VISION...It's MoreThan Meets the Eye

By:  Cara Koscinski, MOT, OTR/L

The Pocket Occupational Therapist

        My son with autism complained of frequent headaches, squinted, and showed difficulty reading. His pediatrician recommended an evaluation by an eye doctor.  We anxiously awaited the appointment with the ophthalmologist and felt we would get answers.  It was a surprise that James’ vision was ‘normal.’  He was seeing a perfect 20/20 for distances both near and far (perfect visual acuity).  We left with no answers about the problems James was having. I’m guessing many of you have had similar experiences.    

       Our story is not unusual.  Many children who have autism experience difficulties with copying from the board, coordinating eyes with hands, frequent headaches after completing class and homework.  Vision concerns manifest themselves in many ways.  All children are required to have regular vision screenings which test for structural defects and deficits in eyesight.  When we think of an eye exam, we picture the chart with letters of decreasing sizes. (FYI, it’s called the Snellen chart and was invented in the early 1860s.)  While it is important that we ‘see’ the information properly, how we extract meaning and understanding of what we see requires further testing.  Our brains devote a huge amount of space for visual processing.  There are many more parts of the brain involved in vision and making sense of what we see.  When we see colors, light, movement, and distance.  According to DiscoverMagazine.com, “in the brain itself, neurons devoted to visual processing number in the hundreds of millions and take up about thirty percent of the cortex, as compared with eight percent for touch and just three percent for hearing.” 

     Developmental optometrists specialize in the neurological process of vision and are specially trained to evaluate functional vision skills such as peripheral vision, focusing eyes in near and far, color perception, and fine and gross visual-motor coordination.  So, a visual screening which is routinely done in school looks at the eye structure and ability to see near and far, a functional visual evaluation focuses on how the eyes work together and if there is a developmental problem with the eyes as they move together.  Visual figure-ground is when the eye can choose what’s important out of competing visual information.  We’ve all asked our children to get an item out of the refrigerator, only to hear, ‘mom, it’s not in there.’ Children often don’t take the time to scan and identify the refrigerator for the item they need.  The popular book series, “Where’s Waldo” is an excellent example of exercises designed to work on honing visual discrimination information. 

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Here are a few examples of eye problems and how to help at home.  In my books, I call them ‘Out of the POCKET Activities.’

What is visual discrimination?

Recognizing letters and numbers is critical for math and reading skills.  Not only does the eye ‘see’ the information on the page, the viewer must make sense of, or interpret the information.  If a child is not able to discriminate between what he sees, he might reverse letters and numbers well beyond the time in which it’s appropriate to do so.  Additionally, he may experience difficulty recognizing social cues and non-verbal communications with peers.

What can you do to help your child today?

·         Minimize glare and artificial or fluorescent lighting. 

·         Use a cardboard or cardstock sheet and cut a ‘window’ out.  This will minimize competing objects on the paper.

·         Practice by doing word searches.  They help the eyes to scan for important information.

·         Cut out small newspaper clippings and ask your child to circle a specific letter each time she sees it.  So, every time she sees a letter a, she circles it in red pen. 

·         Move her homework space to a less distracting area of the home.

       I was recently trained as a certified Irlen screener.  Until recently, Irlen syndrome was not on my professional radar.  Helen Irlen found that many people have difficulties processing visual information in the brain.  Some of the symptoms are eye strain, headaches, difficulty with reading comprehension, and poor depth-perception.  Of course, anytime a child struggles with vision or has weaknesses, his self-esteem may be impacted.  Irlen syndrome causes a sensitivity to different types of lighting.  Sensitivity to fluorescent lighting, sunlight, or glare are common complaints of someone suffering with Irlen Syndrome.  To help make life more comfortable, special colored overlays or even filtered glasses are prescribed for optimal comfort.  Results may be amazing!  For more information, visit www.Irlen.com.  There’s a self-test and the screen even changes colors while on the site in order for the reader to try out how color affects reading while on the site.

Here are some tips you can try today for light sensitivity:

·         Print worksheets and homework on pastel paper.  This is commonly found in office supply stores.  Try copying the same worksheet on each of the colored papers in order to determine which color you/your child prefers.  Sometimes glaring white paper is too intense for our eyes.

·         Use natural lighting in the school or homework area.  Turn off overhead fluorescent lighting.

·         Magnifying reading strips help to focus on the lines that are being read and help alleviate the stress and overwhelming visual input when reading a long passage in a book.

·         If fluorescent lighting must be used, permit students to use a hat with a brim to decrease brightness.

       Some of the exercised prescribed by a developmental optometrist combine motor skills with vision concepts.  For example, look at an arrow drawn on a chalk/whiteboard in front of the student and ask him to point his arm in the direction of the arrow; bouncing a ball as many times as possible with the right hand while calling out ‘right’ and then switch to the left hand and calling out ‘left.’  When children have mastered this, switch between the two hands.  There are many other fun exercises and games which work to strengthen visual-motor coordination.  One of my favorite websites is www.eyecanlearn.com  it’s packed with information and exercises you can do at home.

      Out of the Pocket Activities:

·         Hit balloons with a partner

·         Play BINGO.  Complete geoboards, mazes, puzzles, and parquetry.

·         Write letters and numbers on different colored post-it notes and stick them around the room.  Use a flashlight to find the notes and then call out each letter that’s found.

·         For figure-ground (finding an item when it is presented in a busy/complex background), find and pair socks; use a dictionary to look up a specific word; complete word search puzzles

·         For visual memory (remembering information that is presented in the short-term which is important for reading comprehension and math problems), look at a picture for thirty seconds and then ask questions about the picture; highlight key vocabulary words in reading passages and ask children to look for them; provide a sheet or paper on the child’s desk vs. asking him to copy from the board.

There are other visual concerns that are common in both children and adults.  Any time headaches, light sensitivity (including when driving at night), reading and writing difficulty, dyslexia, difficulty noting left from right, watery and tired eyes, and/or reading comprehension difficulties are suspected, it’s best to have a full examination by a developmental optometrist.

For more information on vision and to find a developmental optometrist in your area, visit:  www.COVD.org or www.familyconnect.org