21st Century Lifestyle Demands


Our visual system was not made for prolonged
periods of near point work like working on a computer.

  Our visual system was designed for distance work

It was made to hunt, fish, farm and locate danger.

 Many of us experience:

  • eyestrain
  • eye fatigue
  • headaches
  • blurred vision after using a computer for a short period of time




  Computers                                               and                                          hand held devices 

   have made their way

 into our everyday  lives.

Be it at work and/or at home, adults as well as children inadvisably push their eyes past the point of eyestrain. Excessive computer use and/or uninterrupted close work can induce eyestrain, headaches, and/or other visual difficulties, which can be effectively treated with Vision Therapy.

 Do you experience eyestrain, headaches or blurred vision after working at your computer?  You may have Computer Vision Syndrome (CVS).


The National Institute for Occupational Safety and Health (NIOSH)  defines computer vision syndrome (CVS) as “eyestrain associated with prolonged computer use.”

 The American Optometric Association (AOA)  expands on this definition, calling CVS “eye and vision-related problems related to near work which are experienced during or related to computer use.”

 Symptoms of CVS fall into three categories:

  1. vision problems
  2. eye problems,
  3. general discomfort

Vision problems can include:

  • blurred vision (both near and far)
  • difficulty changing focus
  • double vision
  • glare
  •  flickering sensations
  • temporary changes in color perception.

Eye problems can include:

  • redness
  •  burning sensation
  • soreness
  •  stinging
  •  itchiness
  • dryness
  • excessive tearing
  • eye fatigue
  •  eyestrain
  • light sensitivity
  •  contact lens discomfort

General discomfort symptoms can include:

  • headaches
  • neck tension or pain
  • shoulder tension or pain
  •  back pain
  • pain in arms or wrists
  •  excessive fatigue
  • irritability
  • drowsiness 


The American Optometric Association estimates that 70% to 75% of all computer users experience CVS symptoms.

 Approximately 95 percent of the population keeps both eyes aligned on the object of regard, as shown in the Figure below.

Even though most people work hard at keeping their eyes aligned when viewing an object, many individuals have difficulty maintaining this ocular alignment. The symptoms associated with phorias can be:

  • eyestrain,
  • double vision,
  • headaches,
  • eye irritation, and
  • general fatigue.

If the eyes do not naturally line up, as is the case for most people, then a constant neuromuscular effort is required to avoid the above mentioned symptoms.

Vision is our most precious sense. Our    are in constant use every waking minute of every day.

The way we use our    can determine how well we work throughout our lifetime.

Over 80% of our learning is mediated through our 

indicating the important role our vision plays in our daily activities. Vision disturbance is a silent enemy that only appears after a long period of continued stress.

Today, millions of children are using computers every day, at school and at home, for education and recreation. Visual demands in school require the integration of a number of different vision skills:

  • visual acuity (sharpness of vision);
  •  visual fixation (eye aiming);
  • accommodation (focusing);
  •  binocular fusion (forming a single image);
  • convergence (turning of the eyes);
  • field of vision (side vision); and
  • form perception (recognizing shapes).

These systems can be stressed and overworked if not used efficiently. Computer viewing is complicating how children use their 

in school because these visual skills are not yet fully developed in children—making any near-point activities that much more difficult.


Many adults have vision problems, eye problems, headaches, visual difficulty using computers or doing close work, both on the job and on their own time.  The cause may also be a vision problem that can be addressed by vision therapy why put up with computer eyestrain when you don’t have to?


Handwriting and Learning Disabilities


Many children with learning difficulties also have writing difficulties.

Ernest J. Kahn, O.D., discovered after administering the “copy form” tests to many of his patients that:

  1. Practically all nearsighted children held their pencil no more than a quarter of an inch from the tip.
  2. Almost all children with learning difficulties exhibited some form of unusual pencil grip and fine motor in co-ordination.
  3. In all instances of improper pencil grip, the fingers blocked the line of sight from the eye to the pencil tip, causing the writer to bring the head to the side and/or down closer to the page in order to see what was being written.

Many of those who work with learning-disabled children have found that these children, in addition to having problems with reading, also have problems with handwriting.


Awareness of the problem is the key to change


Correct handwriting posture is very important.

  • Both feet should be on the floor.
  • For right-handed the body should be slightly turned to the left.
  • For left-handed the body should be  slightly turned to the right.


The position of the paper is also very important.

 In many cases, just learning how to correctly orient the paper may help poor handwriting.

