Episode 46: Vision Problems You Never Realized Could Affect Learning – Dr. Valerie Lam

Jill Stowell: Do you have a child who can’t or won’t do schoolwork on their own? Sam was like that. At eight years old, doing homework was a battle of wills and tears at his house every single day because he was so frustrated and reading was so difficult. Then, one day, his mom got him some plain glass glasses. Sam was so excited. He told his mom, “Now, I can be smart.” This is LD Expert Live.

 

[Intro Music]

 

Jill Stowell: In our experience, your kids who resist reading and schoolwork desperately want to be capable, successful students. There are real solutions to reading and learning challenges including dyslexia but plain glass glasses or other accommodations probably aren’t going to do the trick.

 

If we want to permanently change a learning challenge, we have to identify and address the underlying skills that are not supporting the learner well enough. One of those critical areas is visual skills and visual processing.

 

Today, we are going to be talking with Dr. Valerie Lam about vision problems you never realized could affect learning. Welcome to LD Expert Live, your place for answers and solutions for learning disabilities, dyslexia and attention challenges.

 

Did you know that if you have 20/20 vision, it doesn’t necessarily mean that you have the visual skills that you need to succeed in learning? We are going to talk about that and much more today with our guest Dr. Valerie Lam. 

 

Welcome to the LD Expert Podcast, your place for answers and solutions for dyslexia, learning and attention challenges. I’m your host Jill Stowell, Founder of Stowell Learning Centers and author of a brand new book Take the Stone Out of the Shoe: A Must-Have Guide to Understanding, Supporting and Correcting Dyslexia, Learning and Attention Challenges.

 

This book will help you understand why some bright children and teens have more difficulty than expected in school. It provides simple, practical tools for supporting struggling students at home and in the classroom. Most importantly, it presents real solutions and the science behind them.

 

Our guest today is developmental optometrist Dr. Valerie Lam. Dr. Lam is the cofounder of Insight Vision Center in Costa Mesa, California, a private practice dedicated to vision therapy and specialty contact lenses. She and her team of 10 live by their mission statement to give patients a lifetime of healthy vision, so that they love the way they see.

 

Dr. Lam is a fellow of the American Academy of Optometry and a fellow of the College of Optometrists in Vision Development. When she’s not wearing her doctor hat, she enjoys just being a mom and playing bubbles and Play-Doh with her two-year-old and four-year-old daughters. Welcome Dr. Lam!

 

Dr. Valerie Lam: Good morning! Welcome. Thank you for having me on the show.

 

Jill Stowell: Oh, well, I am so delighted to have you on our broadcast today. I think that we are very like-minded in our thinking about reading and learning challenges. If we want to permanently change them, we have to really explore what the root cause of that difficulty is.

 

I think most people believe that if you have 20-20 vision, you’re all set. You have perfect vision. But we have students come to us at our centers who have 20-20 vision but who are still struggling. Can you talk to us a little bit about the vision skills below the surface that students need in order to succeed in learning?

 

Dr. Valerie Lam: Absolutely. And you said it best Jill when you said, you know, they went to their general eye doctor. They sat in the chair. They read the letters on the screen. You know, T, Z, V, E, C, L. Great! The doctor says, “You have 20/20 vision. Your eyes are perfect. You don’t need any glasses. See you next year.” Right?

 

So we do general eye exams as optometrists and the general optometry exam is looking for refractive error which is to say, you know, “Do you need a prescription?” and it’s also just doing a general check of the health and wellness of the eye and as long as those things look good, most of these patients are saying, “OK, great. They’re being passed on.”

 

But what we’re seeing or what we do with our developmental vision exam is we’re saying, “I want to look at those other skills. All the other skills that are required and necessary for a child to succeed in an academic environment.”

 

That’s exactly like you said where we go below the surface and we’re looking at the functional vision skills of what they need to be able to succeed. For example, when you are sitting in a classroom and you’re sitting at your desk and you’re having to copy something from the board. You don’t even realize what your eyes are doing when you’re doing that simple task. So from the medical side, right, we have muscles in our eyes and our muscles work like focusing lenses of a camera, right?

 

So when you take a picture, you can’t – your lens have to adjust to the distance at what you’re looking. So if this student is looking down at the desk, their eyes are having to Zoom in and then when they look up at the board, their eyes have to Zoom out and it’s going in and out, in and out. That muscle is working all the time while the student is learning. If those skills aren’t working properly, the student is going to fall behind and the teacher is not going to know why but the students can be falling behind because it’s really difficult for them to see.

