This presentation is geared towards teachers and professional teaching staff, but can also be adapted for parents and others. It reviews the three O's of eye care (Optometry, Ophthalmology, Optician), the optometric examination, learning related vision problems and more.

1. The A, B, V’s of School
Performance:
Academics, Behavior and Vision
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Professor, Pediatrics/Binocular Vision Illinois Eye Institute/Illinois College of Optometry
Michelle O’Brien
Vision Therapy Coordinator
Lyons Family Eye Care
Chicago, Il

2. The 3 O’s of Vision Care
•Optometrist
•Ophthalmologist
•Optician

3. Optometrist
• 4 Years of College
• 4 Years at an
accredited College of
Optometry
• Residency (Optional)
• Pass National and
State Boards
• Practice

4. Optometrist
Dx & Tx
• Eye Diseases
• Refractive errors
• Binocular vision
problems
• Vision information
anomalies

5. Ophthalmologist
• 4 yrs college
• 4 yrs medical school
• Residency
• Boards
• Practice
• Eye disease & surgery

6. Optician
• Variable education
(on the job)
• Makes glasses
• Assists in eyewear
selection
• Fits/adjusts glasses

7. The Optometric Examination
• Case History
–Medical
–Vision
–Vocational
–Educational
–Recreational

8. The Optometric Examination
• Visual Acuity
– Snellen
– Lea Symbols
– Broken Wheel
– Teller Acuity
Cards
– Fix and Follow

9. The Optometric Examination
• Visual Acuity
– Snellen
– Lea Symbols
– Broken Wheel
– Teller Acuity
Cards
– Fix and Follow

10. The Optometric Examination
• Visual Acuity
– Snellen
– Lea Symbols
– Broken Wheel
– Teller Acuity
Cards
– Fix and Follow

11. The Optometric Examination
• Visual Acuity
– Snellen
– Lea Symbols
– Broken Wheel
– Teller Acuity
Cards
– Fix and Follow

12. The Optometric Examination
• Visual Acuity
– Snellen
– Lea Symbols
– Broken Wheel
– Teller Acuity
Cards
– Fix and Follow

13. The Optometric Examination
Muscle Function Tests
• Cover test
• EOM’s
• NPC
• Hirschberg
• Kappa

14. The Optometric Examination
Refractive Error
• Myopia
• Hyperopia
• Astigmatism
• Presbyopia

15. The Optometric Examination
Refractive Error Tests
• Subjective
refraction (which is
better one or two?)
• Objective
refraction
(retinoscopy: static,
dynamic,
cycloplegic,k
autorefraction)

16. The Optometric Examination
Tests of Binocularity
• Heterophoria
• Fusional vergence
• Stereopsis

17. The Optometric Examination
• Stereopsis/3D

18. The Optometric Examination
Tests of Accommodation
• Positive Relative
Accommodation
• Negative Relative
Accommodation
• Amplitudes
• Facility
• Lag of Accommodation

19. The Optometric Examination
Eye Health
• Eye drops
• Biomicroscopy
• Tonometry
• Binocular indirect
ophthalmoscopy
• Visual fields

20. The Optometric Examination
• Assessment or Diagnosis
• Plan or Treatment
• Patient Education

21. The Optometric Examination
Assesses Vision

22. Pursuits/Saccades
• Oculomotor
Dysfunction
– Looses place while
reading
– Skips words
– Confuses words
– Reversals
– Must re-read often
– Words run together
– Slow reader
– Avoidance of reading
– Uses finger as a guide
while reading

23. Accommodative
Excess/Insufficiency
• Accommodation
– Blur
– Headaches
– Avoidance of
near work
– Eyestrain

24. Convergence/Divergence
Insufficiency/Excess
• Binocular Vision
Dysfunction
–Diplopia
–Eyestrain
–Avoidance of
near work

25. Amblyopia/Stabismus
• Amblyopia:
reduced vision do
to refractive error
and/or strabismus
• Strabismus: an eye
turn in/out/up/down
Intermittent, constant,
monocular,
alternating

26. Vision Information Processing
• Vision perception
or Vision
development
– Laterality &
Directionality
• Reversals
• Up/down/left/
right
– Non-motor
Visual
information
Processing
• Visual discrimination
• Visual memory
• Visual spatial
relations
• Visual form
constancy

27. Vision Information Processing
– Non-motor Visual
information
Processing
• Visual sequential
memory
• Visual figure
ground
• Visual closure
• Motor VIP
– Visual motor
integration
– Eye-hand
coordination
– Motor
speed/precision

28. Auditory Information Processing
• Auditory
discrimination
• Auditory
memory
• Auditory visual
integration

29. Other Tests
• Dyslexia
Determination Test
• Slossen Intelligence
Test
• Peabody Picture
Vocabulary Test

30. Optometric Vision
Therapy/Orthoptics
• Visual motor integration problems
• Oculomotor dysfunction
• Focusing problems
• Binocular vision problems
• Learning Related Vision Problems

31. Optometric Vision
Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
“The symptoms of convergence insufficiency (CI) can make it
difficult for a student to concentrate on extended reading and overlap
with those of ADHD.”
“Some of the symptoms of ADHD overlap those of convergence
insufficiency (CI). Comparing the Convergence Insufficiency
Symptom Survey... with the DSM-IV criteria for ADHD, we noted
that 5 of the 9 symptoms of inattention could also be applied for CI
(symptoms 1, 2, 4, 6 and 8 as follows).

