Welcome to The Bright Eyes Podcast: Advice for Healthy Vision for All Ages. Your hosts are Dr. Nate Bonilla-Warford & Dr. Beth Knighton, residency-trained optometrist that provide eye exams for glasses and contacts, and specialty services including vision therapy, myopia control, orthokeratology, and sports vision training. Their mission to empower patients by providing the best in friendly, professional, and individualized eye care.
In this episode, Dr. Nate talks about vision and learning with Wendy Taylor from Learning Essentials.
Cross posted from the IEP Pro Tips Podcast.
You can listen in the player below or read the transcript. The show is available via Stitcher, iTunes, and the webplayer below. You can find all previous episodes here. If you have any questions or suggestions for future episodes, please email office@BrightEyesTampa.com.
- Episode #12: Betsy Yaros on Vision Therapy and Developing 3D Vision
- Episode #9 – Vivid Vision With James Blaha
- Episode #8 – Vision Therapy with Edna Moore
- Episode #3 – Vision Leads
[00:00:10.040] - Intro
Welcome to The Bright Eyes podcast: advice for healthy vision for all ages. Your host are Dr. Nate Bonilla- Warford and Dr. Beth Knighton, two optometrist who really see "eye to eye". They can help you get perspective of the latest visual scientific evidence for improving your vision and helping you "keep your eye on the ball". We have real facts and (aqueous) humor without making "spectacles of ourselves." And don't worry, the jokes don't get any "cornea".
[00:00:39.150] - Dr. Nate
From Rainy Tampa Bay, Florida. It's The Bright Eyes podcast. You might be able to hear the thunder in the background. This is episode number 17, I'm Dr. Nate Bonilla-Warford, and today's episode is a special one. It is all about vision and learning. This episode is actually being cross posted from the podcast IEP Essentials Pro Tips with Windy Taylor. Wendy is the executive director of Learning Essentials an online resource for parents with a mission to understand and meet the educational needs of each child by creating a playbook for learning.
[00:01:16.870] - Dr. Nate
Learning Essentials incorporates one on one tutoring, interactive brain camps, informative workshops, and creative professional development programs to promote learning success for students. I really enjoyed this conversation. Wendy is very knowledgeable. She's got her Masters in Education and she contacted me via Instagram about being a guest on her wonderful podcast that is packed with information about IEPs special population students, College readiness, and so much more. We talked about how important vision is for learning things parents need to know and about vision therapy. So without further Ado, here is our discussion.
[00:02:05.140] - IEP Essentials Intro
Hello and welcome to IEP Essentials Pro Tips Podcast brought to you by Learning Essentials. Learning Essentials offer special education-based tutoring in your home by state certified educators with advanced degrees in all areas of special education. IEP Essentials Pro Tips Podcast bring professionals together to educate and empower families navigating special education needs in the IEP driver.
[00:02:32.120] - Wendy Taylor
Welcome to IEP Essentials Pro Tips Podcast. I am your host, Wendy Taylor, to follow us on social, you can find us on Instagram at Learning Essentials. Today, we're talking about empowerment through vision with Dr. Nate. Dr. Nate received his doctorate of optometry from Illinois College of Optometry, located in Chicago, Illinois, In 2004. The following year, he completed a residency program specializing in pediatric and binocular vision at the Illinois College of Optometry. During his Optometric internship, he studied development division in Denver, Colorado, in contact lenses and Ocular disease in Chicago, Illinois.
[00:03:17.400] - Wendy Taylor
Owing to his passion for improving the vision of children, Dr. Nate has published articles on such topics as the use of vision therapy to improve reading skills, and has lectured to optometry students and paraprofessionals, as well as the general public on visual care of children, the importance of vision in personal development and options for controlling nearsightedness. Dr. Nate was always smart as a student in Florida public schools but was a slow reader and standardized test were intimidating. He always had to work very hard in high school and at University of Florida, when it came to courses at the Illinois College of Optometry, he failed a class because he could not perform the eye exam techniques. One of his faculty members suspected that the root cause was that he had a functional vision problem. This was identified and treated and passed the course! Dr. Nate fell in love with functional vision and made it his life goal to help as many people of all ages as possible. He now practices in Tampa, Florida, at his practices Bright Eyes, Family vision Care and Bright Eyes kids. Welcome, Dr. Nate, and thank you so much for joining us.
[00:04:30.760] - Dr. Nate
Thank you, Wendy. I'm really honored to be invited, and I'm excited about our conversation.
[00:04:37.280] - Wendy Taylor
Absolutely. Let's dive right in. So can you just tell me what is vision therapy? There's a lot out there on the topic, but I would love to hear from an expert such as yourself of what vision therapy is, right.
[00:04:49.820] - Dr. Nate
So vision therapy is a little bit of a catch all term for anything that we can do as professionals to help empower patients to take control of their own visual system. So it's basically kind of like being an eye coach where we teach children of all different abilities how to increase their awareness of visual perception, how to increase their fine motor visual skill, how to basically use their eyes better to improve their quality of life and meet their goals. And sometimes that is more centered around at academic success.
[00:05:37.520] - Dr. Nate
Sometimes it's more centered around their quality of life and comfort if they're either having headaches or other vision and type related problems, or sometimes it's more to do with sports, competitiveness and achievement. So it's a series of activities that are individualized and programmed to help individuals meet their goals.
[00:06:02.290] - Wendy Taylor
Does it involve more the physical or a cognitive approach?