 

So there are several very common skills that we do see in students that do cause learning issues. Is it OK if I share them with you?

 

Jill Stowell: That would be great. Yeah. I think it’s really relevant to our students and our families.

 

Dr. Valerie Lam: Great, yeah. One of the most common conditions that you will hear with vision, it’s called convergence insufficiency really and it’s very common in young students. Actually young and older students as well and it’s the concept that the eyes need to be able to point to what their eyes are focusing on, right?

 

So we have a right eye and we have a left eye, right? And our eyes are actually connected all the way back to our brain and the brain summates what the right eye sees with what the left eye sees and it puts it together in a single picture in the back of our brain called the visual cortex.

 

Now if these pictures line up perfectly, right, we should see a single image. But if our eyes are not pointing exactly at the same direction at exactly the same time, these images will be slightly offset. When they’re slightly offset, you get a symptom called double vision, right? So convergence insufficiency if the eyes are not pointing at exactly the same point when they’re looking at something up close, they can result in intermittent double vision, which means sometimes the words go into two and then they slide back into one and they go back into two and that could be very distracting for a student. It can be very difficult for them to love reading when the print can’t even really stay together on the page.

 

Jill Stowell: Definitely. So you called that convergence insufficiency. I know sometimes the words that are used are really big words that we don’t typically use and so when parents see that, that’s kind of what that is talking about, if their eyes are working – coming together. Is that – now I’m afraid I’m going to say this wrong. That their eyes are coming together at the same point.

 

Dr. Valerie Lam: Yes, yes. You said that excellently. 

 

Jill Stowell: And one of the things they might see if that was a problem was double vision. I think one of the challenges is that sometimes kids don’t even realize it’s not supposed to look like that.

 

Dr. Valerie Lam: Absolutely.

 

Jill Stowell: So what are some of the other skills that are really needed for learning that get in the way of our students learning as easily and as comfortably as they could?

 

Dr. Valerie Lam: Great. So another skill, going back to our first scenario when we talked about a student, being in class and having to copy from the board, right? We talked about that muscle having to focus, right? So in optometry, the official term that we use for that skill is called “accommodation”. But for the general population, you can think of it as the focus of the eyes.

 

So if we have weak accommodation, a weak focus of the eyes, what we will see in our learners is we will see that when they are reading or doing something up close, things tend to go out of focus. It goes blurry on them and what they will do is they will rub their eyes and they will kind of like try to hit their head and say, you know, “I can’t make that clear.”

 

They can look up and kind of things seem out of focus and again they will rub their eyes and say, “I don’t know why I can’t get it clear,” and it might take them a couple of minutes for them to readjust their eyes back to the thing.

 

So when we see this, we definitely see signs of an accommodation issue and again it is a weakness of that muscle to be able to focus their eyes in not only clearly but quickly, right?

 

So we have a spectrum and young kids have the strongest accommodation that you ever can, right? Because your muscles are young, right? And then you know that there becomes an age where everybody will start to need reading glasses and at that age, maybe it’s 40, 50, 60, around that age. It is natural. I tell my patients to say that’s still 100 percent of the population, right? You’re no exception.

 

Jill Stowell: So Dr. Lam, you were talking to us about vision skills that impact learning and you talked about convergence and accommodation. What about tracking? Because that’s one that we hear about a lot and of course it’s important for reading.

 

Dr. Valerie Lam: Absolutely, yes. So we actually get a lot of patients coming into our office saying that their child they suspect has a tracking issue or their teacher has mentioned I think my child has a tracking issue.

 

Tracking is the ability to move your eyes smoothly from left to right as you read along the line of text on a page, right? So when we read, it’s actually inefficient to look at every single word independently. Our eyes are not supposed to do that when we read. We’re actually supposed to have fixations of four to six words at a time. That’s a more efficient way that we read.

 

We also have one other skill where when we get to the end of a line, end of a line of text, our eyes make what we call a return sweep where our eyes jump back to the beginning of the second one, right? And what’s very common is they don’t jump to the second line. They jump to the third or fourth line and then as you can guess, reading comprehension goes down because they’re saying, “These words don’t make sense.” So we see commonly a lot of tracking issues whereas students are having trouble reading smoothly and they’re skipping over words or skipping lines when they read.

