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So, I want to talk to, a little bit about vision. Vision is more than just seeing 2020. Most people think of vision as just the clarity of sight, and really with vision all encompasses is the ability of gathering visual information efficiently and then processing what we're seeing in array. It tells our body where we are in space and it identifies what we are seeing an locates where things are. It guides where MoD motor movements are doing and coordinates with other senses. And research has shown that 80% of what a child learns is presented visually and now that's even a much higher percentage since more kids are learning from home. Unfortunately, our visual system was not designed for prolong near point use on digital devices. It was designed through be able to look far and near and far and near but not a prolonged use for up close. 

So, when I'm looking at a child visual gathering information skill, we're looking at three different categories. First is the eye movement which is looking at how the eyes fixate on follow where we call it "pursuit" also how they jump fixate from one point to another which is called a "cicada". And both of those eye movements are involved with learning and because they're with reading with locating things that are on a computer screen, looking at the computer then at your book and then your paper, and so if those skills are not working or developed correctly for their age group then then it's much more difficult. We're now seeing children that are in kindergarten better on the computer with their digital learning for up to five hours a day rather than being in the playground. So we're concerned of course that they're not getting the movement that you need in order to develop some of these skills are focusing system is controlled by the lens that's on the inside of the eye. The lens changes its shape in order to focus from far and then to near, kind of like a camera lens when you're focusing it far and then near. And it has to be very flexible and accurate in order to focus at where you want to look. As a child it should be very flexible as we get older over 40 then that lens becomes less flexible and that's when we start meeting reading glasses and bifocals but we should see that the focusing system is nice working properly at a child's age. And then the most difficult and challenging visual skill is how coordinating the two eyes to work together as a team. So you have the image of the right eye and an image of the left eye and you want them to not only overlap but to fuse to make 1% that has depth. If you have problems with your eye teaming ability whether one eye has a tendency to cross or turn out or up or down and that can cause a lot of problems with learning and with actually just seeing through life. So here are some of the signs and symptoms of visual fatigue that can occur when you're using a computer for prolonged periods of time. One of the things with our focusing system is that when the lens on the inside of the eye goes into a spasm, it can cause a frontal or temporal achy headache. Not necessarily a pulsating headache but an achy pain, so if your child is complaining of headaches then that's something to be concerned and check their vision for.

Dr. Daniel apologize for interrupting here I just want to make sure are you sharing your screen on anything yet?

Are you guys seeing the screen? 

I don't see your screen right now so I just want to make sure that the participants can also see it as well. If you could click share screen, cause you're sharing such amazing information.

Share screen again so you didn't see that OK.

There we go there we go, perfect thank you so much

Thank you for interrupting that's helpful so let me go through this way about vision and movements. Thank you breck. So one of the things that happens is that if the eyes are not converging in order to look at the screen then you'll get a pulling sensation that's between the eyes. And so children and adults will complain that their eyes are are achy and there's a pulling sensation. One of the other things that happens is that research... lottery well the reason why is that with a dry eye when after you're staring the tear it composition breaks up and it causes reflex tearing that causes more of a watery drippy eyes. So, if you see your child have lottery or there glassy or red then that can be too much time that is being spent on the computer. You may also see them rubbing their eyes and rubbing the eyes is one of the symptoms of the two eyes not coordinating together as a team. It could also be a symptom of allergies and we're having an increase of that because of the local fires and the smoke that we are having in the air and then combined with having our eyes staring at a computer a long time. We're getting more problems with children with having dry and irritated allergy eyes. Have any of you had your eyes were they just start twitching? That is a cause one of the main causes of eye twitching is stress and that can be visual stress or it can be stress on the body. And so one of the things to lookout for is if your child has some eye twitching then there are some things that I'm gonna talk to you little later about to help prevent that. And squinting, squinting is one of the symptoms that they're not seeing well that they're trying to focus, the focusing system may not be working. They have a uncorrected refractive error there nearsighted or farsighted or have a stick it to them, specially with this statement to them or their sensitive to light. One of the most frustrating symptoms to have for a child or an adult is have double vision. And I used to have double vision I had it for about 17 years and I never complained that I saw double, that it's because I never knew any different. Children don't complain necessarily that they see double because that's always what they've experienced and they don't know it normal looks like. So but they usually will complain at is that my vision is confusing or the words are floating on the page or it's blurry.
The one of the compensations that children will do is that they'll close when I look at my pictures of when I was a kid I had left eye closed all the time 'cause my eyes did not coordinate together as a team well, or they covered their eyes with their hand you'll see some kids do that or they'll put their hair in front of one eye. And what that's doing is that it's decreasing the input from when I so that they don't see double. Also lookout for head turns or head tilts, if one eye has is pointing higher than the other if you tilt your head then the images of the eyes will be next to each other. And then they confuse better but the problem with that is that you can get a neck ache an an affixed posture to where their head is tilted all the time. A head turn like this is using just one I also because the nose is walking in it from the other eye. We talked about losing your place when reading and that's because of some double vision or the eyes not tracking well and that they're not going from left to right in orderly fashion or the images are splitting into two. Now when they do that the brain doesn't like to see choose so little shut off one eye. So, now the images that were here it jumped and so it causes a loss of place when they're reading and it causes them to have decreased comprehension because they're missing part of that information. They also may see that their depth perception is affected and that the images will appear to move and that can make them nauseous and dizzy. They may in order to compensate that their head close to the computer or way far away from the computer or just avoid the computer in order to avoid the headaches and eyestrain that you get from your system not working well.
Now if you have these problems it's very obvious that kids will want to avoid to do the work that is in front of them. If you're getting achy dry red eyes and pulling sensation, double vision, you'll have decreased visual attention. Their posture will be poor they'll be slouching, your head will be on the table. They'll try to lay down, they'll be complaining fidgety and an as I talked about how that neck and shoulder pain. Some of the signs for focusing problems is that they can't change focus from near to far as easily. And so when they're on the computer for prolong time than that lens on the inside the eye goes into a spasm, then it gets blurry when they look up in the distance. And what that can do is cause an increase nearsightedness where they start to need glasses for the distance and this is becoming an epidemic problem throughout the world to where those who are digitally learning. Like those in China they have 95% of people in China wear glasses for nearsightedness and so there is a lot of research going into how to slow that process down. And one of the best things to do is to relax your visual system and train them so that they do work efficiently and give yourself a break.

So, what do you do to help all of these issues? One of the first things is to pay attention to what we call visual hygiene and that is to set up your work station so that you are in the correct posture. That your added desk rather than lying in bed or on the couch or on the floor. You want your laptop or computer screen to be at eye level or just a little bit down from eye level. You want your arms to be at a 90 degree angle and most importantly as you want your child's feet to be on the floor or on a bench or something to where their feet are not dangling because that helps keep the posture into upright position so that the eyes can then coordinate together as a team and focus in a straight ahead fashion. So, we talked about supporting the feet and encouraging desk work, one of the other things that is recommended is the use of a slant board. And slant board puts the paper or book that the child is working on at an angle to where it's best for their vision too keep your eyes to working together as a team and focus from the top to the bottom of the page. And it said the equal amount, so it has to wear it decreases the demand on the visual system. One of these the slant boards is... a lot of them have you Google slant board there's a lot of them that are sold online. If you don't have a slant board, 3-inch 3 ring binder and an empty binder that is slanted on you picture your paper or your book on the slant boar.

