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