 

Jill Stowell: So that all fits under that umbrella of tracking where they’re having to go back to the beginning of the next line.

 

Dr. Valerie Lam: Yes, yes. So as we said before, right, the eye and the vision system is like a muscle system. We have six muscles that surround each eye and that helps the eyes to move smoothly, right? So what we do is a lot of times we do training for tracking issues because it’s also coupled with an attention issue, right?

 

They’re having trouble keeping attention and pointing their eyes directly where they want their eyes to go when they’re reading text on a page. So we check for the flexibility of their eyes, their convergence and their divergence. We also check for their accommodation skills that we talked about earlier, the focus of the eyes and the movement of the eyes, the tracking skills that we just spoke about. So those are the three main areas that we check for in the developmental eye examination. 

 

Jill Stowell: Great. When parents call us about their struggling student, they are typically seeing problems with reading or math or schoolwork taking too long and what they don’t realize is that when bright children or adults struggle, it’s almost always because there are underlying skills underneath that reading or underneath that schoolwork that are weak or inefficient and these are skills like memory or auditory processing that are not taught in school but they are assumed to be in place when kids go to school.

 

If any of those underlying processing or learning skills are weak or inefficient, it causes the student to have to compensate, which takes a lot of mental and emotional energy and which can really stress the attention system.

 

I would love for you to talk a little bit about visual processing because it’s one of those underlying skills that is connected with reading and comprehension and planning and organizing and just so many other things.

 

Dr. Valerie Lam: Excellent and Jill, I think why you and I get along so well is when I came to visit your center, I worked with Lita and she showed me your learning continuum, right? And I just loved it because I said that’s exactly what we need too and you have here on the bottom of your continuum, it said the core learning skills, right? And that’s where we have to have the basic foundation in order to be able to learn first.

 

Your second level on your continuum is called the processing skills and so we are very big advocates in in believing in visual processing as one of the processing skills that are so necessary to have higher order learning.

 

So as far as what we’re looking at, there are several aspects of visual processing that we focus on. One of them is what we call “visual-spatial” and visual-spatial skills are the ability to know which way things should face, at which direction we should face in space, right? I know a common one that we both see is letter reversals.

 

Jill Stowell: Right.

 

Dr. Valerie Lam: And we know that sometimes students have difficulties knowing which way the Bs and Ds should face and that’s a very common visual processing problem.

 

Another thing that we do see in our students is visual analysis skills such as visual discrimination. So visual discrimination would be kind of like those – remember those lookalike pictures in your Highlights magazines. You know, you have two pictures and there are 10 differences and you have to find the differences between both pictures. That requires a lot of problem solving, right? So that’s discriminating to find differences between the two images.

 

Another one that you will be very familiar with is visual memory, right? Can you look at something and remember what it looks like? And not just what it looks like but if you were to close your eyes, could the student remember all the details, right? Now how is this important for learning? It’s so important, right? Eighty-five percent of what we learn in a classroom is from visual input.

 

So if they’re looking at something, if the teacher or the instructor is presenting something visually and the student cannot comprehend it or be able to retain it and memorize it, that’s going to definitely affect their ability to acquire information.

 

Jill Stowell: Right, and just really understanding the visual organization on a page. You know, we expect kids to be able to use planners but sometimes they look at that and they cannot make sense of how that’s organized, why it looks that way. 

 

Dr. Valerie Lam: Right.

 

Jill Stowell: And another skill, very really a high level visual processing skill is visualization and mental manipulation of those visual images, being able to picture things and kind of mentally manipulate them. Those are high level visual processing skills but they’re really critical to problem-solving. You know, thinking about different options, planning, comprehension and holding on to information.

 

Dr. Valerie Lam: Absolutely. No. When you just said visualization, the first thing that popped into my mind was word problems and math. So I’m married to a math teacher and my husband is a math teacher and we heard so much when school started talking about bringing in Common Core, right?

 

So that really affected math a lot because suddenly math became very conceptual, right? So when you were just explaining visualization, that’s a perfect example of a child having to solve a word problem, a math word problem where there’s a paragraph and that paragraph is building a scenario.

