ADD/ADHD

Approximately 11% of school-aged children have been diagnosed with attention deficit/hyperactivity disorder (ADHD), according to recent studies. The central symptoms of ADHD — difficulty sustaining attention, poor control of behavior, hyperactivity — make it difficult for children to succeed in school. Additionally, parents of kids with ADHD may become frustrated with their behavioral outbursts and difficulty following instructions.

Although the primary treatment for ADHD is stimulant medications such as Adderall or Ritalin, these drugs may not address other problems associated with the disorder. Vision problems are common among kids with ADHD, making it important to receive a comprehensive eye exam and individualized treatment recommendations.

Impact of ADHD on Vision

Scientific research suggests that people with ADHD have a higher rate of vision problems compared to those without ADHD. For example, a vision disorder called convergence insufficiency appears much more often in those diagnosed with ADHD. Vision problems may exacerbate symptoms of ADHD; alternatively, common vision problems may lead to behavioral symptoms that are misdiagnosed as ADHD.

Some of the most common vision-related problems seen in people with ADHD include:

  • Problems focusing on nearby objects
  • Headaches or eyestrain when reading or doing close work
  • Loss of place when reading text
  • Feeling as though words “swim” on the page
  • Difficulty concentrating on reading or other close tasks
  • Tiredness or distractibility during reading

Vision Therapy for ADHD

Because of the relatively high number of people with ADHD who also suffer from vision problems, it’s important to get an accurate diagnosis. A comprehensive eye exam can uncover difficulties with focusing, eye movements, or ability to the eyes to work together. In many cases, vision therapy is recommended as a first-line treatment.

Vision therapy involves 30 to 60 minute sessions with a vision specialist; sessions often occur once or twice per week. During vision therapy, you will be asked to perform a number of exercises designed to retrain your eyes. This might include looking through prisms, tracking objects with the eyes, focusing on close-up objects, or practicing other visual tasks. Vision therapists often assign homework, allowing you to practice your skills every day.

For kids with an ADHD diagnosis and associated vision problems, vision therapy may significantly decrease symptoms of inattention, distractibility, fidgeting, or behavioral outbursts, leading to great improvements in quality of life.

Dyslexia

Dyslexia

When a child has difficulty reading due to problems recognizing speech sounds and learning how they connect to words and letters, the condition is known as dyslexia, a learning disorder caused by genetic traits that disturb how the brain works. It affects areas of the brain dealing with language and inhibits one’s ability to translate words and written letters into speech.

Dyslexia commonly occurs in children, although it may go undiagnosed for years and not recognized until adulthood. Symptoms may be hard to spot prior to the child attending school, but it is not impossible. Early warning signs include:

  • Challenges playing rhyming games or learning nursery rhymes
  • Talking later than what is considered normal
  • Learning new words at a slow pace

How Dyslexia Can Affect Cognitive Processes

Once a child begins school, his or her teacher may be the first to recognize the signs of dyslexia, particularly when he or she begins to learn how to read. This may come in the form of the child:

  • Having trouble comprehending instructions
  • Struggling to process and grasp what is heard
  • Having difficulty remembering sequences
  • Reading well below the level expected for their age
  • Having problems spelling and seeing likenesses/distinctions in words and letters
  • Failing to sound out the pronunciation of a word he or she is unaccustomed to

If dyslexia is not recognized by the time the child has reached adolescence or adulthood, he or she may have:

  • Challenges with time management
  • Trouble reading, even aloud
  • Problems summing up a story
  • Difficulty understanding expressions or jokes with a meaning not easily understood from the idioms
  • Obstacles with memorization and math problems

When diagnosing dyslexia, a doctor will request a variety of tests and look at a number of factors, including vision. Learning is achieved via intricate and interconnected processes, one of which is vision. Concluding the relationship between vision and learning requires assessing vision acuity (clarity of sight) and eye health, among other things. Having a vision test can assist with determining whether another disorder is the cause or adding to the child’s reading disability.

How Do You Treat Dyslexia?

If vision is the source or part of a learning-related vision problem, the optometrist’s goal will be to provide treatment necessary to improve visual function and reduce associated symptoms and signs. This may include prisms, eye drops, lenses, vision therapy or other visual aids.

It should be noted that while some proponents of vision therapy contend that it is an absolute treatment for dyslexia, professional optometric associations state that vision therapy does not directly treat dyslexia and other learning disabilities. Rather, vision therapy can be used to improve visual processing and visual competence, which then allows the child to be more receptive to education instruction. Therefore, vision therapy should be used in conjunction with other multidisciplinary approaches, such as tutoring and a specialized education program.

