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The Better Behavior Show with Dr. Nicole Beurkens

Feb 6, 2019

My guest this week is Dr. Dan Fortenbacher, a board-certified fellow and clinical professor at the College of Optometry at Ferris State University specializing in developmental vision, Neuro-Optometry and vision therapy. He has developed models of innovation in the delivery of developmental, binocular and Neuro-Optometric vision rehabilitative care. In addition to his private practice, Dr. Fortenbacher is an adjunct faculty at Southern College of Optometry, where he is the program supervisor for the W.O.W Vision Therapy developmental vision and rehabilitation private practice residency.

In this episode, Dr. Fortenbacher and I discuss how to detect vision problems in children (even if they have 20/20 vision) and when parents should prompt their doctor for further testing. Dr. Fortenbacher highlights the most common vision problems, how often they are overlooked by routine eye check-ups and their effects on academic success. Visual issues such as convergence insufficiency, developmental dyslexia, amblyopia or lazy-eye, strabismus or crossed-eye can be effectively treated and eradicated with proper visual therapy techniques. Learn more about Dr. Fortenbacher here.


How Vision Problems Can Easily Go Undetected

  • Vision goes beyond being able to see clearly
    • Having 20/20 vision does not mean that your eyes are working together
  • When your eyes aren't working together there are a variety of possible outcomes
    • Difficulty in sustained attention
    • Unwantingly divided words or overlapping words when reading
    • Clarity at near may be blurry or with overlapping images/words
  • All of these outcomes can affect a child's performance, attention, and reading fluency
  • Oftentimes if the parent does not specifically question their doctor about the child having a vision problem that affects reading, the proper testing can easily get overlooked


The Complexity of the Visual System

  • BOTH eyes have to: Team, Track, and Focus.  
  • The child then has to visually process and make sense of what they are seeing
    • This is integral for optimal performance, reading, and attention skills in and outside of the classroom
  • Integration - ties in all visual function motor skills with balance, listening, and thinking
  • ALL of the above are developmental processes that are to occur naturally but many children struggle and experience delays


Emotional Consequences of Visual Conditions

  • When the child is trying to apply themselves and they are unable to perform correctly, frustration ensues
  • Children become overwhelmed when dealing with a vision issue and at times it can appear as a behavioral challenge
    • They may have an attitude that shows they are unwilling and uninterested in trying


Common Visual Conditions

  • Convergence Insufficiency - the inability to converge the eyes
    • Occurs in 8-12% of the pediatric population
    • The top binocular visual eye condition
      • It can be effectively treated with vision therapy
  • ‘Developmental Dyslexia’ - JAMA (Journal of the American Medical Association) coined this term when researching the frequency of visual conditions such as convergence insufficiency and  oculomotor dysfunction
    • A significant amount children with developmental dyslexia have binocular, accommodative and oculomotor dysfunction
    • There are treatments to help these conditions
  • Motion Sickness - vision therapy can help resolve this issue fairly quickly


Signs That Indicate A Possible Vision Condition

  • Is your child struggling in reading and learning?
  • Does your child resist or have difficulty with their homework?
  • Do they avoid or dislike reading?
  • General coordination difficulty?
  • Have their vision evaluated beyond the routine eye health check
    • An evaluation of binocular vision, tracking, focusing and visual processing


Assessment and Treatment Process

  • First assessment includes testing: binocular vision, tracking, and focusing.
  • If determined that there is a reason for concern, the child will need to return for further evaluation of their visual perceptual abilities where extensive testing is done on the following:
    • Testing perception to visual memory and visual directionality to measure reversals
    • Hand-eye coordination
    • Reading tests to evaluate whether the struggle is a reading disability or a reading fluency issue
    • Visually directed gross motor skills, vision imbalance, and visuall directed fine motor skills
  • Diagnosis - much like rehabilitation in occupational therapy or speech-language therapy, vision therapy is therapeutic
    • Fun activities with visual challenges are guided by a therapist once or twice a week
    • Progress is measured and can take around 3-4 months to remediate the issue
    • Patients with more complex issues, with autism or who have crossed eyes, lazy eyes, will take longer but can be treated effectively
  • Vision therapy can also be applied to adults - age is not a barrier


Where to learn more about Dr. Fortenbacher


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