 

You have a person standing here and they’re looking up a hill at a tree on a hill that’s 50 feet high. That’s 60 feet away. What’s the shortest distance to get there, right? And the child is having to visualize this and then manipulate it. Like you said, they have to solve a math problem while being able to visualize what’s going on in their head, right? That requires a lot of visual processing.

 

Jill Stowell: It does and, you know, I just want to put a little caveat in there. If your kids are struggling to do math word problems, you’ve got to be talking about the visual images and what that problem is really all about. I know this is taking us just slightly – a little slight left turn there. But so often, we try to do everything by rote and as soon as we add in the image of what’s really happening, it makes it all make so much more sense. So hugely important skill, that ability to visualize.

 

Dr. Valerie Lam: Right. The last area of visual processing that we didn’t get to chat about yet, that was visual motive, right? So I know that a lot of students or parents come in concerned that their child has really poor handwriting and we say that the eyes guide the hand and what the hand is doing, right?

 

You cannot have nice handwriting without looking at what you’re doing on the page and being able to judge spacing, be able to understand how to recreate. Let’s say they’re drawing a picture, being able to recreate something in the right proportion. All of that is incorporating visual processing and visual motor skills. So that is the last component of visual processing that we really feel is very important especially for a child to succeed in school.

 

Jill Stowell: I had not really heard that term, relieving lenses, but I love that and I would love for you to just mention again what those are, Dr. Lam.

 

Dr. Valerie Lam: We talk about lenses having such a great impact or being very helpful to students when they’re reading. We do prescribe developmental lenses. So developmental lenses are not because the child sees – or has a large prescription and needs those classes necessarily to see clear.

 

I’m near-sighted. If I take my glasses off, I can see nothing in the distance, right? So I put my glasses on because I have to see. So that’s one type of prescription. But the developmental lens is really more of a behavioral lens, right? And it can be a combination of a low plus power, so like a low reading magnification that we give them.

 

It could have a slight tint on it where we put different colored tints to help decrease the fatigue or to help them concentrate better. We could put a slight amount of prism in the lenses and what a prism does is it can make either the words look more stable on the page or could help their eyes to feel less fatigued when they’re reading.

 

So there’s definitely a couple of great tools that we can put in these lenses and when a child puts on a pair of developmental lenses, it’s almost like it just wakes up [0:21:51] [Indiscernible]. It says it’s time to pay attention. It’s time to focus your eyes and really be able to be more attentive to the material that you’re reading or that you’re working on.

 

So that’s the power of developmental lenses that we see. In lieu of COVID and all this virtual learning too, we’ve actually been also recommending blue blocking lenses. So I’m sure – I get a lot of parents asking me, “Should I have my child wear blue blocking protection now that we’re doing so much screentime?” That can also be …

 

Jill Stowell: Great question.

 

Dr. Valerie Lam: … very helpful. Yes. I say, well, when you go outside into the sun, do you put on sunglasses? You know, there are UV rays coming from the sun. There’s also a lot of blue light coming in your eyes from any backlit screen, right? So that can be a computer screen, a cell phone screen, an iPad screen. So this blue light just like if you were outdoors, it’s having some light emissions that’s going to the back of the eye and to the back of the retina.

 

So research is being very proactive to say, you know, we need to be protecting our eyes from any light source and now that we’re all on screen time so much, it’s not a bad idea to also be protecting our eyes from the blue light coming from the screens.

 

Jill Stowell: So they can do that through blue light filters or what are those glasses called? Blue blockers?

 

Dr. Valerie Lam: Yeah. In the layman terms, they’re called blue blockers, right?

 

Jill Stowell: Yeah. 

 

Dr. Valerie Lam: We have a very nice – so when you purchase a pair of glasses, you can put what we call and consider an anti-glare coating on those lenses, right? So they have a customized glare coating that blocks the blue light. So that’s one option when you get a prescribed pair of lenses.

 

Another one I know that they sell online is they have a lot of blue blocking plano glasses, glasses with no prescription in them but it just has that blue blocking filter, right? And I know that you can buy those online.

 

Also computer screens and devices have a blue blocking filter built into their settings. So you can go on into the settings into the display function of your computer and put the blue blocking filter on and that will change the color tone of the screen to decrease the amount of blue light being emitted.

 

Jill Stowell: Which then might help a little bit with the fatigue.

 

Dr. Valerie Lam: Absolutely. Yes. So they’ve been saying that this blue light, it affects the circadian rhythm of our sleep cycle, right? So blue light is typically what we see when it’s daytime, right? So it kind of makes our body more awake.