32. Optometric Vision
Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
DSM-IV Criteria for ADHD:
1. Often does not give close attention to details or makes careless
mistakes in schoolwork, work or other activities.
2. Often has trouble keeping attention on tasks or play activities
... 4. Often does not follow instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions).

33. Optometric Vision
Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
... 6. Often avoids, dislikes, or doesn't want to do things that take a
lot of mental effort for a long period of time (such as schoolwork or
homework).
... 8. Is often easily distracted.”
“For the diagnosis [of ADHD], a complete medical, optometric and
psycho-educational evaluation should be performed and vision or
hearing deficits should be ruled out. Underlying visual or hearing
problems may cause the child's academic underperformance and/or
lack of concentration.”

34. Optometric Vision
Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
“Since the symptoms [of ADHD and convergence insufficiency] can
be similar, it is not hard to imagine a diagnostic confusion.”
“We observed in our clinic that an unusual number of children with
or suspected to have ADHD also had convergence insufficiency.”
Medication Issues:
“...it is possible that the medications used to treat ADHD are
aggravating CI. For some of these drugs, difficulties with
accommodation and blurring have been reported.”

35. Optometric Vision
Therapy/Orthoptics
The Relationship between Convergence Insufficiency and ADHD
“No matter what the true cause or cause and effect relationship, it is
unavoidable that the presence of CI may cause (1) misdiagnosis, (2)
diagnostic confusion or (3) exacerbation of the symptoms of
ADHD.”
“In view of these findings, we believe it reasonable that CI be
evaluated in patients with or suspected to have ADHD.”
CI is a condition that responds well to optometric vision therapy
treatment...

36. Optometric Vision
Therapy/Orthoptics
These statements were from:
The Relationship between Convergence Insufficiency and ADHD
Strabismus 2005 Dec;13(4):163-8.
David B. Granet, MD FACS FAAO FAAP, Cintia F. Gomi MD,
Ricardo Ventura, MD, Andrea Miller-Scholte, CO

37. Optometric Vision
Therapy/Orthoptics
Vision Therapy
Phases of Therapy
Monocular, Biocular, Binocular, Integration/Stabilization

38. Websites
• http://www.MainosMemos.blogspot.com
– Latest research in children’s vision
• http://www.covd.org/
– College of Optometrists in Vision Development
• http://www.ico.edu/
– Illinois College of Optometry
• http://www.oep.org/
– Optometric Extension Program

39. Websites
• http://www.opt.indiana.edu/vtlit/vtlit.html
– Research articles on vision therapy
• http://www.indiana.edu/~v755/Amblyopia/ambss/sld001.
htm
– University course on lazy eye (amblyopia)
• http://www.children-special-
needs.org/vision_therapy/what_is_vision_therapy.html
– What is vision therapy?

40. Websites
• http://www.aoanet.org/ia-op-vis-ther.html
– AOA POSITION STATEMENT ON
OPTOMETRIC VISION THERAPY
• http://www.optcom2.com/covd/covd7/page
144.html
– Article from The Montgomery Journal, Montgomery
County, Maryland on Attention Deficit Disorder
(ADD) and Dyslexia
• http://www.vision3d.com/optical/index.sht
ml#stereogram
– 3D Pictures

41. Websites
• Online Vision Therapy/iPad Therapy
http://www.centerforvisionandlearning.com/in
dex.php/resources/apps-and-games.html

42. Websites
• http://www.LyonsFamilyEyeCare.com
–Office website
• Illinois Eye Institute
–http://www.illinoiseyeinstitute.org/

43. Lyons Family Eye Care
Dr. Stephanie Lyons
Dr. Kelsey Frederick
Dr. Rachel Barker
Dr. Dominick Maino
Ms. Michelle O’Brien
Mr. John Lyons

44. Lyons Family Eye Care

45. Websites
Not Vision Therapy Related
Filament Theatre
http://www.filamenttheatre.org/

46. Questions?
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Lyons Family Eye Care
3250 N. Lincoln Ave Chicago, Il 60657
773-935-2020 Michelle O’Brien
Illinois College of Optometry/Illinois Eye Institute
3241 S. Michigan Ave. Chicago, Il. 60616
312-949-7280 dmaino@ico.edu