Lighting makes a big difference difference as well and you want to have as much natural lighting but have it facing towards the side. If you have an open window that's behind you the glare from the light is going to go against the screen. If you have the light the the window in front of you then you're going to have the glare directly into your eyes. So, you want to position their workstation so that the light is coming from the side. You also would do well to have a full spectrum desk light lamp. They make many brands of this but it's a special type of light that mimics the full spectrum light that you have from outside. So if you don't have windows it's good to get a desk lamp even if the room is lit by other lighting because with this type of full spectrum does like does is that it decreases that focusing lock as well. One of the brands that I use is the Ottlight I'm not I don't have any money that they give me for saying that but Ottlights are sold in fabric stores and on the seamstress and I'm in my sewing room right now. And with the fabric it's reuse these lights in order to match the the thread to the fabric and so they but they're very relaxing to the eyes even when the other lights are on. So you can do the work a lot longer without getting tired. You also want to adjust the brightness on your computer to be approximately the same as the brightness in the surrounding workstation. So you don't want to have it overly bright or overly dim and you don't want to be working in the dark because that does put more strain on the central visual system 'cause you're losing your peripheral system, and that will be more stressful for the eyes.
I also want to encourage drinking water 'cause you're... you don't want to have your child be dehydrated. That hydration is very important for the tears and but it's also important for learning and the brain health. The most important slide in here is to remember to take a break from the computer use and get up and move. As Dinah was talking, she learned and she's incorporated into her vision therapy with her students, a lot of movement because visual skills are learned from movement skills and when you don't move then the visual system gets locked up.
And so, I had a patient yesterday who I asked him you know "How long are you working on the computer for your classes?" and he said five hours. He had two breaks and during those five hours and I asked him "What do you do during your breaks?" and he goes "I work on my tablet." and I'm like "Well that's the one thing that I want you to stop." I said "During your breaks you need to get up and move. You need to go out and kick a ball, you need to jump rope. You need to go biking, need to do jumping jacks. You just need to get up and move your body because that's gonna help re-calibrate your visual system after prolonged work." And like I said before it decreases that chance of becoming nearsighted and needing glasses for far away. So these are some things that you can do to get ready to work in the morning on your with your student online. What we do, we call them "eye stretches" and these get the muscles to be working in the full range of motion. So, what you do is you're going to cover up one eye, keeping your head straight. You're gonna look up as high as you can go and hold it for five seconds. You want to breathe through this so that you're not straining and looking up and then you relax looking straight ahead. Then you're gonna look over to the side to the left for five seconds and then straight ahead and then down and then to the right. So it's like in a plus pattern then you're gonna do the same thing in an X pattern look up into the right, down into the right, down to the left. And what that does is work on all of the six muscles on each eye, 6 on each eye to be fully stretched just like you do your warmup stretches to go workout.
The other thing that you want to do is after 20 minutes of working on the computer you want to link an squeeze your eyes about 10 times. And what that's doing is squeezing the meibomian glands which squeeze out the oil for your tears so that you have better tears. And like I said the research shows we blink 2/3 less when we're working on a computer then when we're working on paper and so you need to get those tears to be pumping and to lubricate your eyes. So the American Optometric Association has been publicizing the 20-20-20 rule that whenever you're working on a computer to prevent digital eyestrain. You take a 20 second break every 20 minutes and look at something 20 feet away and that again is to protect your eyes from becoming more nearsighted. It releases the focusing system and is a break to the eye tuning system. "Do our children need computer and reading glasses?" is a very common question that I'm getting a lot and there are when you talk to your doctor they'll give recommendations depending on how their examination of the child is going. So if if they have functional vision problems like I've been discussing then reading glasses is one of the treatment options that we use. And I think reading and computer is for both. The reading glasses can also if we start to see an increase in the nearsightedness then we can prescribe reading glasses for close up used only even if they see 20/20 in the in the distance to help slow down that increase in myopia. And when you're working consistently on a digital device for long periods of time then computer glasses are a good option. All my children have, all three of my children have excellent vision they see 20/20 near and far but they all have computer glasses with blue light blocking lenses when they're working on the computer 'cause they were all in college and it lots of their work on the computer all day all night. My son who's autistic he works on an iPad all day long from morning to evening because he uses that as his communication device and so that's his voice. So he also has special lenses that give more magnification up close and also has a blue blocking lens.
So what is this blue blocking lenses I've been talking about? The computer emits a certain wavelength of light of blue light that can be harmful to the visual system as well as causing the visual system to lock up. It can cause problems with the retina the tissue on the back of the eye as well as the lens on the inside of the eye. And so what they do is it the glasses have a anti reflective or anti glare coating that blocks out that particular wavelength of light. But they did find is that when you're working on a computer all day that and you're exposed to this blue light and especially if you're working on a computer into the evening that that disrupts our serotonin levels in our sleep levels. And so you may have children that are having a hard time relaxing and getting sleepy to go to bed. You want to stop you know ideally working on a computer screen one to two hours before you go to bed. And then wearing the blue blocking light glasses can help with decreasing that blue light exposure in case you are studying to the evening so that you can go to sleep at night. 

Dr. Daniel we actually have a good question that came in through the chat. I know we've got question answer but particularly on the topic "Are computer glasses and blue light blocking lenses the same thing?"

That's a great question, yes and no. So with computer glasses can have a blue blocking lens that has that anti reflective glare but they can also have extra magnification that brings the focal point of the magnification lens brings the focal point to the exact distance at the computer screen so it relaxes the eye. Some of the over the counter blue blocking lenses may not have the magnification that is in the lens. And you want to have an eye exam to see if those over the counter glasses will even work for your child because if they have different prescription in one eye compare it to the other the blue blocking glasses that are over the counter may not be the wise choice because they may still cause problems with the two eyes coordinating together as a team. So a prescription computer glasses that has anti glare will have the right balance of the prescription so each eye sees equally well. Have another question Beth?
OK so if it's been more than one year since your child's eye exam, bring him in because you want to check for their eye health and especially now getting their back to school. Eye exam is really important so that your doctor can discuss with when your child or student the visual things that they should do for fast utilized their eyes. If they don't your child symptoms don't improve with the suggested treatment that we're going over then definitely see the eye doctor. Even if it's been less than a year central last exam and like we are saying that the things if you need or considering to get computer glasses, then have an exam to make sure that they're the right prescription. If you also notice a decrease attention or increased average behaviors in your child then it's good to rule out a vision problem is one of the causes. And especially if you see a recent onset of difficulty seeing far away and that's that near sinus that may be creeping up then you need to see your eye doctor. And just all of the symptoms that we're talking about if you notice those in your child then.