 

So if you are looking at a computer screen let’s say at 12 o’clock – well, not for your kids. Let’s say 10 o’clock at night, when they should be going to sleep but they’re looking at screentime. The blue light is almost – kind of tricking their brain saying, hey, it’s daytime still.

 

So their brain is actually more active and that can actually affect their ability to be able to fall asleep. So you hear the recommendations of no screentime an hour before bedtime, right? And there’s actually a lot of truth to that because that blue light is messing up our natural daily rhythms of our body and our body knows that when it becomes dark, it’s time to quiet down and get ready to go to bed.

 

Jill Stowell: So there was something that you shared with me and I just want to make sure that we bring this up because I just think it’s the coolest little tool and you called it “20-20-20”. Can you tell us about that?

 

Dr. Valerie Lam: Yes. So we’re in the year of 2020. We say this is the year of optometrists and we have our 20-20-20 rule and so that says every 20 minutes, you should take a break from what you’re doing, whether that’s reading or your devices and you should take a 20-second break to look 20 feet away, right? And 20 feet away is the equivalent in optometry terms of infinity or like distance.

 

So when your eyes are looking in the distance, your eyes are in a more relaxed position. When you’re looking at anything up close or within arm’s distance, your eyes have to work harder to focus in on that subject.

 

So if you take a 20-second break to focus your eyes 20 feet away, you’re resting your eyes, right? We recommend to you to take a visual break every 20 minutes of when you do an activity, whether that’s virtual learning or reading, playing iPad or playing video games. You need that break frequently to rest your eyes and your eyes are not straining.

 

Jill Stowell: That is great. I actually have been doing that and I think it’s really helpful. So keep that in mind, 20-20-20. Everybody gets to relax their eyes just a little bit.

 

Dr. Valerie Lam: Well, thanks for being a role model Jill to all our learners.

 

Jill Stowell: This is LD Expert Live. I’m your host Jill Stowell, founder of Stowell Learning Centers and my guest is Dr. Valerie Lam of Insight Vision Center. If you would like to contact Dr. Lam or Insight Vision Center, you can call or email. Thank you Dr. Lam for being with us today.

Jill Stowell: Dr. Lam was talking about this issue of convergence and then accommodation and so I was thinking about, you know, kids don’t know to say that the page looks funny to them. They just don’t know. That’s how they think it is and so I was thinking about some of the kinds of things that a parent might see that would help them to know that their child – you know, that they should maybe get a developmental eye exam or that their child is struggling because of how it looks on the page.

 

I know that’s something we deal with as well. Are there things that you guys see as you work with students that tell you, wow, I don’t think the page looks the same to them as it does to me?

 

Dr. Valerie Lam: Definitely. I mean we see that a lot of times because of the work that we do with attention challenges, sometimes our students’ behaviors like get chalked up to attention challenges. They’re avoiding reading. They’re avoiding looking at the page. They just kind of glance at words and they guess.

 

So we see a lot of those behaviors and a lot of times it does indicate that the child actually has weak underlying visual skills. So I hear that a lot from teachers that like well, he won’t even look at the page or he’s just guessing. But if your visual skills are not supporting you well, yeah, it’s going to be uncomfortable to look at the board or to look at the page and you’re going to avoid focusing because maybe you do have a convergence problem with your eyes. So it’s going to look like an attention problem. We see that all the time.

 

Jill Stowell: Yeah, we do. And, you know, I think one of the things that’s really important to remember is that behavior has its root in something. So you may have a child who, boy, they are just – you know, they try so hard but they have really low stamina. So they start out really well and then they’re just not able to finish.

 

Well, if they’re working that hard, that inability to finish can be fatigue on many of their systems but right now, I mean definitely could be fatigue on the visual system or, you know, they’re refusing to copy from the board. You know, maybe they are so slow at it because it’s so difficult for them to shift back and forth between looking far at the board and close.

 

That, you know, they don’t want to be embarrassed like that. They don’t want to be the slowest one. Maybe they will just not do it at all. So sometimes the behaviors we see are actually symptoms of something else.

 

Dr. Valerie Lam: We were talking about screentime and how screentime affects learning, right? So for screentime, remember when we were talking about our focusing system, right? So our muscle is having to focus according to the distance at the subject that we’re looking at, right?