[00:06:06.880] - Dr. Nate
Well, like almost everything that I'm probably going to say when we're talking about patients, it absolutely depends on the individual patient and their diagnosis. A lot of it is physical or at least rooted in physical because of the visual system. The way our eyes learn to perform is really rooted in movement and development. And so a lot of the type of stimulation that kids get as infants, when we're talking about tummy time and crawling and lots of bilateral activities and stimulation, all of that kind of gross motor and body awareness sort of sets the tone for visual fine motor skill, which in turn affects the visual perceptual skill. So it sort of depends on where the patient is on that continuum. So if they're really, really having problems with tracking or what I would call ocular motor dysfunction, then. And we spend a whole lot of time on gross motor body awareness and then work towards eye movement. Fine control, if they're fine movement control and their visual focusing, et cetera, is really good, but they do have visual information processing or perceptual deficits, then it's a lot less body movement and a lot more worksheets and cognitive kind of skill development. So it just really depends on the patient.
[00:07:48.440] - Wendy Taylor
If the focus was kind of more school readiness reading that impacts in the classroom, can you walk me through what a session would look like?
[00:07:58.560] - Dr. Nate
Sure. So if I can set the scene just briefly, very many of our patients do not have isolated visual dysfunction or isolated vision problems. Vision is just sort of one piece of a big puzzle of the complex nature of patients. So many any of our patients have gone through sort of a sequence in their life, maybe around two or 3. They might have had some speech therapy, maybe a little bit older. They might have had some OT. And then as they're sort of getting ready for school readiness, and especially around the ages of seven and eight, if their vision isn't really quite performing as well as they need to for or the type of academic demands copying from the board, sustained reading, especially nowadays. There's so much technology both in the classroom and at home, not even counting the e learners, but even the ones who are in classrooms. So technology base these days. So that's sort of like our bread and butter most common patient. Of course, there's differences. So for that kind of patient, a typical session would look like this. They would have one therapist that's pretty much through with them the whole program to develop a very close relationship with that patient. And the therapists really get to know the ins and outs of their lives and kind of what they're going through. So they would sort of get kind of warmed up and sort of socialize a little bit. They would usually take their shoes off, and then they would kind of go over. Okay. How did you do with the activities that we assigned you at home? Although we do sessions for 45 minutes once a week, the real benefit of the therapy is the fact that they do about 15 minutes, five days a week at home, because that gives them ownership of what they're doing at whatever skill level they're at. It could be very, very low.
[00:10:00.000] - Dr. Nate
The fact that this is something that they are doing and they are making connections means it's not something that we are doing to them. They don't just show up, and we infuse them with vision therapy. We're teaching them skills that they then can practice. That review of what they've done at home is absolutely critical for each individual session. Then we take those sessions and those skills that they've been working on, and we increase the difficulty a tiny bit, just enough to where your audience? I'm sure it's very familiar with this, but it's all about finding that sweet spot for individual patients too easy, and it's boring or it's insulting, even if it's way too easy, too hard. And then it's just, like, frustrating, and they hate it. So you got to challenge them just enough. And that's really where vision therapists really shine is just really knowing is every patient is different and every day is different. They could be not us left. Well, or they could have a change in medication. I mean, there's just so many different variables.
[00:10:59.480] - Wendy Taylor
So sounds like the classroom.
[00:11:01.060] - Dr. Nate
Yeah, absolutely. It's literally it's like an informal classroom, and we vary it a lot. There's an acronym we use called Love, and it's called Lots of Variety in Everything. So we work on individual skills, but in so many different ways that the patient and their brain never gets bored because we're constantly trying to stimulate them in a variety of ways. And then we prep them to send that home, and then they work on it at home.
[00:11:31.010] - Wendy Taylor
It's so true in terms of finding that sweet spot. And then we say that as a special agent and educators in general, just trying to find that sweet spot. So the kids aren't bored, but they're not frustrated and shut down. And it is that delicate balance and dance, for sure. How our vision issues diagnosed beyond a simple vision test, kids get a vision test just their basic intro. And then how when would a parent know that something deeper has happened?
[00:11:57.780] - Dr. Nate
So that's a fantastic question. And I want to say one tiny caveat, and that is where it absolutely never shows up. Almost never is in any sort of vision screening at either a pediatrician's office or a school screening, because those aren't even designed to pick up those kinds of problems. Those screenings are designed specifically to pick up kids who are near sided or myopic the kids who are having trouble seeing the board. Well, the reason why that is silly, in my professional opinion, is the kids who are near sighted, the ones who are bookworms, the ones who are myopic, they tend to, on average, be advanced performers like those are the ones who are doing really well.
[00:12:41.750] - Dr. Nate
It's the ones who are farsighted or have functional vision problems, who pass all the screenings but are Super struggling when it comes to reading development and other issues. And so right off the bat, screenings don't count. Just get that out there. Now, the second thing is for most people can see. Our listeners can see, but I can see you are wearing glasses. So the chances are really good that you've had an eye exam at some point in your life. And the purposes of that are primarily number one, to make sure your eyes are healthy and if not to treat it, figure it out what's going on. And to make sure that you can see 20/20 at distance in year. And that's pretty much all it is, and it's pretty fast, and it's pretty efficient because most people that is a certain model. That makes a lot of sense. Doctors know it. Patients know it everything just sort of works. What I'm talking about for these sorts of evaluations, I like to call it a visual stress test. It's like a treadmill test for cardio patients, except for it's for the visual system. So it's not necessarily can you see 20/20 that's necessary, but not sufficient for school readiness. But it's all about... When we ask your eyes to work, how well do they work, and how well are they able to sustain extended hard work? Because it's one thing, if kids eyes can do it for 15 seconds in the exam chair, boom, your eyes can move. Your eyes can focus. Great. You're all good. It's another thing if they can do it for two hours or eight hours. And Here's the key thing, as I'm going to say over and over and over again, every child is different.