One of the options for treatment two is with the vision therapy program and most people don't know what vision therapy is. Vision therapy is a program that is where the therapist works with the child or an adult to help learn and improve these particular visual efficiency skills that we've been talking about but also learn about where their body is in space difference if they have letter reversals or they can't tell their right from their left on their body. If they have trouble processing what they're seeing an if they have difficulty with visual attention vision therapy helps out with that. And it's it's it's like piano lessons you come once a week for 45 minutes and we give you some activities to work on at home using lenses and prisms and filters and exercise equipment. And it's like going to the gym for your eyes and your brain and and then they come back and we give you the next hardest step. So in some cases where the visual system is locked up we need maybe six weeks to eight weeks of therapy sessions. And some kids who have more learning problems and or have other visual problems that are exacerbating their learning may need longer vision therapy session.
So these are doctors doctor Dukes myself my husband doctor Davis and doctor Jenness all of us treat these visual conditions. Other than my husband the other three doctors are specialists in vision therapy and so we we do in a refurb between each doctor on each specialty that we have, and here's a picture of our for vision therapist. Dinah is a certified vision therapist and we have April who's going through the certification herself, and Melissa and Felicia who had been... Felicia has been therapist with us for over 15 years and Melissa who's just beginning.

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All right. All right. Hello, everyone. Welcome to another edition of our vision and learning webinar. My name is Diana and you see all, um, for those of you who are joining us for the first time, we do have a recording of last month's webinar on our Facebook page. So you can find it there if for whatever reason the Link's not working, or if you don't have a Facebook account, you can just send me an email and I'll share the YouTube link with you. Um, I'll post I'll post my email address later on. So looking to October. Um, October is the national awareness month for both ADHD and dyslexia. And those are two diagnoses that commonly have vision problems associated with them. And if it's left untreated, it could really have for a child's success. So as most of you know, I'm a vision therapist and I've been a vision therapist for the last 14, almost 15 years.
I've been a mother for 13 of those years. So vision and learning as you can see is not just my career. It is what I come home to every day. And I'm committed to making sure that my children and you and your children can feel empowered. And one of the ways that I can do that as a vision therapist is to build confidence in visual skills. Over the years, I worked with some amazing doctors and dr. Susan Daniel is one of those doctors that shares the same passion that I do as a parent. She has her own experience with vision and learning and autism and ADHD. She's a current member of the college of optometrists in vision development, and she's the past president of the neuro optometric rehabilitation association. She provides in-services for school districts, parent groups, and even some continuing education for professionals speaking at autism society of America and the whole behavioral vision seminar since treating her own vision therapy patients back in 1991, she now has four doctors and four therapists on her team.
Ladies and gentlemen here is dr. Daniel, I thank you for being here for our second webinar, and I'm so excited that you have joined us. Um, like Dinah said I have personal experience, um, as a mom, uh, with, uh, the challenges of raising a child who has some special needs or, um, some, uh, difficulty with learning and attention. And so, um, I have a child with autism, uh, who is now 22 and, um, a daughter who has ADHD. And, um, and so it had some experience with that. Uh, I've been an optometrist now for 29 years, um, going on 30 and this is my passion is working with, um, children, um, with, uh, learning disabilities and difficulty with visual skills that hampered their learning.
Uh, so,
So here are the definition from the AOA which is the American optometric association of learning disabilities. And it's a group of disorders that have significant difficulty with both, um, spoken language, written language and mathematics. And so the prevalence of learning disabilities in the United States is pretty high and that, um, there is 7.1 million children and 14% of all public school students, um, have special education and need special education services. And out of that group, 33% of them has specific learning disabilities. And that's another name for a difficulty with reading or dyslexia, ADHD, and, um, just not living up to their potential, um, their, uh, their potential in learning depending on what their IQ is
The next slide. so with, undetected vision problems, there are a big concern because they can hamper the ability for a child to, um, learn efficiently. And so that's, what's called learning related vision problems. So we have really two sets of visual skills, um, that are developed, um, starting from the baby on up. And we have two different categories. One is the ability to efficiently gather visual information, um, and that is including whether they can, uh, see clearly whether they need glasses for astigmatism or farsightedness or, um, near-sightedness, um, how the eyes move in that are they able to fixate and follow a target and space? Can they jump fixate from one point to another, like they need in reading? Um, also can they accommodate, which is our word for the ability to focus from near to far, and this is not focused pay attention, focus, but focus, making clear, like adjusting the camera lens to make it clear both near and far.
Um, so that's one of the skills that is developed where the brain has to change the shape of the lens on the inside of the eye in order to make it clear both near and far. And you can have focusing problems, even if you see 2020 on an eye chart, and that makes it difficult for learning. And then the third most difficult skill. And, um, in the input skills is the ability for the two eyes to coordinate together as a team, uh, to form one image so that you have the image of the right eye and the image of the left eye. They overlap to form one percept that has depth to it. But when there's a difficulty in the alignment of the eyes, um, whether it's an intermittent I turn or a tendency for the eye to turn either in or out or up or down then that can cause, um, a lot of symptoms where it makes it hampers with learning.
The second group of, um, visual skills is once the information is received, um, efficiently, then how is the brain processing, what you're seeing, and this includes, uh, non-motor aspects of visual perception, uh, thinking cognition, um, and their integration with, um, like visual motor skills, visual auditory, language development, the stimuli, which is a word that describes, um, uh, our, our, uh, where our body is in space and also, um, whether we get dizzy or not, and our balance, and then our, um, attention systems. So I'm going to go over some signs and symptoms of these different problems. So the reason why I wanted to show you is that many people do not associate some of these, um, uh, problems with the vision. And the reason why is that vision problems are, um, silent problems. You know, you can look at someone and they look like they have good eyes.
And, um, the person who has, um, maybe some of these, uh, vision problems are not aware that these problems are caused by their vision. And, uh, so if you have a speech problem, then people know, Hey, you need to see a speech therapist. And if you have a physical problem, then you need to see a physical therapist, but vision problems are not, um, easy to detect. So the way to know whether your child or your student, um, needs a a specialty type of vision evaluation is to look at some of these symptoms. Um, so for eye movement dysfunction, um, what we see is that the child may be moving its head accessibly, um, while they're reading back and forth, uh, they skip lines when they're reading. So as they go to one line, they may skip on an entire line. Um, they may emit words or transpose words while they're reading. losing place is a very common problem to where they may need to use a finger or their marker to keep their place. Um, and they may have difficulty with playing ball sports and, um, and you may toss them about, and they're afraid of the ball coming towards them because they're not able to track it, um, and see where that ball is accurate.
Some of the,
Um, symptoms of focusing and iteming problems is that you'll get some eyestrain when you're reading or writing, um, headaches that are associated with mental tasks are usually on the front. And on the side of the head, um, with focusing, you may have difficulty with that blurred vision at distance and near that can fluctuate with eye tuning problems. You can have double vision like the pictures below the images, instead of being entirely two separate images, they can be where the images seem to be sprayed or just on top of each other or floating. Um, and you can see that you can still read, um, what it's saying, but it's much more difficult, especially if, um, the print is moving. Um, and it, and that's what the appearance is like. I had these difficulties when I was a kid and that, um, I had one eye that turned in and I saw double, um, for the first 17 years of my life.