 

So if we’re looking at a screen let’s say 16 to 18 inches away from our eyes, our eyes are constantly – our muscles are constantly focused in at that part.

 

Let’s say you’re doing distance learning for two hours without taking a break. Your muscle is so tight after that, that that can actually create – sometimes if you look up and you try to look out the window, it’s hard to see that clear because your muscles are almost like clenched in, right? So we are seeing – as well as the position of the eyes. You’re having to have your eyes in a convergent position for a couple of times.

 

So those two skills coupled together can create a lot of eye fatigue. So what we are seeing visually as a result of distance learning is we are seeing more eye fatigue, more headaches or eye strain. Definitely number one. We actually are getting a little bit more of worry or accommodation issues. They’ve been saying my eyes are seeing a little bit more blurry. We can also see an increase in near-sightedness. So we call that myopia, right?

 

But we know that near-sightedness can be partially environmental of what we’re doing with our eyes if we’re spending so much time on screentime and computer screens. That can actually cause a prescription to change as well.

 

Jill Stowell: Wow, because our eyes are working so hard at that distance for so long.

 

Dr. Valerie Lam: Exactly.

 

Jill Stowell: Wow. Yeah. 

 

Lauren Ma: So symptomatically, would that make a child not want to read or do other activities that involve visual skills that might be straining on the eyes other than screen time? Because we see our kids just preferring screen time all the time. It’s almost like – kind of like a drug. You get a little bit of it and then that’s where they prefer to be all the time.

 

So I’m hearing from a lot of parents right now that like well, ever since we went for remote learning, they’re avoiding reading altogether. They don’t want to do any work like on physical pages.

 

Dr. Valerie Lam: Yes, yes, and you know, I think the computer screen is great for many things. It has better contrast. It has better lighting. It moves. So it’s dynamic. So from the attentional side, right, that’s why I think kids gravitate so much more towards screentime than text on paper.

 

But the thing that screentime is different than text on paper or different than a classroom environment is that our bodies really were not designed to sit behind the screen for eight hours a day. Our bodies were designed to move.

 

We need motor skills. We are dynamic. We have interaction with other people. You’re getting all of that interaction in a classroom environment and visually you’re constantly changing your visual system. You’re looking far. You’re looking out the window. You’re looking at your teacher. You’re looking at your classmate and that movement of your visual system is actually good for your eyes. They say the best thing for your eyes is actually to be outdoors because that’s a more like natural environment for our body. So taking all of that interaction and then condensing it into just screentime and less movement. There’s less body movement, less motor coordination going on. There’s less eye movements going on. I think definitely it is not really how we’re supposed to learn. I think it’s a great tool. I think that technology and virtual learning is an excellent tool. But it’s not where we want to be eight hours a day.

 

Lauren Ma: Right.

 

Jill Stowell: Right, right.

 

Lauren Ma: Certainly not me either. I don’t [0:07:03] [Indiscernible] a day too and I’m exhausted. So that makes a lot of sense. We do have another question and was going to shift a little bit and has a question about – anything you can do if a child complains about floaters in the eyes?

 

Dr. Valerie Lam: Great question.

 

Lauren Ma: OK.

 

Dr. Valerie Lam: OK. So we have an eye. Our eye is actually not hollow. Inside of our eye, it’s filled with a jelly and that jelly is called the vitreous, right? So I always explain to patients. I say the vitreous is like a – it should be like clear gelatin because you are seeing through that jelly in order to be able to see like outside.

 

Now what can happen is sometimes you can get like proteins or it’s almost like you will get clumps in your gelatin, right? And at that point, we will call that a fluid. Now there are many normal fluids. So what you’re seeing actually is when the light comes through the vitreous and it catches maybe that – there’s like a little – you know, what we call like a clump of gelatin, right? Like it goes through that floater. It casts a shadow on the back of the eye and that’s what you see.

 

So commonly they will say, oh, I saw something moving in the corner of my vision and went to look at it. It’s gone. You know, some kids say it looked like a spiderweb or it looked like a little ghost. All of those are normal. OK?

 

So floaters can be natural. You will see them more commonly when you look at blank screens. You look up at the sky and it’s like a blank background and that’s when you will notice them just kind of drifting in your vision. I wouldn’t be too worried about that.