[00:14:25.700] - Dr. Nate
Every person is different. So when some people are challenged visually, some people's eyes just shut down. They just shut off. They're just like, no, I'm not doing this. I'm done. I'm checking out. Some people go into, like, way over drive. They have, like a hair trigger, everything just like, absolutely maxes out in red lines. And they also can't function, but they present with different symptoms. There's other people who go into sort of like, for lack of a better word for the audience, sort of like denial, meaning they just sort of like they have all of these problems, but their brain filters all of them out, and they perform terribly on exams, but they don't present with the same kind of symptoms because they just are sort of checked out from their vision entirely. So these exams are longer and they're all a lot more about observation. How are they doing these different things? When I ask them to look at something up close, are they holding it Super close? Are they getting really, really tense? Is their breathing getting, like, Super shallow, or do they just look at it and be like, Yeah, I can see it. Now. We also have very specific tools. We have flashlights called retinoscopes and all of these other fancy things, which allows me, as a developmental optometrist to look and see where they are focusing.
[00:15:51.430] - Dr. Nate
And this is absolutely key so I really kind of want to talk about this for a few seconds. There are lots and lots of times where children of all ages, but especially patients who have different types of developmental disabilities look at something, say it's a paper in their hand, and they think they are looking at it. But their eyes, because of their poor, fine motor control, their eyes are actually focused either far away or about a foot or two behind it. And I can see that with my flashlight. I know literally where they're focusing. Or Conversely, they could be looking at the board, and they think they're looking at the board, but their eyes are still focused on the page. So it's all blurry and frustrating for them, even though they can see 20/20 and their eyes are healthy. So there's lots of different ways that we evaluate that sort of autofocus system. And I talked about eye tracking a little bit. That's the most intuitive for parents, because if they can see that their kids eyes are just not pointing where they need to, if they're just kind of like all over the place, people kind of intuitively understand that.
[00:16:56.810] - Dr. Nate
And then the last part that I'll mention is the way the eyes work together, depth perception. If both of you eyes are pointing at the same place, they're sending the same information to the brain. The brain can process that spatial awareness, and we have ways to evaluate that. So the whole process is like, depending on the patient, like, an hour. I mean, it's a lot of work. And I always ask parents when I talk to them afterwards, how was your kid after when you got in the car and you went home? Because a lot of kids, well, they're eager to please. They're great, great, great kids. So they hold it together in here and they work and they do everything I ask, and they smile and they're Super sweet and they're great. And they get in the car and they absolutely fall apart because it is so difficult. They have headaches, they're exhausted. And if you just watch them, it doesn't seem like any of this is difficult because they're just sitting in the chair looking around like it's not like I'm asking them to do push ups, but it's so hard for them to coordinate this much effort. And I wouldn't know it because they're so good at asking it and being delightful that it's only when they leave. And the parents say, like, Yeah, he was like toast.
[00:18:06.730] - Wendy Taylor
it's fascinating to me, this whole conversation, we could speak many hours on this topic. Absolutely. And that's why I'm so excited to have you here and just thinking about my special education lens. Right. So you have parents as being in a classroom and then now doing the support that I do through educational therapy, an IEP coaching. You have parents say something's happening, and you're absolutely right. You mentioned the kids have had maybe speech or T or P parents are just trying to figure out something is happening, something's going on, and that fatigue is so real and agreeing with what you're saying in terms of you have these kids, they're in class.
[00:18:50.770] - Wendy Taylor
I'm just thinking of what you're explaining as you're doing your process. But I see these kids in class and they're lovely and working so hard, but then they're so fatigued and they fall apart and and it's trying to figure out what is happening. How would a parent know? How would a teacher now to refer to a visual exam? What would that be called? What are they looking for? What are they asking for? Because I'm sure this is not something like a neuropsych is not going to pick up on this or what.
[00:19:22.220] - Dr. Nate
Well, yes and no. Where the neuropsych evaluation may pick up on. It is the non verbal section, because there's definitely only some visual processing and spatial awareness things that happen during that evaluation. And the challenge that I see parents having with that specifically is the neuropsych evaluation is great, and I encourage it frequently, so I don't want anything I'm saying to sound anything other than positive, but the frustration the parents sometimes have is okay. They do poorly and the non verbal section and there are some accommodations, but there often isn't, like a next step, like, okay, so how do we improve this situation?
[00:20:15.220] - Dr. Nate
And I don't know. I know some, but I don't know all of them. I don't even know a lot of school psychologists or pediatric psychologists to have that conversation a lot. But anyway, that's one way. It's not the most common way, but it's the most common way. There are some very classic tail tail signs, for example, headaches if the child never wakes up with a headache, but often gets a headache in the afternoon, especially if it's pretty highly correlated with visual work, especially like up close work, either tablet or screen work, and then it kind of goes away when they're done, especially if it starts in the forehead and maybe sort of goes around to the temples.