And, uh, I never had an eye exam. I had a school screening where I cover up one eye to see that eye chart, and I could do that and cover the other eye to see the eye chart. And I could do that. Um, but nobody ever asked, do I see two eye charts? And I did. And so what ended up happening is that I would turn my head, um, to block the image out of the one eyes so that I didn't see double or I would just close one eye or get really close to the paper. Um, and so those are some things that you're going to look at in your children to see if they have any of those signs. Um, one of the things too, is that it takes a lot of effort to, um, maintain the focusing in the eye teaming, um, and that, uh, the stamina of holding it together and by doing that, we tend to stare. And when we stare that our eyes can burn and tear during visual tasks. Mostly at near, but you can have that happened in the distance as well.
Some of
The things that we're also looking at is, um, being able to, um, tell spatial orientation. Um, now when we're, about it is where, the difficulty of where am I and where is it the where am I means that does the child have the ability to tell where their body is in space? And if you don't have that, then you cannot tell where an object is in space at accurately. So first comes, where am I then comes? Where is it? whereas the object and then comes the, what is it, the visual discrimination? Can I tell what that thing is that I'm looking at? Um, and that is the sequence of development. Um, when a lot of movement is required, um, in order to, uh, develop a child's sense of where they are in space and so creeping and crawling and climbing and swinging, and all of those things, um, tell the, the patient where their body is in space.
Um, and that comes before you can, um, have the eyes coordinate together as a team and focus and track. Um, the other thing is that it's important for a child to learn, to cross the middle of their body. And we call it crossing midline of the body or crossing midline of their visual system. And so up until the age of two, um, a child will take an object from the right side of their body, um, transfer it in the middle of their body and then put it on the left side of their body. Um, they don't have the ability to yet pick up the object, cross it over their body in order to place the object. Um, so what they'll also do is pick up the object, turn their whole body in order to place the object. Um, they need to be able to learn that crossing midline, which occurs right around the age of two, um, in order for them to be able to cross visual midline in reading.
And there are a lot of children who at seven to 10 years old, still have difficulty with crossing their midline. Um, and when that happens, then that causes a whole host of problems with the eyes not coordinating together as a team and the ability to track across a page. Um, you'll see D delayed development of gross motor skills that is caused by the visuals skill. Um, you'll have confusion of where is my right and where is my left on my body. And, and that's a normal thing that is learned up until age seven. So if you still see that it's difficult for your child, to tell their right and left, um, on their body and in space past age seven, then that's an issue that you have to work with, because if you don't have a sense of direction on your body, then you won't have it in space, meaning you'll have more letter and number reversals. And, uh, you may be, um, reading from right to left instead of left to right. Um, and, um, have difficulty with that directional attack when you're reading.
Um, you'll also,
visual, spatial orientation problems, um, affect coordination and balance involved planning as well. And one of the things that we look for too, is that has the child. After H five developed a dominant hand, are they right-handed or left-handed, um, when you still have an inconsistent, dominant handiness to where sometimes it's right, sometimes it's flat, um, that has been shown to have more, um, association with children who will have learning problems
Because they haven't
Developed that sense of where their body is in space and have that directionality on their
Body. Some of the
Signs and symptoms of visual analysis skills, um, are that difficulty of determining what is it, what is, um, what is it that I'm learning at? And that can be, uh, shown in delayed learning of the alphabet. Um, it can have poor automatic recognition of letters. And so, um, you know, in our English vocabulary, we have our phonetic words, where you can sound them up and then sight words to where you just have to memorize what the word is because it doesn't make sense if you try to sound it out. Um, so if you're not able to, um, automatically recognize a word that you've known before or seen before, um, then that is assigned to that, you may have some learning, visual challenges,
You have
Difficulty in spelling and also confusion between similar looking letters and words. Um, some transpositions like was and saw, um, and if a child is reading and they're mixing up these little words, um, and, uh, transposing, then what they're reading doesn't make much sense. now often, learning problems that are not as apparent to others until around second grade, um, because when, if you look at the kindergarten and first grade, but, um, a lot of the books have pictures and also just one line per page or two or three lines that are spaced really far apart. So if you have a tracking and analysis problem, um, you're still able to figure out what the story is about, but then second grade, it really changes because now you're reading in paragraphs, the words are closer together. Um, there'syou have to be able to track and follow and then make a picture in your head of what you're reading, um, in order for it to make sense. And so we see a lot of children, um, that come in because their symptoms are more apparent to right around second grade.
Some more symptoms
Of visual analysis skills are that difficulty to perform a basic mathematic, um, operations like division and multiplication, subtraction, and addition, difficulty for visual search tasks. I called this the where's Waldo, um, being able to find Waldo in a picture. but this is even being able to find, catch up in the refrigerator or, um, find out where your socks are when they're right in front of you. Um, there can be some spatial confusion can a measuring tape, because it's that difficulty of telling, um, where in space you are compared to, um, the objects that may be in the room or
In the world,
Um, more symptoms are difficulty with attributes and categories. Being able to separate things by size and shape and color, um, that automatic recognition of what to different and what is the same. And then also sequencing being able to, um, memorize a sequence of, objects or letters or words, and put them in the proper sequence. So these are some signs and symptoms of visual motor integration problems. And you'll see from the, um, demonstration on the left of a child who has problems with their writing and spatial organization staying on the line, um, and, uh, there's some reversals of letters as well. Um, you'll also see kids with visual motor integration problems, difficulty with coughing, from the chalkboard, a lot of mistakes and confusions that transpositions. And, um, uh, staying within that printed line, like I said, here's some more, misalignment of numbers and columns when doing math problems.
Uh, one of the things that we suggest when a child has that difficulty is to do your math homework on a graph paper instead of just like paper, because it then aligns the numbers going up and down and side to side, and it helps the child know how to align the numbers so that they add and subtract and multiply the correct numbers, um, with the together you'll have, um, with visual motor skill deficiency, more written spelling, um, uh, problems than oral spelling. Uh, the posture makes a big difference with writing and, um, you know, we can go as developmental optometrist into a classroom of children and can tell who will have a decreased, who has decreased visual motor skills and called central and peripheral integration skills just by their posture and their head tilt. Um, and, uh, and you'll see even how they moved their paper. It'll be exaggerated when they're writing and their pencil grip will be
Okay.
So what do we do about all of these symptoms and signs and those, the things that we ask about our children's survey that a parent or teacher will fill out for us so that we know what tests to do. Uh, so when we do the testing, we're not only checking the eye health and whether they need glasses, um, for visual acuity but we're which we call the hardware of the visual system. Um, we're also checking all of the, um, the software of the brain. How is the brain analyzing what you're seeing and how is it, um, controlling those input skills? And that there's really three different evaluations that we do, um, a regular comprehensive exam, um, that checks the eye health and visual acuity, um, the, um, visual efficiency evaluation, and then the visual processing of information.