  • Right-handed writer should have the paper turned so that the bottom left-hand corner points directly to the navel.
  • Left-handed writer should have the bottom right-hand corner pointing to the navel.
  • The paper is aligned in such a manner that the sides of the paper are parallel to the writing arm when it is resting on the paper.


  The non-writing hand is not just a “paperweight.” 

  • The non-writing hand has the role much like that of a typewriter roller as it moves the paper up to prepare for writing on the next line.
  • The non-writing hand plays a very important role in paper orientation while writing. 
  • The non-writing hand should be kept resting on the side of the paper, with the elbow on the table.  This allows an open view for writing and puts the body in balance to keep the paper from moving, while writing. 
  • The elbow and forearm of the writing hand must lie on the desk. It is better to keep the elbow in place and move the paper upward as writing is done. The writing hand moves across the page from left to right and line to line.
  • The distance from the eyes to the writing or reading material should always be the distance from the elbow to the middle knuckle,  aka  “The Harmon Distance.”


 The way students hold a pencil or pen to write, the manner in which they orient their paper, heir posture while writing, and the way in which they form their letters will be carried over to adulthood.

Copying and Reproduction Skills

Many parents are concerned with their children’s handwriting abilities.  Graphomotor performance is related to visual analysis, motor planning, and spatial organization. 

Writing and copying skills principally relate to the following visual skills:

  1.  Fixation – the ability to direct and maintain steady central visual attention on a target.
  2. Ocular motor skills – the neuro-muscular control skills which point the visual system on a moving target (pursuit eye movements) or jump from one object to another as in reading (saccadic eye movements).
  3.  Accommodation – the vision skill which involves focusing.
  4.  Binocularity – the ability to team the eyes.  This allows for coordinated eye movements as targets move from distance to near.  This skill has a sensory and motor aspect, information on location (depth perception) and allows both eyes to remain on the target as it moves closer and further from the eyes.

 Children have been asked to write meaningful material before they have learned to write.


We often hear the term “reading readiness”

(a time when the child is developmentally ready for reading).

We seldom hear of “writing readiness.”

Reports show that children with learning disabilities, in addition to having reading problems, tend to reverse letters, invert letters, place letters and numerals on their sides, mirror their writing; in general have numerous handwriting problems.  These errors have been reported as “additional problems.” Such writing however is the cause of vision problems.

Mistakes, wrong moves, incorrect sequence, etc. have been shrugged off as unimportant.  As a result, many early handwriting problems have been permitted to become established as habit.  This, we contend, is responsible for many of serious reading problems from which 15% of our children suffer.


According to the American Optometric Association:




These visual abilities are basic skills used to perform tasks such as reading and using a computer. About 40% of all Americans have functional vision deficits. Vision problems not only affect an individual’s ability to perform tasks, but it can have a negative affect on ones self-esteem.






75%-90% of classroom learning comes through our visual system

It is essential that our visual system is efficient because two-thirds of all information we receive is visual. The visual system is composed of the following visual abilities.

·        Distance and near acuity (20/20)

·        Accommodation (focusing)

·       Binocularity (two eyed vision)

·        Oculomotor skills (eye movement skills)

·        Peripheral vision

·        Visual-sensory integration

·        Visual perceptual skills

·        Visual Figure-ground

·        Visual Form constancy

·        Visual Spatial relations

·        Visual closure

·        Visual discrimination

·        Visual memory

·        Visual Sequential Memory

·        Visualization

When weak visual processing and perceptual skills are present, an individual’s ability to quickly and accurately comprehend reading material may be reduced. Once these skills have been improved through the treatment of vision therapy, reading and learning becomes easier. 

Distance and near acuity:  is to see clearly at a far distance such as 20 feet, and the ability to see clearly at a near distance such as 16 inches.

Accommodation: the eye’s ability to adjust focus on objects with various distances. 

Binocularity: the ability to use both eyes as a team. Proper eye alignment and coordination is necessary so that the eyes can unite two images into one (fusion), which allows an individual to perceive a single three dimensional image (depth perception, stereopsis).  

Oculomotor skills: the ability to quickly and accurately move our eyes. These skills allow us to move our eyes so we can direct and maintain a steady visual attention on an object (fixation), move our eyes smoothly from point to point as in reading (saccades), and efficiently track a moving object (pursuits).

Peripheral vision: the ability to see or be aware of what is surrounding us (our side vision).

Visual-sensory integration: after visual data is gathered, it is processed and combined in the brain with information from hearing (auditory-visual integration), balance (bilateral integration/gross-motor), posture, and movement (eye hand coordination, visual-motor integration).