[00:21:06.940] - Speaker 1
Not always. There's a zillion reasons for headaches, but vision is a big one. You know, if they're doing a lot of rubbing their eyes, not when they're tired, because everybody does that when they're tired. But I mean, just like, in general, that's a red flag. But honestly, I want to say two things about this, if kids just look like they are just not able to kind of do the work, if they sort of start off strong, and then 10 minutes later, they sort of drift out. This is where it absolutely looks like to parents, not to give dad the bad rap because I'm a dad, but to dad, it it can look like they're just being lazy and even to teachers, and honestly, even to excellent special Ed teachers. If you don't realize how hard. These kids have to work. It can just sort of appear like they're just kind of not interested. Like they're just not applying themselves, even though they're doing their very, very, very best. Quick caveat, I'll just say is that little window before they kind of lose confidence. Like at first they're working really hard and they're into it, and then eventually they sort of like, Oh, maybe I am just dumb. Like, maybe I just shouldn't expect myself to do this. Like catching them before then is like, absolutely critical. But that's a whole other thing. So I would say any of those are key. Now I will say this and you can put a link in the show notes. I think you will. But there's an organization called College of Optometrists in Vision Development. Cod org is their website, and they have a symptoms checklist that has been very well studied and vetted. They have normative data and what you can do, you can use it in two different ways. One, you can just sort of look through the checklist and see. I wonder how much this sort of its my child. Now, the younger they are, the more they're going to Act like immature people because they are. So you have to take that into account. But you can also click on the buttons and get a number. And then there are doctors there that the website can kind of connect you with on one of them, but there's tons of them. Then you can see if you really need a a thorough pediatric evaluation.
[00:23:28.450] - Wendy Taylor
What an excellent resource. Thank you for sharing that. I absolutely put that in our show notes. Does vision therapy have the ability to permanently fix issues, or does it provide strategies to help children overcome the obstacles? So in other words, does vision therapy provide more of a cure or treatment?
[00:23:43.480] - Dr. Nate
So like everything, it depends. So I like to break it this way. This is not true in the very most literal sense, but I like to break it down this way to parents, because I think most parents understand this. It depends if they have more of a hardware problem or software problem. So if it's a software problem, meaning their brain just never quite calibrated their eyes, they think they're moving to from one word to another, but they're actually moving three words down. And so they're skipping, and then there's gaps. But they do it so often that their brain sort of filters it out and think that that's just how you read, then that's the type of problem that by improving their awareness, by calibrating their eyes. When I move this much, it looks like this, and it feels like this. And with enough practice, I can not only do it, but I can do it over a period of time, and I can develop my stamina. And then eventually I can do it while I multi tasking and I can do it long problem solving, and I can even do it while the teacher is talking. And I'm really thinking about a thought, but I'm still copying from the board at the same time, all of that is happening. So that is an absolute permanent fix. Similarly, with the auto focus issue, if they can't copy from the board because it's just too blurry, they can see the board perfectly fine. But then they look down at their page and then they look up at the board, and then it's blurry because they focused on their page. Those problems are totally fixable. We fix them. Then we give them some maintenance therapy afterwards, and then they come back. Three months later, we quantify all of the exam tests. We confirm, Yes, you're exactly as good as you. You're need to be your exactly average or above average because you've sustained it for three months. It's assumed that unless if you have some sort of event which we can also talk about, then you're done, you're fixed. If it's a hardware problem. Meaning they either have a physical issue with the muscles of their eyes the way they were developed, or they have, like an actual either congenital or developmental genetic condition with the way their brain processes information, then it's not going to be a fix. It's going to be adaptive. It's going to be. How can we help you live with this? So it minimizes adverse effects to your quality of life? And I'll say one more thing about that, which applies to all of our patients, is just as important as developing skills. Is developing good habits because they're not going to be our patients for the rest of their life. They're going to move way. They're going to eventually go high school are going to go somewhere else. Different things are going to happen.
[00:26:26.830] - Dr. Nate
So the more we can teach them good visual habits to reduce eye strain and reduce the types of problems that they are likely to develop, then the better it is for them in the long term. And I spend a lot of time talking about "the race." . To me, the race is... Okay. Like, life is stressful, and school is stressful. And even video games are stressful visually. And all of that stress is not great for us, visually speaking. Meaning we develop bad habits. We adopt for posture, we develop all of these issues. And so all of that is going to create problems also through just natural development from living because we're smart and our kids are amazing, they're going to slowly improve. The question is, which is going to grow more. Is there a natural development going to outstrip the rate of problems that they're going to have? A school gets more demanding, and they have to go from reading individual pages to chapter books or not. And so the whole point about vision therapy is to make sure that they win that race. It all boils down to just that, or at least not make sure, but give them every possible advantage they can to win that race.
[00:27:42.180] - Wendy Taylor
Are there certain vision conditions linked to academic difficulties?
[00:27:46.120] - Dr. Nate
Yes. So there's a couple of different ways to talk about this. There was a paper done by one of my all time favorite optometrist vision scientists from Ohio, and what he did is he had gone through, I don't know, hundreds of students who had IEPs and then did very thorough, like visual evaluations and kind of correlated that with just sort of like a pool of, like, normal or neurotypical kids. And there were some interesting findings there, because definitely the kids who were in the IEP needed glasses more often, especially for far sightedness or hyperopia, the word would be used.
