Awesome Observations!
eye exam of a 2-year old special needs female
Although it was very difficult to perform much of any pre-testing on this child, Dr. Marini was able to almost flawlessly complete the examination. The little girl was a returning patient and will come back in a few months. Patience and knowing the boundaries that shouldn't be crossed are important in such an exam. Some things are more important than others and these should be done first to not lose the focus of the young patient.
Near Testing Galore
Near testing is performed on most pediatric patients. It includes:
AMPS
Pursuits
Saccades
Vergence Measurements
It is possible to check if pursuits and saccades vary when patient is also having to stimulate their thought process by asking them questions while having them track a target.
AMPS
Pursuits
Saccades
Vergence Measurements
It is possible to check if pursuits and saccades vary when patient is also having to stimulate their thought process by asking them questions while having them track a target.
Developmental Eye Movement Test
DEM assesses fixational and saccade activity during tasks of reading and non-reading. It incorporates multiple tests and takes about an hour to complete. This test was developed by Dr. Jack Richman and Dr. Ralph Garzia. It is performed in Dr. Marini's office on patients before they begin vision therapy.
Automated phoropter
Dr. Marini uses an automated phoropter. Although I was at first skeptical about an automated phoropter, seeing it used has made me aware to many of its advantages. It allows the saving of multiple prescriptions which makes it easier for the patient to realize the difference between the current and new prescriptions. It also helps the doctor as less dials need to be turned. If properly set up with a computer, it would automatically transfer information collected by the instrument to the patient's data.
School and eyes are very closely linked.
I was shocked when Dr. Marini did some near testing and asked the parent of the patient if they noticed that the patient was having any issues with a specific aspect of school. The parent went on to admit that the patient was about to be tested for an IEP. Dr. Marini explained to the parent that the binocular vision problem which the child was displaying may be the reason for the problems they were experiencing and so a DEM was scheduled.
During my observations of Vision Therapy I was surprised by how much better a child is at working efficiently and neatly by simply correcting their posture, holding their nose towards the middle of the paper. Some children press with their pens really hard because they are nervous.
During my observations of Vision Therapy I was surprised by how much better a child is at working efficiently and neatly by simply correcting their posture, holding their nose towards the middle of the paper. Some children press with their pens really hard because they are nervous.
VT= where ODs get to be kids again!
Vision Therapy is a place where anyone can feel like a kid again. Although vision therapy requires a lot of work on the part of the patient. The assignments the patients must complete can be related to games the majority of the time.
Among activities in VT are:
Among activities in VT are:
- Connect the dots (make sure that the line ends in the middle of the arrow)
- Connect the dots with arrows (make sure that the line ends in the middle of the arrow)
- Split pupils (holding a lens in front of an eye, with an eye path on the opposite eye and ask the patient to read a chart or specific letter. Ask them to blink to clear what they are trying to see)
- Parquetry blocks
- Mazes
- Wearing red green glasses, match the shape cards
- Card games (this can work pursuits as well as visual memory)
- Golf game (this also works visual memory as one has to visualize a path and take the path while not looking at the paper)
- King-Devick saccades (read the numbers in the order in which they are written on a paper, this increases in difficulty to four levels)
- Wayne Directional Sequencer (this helps with tracking)
- Letter Tracking
- Shape copying
- Kershner Arrows
- Chris's Box
- Life Saver card
- Brock String
- Barrel Card
- Computer games
- Prisms, Lenses, Red-green glasses and patches are all involved at some point
Specialty contact lenses
Synergeyes lenses (hard, soft lens combo; this allows one to have the sharp vision of a hard lens with the comfort of a soft lens)
CRT lenses (hard, soft lens combo worn at night to have good vision during the day; these lenses decrease the amount of myopia in the wearer)
CRT lenses (hard, soft lens combo worn at night to have good vision during the day; these lenses decrease the amount of myopia in the wearer)
Poor vision isn't always caused by a poor prescription
We saw a patient whose contacts were comfortable and there was no logical reason for the vision not to be clear. Dr. Marini taught me that sometimes an astigmatic lens may not be positioned correctly, causing troubling vision. When looking at an Acuvue Oasys for Astigmatism lens through a slit lamp, a marking is visible. Upon moving the lens so the marking is where it should be, vision returns to normal and acceptable by the patient.
Balance Board
I have learned many exercises which can be performed on a balance board and benefits from using the board. Use of the board can help boost memory and even after performing a short balance board sequence, reading efficiency and fluency improves. There are exercises the therapist can perform with a patient but there are also many exercises the patient can perform on their own. Bean bags of varying weights can be used with this activity.