Laterality or bilateral integration: The ability to distinguish left and right on ones self. Good bilateral integration skills allow children to use their visual systems to monitor and adjust placement of their body weight against the gravitational forces on both sides of their body’s “midline”, allowing for good balance and coordination.  Children with poor eye-body skills may have difficulty in such areas as sports, learning to ride a bicycle, or general “clumsiness.”

Directionality-visual spatial orientation: The ability to distinguish left and right in space. The most common cause of reversals in older children is a lack of visual spatial development.  Children with poor visual processing have not developed adequate skills in visual perception and spatial orientation.

Visual perceptual skills: the ability to organize and interpret information that is seen and give it meaning. These information-processing skills include figure-ground, form constancy, spatial relations, visual closure, visual discrimination, visual memory, visual sequential memory and visualization. 

Visual Figure-ground: the ability to recognize distinct shapes from their background, such as objects in a picture, or letters on a chalkboard. The ability to perceive and locate a shape within a busy field. Children struggling with this skill, get lost in details. It affects their concentration, attention and they tend to have difficulty scanning text to locate specific information. 

Visual Form Constancy: the ability to recognize two objects that have the same shape but different size or position and to mentally manipulate forms and visualize the out come.  Children that struggle with this skill may frequently reverse letters and numbers.  This ability is needed to tell the difference between “b” and “d”, “p” and “q”, “m” and “w”.

Visual Spatial Relations: the ability to distinguish differences among similar objects or forms. This is needed in reading and math.  Children that struggle with this skill have the challenge in problem-solving and conceptual skills required for higher level science and math.

Visual closure: the ability to identify or recognize a symbol or object when the entire object is not visible and to visualize a complete whole when given incomplete information.   Children struggling with this skill may have difficulty in not remembering or comprehending what has been read.  They might be unable to picture in the minds eye descriptions, directions or instructions.

Visual discrimination: the ability to discriminate between visible likeness and differences in size, shape, pattern, form, position, and color. Such as the ability to distinguish between similar words like “ran” and “run”. Children that struggle with this skill have a hard time distinguishing between similarly spelled words such as was/saw, then/when, etc.

Visual memory:  the ability to remember for immediate recall of a given object or form.  Children with poor visual memory may struggle with comprehension, remembering what words look like or fail to recognize on another page.  Take longer copying assignments because they must frequently review the text.

Visual Sequential Memory: the ability to remember shapes or characters in correct order.  Children struggling with this skill will have trouble with spelling. They tend to whisper or talk to themselves as they write.

Visualization: the ability to create or alter new images in the mind.  It is needed in reading and playing sports. 

the key to a better education is better vision

Former President Johnson’s daughter

Luci Johnson Turpin

At 16, I was an underachiever in school and had been most of my life. I had been told- as the result of every kind of test imaginable- that I was a relatively bright child. There were times when I actually believed it and would go home and spend hours writing a paper I thought so brilliant a special assembly would be called to have it read- only to have my teacher tell me, “Oh, Luci can’t you see where you made mistakes?” (But that was the crux of the problem. I couldn’t really see.)

The fact that we use the word “see” to mean understand indicates just how important vision is to our learning process. Here I was, the younger daughter of the man who was then Vice President – and a few months later became President- of the United States. My father certainly had the desire and the means to have my health problems diagnosed and treated. And yet, I had a major visual problem that went undetected for many years. I came from a family of achievers and worked diligently at school, but no matter how hard I tried, I found it impossible to rise from C to even a C+. Not only were my academic abilities affected, but because my eyes did not work well together, my total coordination was poor. And because I was physically uncoordinated, I was inevitably the last choice for team games throughout my childhood.

And so, at 16, I was on my way to dropping out. You can’t face the frustration of not being able to succeed indefinitely without wanting to run from the scene of you failure. Fortunately for me, my problem became so acute that I started blacking out during tests. Finally, as a last-ditch effort, Dr. Janet Travell, then White House physician and a lovely lady, suggested that I visit a local optometrist, Dr. Robert A. Kraskin. We had never considered going this route before because I apparently had no acuity problem. (In fact, the Snellen eye chart indicated that I had 20/20 vision.)

Dr. Kraskin told me that my eye coordination was poor. In response to my request, he supplied me with the following information about my type of visual difficulty:

“This type of problem arises initially as a reaction to stress created by the use of the eyes for close work and, in turn, brings about an interference in the coordination of the visual system. In other words, there results a dysfunction in the coordination of both eyes which reduces and lessens the ability to derive meaning from that which is seen. Not only is reading efficiency restricted, but there is also difficulty in general coordination activities, such as sports, which are highly dependent upon the use of visual information. Thus, hand-eye activities are limited. More frequently than not, there are no measureable ocular defects (such as nearsightedness) and 20/20 visual acuity usually is measured.