And when we, um, finish those, we find a profile of that child and develop a, um, a plan to help those skills. One of them could be using different types of lenses, um, like in this, uh, example on the screen, you'll see that, uh, in the picture a, that the child has an eye, the left eye that is turning in its crossed eye and that's a particular condition, um, that is culture, business, or accommodative. Esotropia the fancy name for that. They need glasses in order for their eyes to align so that they don't see double. So this is one type of, um, I turn that as corrected with lenses onto the right side of the screen, you'll see, um, glasses that have a very thick type of lens. Um, and this is for testing. This isn't something that somebody would wear in this, high of power, but it's a type of a lens called a prism
And what a prism does is, um, look at takes a child's misalignment of the eyes and the prison moves the images, so that they're closer together so that the brain can fuse them to make one image that's called a compensating prison that we may put in their glasses, prescription there's other types of prison. Like the one picture that's called a yoked prism that actually just moves the, um, the spatial perception of the world, um, that the child is seeing. And, then we do different various activities to, um, have them adapt to where things are so that they're looking and touching at the same time, like being able to look and tap a ball, um, while they're maintaining their balance. And then we changed the lenses, um, so that direction, so that they have to readapt. And what that does is give them a better sense of where their body is in space and improve their spatial projection.
We also different tents and filters, um, uh, different colors affect the autonomic nervous system. And I'll be going into that a lot more in detail and our next webinar series but tints are very powerful and not only changing contrast and what you're seeing, um, but also decreasing the, um, visual confusion and headaches and light sensitivity as well as, um, balancing the autonomic nervous system. So it can decrease anxiety and increase attention. And then you'll see on the bottom, right. there is what looks like tape on a pair of glasses, and that's a type of selective occlusion. so a child who has an eye turn, um, like the example above that is not corrected with just a prescription glasses. they may wear certain types of occlusion that when their eye is crossed, um, the tape includes that eye image, uh, so that the patient doesn't see double and then they have to work on in therapy to align their eyes, um, and look beyond that tape in order to use both eyes together as a team.
Uh, so I just mentioned vision therapy, and you're probably wondering what is that? Well, the vision therapy is a series of, um, activities and, using lenses, prisons, filters, and inclusion, um, and different activities to help develop, um, the focusing skills, eye teaming tracking, and visual processing skills. So what I'm going to do is give you some examples of, um, the different types of some different types of therapies. And there are thousands of different activities that we do that are specifically program, for each child that we see. Um, so this is one of the, um, activities that we can do for, to improve visual tracking. So you'll see there's a paragraph of what it looks like words that make no sense and that's on purpose. Um, and what the child has to do is underline the letters until they find and then keep underlining, um, the letters till they find a B, and then a C and then a D.
Um, and they go through the paragraph as quickly as they can and finding the letters of the alphabet and the sequence. And if they, don't miss a letter, um, then they'll end up on Z. if they do, then they're not going to end up on Z and we time it. and that's how we do one of these for each eye, um, and practice each day. And as it gets faster than the print size gets smaller and smaller and smaller, um, and that helps with the visual tracking and helping with learning to read.
We also have an equipment that measures the eye movements while the child is silent reading. now even if say my child is, can read out loud, just fine, because you're using the auditory system to help make sense of what you're reading. Um, and if, if you're skipping and rereading the paragraph, is that going to make sense? But the problem with silent reading is that you don't have that auditory component to, um, uh, to tell you whether this paragraph is making sense. And, um, so this, what these goggles do is that they have sensors that measure how the eyes move as the child is reading a paragraph. So you'll look at the, um, the test results on the right side. And you'll see, um, one of the columns that looks like a staircase is the right eye, and the other column is the left eye.
And if the eyes are coordinating together as a team, it'll look like a staircase where it's coming down and then you get to the end of the line of the paragraph, and then you go to the beginning of the next line. And so a person who is a good reader with good eye tracking skills, the, uh, it will look like the charting on the right. Um, when we, uh, see children whose eyes are not coordinating together and not, um, tracking well, it'll look more like what is on the left side, and you'll see where the two lines are intertwining. And that means that the eyes are crossing. Um, they're trying to read, they're not going from left to right. They're more going up and down. Um, and then their eyes cross, and then they come back and then they cross again. And you can imagine how confusing that is. Um, when you're trying to understand and comprehend what you're reading, doesn't make much sense when you're going out of
Order. So
This is an activity that is training a few different things. Now, when we're doing, uh, activities, we start with, um, doing therapy for the most basic skills first, which is the eye fixation and eye tracking, then go to focusing then go to eye teaming and then do all three at the same time, and then do all three of these with movement and balance, and then with a cognitive demand and an auditory demand, um, so that it becomes a generalized skill that you can use in everyday life, because we're not just sitting, looking at a stationary object all the time, we're moving in space and the objects are moving in space, and we have to be able to, um, to take in all that information quickly, accurately and have stamina doing so. So this, um, we start with it's simple, and then we make it more complicated.
So this is a more complicated, um, activity. The child is, um, magnification and minification lenses that stimulate the focusing system to where the child has to it'll see blurry, and they have to make it clear. And then you flip the lenses and it goes blurry, and you have to make it clear. It's using filters, you'll see a red and green lenses that are on her eyes. And what that does is that, uh, the right eye, um, that has the red filter, um, will only see what she's looking at on the paper. If the brain is turning on that eye and the left eye has a green filter and the left eye will only see what's on the paper. If the brain is turning on the left eye. And why is that important? Um, it's because when you have an eye turn or a tendency for the eye to turn, um, the patient has either, um, two choices it'll see double, or the brain will shut off one eye.
And when it does that, the patient is not aware that they shut off when I, um, so they may be reading along with when I shut and then their brain switches to the other eye. And you'll see that the images will jump, um, from one word to a word that maybe three words down on the paragraph. Well, this gives the patient a feedback, um, a biofeedback to tell them, um, to turn both eyes on in order to do this activity and be able to focus. And then you see she's on a swing. Um, so she's in movement. And then she has, um, an auditory stimulus as well on the headphones.
This is an activity that we do for training spatial awareness. And there is a, these dots on a plexiglass, picture that is in front of them. They have to take their finger look and then touch as quickly as they can at each dot. We may put letters that are out of sequence to where they have to look at a, um, be aware of where B is. Look at B, look at C, look at D and have the eyes, uh, point to exactly the plane of where that object is. And that helps with spatial awareness. You'll see that they're doing monocular skills. Cause when eye is patched and it's using, um, a lens, a magnification and a minification lens to also challenge the focusing system to make that clear and for you to have accuracy for exactly where that thought is.

This is a child that is doing an activity called the Brock string, and it works on eye teaming. So, for those of you in the audience, I want you to hold up your fingers in front of you. And first at your finger that is closest to you. As you're looking at the finger, that's closest to you. You'll notice that there's two fingers in the background. And then when you look at the back finger, you'll notice that there's two fingers in the foreground and that is what's normal. Um, and so this activity, um, uses a string with beads to do the same thing that you are doing with just your fingers, but what it also incorporates, um, is the string. Now what, um, if your visual system is working correctly, you'll see two strings that cross right at the bead that you're looking at.
