Frequently Asked Questions - Optometry Services
An optometric practice isn't just one single thing and therefore it is hard to describe all the kinds of care that we offer. One thing that is interesting to me, is that over the years how often people that come to me a specific type of care, end up thinking that I'm just a specialist for people with that kind of condition. Well into their care or towards the end of a treatment program for a loved one of theirs, they may ask me if I see other people for other reasons. The one I love is when they ask if I see "normal people who just need glasses or contact lenses"! My answer is always of course. I say, "I specialize in seeing members of the human race."
Behavioral optometric care is about identifying my patients unmet needs and then seeing, if in the bag of tools I have if any of those could help the person in front of me better met those needs. If so, then we are in business, with me being able to help and the person in front of me having their life changed for the good.
Another pet peeve I have is people who come in with labels or volumes of reports from others as if knowing what others have labeled them as will help guide me in my testing. When I first meet a person, regardless of their history, regardless of the life path that has brought them to me, regardless of what others have labeled them as or what they have tried with them, my job is to look at the person in front of me anew and to get to know them, what they want to do in life and to find out if by helping them use their visual process in a different way, if their life can be changed.
Since the world seems to like categories, here are just a few of the kinds of services we offer:
- What are Learning Related Visual Problems?
- What is a InfantSEE™ Vision Assessment and what age children can be seen?
- Who should get a visual screening for learning related visual problems (LRVP)?
- What do you do in the Visual Evaluation and how is what you do different than other eye doctors?
- Why do you do VT Progress Evaluations and what kinds of information will we get as a result?
- What is Visual Therapy?
The number one condition that we address in my practice are children who are having difficulties learning and achieving their potential in school and the primary cause of their problems is a visual development problem. The prevalence of these conditions is 20-23% of the general population and as many as 93% of those identified under public law 94-142 as requiring extra help in school.
Children with LRVP's have visual development problems in three general areas. 78% have a tracking orocular motor dysfunction which is affecting their ability to keep their place or to move their eyes from place to place across the page. By the age of six and a half a child should be able to track or follow a moving target in front of them without moving their head. This developmental milestone of learning to separate the movement of the eyes from the movement of the head and upper body is essential in learning to read and write. Fortunately this is one of the easiest visual developmental problems to diagnose and to treat. Clinically we see a child who loses his or her place, moves their head when reading, uses a finger to help keep their place, and is often a child who is clumsy.
63% of the children have problems using their two eyes together. The general condition is called a binocular dysfunction with convergence insufficiency being the most prevalent specific diagnosis we see in practice. Children with this problem often have short attention spans, fatigue rapidly, the quality of their work declines rapidly over time, and they may rub their eyes and complain of headaches.
58% of the children have problems focusing their eyes and harnessing their visual attention skills/abilities for long enough to get their work done in a timely manner. This problem is called an accommodative insufficiency or it may be an accommodative infacility.
Obviously many children have combinations of these three problems: tracking, teaming or focusing. I am quite proud of our very high success rate in helping these children.
Dr. Harris is proud to be participating in the InfantSEE™ Vision Assessment program that is part of the American Optometric Association and supported by Johnson & Johnson Inc. If you have a child between the ages of 6 and 12 months, who has yet to have their vision assessed, call now for your free appointment. Many vision conditions can be identified very easily, and long-term serious consequences may be averted. Many parents think that because their child cannot respond to verbal questioning that we cannot assess their eyes and their vision development. This is a myth. We have a whole series of tools that allow us to get an excellent view of the optics of the eyes, the health of the eyes, and to see if your child is developing the visual tracking and eye teaming necessary to develop normally. Pediatrician Dr. Arnold Gesell said, "Vision development is child development viewed optometrically." Often we can assess a child's visual and intellectual development better than many other disciplines because of the powerful tools we have and the primacy of vision and the visual process. Former President Jimmy Carter is the national spokesperson for this program. Two of his 11 grandchildren had undetected amblyopia and he wanted to make sure that no children in this country would end up in the same situation. He challenged the profession to take care of the children, and the American Optometric Association listened and created this program. Dr. Harris served as the InfantSEE™ State Leader promoting amongst his peers a program he supports 100%. He also served as an instructor for the other optometrists, putting on courses in Maryland and other states to help them learn how to examine these infants. The vision assessment lasts about 30 minutes and should be scheduled in the morning during a time your baby is normally awake. Please change your baby prior to the visit. Often the child, particularly those very young ones, are most alert during feeding. If possible, try to hold off nursing or giving them their bottle until your actual visit. Also, if possible please try to leave siblings home. For more information vision the InfantSEE™ website. More information is available at Baby Center.com.
