Monday, September 22, 2008

Identifying signs and symptoms for a visual problem

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Detection of visual upsets, mainly in childhood stage, is done when we observe and assess the child’s attitude and behavior when he performs a task.

- Itching, stinging or watery eyes
- Blinks or rubs his eyes a lot
- Frowns or scowls in order to seeing better
- Blurred vision at distance or at near
- Rigid body or moves his head forward or backward when reading or looking at a remote object
- Very close distance when watching TV, writing or reading a book
- Has difficulty for copying from the board
- Unusual eyestrain when finishing a task or decline in the reading after long periods
- Omission of tasks at near
- Fatigues quickly during reading, writing or drawing
- Bothered by the sun and lights changes
- Headache and eye pain
- Negative behavior at school or at work
- Bad head or body posture
- One eye drifts or aims at a different direction than the other (look carefully, this can be subtle). This is significant even if it only occurs when the child is tired or stressed
- Closes or covers an eye, or twists or tilts head, when reading and writing or watching TV…
- Double vision

- General difficulties at Reading:
  • Moves head when reading instead of to move the eyes
  • Words slide together
  • Reading speed below chronological age
  • Does not understand what he has read or does not remember it
  • Loses place, skips lines or rereads words or lines
  • Needs to use finger as a marker to keep place
  • Reads in loud voice or moving lips
  • Omits or adds words or tries to guess them from the fast recognition of one part of them
  • Mixes syllables when reading and numbers in maths
  • Reverse letters, syllables or words
  • Avoids reading or other close-up tasks

- General difficulties at writing or in the hand’s motor skill:
  • Irregular and changeable letter size
  • Small spacing
  • Inability to write in a straight line
  • Reverses letters, words and numbers when writing or copying
  • Favors the reading with regard to playing or motor activities
  • Favors oral exams with regards to the written ones
  • When coloring, he can not keep his work inside the lines
  • Does not like to draw
  • Grabs the pencil badly, or takes out his tongue or does strange gestures with his face when he uses his hand to perform something that requires eye-hand coordination
  • He is slow when he has to follow a dictation

- Difficulty to comprehend and perform instructions
- Bumps into things
- Sometimes he appears clumsy
- Becomes easily distracted
- Has a short attention span and needs a lot of rests
- Poor concentration
- Homework takes longer than it should
- Poor visual memory
- Negative and/ or aggressive character
- Troubles for adapting to the changes
- Gives up easily (says “I can’t”, before trying)
- Dizziness, nausea or motion sickness
- Poor posture when sitting down and working
- Incapacity of being kept sat down on a chair more of 5 minutes
- Walks on tiptoe
- Balance troubles
- Confuses right and left in himself and/or in the space past age 7 (and sometimes up and down)
- Poor performance of sports or coordination of hand-eye and foot-eye (ball skills and team games): catching and hitting a ball
- Etc.

These manifestations will help you yourself to detect if any child, in your environment, may have an undiagnosed visual problem.

Moreover, in the optometric office, the professional will give you or ask you a brief questionnaire about the child, his development and his visual habits. Sometimes it is very long and tedious or even sometimes, you do not know what relation, some questions may have with the eyes or with the problem that you bring to the office; but there is not random question in these questionnaires, all of them give very important information that will help the optometrist to achieve a better diagnosis about the problem that the child has got. Therefore, even though everybody thinks that their children are wonderful and perfect, think that if you go to the office is because you suspect something, and if so, being as sincere as possible when you fill in these questionnaires is better, because the lies and half truths or half informations or underestimating the details that show where the child is not so handy, will not help; this information is the most valuable in the questionnaire.

An apple a day really does keep the doctor away

Thursday, September 04, 2008

Back to School!!!

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When September arrives everybody begins our “school year” –not only children-, whether we went on vacation in June, July or August, or even if we did not leave. In summer, all of us reduce our rhythm of work; the good weather, the heat, children without school, emptier and more peaceful cities, allow us to enjoy our time much more and to calm down from the frenetic rhythm of the rest of the year.

Therefore, our visual system is much more relaxed, since if our work stress decreases, as well as our visual stress decreases. On vacation, if we read is because we want to do it, or if we perform some task at near is because we are getting back to some forgotten hobby. In any of these cases, the strain is minimum and we rest when we want. So, this is the best month to check our vision. This vision will be in its purer and more relaxed state, it will give more real values both in quantity and quality of vision (refraction, focusing, fusion, perception, visual acuity, integration into other systems,…); moreover, in an emotional way, everybody is more relaxed when we are back from vacation, and everything affects.

Consequently, before going back to the intensive rhythm of all year, it is recommended to receive a complete visual exam to check that everything is right or in order to give solutions if there exists any problem before the symptoms arise, or simply in order to receive a guide from the optometrist about some good Rules of Visual Hygiene and/or of Relaxation; these are not bad things to do (I will give this rules in another post later).

The particular case of the child

But if checking that the visual system is in full performance (with nothing that disturbs it) is important in adults, imagine how important this is in the case of a child, where any visual problem can make it difficult for his right learning when reading or writing, in his hand-eye coordination, in his motor development or in his balance when he practices any sport, in his perception, in his integration of the visual information with that of other senses,… All of this will create social limitations that will be detrimental to his development, his personality and his character.