And then you'll see two beads in the foreground. Then when you look at the backbeat, you'll see two strings in the foreground, but the string is crossing right at the bead. That's what the normal response is. If the eye is, um, over-crossing, then cross, the string will be before the bead. If the eye is turning, out, then you'll see the cross and the string behind the bead. So this gives the child the feedback of am I looking exactly at the bead are my eyes accurate? And so if they're looking beyond the bead, then we tell them to try to over cross, to try to get that cross right at the bead. Then we make it harder by using a prism lens. And that's what I'm holding. In my hand, we put that in front of the, one of the eyes and it challenges all of a sudden that bead is now double and the eyes have to either, um, depending out what prism I put on have to either converge the eyes to make it single or diverse the eyes to make it seal.
And then we do it to where we try to make it faster and faster to where they can move their eyes as quickly as they can. And that will help with, um, when objects are coming at them quickly, to be able to tell exactly where it is in space, like a ball or later when they're driving, it's a really important skill. So here's another example of a vision therapy activity, um, to where, um, I want you to take your finger, put it in the middle of the screen between those two rectangles, um, look at your finger. And as you bring your finger closer to you, you'll notice in the background that those two circles will form a third circle in the middle, and then you stop when it gets three circles. if you keep going, you'll get four. So you want to find, there's like a sweet spot here where you'll have three circles.
When you get that, then you try to focus on it without looking back at the screen, but focus on that middle circle to make it clear. And when that happens then you'll see a 3d dimension, and this is another way for us to train the eyes, to coordinate better and for the eyes to coordinate and make it clear at the same time, then we can do this activity by, um, also while walking in space, like an obstacle course, so that they're aware of a central activity and being aware of their peripheral space simultaneously. Now, many of you will try this activity at home and not be able to do it. Don't worry. It takes some training. Um, some people can do it right away and some people, it takes, um, some training in order to do it correctly. Here's another example of, um, doing an eye, hand coordination tasks with balance and body control.
a child is on a balance board, which you can't see, and hitting a ball that suspended on a string. The advantage of having the ball on the string is that it moves in a pendulum. And so if you're training on spatial awareness and, um, speed of where things are in space, when you can anticipate a pendulum and the speed is the same each time, then it's less scary and the ball doesn't hit the child. So you'll see a lot children, you throw a ball to them and they're like this again. this is the right training for that. And so we're having this child hit the ball with the, um, with the bat and, our budget, and then also maintain their balance. And then there's letters on the ball that they have to identify the letter that they're hitting. Um, so it's that central peripheral vestibular visual motor integration all rolled into one activity.
This is another one where the student is learning to learning, to play tennis. And, um, and he was having a hard time tracking the ball. So we put them on a trampoline where he had to move a little bit like he would with tennis and the ball comes towards him and he has to cross over. So it's looking, um, and hitting and tracking and maintaining balance simultaneously. This is one of the activities that we do for depth perception, where, um, the student will see, um, the images pop out toward you like a 3d movie, and then we can move the slides to make it harder for them to, they have to cross more, or they have to divert their eyes more. Um, once you get a good sense of that three-dimensional space, um, then that it locks in that ability for the eyes to coordinate together as a team correctly.
Now, this is a short little video showing, um, how we, uh, one of the activities that we use to train, um, whereas my body and space and right, and left directions. So we come to the edge of the square. Um, they'll see what direction they need to turn. They'll have to say, right and touch the right side of their body because when you have a motor movement with the verbal and, , then, with direction, then it centers more just like we have this motor memory. , and then when they come to the next edge, they have to tell us what direction. So here's a little video.
Great. Are you sure? Okay.
Um, so this one is a, one of the activities that does , learning attributes and categories. So, um, this student had difficulty with, size and shape and color and direction. And so he's putting, um, you can't see, but he has a yellow triangle on the whiteboard, and he's putting descriptions of, um, that triangle, whether it's big, whether it's turning up and what color it is. And then we have a special piece of equipment at our office that, um, it's called the sensory learning program and it incorporates, um, visual, vestibular, auditory, and, stimulation of the autonomic nervous system, uh, simultaneously for, um, the brain to learn how to coordinate those sensory systems. there's a diagnosis called sensory integration dysfunction. And for children who have problems with being able to look at you and listen to you simultaneously be able to have visual motor integration, maintain their balance and process what they're listening to.
And so what this, um, particular equipment does is that the child lays down on the bed, um, and looks up towards a light source. That's the thing that's on the top, they're in complete darkness instead of, except for the light source. And then the table moves. It goes up and down and side to side. And then, um, uh, I decided forward and back. And, um, and so each, each day that they do the, um, the treatment, the therapy, then the table moves in a different direction. And what it's doing is stimulating the eyes to track better and to work better together as a team and coordinate those senses. So I'm going to talk more in detail about that at the next, um, uh, webinar next month. And, so if you're interested in that. Or it seems like it would be great for one of your students or your child then you can visit me on that webinar too.
So here are our four optometrist at our office, Dr. Camilla Dukes, who's been with me for 20 years now. Myself, my husband, Dr. Davis, who's been with me 33 years, and Dr. Jenness , who's been just with us a few years. And these are our wonderful vision therapist, Dinah who just met, she's a certified optometric vision therapist, which is person who has gone through a very extensive training, oral exams and written exams in order to become, premier vision therapist. And she's one of a few in the United States and I think is one of the top therapist out there. And we have three other extraordinary ones that are also working towards their certification. And it's Melissa, Felicia, and April. So thank you for listening. And I'm going to hand this over to Dinah, um, and she will show you a few more things.
Thank you, Dr. Daniel. So actually before I share my screen, I wanted to open it up to all of you. if there are any questions or anything that you wanted to share with dr. Daniel, we, we have dr. Daniel's time and you could ask her directly. Um, Oh, so I was going to say you can unmute yourself and ask the questions, or if you're comfortable typing it in the chat box, uh, Brooke and I can monitor the questions. Oh, you're welcome, Cassie. So, um, let's see. Does anyone have any questions for dr. Daniel? And just a reminder, if you're looking to unmute, you can press your space bar or also on your zoom screen. There's a mute button in the left-hand corner.
I should also say that if you don't want to ask your question in a public forum, please feel free to email Dinah or myself. and we can answer your questions about your specific areas of interest
Dr. Daniel, would you mind sharing your experience as a parent dealing with the autism and ADHD vision and learning? Yeah,
Well, my, um, three of my four children all did vision therapy with our various therapist and Dr. Dukes and I was their mom. And so I was their encourager. Um, but they, uh, with my son who is non-verbal and autistic, um, he had the, all of the sensory integration problems. And every, every symptom that I talked about, he had all of them. And so he had many years of vision therapy. Um, and he did the sensory learning program when he was six years old and that changed his life and our life to where it improved his, um, ability to walk. Um, he said his first word after that, um, he was able to, um, sit, sit and pay attention and have feedback with, um, other therapists and teachers and his family. Um, so that was huge. And with my, uh, my daughter, um, who has ADHD, um, she also had, um, problems with her, her hips, and so within a brace for the first couple of years of her life.