[00:28:33.450] - Dr. Nate
They also had more challenges with amblyopia and Prisms, what most people would call lazy eye. We don't say lazy eye, but that just basically means the eyes aren't working together. They may not be aligned in one, I may dominate the other. So absolutely. Those types of conditions appear significantly more frequently in the IEP population than in sort of the mainstream population. So that's just sort of kind of one way to look at it. But on an individual basis. Yes. When children have a lot of these, quote, software problems because it just makes it a lot more work for them, it doesn't mean that they can't read.
[00:29:21.290] - Dr. Nate
It doesn't mean that they never learned to read properly. But if their eyes aren't really calibrated for tracking and they make so many mistakes when they're reading, that they have to kind of go back and reread it so dramatically increases how much time they need and how much fatigue they experience when they read. And there's basically correlates to that to the auto focusing system. The word optometrist use is accommodation, but never use that word because it means totally different things to you and everybody listening to this. So I use auto focus instead of that word, even though that's the word. So when we write reports, we're really careful to try to distinguish the two. So those are exactly the type of problems that we look for. But one more thing, and that is there's a whole other group of people who have problems, and they're not really necessarily the people who would be listening to this podcast because those are the academic overachievers. Those are the ones who are, like, gifted, straight as Super motivated. And then what they do is they wind up through overuse and stress at an older age, more like high school instead of Elementary school, creating a whole set of other developmental problems.
[00:30:44.850] - Dr. Nate
We don't need to get into the details of that. But my point is that also affects school work, because if you get headaches so quickly and you just can't even get your homework done when you're used to getting straight A's, that's devastating for high achieving kids because they work so hard to get it done. It's missed forever. They fall through the cracks because nobody knows how hard they're working, because to everybody, they're smiling and they're polite and they're getting straight A's and they're also playing sports, and they're also learning violin. You know what I mean? So why would they possibly be having any problems, but they just can't hold it together forever. So anyway, that's a different group of people, but they're a group that sometimes has a lot of problems.
[00:31:31.160] - Wendy Taylor
What are the more common learning related vision disorders?
[00:31:34.980] - Dr. Nate
Mostly what I've been talking about are the physiological or functional kind of mechanical things, like the brain sends signals to the muscles. Do the eye muscles have sufficient fine motor skills to kind of do what they need to do? But there's a whole separate category, visual information processing or perceptual visual perceptual skill. And this does sometimes come up in neuropsych reports. And it very often comes up in occupational therapist evaluations. And this is less about, like I said, how the eye muscles work. But it's more about, for lack of a better word, like how visually overwhelmed kids get, because there's probably lots of parents and professionals who would be listening to this who are familiar with the kid who on a flash card will get the word every time 10 out of 10 times. Totally, totally get it. But then you put that exact same word in a small paragraph, and then all of a sudden they're just like, Oh, my gosh, I have no idea. Now I have to either try to sound it out or I have to I have to, like, recall, or I just skip it all together because or the most common of all is I just guess I see the first letter is B. And so I'm just going to throw in any word that begins with B, you know what I mean? And so kind of what they may be having a problem with is visual figure ground, meaning they can see the whole thing, but they have a block or a delay in being able to pull out the most relevant thing at that moment. And when you're reading, the most relevant thing changes every second because you're going from word to word to word to word, and it just becomes so completely overwhelming. That is really, really difficult. Visual memory is another one, and that's pretty intuitive to people. Some people just have a very hard time looking at something and sort of like making a picture of it in their mind and then being able to recall it later.
[00:33:37.920] - Dr. Nate
Most people sort of think intuitively get that. Another part of it is visual closure. So that's taking a bunch of individual things and making one mental object out of it. So if you see three dots, just three dots, you can look at it and sort of like, Oh, that's a triangle. And it could be a triangle and different. And then your mind doesn't have to work as hard because you just sort of remember triangle instead of three separate things, there's a kind of a famous that's famous to me, optical illusion, which when you first look at it, looks like random rectangles, just sort of screw in about. But then when you put it together, it says Love, because you can sort of see the individual blocks, and then you can see, like in the contrast, actually, the space in between all those spells out. Love, this visuals closure skill is absolutely important for learning to read because the whole well, I mean, I'm not a reading specialist, and I don't claim to be. But if you look at a word, especially one that's long, it's like seven letters long. And what you physically see in your mind are a lot of lines with sticks and crosses and little loops. And then you have to look at each one individually, but you don't visually group it into one object, which is a word. It makes it much harder. So those are all types of things that we would test for. And then we would help patients with. And then we would re test with the idea that as they develop these visual skills, they would become more proficient at reading. So just to be Super clear, I don't ever promise anything, because these patients very often have other challenges. But if we can solve part of these problems, then all of the other resources and everything that you are so fantastic about and all the people in the system, all of that just makes their job easier. And it makes it less frustrating for the patient. And they do feel empowered because they're like, Oh, look, this is a tiny piece of it that I absolutely learned how to control myself. And I have all these skills, and I have this little tool belt or I have more tools to put in my tool belt. And so that's kind of how that fits together.
[00:36:01.640] - Wendy Taylor
It certainly sounds that vision therapy can definitely help kiddos with their academic success. How often? And I'm sure it depends on the individual patient client. How often will they participate in vision therapy? So they come to you and they do the process. And then what does that? So a segment look like.
