Post on 06-Apr-2017
The A, B, V’s of School Performance:
Academics, Behavior and Vision
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A Professor, Pediatrics/Binocular Vision Illinois Eye Institute/Illinois College of Optometry
Michelle O’BrienVision Therapy Coordinator
Lyons Family Eye CareChicago, Il
The 3 O’s of Vision Care
•Optometrist•Ophthalmologist•Optician
Optometrist• 4 Years of College• 4 Years at an
accredited College of Optometry
• Residency (Optional)• Pass National and
State Boards• Practice
OptometristDx & Tx
• Eye Diseases• Refractive errors• Binocular vision
problems• Vision information
anomalies
Ophthalmologist
• 4 yrs college• 4 yrs medical school• Residency• Boards• Practice• Eye disease & surgery
Optician
• Variable education (on the job)
• Makes glasses• Assists in eyewear
selection• Fits/adjusts glasses
The Optometric Examination
• Case History– Medical– Vision– Vocational– Educational– Recreational
The Optometric Examination
• Visual Acuity– Snellen– Lea Symbols– Broken Wheel– Teller Acuity
Cards– Fix and Follow
The Optometric Examination
• Visual Acuity– Snellen– Lea Symbols– Broken Wheel– Teller Acuity
Cards– Fix and Follow
The Optometric Examination
• Visual Acuity– Snellen– Lea Symbols– Broken Wheel– Teller Acuity
Cards– Fix and Follow
The Optometric Examination
• Visual Acuity– Snellen– Lea Symbols– Broken Wheel– Teller Acuity
Cards– Fix and Follow
The Optometric Examination
• Visual Acuity– Snellen– Lea Symbols– Broken Wheel– Teller Acuity
Cards– Fix and Follow
The Optometric Examination
Muscle Function Tests• Cover test• EOM’s• NPC• Hirschberg• Kappa
The Optometric Examination
Refractive Error
• Myopia• Hyperopia• Astigmatism• Presbyopia
The Optometric Examination
Refractive Error Tests• Subjective
refraction (which is better one or two?)
• Objective refraction (retinoscopy: static, dynamic, cycloplegic,k autorefraction)
The Optometric Examination
Tests of Binocularity• Heterophoria• Fusional vergence• Stereopsis
The Optometric Examination
• Stereopsis/3D
The Optometric Examination
Tests of Accommodation• Positive Relative
Accommodation• Negative Relative
Accommodation• Amplitudes• Facility• Lag of Accommodation
The Optometric Examination
Eye Health• Eye drops• Biomicroscopy• Tonometry• Binocular indirect
ophthalmoscopy• Visual fields
The Optometric Examination
• Assessment or Diagnosis• Plan or Treatment• Patient Education
The Optometric ExaminationAssesses Vision
Pursuits/Saccades
• Oculomotor Dysfunction– Looses place while
reading– Skips words– Confuses words– Reversals– Must re-read often
– Words run together– Slow reader– Avoidance of reading– Uses finger as a guide
while reading
Accommodative Excess/Insufficiency
• Accommodation– Blur– Headaches– Avoidance of
near work– Eyestrain
Convergence/Divergence Insufficiency/Excess
• Binocular Vision Dysfunction– Diplopia– Eyestrain– Avoidance of
near work
Amblyopia/Stabismus
• Amblyopia: reduced vision do to refractive error and/or strabismus
• Strabismus: an eye turn in/out/up/down
Intermittent, constant, monocular, alternating
Vision Information Processing
• Vision perception or Vision development– Laterality &
Directionality• Reversals• Up/down/left/
right
– Non-motor Visual information Processing
• Visual discrimination• Visual memory• Visual spatial relations• Visual form constancy
Vision Information Processing
– Non-motor Visual information Processing• Visual sequential
memory• Visual figure
ground• Visual closure
• Motor VIP– Visual motor
integration– Eye-hand
coordination– Motor
speed/precision
Auditory Information Processing
• Auditory discrimination
• Auditory memory
• Auditory visual integration
Other Tests
• Dyslexia Determination Test
• Slossen Intelligence Test
• Peabody Picture Vocabulary Test
Optometric Vision Therapy/Orthoptics
• Visual motor integration problems• Oculomotor dysfunction• Focusing problems• Binocular vision problems• Learning Related Vision Problems
Optometric Vision Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
“The symptoms of convergence insufficiency (CI) can make it difficult for a student to concentrate on extended reading and overlap with those of ADHD.”