And then she had,my light went off, then she had, surgery on her hips and was in a wheelchair for a while. So she didn't have the motor experiences to learn her right and left and, um, to develop that, where am I in space? And that affected her attention, in school, even though she's extremely bright, um, she is now an occupational therapist. And, um, and so she's doing a lot of these activities to, from an occupational therapy, point of view. Um, but she has now that experience as, um, a student of vision therapy and, um, now as a practitioner, um, and then my other daughter, um, she had vision therapy just to help with her anxiety. Um, there was a lot of anxiety, um, due to her tracking, um, difficulties and, uh, paying attention and, um, her anxiety decreased substantially after she did, um, uh, really all the programs with vision therapy.
And Sarah has a question. Okay. We have a question. Go ahead, Sarah. Hi, can you hear me okay.
I'll try. I'm hearing impaired
Okay. I have a question. Thank you, dr. Daniels for the presentation. I was informed by clinician since my son has an IEP that perhaps this is something that I can request through the school, the school district, um, to handle the expense. Is that something that was related to me correctly? Or do I need to get more information or what has been your experience?
Yes, that's correct. And, um, the, we are contracted with, um, all of the school districts, pretty much all, um, in San Diego County, way out to Ramona all the way down to Chula Vista. and then up into orange County and LA. So we have patients that, um, the school district will, um, after we do our evaluation, which you can ask for, um, specifically ask for a optometric developmental visual evaluation, not an eye acuity test from the from the school nurse, um, because they'll think vision checked very different type of evaluation. And then after that evaluation than, um, uh, if they're recommended vision therapy for, to improve the educational, um, progress of their IEP goals, then the school district, um, may, pay for the vision therapy. And so we have, um, a good number of our students, um, have IEP. And, uh, I have, you know, because my son has autism on the autism mama world. And, uh, so we have a lot of children, on the spectrum and who are contracted with the school district to have their vision therapy paid for at our clinic.
Would you be able to, I think it's Dinah that I, um, communicated through email so that I request the correct terminology that you use there,
We have a sample letter that, you can request it to, um, the district representative of special ed. That would be great. Thank you.
And, um, there was a question that came up, um, how we, or if we tailor our vision therapy and dr. Daniel could add to this, but as a vision therapist, I can tell you, in my 14, almost 15 years of being a vision therapist, um, on paper, these patients may see like, Oh, they have this, this, this, and this just like this patient. So, um, their vision therapy should be almost exactly the same, not the case. Every child has their own personality. And I think I can speak for a lot of vision therapists when we say that we want for our patients to enjoy coming, um, and to be engaged in the only way that we can really engage them is to get to know them as a person, um, and then put their personality into some of the activities. So, it is very much individualized, but I think even from an objective standpoint, when the doctors do these certain measurements, there are certain intensities, right. So if we're working on it with one patient, they may have a more significant issue. Um, then let's see another patient dr. Daniel, would you agree?
Yeah, that's exactly right. Um, and that, yes, and my 29 years, not one patient has had the same program, and that is wonderful for us too. It's a very creative and wonderful profession. Um, vision therapists are the best and, um, and they have that connection with the students that, um, and it's not we're not doing reading and arithmetic. We're using doing the skills that are needed in order for do those efficiently. And so the children have nothing to compare it to. They're not being compared to another student. Um, it really builds their self-esteem as they see that they're able to do these activities better. And if they really hate one activity, there is a zillion other ways to teach the same skill. Um, and we just change it to, um, tailor it to that patient and, and our vision therapists and our doctors work hand in hand.
So every single time that, um, you know, Dinah sees one of my patients, um, after she's seen him, then we program the next session together and we have that communication. So I'm kind of in the background while they're doing their sessions. And then typically every 12 sessions, then we do another progress eval with, um, the treating doctor. And that helps us helps the parents, um, no, kind of, are they on the right track of how many sessions that you think, um, you know, you're estimating, um, are they a little behind, are they a little had, what other areas are you, have you found now that they've improved these skills that you may want to work on? Um, and so it gives that communication, but we're always in communication with the parents when they need us. And, um, and that's, that's the cool part. You know, I have one patient right now that probably emails me every day and I love it because it had significant vision problems. I had a brain brain injuries and, um, and his life is changing every single day so much. And so that helps me tailor his, um, vision therapy as well.
Good question. And there was, I don't think you'd see the other questions on here in that. There's quite a few. So there's another question. Um, how common or standardized are some of these vision therapies in the U S or in other countries also how old or new are some of these specific techniques in terms of literature and research? Okay.
So I shouldn't have done one at a time, so, um, uh, the literature I'll do the last one because that's the I remembered the literature and research. Um, we do have a lot of that if you want us to send it to us, it, but also you can, um, look at the college of, uh, optometrist envision development website, which is C O V d.org, and they have their journals, um, and, uh, references for these vision therapy techniques. Now vision therapy is also very creative. And so once, you know, the theory of what you're trying to accomplish, um, say you want to develop, um, the ability to, uh, do tracking and up gaze then you can develop many different vision therapy techniques for that particular skill. And that's where you're going to see some differences between some therapy offices, then another, is that it also depends on the creativity and the knowledge base of, um, how that therapist understands.
the theory of a vision. We do have, I should say our office is rather unique and that we have educational, um, seminars every single week with the doctors and the therapist, and the therapist share their cases, and we are constantly educating each other as well as going to continuing ed. Um, and so that's why our therapists, um, teach other doctors. we have fourth year optometry students that do rotations at our office to learn these skills. And we get a new one every three months. And it's our therapists who are teaching these new doctors because they understand this better than they do. so what was the other question Dinah?
Uh, the first part of that question was how common or standardized are some of these vision therapies in the us or in other countries?
Yeah, so there's a certain set that are pretty standard, like with some of the activities that I showed today. Um, you'll see those at, um, all of the therapy offices around the world. Um, and then I said, some of them are not now the, um, the testing is, um, rather standardized, you know, there are, um, when we write our reports, there's the Grafman (?) test and the Barry test and, all of the doctors name, these tests after themselves, but they have these, um, standardized tests so that if I did the evaluation, another doctor could do the therapy, which is how San Diego school district works. They have a different doctor do the evaluation, they send us the evaluation, um, uh, records. And then we develop the therapy plan and vice versa. most of the school districts have the, um, evaluator also do the therapy, which I prefer. Um, but some of the school districts work differently.