Vision therapy may include, but is not limited to, the following activities:

  • Looking through prisms
  • Donning an eye patch during a portion of the therapy session
  • Performing letter-finding puzzles
  • Putting tinted plastic over reading material, or wearing tinted glasses while reading material
  • Eye exercises

Each session takes about an hour and is done up to twice a week. Depending on the condition and how the child progresses, this therapy may be needed for three months to a year.

Crossed Eyes

Crossed eyes, also known as strabismus, refer to a condition in which both eyes do not look at the same place at the same time. Often times they both turn in, but may also turn out.

What Causes Crossed Eyes?

The six muscles attached to each eye, which control how it moves, receive signals from the brain. These signals direct the eye’s movements. In normal circumstances, the eyes work in an organized fashion so that both point in the same direction at the same time. With crossed eyes, however, the muscles around the eyes do not work together because some are weaker than others. This causes the eyes to turn inward or in the opposite direction of each other.

It is important to have proper eye alignment. Misalignment can cause:

  • Double vision
  • Poor depth perception
  • Poor vision in the turned eye
  • Confusion

When the eyes are askew, the brain receives mixed images from each eye. In the beginning, the person may suffer from double vision and misperception. Over time, the brain becomes trained to ignore the image it receives from the weaker eye. But, if left untreated, the person may permanently lose vision in the weaker eye.

Risk factors for crossed eyes include family history, a considerable amount of uncorrected farsightedness and medical conditions like stroke, head injury, Down syndrome and cerebral palsy.

Though crossed eyes can develop in older children and adults, it typically develops in infants and young children by the age of three. Though babies are commonly affected, some experience a condition called false strabismus or pseudostrabismus, in which their eyes may appear misaligned, but they in fact are aiming at the same direction. This appearance of crossed eyes can be due to having excess skin over the inner corner of the eyes, or a wide bridge of the nose. As the child’face grows, the appearance of crossed eyes diminishes.

Ways to Treat Crossed Eyes

If the child does truly have crossed eyes, it is vital that he or she get treated. While some believe that the condition can be outgrown, it cannot. Crossed eyes can worsen without treatment. If you are the parent of a child who is older than four months and notice that his or her eyes do not appear to be straight at all times, an examination is in order.

In order to diagnose crossed eyes, a comprehensive eye exam will be performed, and it will concentrate on how the eyes focus and move. This may consist of:

  • Visual acuity – reading letters on near and distance reading charts in order to measure and evaluate the degree to which vision is impacted
  • A review of the patient’s family history
  • Refraction – an instrument known as a phoropter is used to conclude the right lens power needed to rectify refractive errors like astigmatism, nearsightedness and farsightedness. During the test, a series of lenses are placed in front of the patient’s eyes while a handheld lighted instrument (retinoscope) gauges how they focus light.
  • Focusing and alignment testing to determine how well your eyes move, focus and work in unison.
  • An eye health examination to observe the internal and external structures of the eyes.

The information rendered from these tests will allow your optometrist to develop a treatment plan, which can involve prisms, vision therapy, eyeglasses or eye muscle surgery. If the condition is found and treated early, it can often be corrected with excellent outcomes.

Autism

Symptoms and Problems Caused By Autism

Autism is a neurological disorder in which the person has difficulty processing and reacting to information received from their senses. The individual also has trouble communicating and interacting socially.

Signs of autism include:

  • Lack of shared social interaction
  • Postponement in development
  • Untimely response to sensory information

As a result of the condition, autistic people commonly have visual problems, including:

  • Lack of eye contact
  • Gazing at spinning objects or light
  • Short-lived peripheral glances
  • Side viewing
  • Difficulty using visual information efficiently
  • Trouble staying visually focused
  • Eye movement disorders
  • Crossed eyes
  • Problems with motor skills and depth perception
  • Troubles with eye-hand coordination
  • Sensitivity to light

In addition to the above complications, there are often challenges with coordinating central and peripheral vision. So, for instance, if asked to track an object with their eyes, an autistic person generally will not look directly at the target. Rather, they will glance over or look off to the side of the object. On the other hand, individuals may disregard peripheral vision all together and stay fixated on a specific spot for extended periods of time.

The inability to merge both peripheral and central vision can result in problems processing and incorporating visual information. And when visual processing is inhibited, motor, speech, mental and perceptual capabilities could be impacted.

Testing for Autism

Many times, autistic people are visually or tactually defensive. As it specifically relates to vision, this means that the person tends to continuously scan visual information as a way of trying to process its meaning.

A primary care physician will and can diagnose autism, but an optometrist can evaluate vision and perform tests that examine the individual’s visual abilities. Tests usually consist of having the person perform actions—like sitting, standing, walking and throwing a ball—while wearing specialized lenses and/or yoked prisms. By doing this, the optometrist is able to inspect their postural adaptations and how they see and react to visual stimulation.