[00:36:23.020] - Dr. Nate
So it highly, highly depends. The patients who are referred to us from a psychologist or an occupational therapist or another another optometrist. They are very, very often kind of in a growth mindset where they, like, understand like, Oh, this is like another piece of the puzzle. And so this is something that we can do that makes sense. And the good news is unlike a lot of other sort of developmental type, therapies I mean, because occupational therapy, which is the closest analog to what I do, is so broad that can go on for years because there's always sort of a next stage where they could do more. But this is a lot more defined. So this is usually like it's not a trivial amount of time, but it's more like six months. It's like, okay, we're going to do this for a short amount of time. It's going to pay off long term. So the patients who kind of come in that way very, very, very often they will do it. And if they can't do it because they travel from long distances nowadays, we can do it online. It's not quite the same, but we've adapted really well. And so we can do a lot of it online, and that helps. One of the downsides is most of the medical insurance plans cover our kind of service correlate, if at all. And so that is an absolute kind of barrier for lots of patients. And so we kind of have systems to where we sort of make it as accessible as possible because everything is individualized. There's ways that we can see patients once a month instead of once a week, and we can give them a lot more, like, information that they can do on their own. We can prescribe other kind of short term things. Or one of my favorite things to do is if they're already in occupational therapy and they're young and they don't have extra business amblyopia, but they might have, like, an Ocular motor problem is then just kind of work with their OT, like, OTs are fantastic. Like, I can sort of tell them, Hey, if you include these sorts of things into what you're already doing, and I'll say come back in six months, and we'll sort of see one of the things that I don't know the history necessarily.
[00:38:53.910] - Dr. Nate
But unlike speech, that this doesn't exist in schools at all. There are teachers for the visually impaired, you know, there's, like, visual assistants, but not not this exact thing. And so that's a big kind of barrier for a lot of patients. And then one more thing is if patients just kind of come in and parents don't know any of this, and they think the absolute worst case scenario is that their child is going to be prescribed glasses, and that's all they know. And if I'm their first stop because they haven't explored all of those other things we talked about, then it is so overwhelming that they just they need time to process it. They just need they just need time and resources. And so I say, Hey, Let's go to COVD. Look at the information here. So another information come back in six months. We'll sort of regroup talk to your pediatrician or whatever resource you have currently, because it's just too much for them. The conversation we're having right now is they're just not ready for it.
[00:40:03.180] - Wendy Taylor
Yeah, that's a lot of information to absorb, especially if you're coming in thinking you're getting glasses, and then you get a whole other spectrum of information. I love that you collaborate with OTs. You mentioned that do you ever collaborate with schools in terms of kiddos with their IP school support accommodations? Is there any kind of overlap or any way that people could overlap as a school to kind of better serve students? That maybe cost could be a barrier or just in general, to better serve a population in need?
[00:40:39.120] - Dr. Nate
Yes and no, as much as absolutely possible. Every single report that we write based on functional visual evaluation has a whole page of educational accommodations. And that's honestly true. Whether they're in a public school system or whether they home school because they still have the same the same needs, they're just sort of implemented differently. And so we encourage all of our patients to give that part of the report to parents, especially when it's time to get ready for their IEP. We very, very often will write letters to kind of update on their present level of visual performance and sort of how they've improved or how they haven't. And in my in my experience, this is just my experience, but individual teachers are amazing at implementing things. The system isn't always so amazing, but that's just my experience. Now, beyond that, not really. I practice in Florida, and in general, the school system is so under stress that they are not really actively looking for more things to think about. We try to coordinate with the school nurses as much as we can so that they're aware we haven't made a ton of progress in that specific Department. But individual teachers are amazing.
[00:42:18.650] - Wendy Taylor
So my question is how functional vision problems and short attention spans, how are they related? We kind of touched on that in the beginning of our conversation when we started. But how are they related?
[00:42:33.900] - Dr. Nate
Again, This is, like, Super fascinating. So there's been some scientific research into the degree to which visual attention being able to look at something for a sustained period of time and mental attention, being able to pay attention to something for a sustained period of time. And they're absolutely not the same thing, but there is a very high degree of overlap in general. And when you help a child improve either one of those things, kind of both of them tend to improve, like they're so interrelated that you can't affect one without the other. So that's sort of the Foundation for the whole thing. But when it comes down to individual actions, is this sort of my favorite way to think about this? Because most people have never, ever they would have no reason to ever think about this, but two different parts. One, there's some other research that says that when kids, not just kids, adults when they have poor eye movement control, tracking, ocular, motor function, like we've been talking about, they have a very hard time decoupling separating when they are moving their eyes and looking at the world versus their staying still. And the world is moving. Their brain has a really hard time knowing the difference. So if our patients, in addition to all of the other problems, they have also never totally certain whether the world's moving around them or whether they're moving or something else is happening. That's really kind of unsettling. And so they're often distracted by that. And then way that that specifically will happen is this happens all the time? Say, I'm like looking at you were doing this over some, and I want to kind of go over and shift my attention to look at my picture on the Zoom. But because my eyes aren't calibrated, I go a little bit too far. I kind of overshoot. And now I'm looking at my microphone. Well, that can feel to a patient, especially one who's got attention issues or ADHD. Like, the microphone just appeared out of nowhere and inserted itself into my awareness. And so now you are like ancient history. And I am, like, all into this microphone because it's, like, shiny. I'm no longer listening to what's going on, because all of a sudden this is like, right there. And that would have never happened if the eye movements were calibrated accurately. Now there's all kinds of other things going on, but that interference. I mean, it happens all day, every day for these kids. It just happens. It's just, like, kind of watching TV. And then somebody is just, like, beaming in every 30 seconds, like a whole different program. It's exhausting for them. That's exhausting.