Dr. Harris and the entire team of the Baltimore Vision Fitness Center offers to all school-age children (enrolled in Kindergarten to grade 12) access to a free visual screening for potential learning related visual problems (LRVP). Vision or visual developmental problems often masquerade as ADD, ADHD, or other related learning disabilities, when in fact, the primary problem is a visual development problem. Most of these visual problems go undetected because the vast majority of these children have 20/20 sight: they can see small detail and do not require glasses for clarity. However, they may have a primary problem with looking for sustained periods of time (visual attention), with moving their eyes accurately from place-to-place to follow along with reading or with a lesson (tracking problem), or they have a subtle problem with coordinating the use of their two eyes together, causing momentary shifting of images or causing an apparent movement of the words on a page (eye teaming problem - binocularity). None of these problems can be observed by just looking at your child. To find out, call now (1-410-252-5777) or email us to request a time for a free LRVP visual screening for your child. The screening will take about 45 minutes and is done by our capable staff. At the end of the screening, a staff person will sit down with you and let you know if evidence of a problem that requires further investigation by Dr. Harris exists. You are under no obligation to schedule this follow-up evaluation, and if you like, a list of other behavioral vision specialists will be given to you for on-going care. For additional information on undetected learning related vision problems, please go to the websites for PAVE (Parent Active for Vision Education) and to the Children with Special Needs web sites. Please also be advised that this visual screening is for children that have not yet had a vision development problem identified. If you already know about or suspect that there may be a childhood visual problem such as a turned eye, or an eye that is not seeing well, or if you know that there is any problem of overall child development such as autism, pervasive developmental disorder, Asperger's Syndrome, ADD, ADHD or if they are currently taking any systemic medications, then they should be scheduled for a full 90-minute Vision Therapy Workup appointment, which will be charged at the usual and customary fee. Send us an email if you would like us to contact you about scheduling a vision screening for your child.
The Purpose - or Why do I do the Exam? The clarity of your sight is only one of our many concerns. The visual evaluation will also reveal how well your eyes work together as a team. Evaluations of depth perception, eye movement skills, ability to focus easily from near to far and back again, focus endurance for near-centered tasks, color vision, and visual fields are among the many tests of visual performance which we implement. During the visual evaluation, we carefully evaluate the health of your eyes, inside and out, for such problems as cataracts, glaucoma, circulatory problems, hypertension, diabetes, etc. We are part of a wide network of health professionals and will direct any patient in need to the most appropriate source as quickly as possible should we detect any abnormality. However, additional special testing of visual performance is available right here in our office. Contrast sensitivity testing for those subtle visual defects, which can so profoundly affect visual performance, and electro-diagnostic analysis, to rule out neurological problems as a causative factor in eye turns or lazy eye conditions, can be done without leaving the office. Our modern world demands more from our vision than ever before. In fact, 80 percent of all school learning tasks require close-up vision. Adults in our technological society constantly use their near vision at work and at home. Computers especially strain our visual systems, and both adults and children are using them more and more. A thorough vision evaluation and follow-up care on a regular basis are very important for early detection and treatment of eye health problems and for prevention of vision problems created or aggravated by today's academic and vocational demands. Your vision should be evaluated EVERY YEAR or more frequently if symptoms of vision problems occur. Children should have a complete behavioral screening at the ages of six months and three years. They should then have complete visual evaluation on a yearly basis with the first evaluation occurring the summer prior to entry into kindergarten. The Mechanics of the Exam/Evaluation The initial visual evaluation is an exciting time for me. It is a real thrill to meet so many different people who have the need for my services. Many have seen others who have failed to help make a difference. Many have been down several different avenues searching for help and ended up making little or no progress. I love playing the role of Sherlock Holmes and discovering the mystery before me and coming up with alternatives of care to help you alter the path your life is on. Most of you will see me for a full 90 minutes the first time we are together. Generally that time is broken up in the following way. I will spend 15-20 minutes getting to know you and to find out what unmet needs you have that I might be able to help you with. These may vary from not being able to sustain attention on near-centered tasks, to getting headaches when reading or working on computers, to seeing double or seeing the words move on a page of print, to simply wanting to be better at sports or to recover basic skills of daily living following a stroke or head injury. Patients are often struck by my down-to-earth fun-loving spirit. A comprehensive visual evaluation should be fun, in spite of being put through many challenges that will help me see how various aspects of your visual process is working. After the case history we shift to the examination chair. We rapidly will move through a series of tests with lights and a moving steel ball, and lenses, and charts, and Polaroids and color charts and many other things. After as many years as I have been doing this it feels choreographed and you may marvel at how quickly we move from one thing to another. During this part I get a good sense of how you track moving objects and how you move from one place to another while shifting visual attention. I also get a sense of how accurate you are at pointing each of your eyes at precise locations in space. Many people have never learned how to be