Once information from the tests is gathered, the specialist can prescribe lenses to help with astigmatism, farsightedness or nearsightedness. Vision therapy may also be recommended and can be used to encourage visual stimulation, eye movement and awakening of the central visual system. All forms of treatment are intended to help autistic individuals establish visual space, increase peripheral stability, improve central vision, have better eye coordination and enhance how the person processes visual information.

A follow-up examination will likely be scheduled every three to five weeks to evaluate progress.

Lazy Eye

Lazy eye, also referred to as amblyopia, is a condition that develops in infancy or early childhood, and it typically starts when the focus in one eye is more enhanced than the other. The eye with less focus might be impaired due to a significant amount of farsightedness or astigmatism, or something could be obstructing light from getting through like a cataract or debris in the back of the eye. Amblyopia may also develop due to an ocular misalignment known as strabismus, in which one eye turns inward or outward, keeping the eyes from focusing together on an object. This can cause double vision.

How Lazy Eye Effects Your Vision

In all of these cases, the brain receives two different images—be it one blurry and one sharp visual of the same object, or two completely different visuals. In order to compensate, the brain, over time, learns to ignore the image it receives from the impaired or deviated eye, causing vision in that eye to weaken to the point of permanent visual deficiency.

A complete eye exam is recommended for all children between the ages 3 and 5. However, if your child is younger and you have a family history of amblyopia, or notice that his or her eye wanders inward or outward, or if the eyes do not appear to work in unison, it is important that you seek out an opthalmologist or optometrist sooner.

A lazy eye can be corrected and vision can be gained with eye patches, eye drops, prisms, contact lenses, glasses, surgery, or vision therapy if a diagnosis is made early and treatment is administered. Amblyopia is more challenging to treat after the child has passed the age of 7 or 9.

To determine whether your child has lazy eye, a complete eye exam will be needed. The child’s optometrist will look for a wandering eye and assess the vision of both eyes, looking specifically for poor vision in one or both. Tests may include:

  • Looking for cataracts or debris behind the eye(s) using a lighted magnifying device
  • Photo screening
  • Remote autorefraction
  • Putting a patch over each eye and having the child look at picture or letters
  • Examining the eyes’ ability to gaze, fixate on and follow a moving object

Treatment for Lazy Eye

Regarding treatment, the first step may be to rectify any underlying problems in the “bad” eye before applying a patch over the normal functioning eye. While the child will have difficulty seeing with only the weaker eye at first, vision will eventually improve as the brain is forced to use it. This can take weeks or months.

If the child’s amblyopia is mild, the optometrist might solely recommend using atropine in the functioning eye, rather than wearing a patch. The eye drop helps dilate the pupil and blurs the vision in the normal working eye, which causes the malfunctioning eye to do most of the heavy lifting, figuratively speaking.

Many children with a lazy eye will also need glasses or contact lenses to assist with focusing. Should the child have a cataract or debris behind the eye that is blocking light from getting in, surgery may be needed to remove the blockage. Surgery or visual therapy may also be needed if strabismus is present and severe. Operating on the muscles of the eye, or performing certain eye exercises, will allow the eyes to move together.

Stress and Vision

Did you know that your eyes are an extension of your brain? There are six muscles connected to each eye, and they receive signals from the brain. These signals direct the eyes movements and, thus, control their ability to focus. When you are stressed, your brain goes through a number of changes and signals some of your body’s glands to release hormones in an attempt to deal with the stressor. With the brain undergoing all of these alterations, the eyes may become impacted as a result of their connection.

When you suffer from stress, adrenaline is pumped through the body at great speeds. This causes the pupils to dilate, which increases the amount of light that enters the eyes and allows us to better analyze the situation at hand, as well as make rapid decisions. However, if too much light enters during a moment of stress, or if you go through repeat states of stress and light penetrates the eyes, the following can occur:

  • Poor vision
  • Light sensitivity
  • Eye aches and strain
  • Blurriness
  • Eye twitching
  • Eye floaters
  • Tunnel vision
  • Headaches

These symptoms may also develop due to the muscles in the face tightening and blood vessels in the eyes constricting, which are other ways the body reacts to stress. These eye conditions should only be temporary and last no more than one hour.

It is important to note that all of the ways stress affects the eyes are the direct result of adrenaline flooding through the body. When the flood stops, the aforementioned eye complications should stop. Therefore, it is recommended that you attempt to relieve stress in the moment and control it by:

  • Closing your eyes
  • Taking deep breaths and/or meditating
  • Finding a distraction to take your mind off of the stressor
  • Exercising (e.g. walking or running)

If after one hour—and after trying these stress reduction techniques—the problems persist, see an optometrist. He or she can perform a number of vision tests to determine whether there is a non-stress related cause. If stress is simply the cause, tinted prescription lenses or other visual aids can be offered.