The child is in constant development and any obstacle appeared during it (in this case I write about visual development, but he would be affected by any upset of any sense that provides information that he has got to integrate), may disturb all visual information processing. It may disturb:
- the way information is received,
- the way information is integrated,
- the way information is processed,
- or even, the way received information is answered,
doing any of these actions FROM A WAY DIFFERENT THAN THE REST OF CLASSROOM CHILDREN; so, any school or daily activity (even playing with his friends) may require from himself the following: more effort, more time, more energy that makes him feel more tired, more concentration that actually makes him easily lose it when he is tired of maintaining it, more support from other senses or other skills that makes him carry certain activities in an out of balance way, and so on.

Between 0 and 14 years old detecting and treating any visual upset is very important, since constant anatomical and physiological changes are happening in the visual system as the child grows up, making the visual patterns and all neurological connections that will affect his future Perception. Also, in the first years of life, the child is learning from everything that is surrounding him, from everything that he does, and as I wrote in another post, much of this information gets in through the eyes. One visual problem (WITHOUT BEING A PATHOLOGICAL PROBLEM) may cause:
- academic performance problems,
- sport performance problems,
- school failure (to long-term),
- and the worst, self-esteem problems.

Once the visual problem has disappeared (it has been treated), these schoolchildren will improve their grades, will be happier and will be more social. They will feel with capacity to face difficult challenges in their school stage.

This is the reason why an EARLY DETECTION is so important in these ages; and both parents and teachers are responsible for detecting any small problem that the child has when he makes his daily tasks. The child will never complain because he does not know what a vision problem is, and he thinks that everybody sees like him, and if his schoolmates obtain better grades than him or play football better than him, he will simply go make a negative opinion of himself (“I am more stupid or more clumsy than the rest”), reaffirmed by the environment many times, without knowing that there is “something” that hampers him from being in the same conditions that the rest of his schoolmates or friends when he performs any activity.

One out of three children in school age suffers some kind of visual problem WITHOUT DIAGNOSING, and around 25-30% of school failure is related to visual upsets.

In the next post I will give you a list of signs and symptoms that we may take into account to detect whether your child or your pupils have some visual problem (some of that symptoms will as well valid to for the adults), but a summary, any visual problem may cause the following problems to a child:
- he can not attentively follow the teacher’s explanations in the blackboard if he does not see very well at distance,
- he can not read and study comfortably if he does not see well enough at near,
- he can not understand what he reads if he has to strain in order to read correctly,
- he will reject to go to school on a constant basis,
- his behavior will be absentminded and it will take him a lot of hard work to focus on any activity that requires a big attention,
- he will not like doing his homework,
- he will gradually feel isolated and retarded from the rest of his schoolmates with regard to his learning,
- therefore, he may make himself introverted or even develop an inferiority complex, very negative for his development as a student and as a person.

Many times parents and teachers blame these negative attitudes to psychosocial problems, to reading and writing problems (dyslexia) or to hyperactivity, when the most probable cause is just because of visual problems that have not been treated.

Although a child had not developed his visual system in a normal way, the sooner we detect the problem, the sooner we will be able to treat it and to help him promote his visual system, getting back to his normal development level for the child’s age. This happens because the younger the child is, the more plastic his visual system is, due to that although the visual organ develops completely at 2 years old, until 5 years old his visual system is not completely functional. So, if during this period his vision suffers any upset (myopia, astigmatism, eye deviation, lazy eye, retained primitive reflex,…), the development will not be the same, and if it is not treated on time, it will cause difficulties in his daily life. We can not allow for the time to go by and see if the problem is solved by itself, BECAUSE THIS WILL NOT HAPPEN, it will increase and it may be too late when we want to do anything.

Also, it may happen that, currently, the child has not had any problem at school and we think that his vision is perfect, and his parents decide that he does not need any visual check WHILE HE DOES NOT SHOW ANY PROBLEM AT SCHOOL. We must not wait for this moment to happen: a routine check is not bad for anybody and it can avoid that the symptoms and the performance problems at school rise. It may happen that in previous academic years the child had no problems, but as the new year passes by, he shows performance problems or bad grades that he did not have until that moment. That may simply mean that the child has a latent visual problem that was not obvious until that moment because the academic demand was not sufficiently high to show it. But when the academic demand increases, the level increases, and a visual problem that seems in control is suddenly out of hand. For instance, because the effort for understanding a more complicated text may show a reading problem that it seemed it did not exist before.

Owing to all these previous facts, as an optometrist I recommend that all of us should receive a visual check at least once a year, CHILDREN SPECIALLY. And when I write “visual check” I do not simply mean going to an ophthalmologist – which is also recommended, in order to be sure that our eyes are in a healthy state-, but to a qualified optometrist capable to assess if his visual system is ready for working in full performance.

Any visual upset in children or adults, causes our vision not to be efficient and, consequently our learning or work will neither be.