[00:45:44.580] - Wendy Taylor
Yes, 100% exhausting. As a parent, can my child receive special education services for a functional vision issue?
[00:45:54.520] - Dr. Nate
Well, kind of like I said, I mean, like, school based occupational therapists can be amazing at this. It really depends on the issue. If it is ocular motor, they're fantastic at that. If it's like, perceptual, they're fantastic at that. If it's some of the other things. Like I said, where you really need tools and lenses and training, that's kind of more difficult for them. Usually usually not always. But usually when we write these reports and we write these letters and we write these recommendations, they kind of are already identified.
[00:46:33.190] - Dr. Nate
And we are providing more ammo and more recommendations for accommodations. By the time they get to us, it's rare. It's not impossible that we're like the very first ones who say, look, this child needs some additional assistance, attention, and this is what we recommend. So we definitely will advocate as best we can for the children. But just sort of due to the nature of human development, you know, where their skills are at, it's usually not until a little bit later to where vision really becomes critical now, of course. I mean, I think vision is critical from, like, you know, six months. But in terms of being identified, that's kind of how it tends to go.
[00:47:20.280] - Wendy Taylor
Do you typically see an age range where kiddos are being identified?
[00:47:24.160] - Dr. Nate
Well, it depends. There are certain conditions, like crossed eyes, which I would call estropi, which, like, moms and grandparents, like, see, and they freak out about appropriately. And so we see them really, really early. And so if they have additional problems and those are all caught real early. But a lot of times it's really not until nine or 10, you know, unless of somebody like you who's, like, really in tune with these children. And they're like, no, you really got to have their their eyes checked. I mean, it honestly takes it takes somebody to have had this sort of knowledge to be like, Yeah, you just got to just make sure that that's fine. And sometimes it's totally fine. And they say, like, you're all good. Just keep plugging away. You're gonna be fine. But, you know, sometimes it's not that way.
[00:48:21.320] - Wendy Taylor
I hope from this podcast, somebody is getting some additional information and insight and and we'll be able to help. Absolutely.
[00:48:32.800] - Dr. Nate
This is one of the biggest paradoxes of my life, and I'm just going to say it and you can react to it. What I find is that the best, most dynamic, most wonderful, patient, student loving teachers have the worst classrooms for visual attention because they cram every single surface with something that's fascinating. The walls I go into classroom sometimes, and the whiteboard is like three quarters covered with amazing things. And they have this tiny little piece that they write on there's, like aquariums, and then there's, like, tactile sensory stuff in the back. And it's impossible for kids to not all kids, but for a lot of kids, it's just impossible to pay attention in that environment. And it's just a paradox because those are the best teachers, so you don't want to discourage them. It's just very hard. I don't know. What do you think about that?
[00:49:33.220] - Wendy Taylor
I think it's very true. Very true, I think. Dr. Nate, if you teleported to the past my classrooms, that's exactly what you would have seen. And I've taught kindergarten all the way up to post secondary, and it didn't matter what the age was. I had it all happening.
[00:49:51.440] - Dr. Nate
[00:49:54.720] - Wendy Taylor
What are some accommodations that you list in your report that perhaps somebody that may not have access to your knowledge could say, Oh, that's something I could implement.
[0050:04.740] - Dr. Nate
Right. So right off the bat, there is like, the very kind of no brainer things, like preferential seating. If it's hard for them to switch from the board to the desk, then if they're closer, then there's going to be fewer visual distractions and everything's going to look bigger and it's just going to be easier. So that's obvious. Also, I will very, very often prescribe glasses and then they should just be used. But then again, that's, like, obvious to everybody. Ergonomics, makes a giant difference. So we will very often recommend or issue slant boards. Now, when I was a kid, our desks were all at a slight angle and that would promote good posture. And it would sort of help kids stay at the right distance. Desks aren't like that. I mean, my kids are 11 and 13, and they've never had basically, like, an ergonomic desk. And now someone has a computer built right in to his desk, and it's very challenging. So we will issue, like I said, plant boards very often. They will take those to school, and they will become part of their work surface. And that sort of helps. One thing that sometimes creative teachers will do is they will take a sheet of paper and to be environmentally friendly, they will put it on two pieces of paper or sometimes even four. They'll shrink it down so it fits. But then the font gets impossibly small, even for average mainstream kids. But for somebody who's got an auto focusing problem, it becomes impossible. So we make sure that they don't use anything that's less than, like, roughly 14 point on something like that, but not too small.
[00:51:42.650] - Dr. Nate
It becomes difficult for earlier ages. We encourage using their finger to keep their place until they feel like they no longer need to. They probably won't need to do that forever. But a lot of teachers will and discourage that because they want them to learn how to use their eyes independently, which is a reasonable thing. But if they're just not ready for it, then you're mostly just kind of frustrating with them. You can also use either, like, a bookmark or what we call a letter box to isolate individual words or sentences. And that sort of cuts down on that visual information overload there's a certain thing. It's called the Harmon distance, but we often call it the elbow distance. And basically what that means is if you make a fist and put it under your chin, you shouldn't hold anything visual closer than elbow distance. And as you get taller, that ratio stays roughly the same. And that's been validated a whole bunch of times, so that that reduces long term like eyestrain and improve performance. But if you watch kids, I mean, they will get within, like, inches or sometimes even centimeters to the page, and that just causes lots of problems.