 

Now what you do want to ask for is you want to say, you know, is this floater associated with any bright lights or maybe funny things in your vision that you never saw, like little black bugs, right? And if that is the case, then those things could be a symptom that that floater might be associated with something more dangerous, like a tear in the retina.

 

That’s something you would want to get checked out. So just ask for any additional symptoms. If they say no, it’s just that kind of that shadow and it goes away when I look at it, that sounds like a pretty normal floater to me.

 

Lauren Ma: Allison just asked if a parent suspects that their child has a visual processing issue, she’s just asking for kind of the right course to go. So, you know, does that mean that automatically they need a developmental eye exam or is it something that should be addressed, like the services that we have or we do an assessment with students where we’re looking at visual processing in terms of reading challenges and dyslexia? Jill, certainly you have your answer. Dr. Lam, you might have an opinion as well. We do carefully try to sort that out. If we think that a student needs to come see us or if we need to make a referral, we do that all the time. So Dr. Lam, what do you have to say about that?

 

Dr. Valerie Lam: I actually – I like to let Jill answer first and then I will answer next.

 

Jill Stowell: You know, I think that there is definitely some overlap and it’s some of – you mentioned Dr. Lam, you mentioned the core learning level of our continuum and then moving up into the processing level and honestly, a lot of what I learned – I mean I kind of learned from a lot of different people in the field who were doing the clinical research.

 

But a lot of what I learned in the core level and to some degree in the processing skills level were actually from developmental optometrists. So the field of developmental optometry absolutely overlaps with learning. 

 

So I think people are in pretty good hands with both of us. But I will say Dr. Lam, you had mentioned that we want to be sure – we will have to see if I can say this right but we want to be sure that we don’t look at a child’s learning problem and just attribute everything to the learning disability or the processing problem. But that we really make sure that the issues that we can really impact more easily are dealt with and some of those are those visual skills that you talked about.

 

You know, I think. Do you remember when we had that conversation about that, that we don’t necessarily want to assume that every single thing is related to the learning disability? We have to look at the root causes.

 

Dr. Valerie Lam: Right. So what I think is great and we all take this approach is that any child that is struggling, we know that it’s a team approach. We know that you have to get such a great team of experts to really kind of be on the child’s team and helping them to succeed.

 

So to answer Alison’s question, I would say first get all your senses checked. You know, if you want to get that – is there a health check? You see a pediatrician, right? Is there a vision check? You want to see an eye doctor, a developmental optometrist and make sure those things are – is everything great?

 

You want to get their hearing checked, auditory processing and then when you have your complete picture, you will know which areas you need to focus on and Jill, you and I talked about this. Like the great thing about your center is you guys train a lot of these areas, right? You don’t just train one.

 

I just specialize in vision, right? So I know vision and I know it like the back of my hand. But I need resources like you to help with the rest of these. If I have a learner that is not just struggling with vision but that also needs auditory processing, Stowell Learning Center would be a great place that they could get training on both areas.

 

But we have other students that maybe they just need areas in one section, like they just need vision. But everything else is strong, right? Then that would be appropriate to say maybe they just need vision therapy because that’s just the missing piece of the puzzle that is weaker for them. 

 

So I say Stowell Learning Center is the very global approach. You guys have a lot of great resources at your center and you could test for things. But maybe from my perspective, I would say we’re very specific. So if we know that we’re looking for a visual processing issue, then I know exactly how to test and look for that and so Alison, hopefully that would answer your question as far as which route you should go first.

 

Jill Stowell: And, you know, I remember when I was a special education teacher. I had a student who had learning disabilities. I was a learning disability specialist. He was in my program and he really struggled with reading. But one day, he came in with glasses and his whole world had changed because he could see.

 

I mean he was like in wonder at the world because he could see. So we still had some remediation to do. But what a difference. Everything was so much faster then. So really looking at all the different pieces of the puzzle is important.

 

Lauren Ma: Thank you. We have another question. It’s a good question from Andrea. She did have an independent vision assessment for her son and a convergence insufficiency was found among other deficits and she’s asking for accommodations. They’re going to start vision therapy but what accommodations could she ask from the school once they are back in the classroom? What would be appropriate?

 

Dr. Valerie Lam: Well, first of all, I’m excited for your son. That’s really great. I’m excited that he’s going to start vision therapy. Accommodation. So remember that convergence insufficiency probably is a lot harder at near work right?

