this quick explanation helps with some of the confusing terms in an eye exam. As for any others, always ask your optometrist to explain something that does not make sense.

~Lisa Weiss, OD, MEd, FCOVD
California Optometric Association
http://www.coavision.org

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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

Vision therapy to improve academic & athletic performance

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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