“Some of the symptoms of ADHD overlap those of convergence insufficiency (CI). Comparing the Convergence Insufficiency Symptom Survey... with the DSM-IV criteria for ADHD, we noted that 5 of the 9 symptoms of inattention could also be applied for CI (symptoms 1, 2, 4, 6 and 8 as follows).
Optometric Vision Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
DSM-IV Criteria for ADHD:
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work or other activities.
2. Often has trouble keeping attention on tasks or play activities
... 4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Optometric Vision Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
... 6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
... 8. Is often easily distracted.” “For the diagnosis [of ADHD], a complete medical, optometric and psycho-educational evaluation should be performed and vision or hearing deficits should be ruled out. Underlying visual or hearing problems may cause the child's academic underperformance and/or lack of concentration.”
Optometric Vision Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
“Since the symptoms [of ADHD and convergence insufficiency] can be similar, it is not hard to imagine a diagnostic confusion.”
“We observed in our clinic that an unusual number of children with or suspected to have ADHD also had convergence insufficiency.”
Medication Issues: “...it is possible that the medications used to treat ADHD are aggravating CI. For some of these drugs, difficulties with accommodation and blurring have been reported.”
Optometric Vision Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
“No matter what the true cause or cause and effect relationship, it is unavoidable that the presence of CI may cause (1) misdiagnosis, (2) diagnostic confusion or (3) exacerbation of the symptoms of ADHD.”
“In view of these findings, we believe it reasonable that CI be evaluated in patients with or suspected to have ADHD.”
CI is a condition that responds well to optometric vision therapy treatment...
Optometric Vision Therapy/Orthoptics
These statements were from:
The Relationship between Convergence Insufficiency and ADHDStrabismus 2005 Dec;13(4):163-8.
David B. Granet, MD FACS FAAO FAAP, Cintia F. Gomi MD, Ricardo Ventura, MD, Andrea Miller-Scholte, CO
Optometric Vision Therapy/Orthoptics
Vision Therapy
Phases of TherapyMonocular, Biocular, Binocular, Integration/Stabilization
Websites• http://www.MainosMemos.blogspot.com
– Latest research in children’s vision• http://www.covd.org/
– College of Optometrists in Vision Development• http://www.ico.edu/
– Illinois College of Optometry• http://www.oep.org/
– Optometric Extension Program
Websites
• http://www.opt.indiana.edu/vtlit/vtlit.html– Research articles on vision therapy
• http://www.indiana.edu/~v755/Amblyopia/ambss/sld001.htm– University course on lazy eye (amblyopia)
• http://www.children-special-needs.org/vision_therapy/what_is_vision_therapy.html– What is vision therapy?
Websites• http://www.aoanet.org/ia-op-vis-ther.html
– AOA POSITION STATEMENT ONOPTOMETRIC VISION THERAPY
• http://www.optcom2.com/covd/covd7/page144.html– Article from The Montgomery Journal, Montgomery
County, Maryland on Attention Deficit Disorder (ADD) and Dyslexia
• http://www.vision3d.com/optical/index.shtml#stereogram– 3D Pictures
Websites• Online Vision Therapy/iPad Therapyhttp://www.centerforvisionandlearning.com/
index.php/resources/apps-and-games.html
Websites
• http://www.LyonsFamilyEyeCare.com–Office website
• Illinois Eye Institute–http://www.illinoiseyeinstitute.org/
Lyons Family Eye CareDr. Stephanie LyonsDr. Kelsey FrederickDr. Rachel BarkerDr. Dominick MainoMs. Michelle O’BrienMr. John Lyons
Lyons Family Eye Care
WebsitesNot Vision Therapy Related
Filament Theatre http://www.filamenttheatre.org/
Questions?Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Lyons Family Eye Care3250 N. Lincoln Ave Chicago, Il 60657
773-935-2020 Michelle O’BrienIllinois College of Optometry/Illinois Eye Institute
3241 S. Michigan Ave. Chicago, Il. 60616312-949-7280 dmaino@ico.edu