 

So things that can help, one easy thing that we usually suggest for our patients is preferential seating, right? So that means allowing them to sit towards the front of the classroom and even that can be a lot easier on your eyes.

 

Another thing that is an easy accommodation to ask for is they would be able to use what’s called a slant board. So a slant board is a board. It usually has some like pegs behind it that can lift it. But they’ve shown that if the reading material is at a 45-degree angle, according to the eyes, so it’s more perpendicular to their gaze instead of lying flat on the table, that’s actually a lot easier on the eyes and vision system and they should have less symptoms.

 

So even being able to prop up his reading or his worksheets at school, that can be a helpful accommodation as well and lastly, I would say if he requires it, if it’s very helpful to him, asking the teacher to roll up the worksheets on the Xerox copy to make it a little bit larger. That can also be a helpful accommodation and I think that’s not too much to ask of the teacher just to see if they can make a little larger copy if that would be helpful for her son.

 

Lauren Ma: Thank you and then we have – I hope I’m pronouncing your name right. Tehelani [0:16:38] [Phonetic] asked that her son wears glasses. He goes to the optometrist but he has also been diagnosed with ADHD and he complains about dizziness when doing schoolwork. So she’s just wanting to find out, is that – do you feel like that could be vision-related or is it something else?

 

Dr. Valerie Lam: Yeah. So I’m not sure from the comment if these glasses are corrective glasses, like he needs them to see clearly or if they were given to him as reading glasses, like developmental lenses to help ease his eyes when he’s reading. It actually has two completely different prescriptions. But if he’s complaining of dizziness, I would definitely get a developmental eye exam done to test for some of these underlying skills, right?

 

Could the dizziness actually be that maybe that’s [0:17:25] [Indiscernible] double or maybe that when he’s converging his eyes, when he’s reading, it’s very strenuous on his eyes and it can make him feel rather dizzy. So that is very like – and another thing. Let’s say when we talk about the tracking issues, right? If he’s getting lost on the page when he’s reading, that could also be construed as dizziness. So definitely I think there is a high chance that some vision issues could be going on with the person.

 

Lauren Ma: OK. And then kind of, well, similar to the same line, Susan asked her seven-year-old was just given glasses. She did not like wearing them. She is a struggling reader. The eye doctor wants to wait for a vision therapy to see if the glasses strengthen her eyes. She’s just wondering if that’s wise to wait or should they get started with vision therapy.

 

Dr. Valerie Lam: Right. So glasses are great. We always underestimate the power of lenses. So in optometry we believe that lenses can have a lot of – just a great effect on the body. However as well, imagine that you’re looking through new eyes when looking through these glasses. So even if it’s the correct prescription, it can feel very different for your child and now you have to remember that when your child first gets a pair of glasses, there are two things they have to get used to.

 

One is that things look different. Two is that they have something sitting on their face that they didn’t like before. So sometimes when we have kids that don’t like wearing their new glasses, we also ask the parents like, “Do you think it’s actually that they’re just not used to having something sit on their face so long?”

 

It's kind of cool and novel at the beginning. They try it on. They say, “Oh, this is fun.” But when they really actually have to start learning [0:19:08] [Indiscernible] it takes a – they’re getting used to the sensory – the new feeling of having something rest on their ears. Maybe resting along their temples and resting on the nose. 

 

So there may be some correlation to the [Inaudible] just getting a feeling of those glasses, in addition to now, how things look. So even though lenses have a lot of power and I do believe that those glasses can be very helpful for her daughter. It may take a little bit of a training period to get used to wearing them.

 

So that’s where vision therapy can also be helpful. Let’s say she starts bringing her glasses to vision therapy and the therapist helps her to teach her how to use those glasses more properly and when to use them. I think that can really help her.

 

So I – so many times, glasses are a part of our treatment. We will do vision therapy with glasses because we feel like they’re complementary.

 

Jill Stowell: But I think it’s really helpful just to recognize that as soon as the child puts glasses on, things look different than they’re used to even if it’s better. It’s different and then the feel of it on their face.

 

As parents and teachers, if we just recognize, “Yeah, it’s a little different, isn’t it?” that is helpful in just validating where the child is and why it might feel a little bit uncomfortable. We don’t always think about that. I mean it’s like oh yeah, just put your glasses on. But I think that’s a great point.