[00:53:00.220] - Speaker 1
So we just want teachers to know that they should kind of encourage that sort of posture. Not that that's possible to really fix that sort of, because that's like a really long, deep seated habit. So sort of be aware of that. And then, of course, depending on the diagnosis, extra time for assignments and testing and time for additional breaks, you know, that's in my experience, that's gotten harder and harder to to get even when it's appropriate. But we absolutely requested because it's program functional vision problems.
[00:53:37.630] - Wendy Taylor
Are they related more to the eye or the brain?
[00:53:39.940] - Dr. Nate
So this is great because functional vision problems are the brain and coordination and sensory integration and those sorts of things. Now, the other thing that I mentioned earlier, when we're talking about what I would call low vision. But what a lot of people would call a teacher for the visually Imperator, like a vision teacher, like, those are people who are partially blind or have some sort of visual limitation, and that's from a disease or from a developmental anomaly. So if they don't physically have the structure to be able to see either clearly or to see fully, they might have a restricted field of vision, or they might have other reduced contrast. Or there's a zillion different things. That's a hardware problem, and that's their eye.
[00:54:31.500] - Wendy Taylor
Everything else that we talked about is their brain as we're kind of winding down our conversation today. And again, this has been so incredible. And just what a pleasure and honor to have you with me today. What should I have asked that I didn't know enough to ask.
[00:54:48.080] - Dr. Nate
So this is something that is very, very challenging for parents, because I will go through the whole exam findings and I'll say, your child has 2,020 Visio. They're not nearside, they're not farsighted, they don't have a SIGNIS. Everything is great about how their eyes are healthy and they can see really well. And then in the very next sentence, I'll say, and I'm going to prescribe these glasses for your child, and it is such a disconnect that now I'm a little bit more savvy than that, and I try to explain it ahead of time. But the glasses that we will often prescribe has nothing at all to do with seeing more clearly. Their eyes see plenty high res. That's totally fine. The glasses are designed for many of our patients that we're talking about these sorts of students to do some of the work for their eyes. So they have more stamina and they can work longer without having the sort of symptoms or their performance is better. And like my glasses, because I'm like I've got a life sentence, like, I wear glasses all the time, and I will for the rest of my life.
[00:55:57.470] - Dr. Nate
These glasses are very often somewhat temporary. They may only use them for a year or two. And then, as their visual skills improve, they may not really need them or certainly not need them as much. They might need them for standardized testing, but they don't necessarily need them for 15 minutes of homework. But it's just so important for parents to be aware that we do prescribe glasses for lots of other reasons other than just improving clarity. And nobody knows.
[00:56:30.530] - Wendy Taylor
Thanks for sharing that. It's fascinating, and it's great to know. My final question for us is always, if you had a Billboard with one tip for parents, what would it be and why?
[00:56:41.720] - Dr. Nate
Right. And I thought about this a lot, because a lot of times I have very limited time to sort of talk to parents. And this relates Similarly to kind of what I was just saying. But vision is more than 20/20. I ask parents like, what do you think 20/20 is and they'll be like, it's perfect vision. It's like everything there is. But in reality, it only takes us, like, five seconds to measure. Do they have 20/20 vision? Yes, they can read those letters. Great. But it's so much more than that. It's not just that your eyes can see, it's that they can see easily and comfortably. And it starts at infancy where vision is movement. Vision is coordination. Vision is gross motor skills and fine motor skills. And all of the systems have to have to work together. And that's why every single patient I see, even if they're normal and every single way, middle of the Bell curve and every single possible way, I say. And it's really important to go outside and play.
[00:57:43.740] - Speaker 1
I joke sometimes about, like, I'm going to start prescribing dogs because if they have dogs and they have to play with them and they've got to take them outside and they've got to go for walks and their eyes have to do all of these different things. And it's very difficult to be on an iPad or a phone while you're paying attention to your to your dog. And that's because our visual systems grow and develop through movement and interaction. It's way, way more than just 20/20. So that's my billboard.
[00:58:15.380] - Wendy Taylor
Excellent final advice. I love it. And thank you again for this tremendous conversation. And I'm excited to have our listeners digest it. And I'm sure some are furiously taking notes as they're listening to this and to kind of go on and help support kiddos in the future. So I really appreciate your time today.
[00:58:35.060] - Dr. Nate
Well, it's an honor to be here. I enjoyed it so much. You do so much fantastic work for both parents and professional. I mean, it's just really important, and I'm happy to do it.
[00:58:49.440] - Wendy Taylor
[00:58:50.950] - IEP Essentials Outro
Thank you for joining us today for our IEP Essentials Protip podcast. To hear more protests and find additional IEP Essential, including our IEP webinar, please visit www.LearningEssentialsEdu.com.
[00:59:09.060] - Dr. Nate
So I hope you enjoyed that as much as I did. Of course, I will put the links to Wendy Learning Essentials and the IEP Pro Tips podcast in the show. Notes, Thank you for listening. If you have questions, comments or suggestions about how we can improve our podcast, you can email us at office at Bright Eyes Tampa, com until next time. Stay safe out there.
[00:59:35.410] - Outro
Brought to you by Bright Eyes Family Vision Care and Bright Eyes kids. Find previous episodes and more detailed information at Bright Eyes, Tampa com. Creative Commons Copyright attribution Noncommercial use. The only purpose of this podcast is to educate and to inform. It is no substitute for professional care by a doctor experienced in the area you require. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. Please consult your position for diagnosis and treatment.
Intro/outro music: Lucas Warford of Three For Silver.