very accurate with the placement of both eyes at the same time and this can cause all kinds of loss of efficiency as the brain attempts to decide which channel to trust, rather than having the benefit of a well-merged dual view of the world. I then move in a testing device called a phoropter, which has many different lenses and allows me to analyze the optics of your eyes precisely while also giving me the chance to put your visual process through a series of visually stressful probes to find the range and ease that you can extend the use of your two eyes through. Once this is done we typically move over to a table top where I will do several performance tests. It is one thing to look at the optics of the system and to see the ranges through which you can keep both eyes aligned for example, but it is another thing entirely to see how quickly you can call off numbers from a paper or follow intertwined lines in a maze. I may have you read or copy text or write some spelling words, to see how you use your visual system in the real world. For some the final test uses infra-red technology to record your eye movements to a computer system so I can analyze the data and understand the mechanics of how you use your eyes to read. All of the testing usually can be completed in 50-60 minutes. The balance of our time is spent in me explaining to you and those who have come with you to your appointment, in terms you can understand, what my understanding is of your visual process. We will discuss the various potential etiologies that brought you to this point of your life and then I will give you the three alternatives of vision care and help you understand the potential outcomes of each of these alternatives. Many times problems can be addressed by using lenses alone. If so, this is great as it means we may not need to engage in vision therapy. However, some problems can only be overcome by vision therapy and if you have one of them I'll come right out and let you know that this is your best option. With your permission I will make a digital recording of our conversation and I will make it available to you and to whomever you wish to share it with via the internet later that same day or the very next day. Many people have found this refreshing that they will be able to go back through our dialogue later and not feel so overwhelmed with all the new information that is so important to learn. My goal is to find a path that helps you improve your visual abilities so that you can meet the demands that life throws your way. I look forward to meeting you and those whom you bring with you to the office.
The name of these visits that occur after each group of eight therapy sessions is a bit misleading. As patients progress through their vision therapy both they and my staff are getting direct feedback as to the level of progress being made. We use a curriculum model of providing vision therapy. This refers to the fact that based on the kinds of unmet visual needs you present with I will have either selected an appropriate curriculum (sequence of activities in a proscribed order) program from our standard selections or customized a curriculum for your special needs. Based on the length estimate I gave you at the first visit we have a shared expectation of how long it will take to work through your curriculum. Each week we can see if you have mastered the prior weeks assignments and are ready to move on or if you require additional time to master these activities. As you move through the curriculum you will get a sense of accomplishment and will know you are making progress. As well, you will note many things in your life that are changing, as your needs are beginning to be met. For example it is not unusual for people who have come in with headaches when doing sustained near concentrated tasks to have those headaches be gone by the first 8-week progress evaluation. So if you and my staff and I know you are making progress why do we need to get together once every 8 weeks? The primary purpose is for me to take some independent objective measures to be sure that the curriculum we have chosen to work on is still most appropriate. Another aspect of the testing is to make sure that any lenses that you have are indeed correct. Many times lenses are given to help treat the underlying problem but as the therapy progresses their role changes from treatment to helping to reduce visual stress. In some cases the actual prescription will need to be changed and at others the form of the lens (ex: single vision lens to a bifocal) may need to occur. Finally, as your life demands change you may identify additional needs that we may be able to address which might require me to alter the curriculum we have set up for you. All this occurs during the progress examination. After you have completed your vision therapy, I generally see you at one, three and six months to make sure that all gains are holding and again that you have the correct lenses on. Vision therapy plants a seed. And through continued use, it generally continues to grow and develop well after we have finished office-centered therapy. Many people continue to make excellent gains during this post-therapy period.
Visual therapy is a step-by-step developmental program designed to provide patients with the necessary meaningful experiences to acquire full use of their visual process. Visual therapy is based on Piagetian principles of learning, in which a series of graded problems are presented to a child under very controlled circumstances and then practiced for reinforcement.
Therapy in my office is done on a one-on-one basis for 50 minutes. Each session consists of four to five activities which are done for 8-10 minutes each. Then two to three of them are assigned for home practice. The most difficult aspect of being a therapist, as well as being a teacher, is to know exactly how demanding a particular activity should be. Too intense and the child may go into a "flight" pattern and avoid the activity or go passive and not fully engage in the activity. Too little intensity, where a child is asked to do something that they can already do, is a formula that simply wastes everyone’s time, effort and energy. My therapists are trained to adjust the demands of the activities to maximize the speed of improvement, but not at the cost of putting the child under too much stress.
A key aspect of therapy is the involvement of the parents as home therapists. We require from 15-20 minutes of practice or drill a day under the direct supervision of a home helper, who is most often the child’s parent.