And then, yeah,
I'd say there are some differences, you know, between therapists, our office is really known for, um, learning disabilities and autism, um, uh, stroke and brain entry. And so we see kind of the kids that have, the kids and adults that have, um, a lot of severe delays and deficits. So not all offices, our office is really known for autism because of, um, all that my son has taught me over the years. Um,
And then, um, uh, can you, there was a question asked if vision therapy is for dyslexia. Could you give us your input on that? Yeah, so
Dyslexia is a multi-pronged, um, treatment effect. so dyslexia, just the word itself means difficulty with reading now. Um, there are many visual problems that need to be addressed prior to, or in addition, at the same time as phonological and language therapy that works on, um, the language part of reading. And so when a child has been diagnosed with dyslexia, it's very, very important to have a developmental optometry evaluation to make sure that those skills are up to par. And if they are, then we know you only have to do this educational therapy, like Lindamood-Bell or Orton-Gillingham therapy. but often these kids are struggling on two basis. They have both the language, part difficulty with dyslexia and the visual part, and the visual part is completely treatable. And when you do treat that, then the child has much better energy to work on the other parts of dyslexia.
Yeah. Um, and William has a question. What does the process look like from start to finish when considering vision therapy or neural rehabilitation for a friend or family member at Daniel and Davis optometry?
Okay. So I will, so, yes. So with the, um, process that we do, if you have a person that you want to refer to us, or you have a child of your own, um, or you are related to our people at our office you call it when you call to make an appointment. you let our front desk know, they'll be asking you, does your child have any special needs or were you referred by somebody? And that helps us to, um, decide what type of evaluation to do. Um, if you're saying, you know, my child has autistic or has learning disabilities, and I want to, um, check how his visual development is then, um, the there's three appointments that are made. Um, the first one is a visual or history appointment. We send you a questionnaire is quite long, but we want to go over all the signs and symptoms.
Then one of our therapist like I know we'll make a phone call, um, history appointment that can be up to an hour, um, so that you can go over in detail what, uh, your concerns are with your child. Um, and then we set up an appointment with the doctor, um, and then I have all that information already with the history, so that once you bring your child in, I can go right to seeing the patients. So they don't have to listen to us chit chat about their long history and hadn't have full attention on the child. Um, after they see me for, um, the first half of the evaluation, then the second half of the evaluation is a different appointment with, um, the vision therapist to do more of the testing after that is done, usually that part's on the same day. Um, then we set up one more appointment for a consultation. Um, so I will write a report over all of the, um, the Tuscan recommendations, um, for your particular child. And then I have, um, the parent and parents, um, come to the office without your child, and then I spend up to an hour, um, talking to them about their specific child's results and recommendations, so that they're fully informed and understand the, um, the underlying basis of what we're, why we're recommending it.
And there is, um, a parent has a question for their child. How would they go about getting their child tested for dyslexia? Should they start with the pediatrician or with the school district?
Um, yes. There's two ways to go about it, both what you just described there's through, um, uh, the pediatrician through your health insurance will pay for a evaluation with a developmental pediatrician or a psychologist who specializes in dyslexia, so where it can be, um, uh, covered under your medical insurance. there are some limitations to that, um, and that it's, uh, not, uh, there are some, uh, different levels of expertise that are on the insurance panels of those, um, doctors. Uh, so there's also, um, through the school district through an IEP, which I definitely recommend to do. Um, there's when an IEP is for those who don't know is an individual educational plan, um, there's different. Um, when a child has difficulty in school, uh, the first level is a student study team or SST. It's kind of a powwow between the, the student, the parent and the teachers, um, to go over what things that we can do to help that child succeed in school.
Um, the next level up is a section five Oh four, which are, if they have these, um, visual difficulties or other difficulties, visual, motor active, um, problems, like they can't do their handwriting, we'll teach them how to use keyboarding. And so those are accommodations that are given, and then an IEP, a five, a four is a contract between the student and the school. An individual education plan is a contract between the student and the state. So that means that there's, um, the, if you request a IEP for your child, the, um, the school district within 15 days of a written request has to do a full testing, and you can choose what testing, including a divisional developmental exam. Um, but they look at all of the, um, there's a occupational therapist, school psychologist, um, educational specialist, and they do a full panel of testing to determine if the child has a specific learning disabilities. And, um, then with that, you have a contract in which to, um, uh, ask for services to help remediate those difficulties.
And,
Um, Cassie, she has a question for you.
Go ahead, Kathy. Hi, dr. Daniel. Um, I am actually in my third term right now of my doctoral studies for occupational therapy. So that was really awesome to hear that your daughter does that. Um, I guess I'm just interested in knowing it sounds like there's possibly some special certifications that OTs can get, um, to better assist with this sort of thing, especially because I'm really interested in pediatrics. And so I'll probably be seeing a lot of this. Um, so yeah, I'm just kind of curious to know what things maybe I could look into, um, for later on just to help, you know, um, help with you guys too.
Absolutely. Um, occupational therapy and vision therapy have a lot of overlap, which we work really well together. And so my daughter and I had discussed cases all, every single day. And so, um, and she works with both adults and children. And so, um, it's, uh, there are a lot of things that you can learn as a OT from the visual perspective. And I'm so happy that you came to the webinar to kind of see, Oh yeah, I see that. And what vision therapists do with lenses and prisons and therapy that may be different than what you can do, but then also as an OT, there's a lot of that sensory integration and central peripheral activities that you can incorporate into your therapy. Um, so actually email me, but we do have a lot of OTs that come to our office or to our training sessions and if you're local, um, and if not, then I can connect you to, um, some other educational, um, places that you can, you can learn from. Okay. And in San
Diego, is that right? Carlsbad, Northern town, San Diego. Oh, okay. Um, yeah, I'm in LA, but I'm kind of a nomad right now cause I'm doing online classes. So, um, but I would love that I will definitely email you. Thank you so much. This was really a cool information.
All right. Thank you. Thank you. These are some great questions. Um, but we're, uh, our time is running out. Um, but if you have any more questions, please email us, again on I'm going to show our email information in just a little bit. Um, but thank you dr. Daniel for your information and for your time, and thank you everyone for just joining us today. You know, I really wanted to make sure that these webinars are like a conversation versus a presentation and a conversation can't happen without all of you. So I really appreciate your input. And with that being said. Oh, dr. Daniel, may I share the screen?
Okay. I think I unshared it. There you go. Okay. Yeah. Okay. So as a thank you for joining us? We wanted to offer a $50 voucher to use in our Carlsbad location. As you can see, it doesn't expire until October of next year, so you'll have plenty of time to use it. just send me an email and then I can reply and attach the voucher for you to print out and then bring in with you and be sure to join us next month. As you remember in her presentation, dr. Daniel spoke a little bit about the sensory learning program. So next month she'll have the opportunity to go into more detail about sensory integration and the syntonic behind that. That's going to be Thursday, November 19th at six 30.
And then here is our information, our phone number, and then Cassie, there's our exact address for you. I've included our general mailbox as well as my direct email. So please reach out to us if you have any questions. Um, thank you again for being here. Thank you, Brooke and Leslie for your help for today. Um, but with that being said, uh, stay safe, everyone. And then again, email us if you have any questions or maybe there are some topics that you'd like for us to cover in some future webinars, just let us know. All right, everyone. Thank you. We'll see you next time. Bye. Bye.