Oftentimes people with long-term anxiety and stress experience hypersensitivity to light and eyestrain, especially during the day when light is at its greatest. Any slight movement can cause visual disturbance and, over time, the strain put on the eyes can lead to muscular tension and tension headaches. Wearing tinted lenses can help with light sensitivity and ease eye strain, as well as minimize head pain.

Wandering Eye

A wandering eye is a type of eye condition known as strabismus or tropia, and it may be caused by damage to the retina or muscles that control the eye, stroke or brain injury, or an uncorrected refractive error like farsightedness. With a wandering eye, one eye deviates or wanders in a different direction when looking at an object.

What Causes a Wandering Eye?

The eyes contain muscles to which they are attached to, and these muscles receive signals from the brain that direct eye movement. Normally, the eyes work together so that they focus in the same direction at the same time. However, with a wandering eye, there is poor eye muscle control and one eye turns away from the object that the person is attempting to hone in on—either up, down, in or out. The eye that turns may do so all the time, or it may only do so at certain times, such as when the person is fatigued, sick or has overworked the eyes as a result of prolonged reading or staring at a computer. There are other cases where the eyes may alternate turning.

Because the eyes are misaligned, the brain receives a different image from each eye. While the brain will learn to ignore the image it gets from the wandering eye, if left untreated, lazy eye or amblyopia can present. This is characterized by a permanent reduction of vision in the traveling eye, and can lead to poor depth perception.

A wandering eye can be classified by the direction the eye turns:

  • Inward (esotropia)
  • Outward (exotropia)
  • Downward (hypotropia)
  • Upward (hypertropia)

It may also be classified in other ways:

  • Alternating (the eye that turns alternates from left to right)
  • Unilateral (always involves the same eye)
  • Constant or intermittent (the regularity with which it occurs)

Testing and Treatment

To determine the classification, and in order to develop a treatment plan for a wandering eye, an optometrist will look at a number of factors to understand the cause of the condition, as well as how the eyes move and focus. This may include:

  • Looking at the patient’s family history
  • Reviewing the patient’s medical history
  • Observing the external and internal structures of the turned eye
  • Refraction – a string of lenses are put in front of the patient’s eyes and a handheld instrument with a light source is waved pass. This is done to gauge how the eyes focus and can conclude the lens power needed to correct refractive errors like nearsightedness, astigmatism and farsightedness.
  • Visual acuity – reading letters on distance or near reading charts to measure and estimate the amount of visual impairment
  • Focusing and alignment testing to determine how well your eyes move, focus and work together.

Information gathered from these assessments will help your optometrist devise a treatment plan, which could consist of vision therapy, eyeglasses, prism or eye muscle surgery. If treated early, a wandering eye can be corrected and vision can be restored.

Reading and Writing

For many adults, reading and writing come so naturally that they seem almost effortless. However, reading and writing are actually complicated skills that take significant effort to learn. For example, reading involves recognizing letters, associating letter combinations with their corresponding sounds, blending sounds together, identifying words, and connecting words to their meanings. Vision problems can interfere with several portions of this process, resulting in significant reading or writing deficits that may be diagnosed as learning disabilities.

Symptoms of Reading and Writing Difficulty

There are many reasons that kids might experience difficulty with reading or writing, but it is important to rule out vision impairment. Common symptoms of vision-related reading and writing problems include:

  • Reporting that words appear blurry or shimmer on the page
  • Words “swimming” or switching locations
  • Low attention span for reading and writing tasks
  • Behavioral outbursts when asked to read or write
  • Eye strain
  • Headaches after short periods of reading or writing
  • Poor grades in reading and English classes
  • Making spelling errors
  • Problems recalling the sequence of letters or numbers

Common Vision Problems Affecting Reading and Writing

Several vision disorders can negatively impact reading and writing, including the following:

  • Refractive disorders. Farsightedness, nearsightedness, and astigmatism lead to poor visual acuity. This may make it difficult to clearly see written words.
  • Convergence insufficiency. Convergence insufficiency is a function vision problem in which the two eyes do not stay aligned, particularly when doing close work.
  • Eye movement disorders. Effective reading and writing require smooth, synchronized eye movements. Problems with the eye muscles or execution of these eye movements may significantly impair reading and writing abilities.
  • Accommodative dysfunction. If the eyes do not focus accurately, words may appear blurred or may seem to move on the page. While children may be able to focus well when concentrating hard, this often leads to eye strain.

Vision Therapy for Reading and Writing Problems

Vision therapy offers an opportunity to teach the eyes to work more typically. Performed in an eye doctor’s office, vision therapy involves performing special tasks to correct vision disorders. This might include corrective lenses, prism lenses, computer tasks, focusing exercises, or eye movement tasks.

Over time, completing vision therapy exercises retrains the eyes and brain to work together more effectively. Vision therapy can correct many of the problems that lead to reading and writing difficulty, resulting in improved academic performance and better visual attention.