“Fortunately, this type of visual problem can be alleviated. Generally, glasses alone will not solve the problem, although the use of proper glasses for close work is an essential aspect of the proper therapy. To alleviate the problem, a program of activities and exercises is recommended.”

When I began my visual training course I was probably the most belligerent patient Dr. Kraskin ever knew. (Since I later worked in his office, I can tell you this attitude is not uncommon among people who are frustrated by visual difficulties.) I complained constantly. I couldn’t see the sense of being yanked from my study hall to do seemingly senseless exercises- like drawing circles on chalk boards, or writing down numbers flashed from a tachistoscope onto a screen, or putting pegs in proper holes, or tracing pictures through a machine called a cheiroscope. (Actually Dr. Kraskin was teaching me to use my eyes as a team.)

Then came that November day in 1963 that none of us will forget. As a nation we endured great trauma and transition. As an individual whose father’s responsibility it was to lead our nation, I felt the tension of the time acutely. My adjustment was quite a demanding one. In fact, my teacher expected my grades to stay on the low level they were- or even go down. Instead they rose a grade point per subject- and then kept on rising!

From then on, my grades improved and a year-and-a-half later I had gone from Ds to Bs. During my freshman year at college, I made the honor roll- and for someone who had been on scholastic probation for so long, this achievement was a thrilling one indeed. Also, my physical coordination noticeably improved. I was still far from being an athlete- but I’d come a long way. Then, I had a long way to come.

During the summer of 1964, I began to reflect on how my life had been radically changed by my visual training. The memory of my early resentment and rebelliousness was still vivid- and I felt that I could not just reap the benefits I’d had and walk away. I knew the frustration that students in visual training were going through- having faced these problems myself- and decided to work for Dr. Kraskin as an assistant during the summer. I worked that summer and the following summer, while I continued to take training myself. During that time, I saw a bright little boy who was having difficulty in kindergarten transformed from an angry failure into a happy, successful student. I saw youngsters like myself go from failing grades to the honor roll. I saw young men eager to be military pilots make such marked improvement that they finally achieved their wish. One young girl who won my heart had had two unsuccessful operations to correct strabismus (crossed eyes). With persistent effort, she achieved a marked degree of control.

Out of my own personal experience first as a patient and then later as assistant, I found a permanent vocation in helping the visually disadvantaged child. When a preschool vision screening program, Volunteers for Vision, was born I was asked to be national honorary chairman and later became a member of their board of directors.

Since the time I first saw Dr. Kraskin, I have graduated from high school, have attended college, have married and have been blessed with two lovely children. As a mother, my interest in VFV has not dimmed at all; it has only grown. In 1969 I formed a local chapter of VFV in Austin, Texas where I now live. During our first six months in operation, we screened 2100 children.

I speak as an interested mother, but I am by no means an authority in this field. My only hope is that this simple testing, which only detects gross visual problems, will serve as an impetus to get parent to take their children to a vision specialist of their own choosing. For, just because your child passes a test, he is not necessarily problem free. The three major tests- the Keystone Telebinocular, the Titmus Vision Screener, and the Massachusetts Vision Test Screener- are not substitutes for a professional examination.

As a parent, there are many things you can do to promote good vision. Start at birth by hanging toys and mobiles over the crib to develop hand-eye coordination. Later, encourage your child to use proper lighting and posture when he reads, and to maintain adequate distance for reading, studying or watching TV.

There are also danger signals a parent can look for. Do your child’s eyes frequently “run,” as if he were crying? Does one eye turn involuntarily? Does your child have persistent sties about his eyes? What about his reading habits? Does he (or she) experience headaches or nausea; does print blur after only short reading periods? Does he see double, squint or omit words or letters when writing?

Does he have hand-eye coordination problems? One indication of this is a need to touch things in order to understand or interpret information.

Helping someone to see better is a magnificent achievement, particularly since seeing and understanding is considered synonymous in our society. For as I once pointed out in a speech I made a few years ago, if the key to a better society is education, then the key to a better education is better vision. If you don’t have that key, you can’t open the door to a better life.

Convergence insufficiency, ocular surface disease share symptoms

Posted on the PCON Supersite November 18, 2010
SAN FRANCISCO – Treatment of symptomatic convergence insufficiency in presbyopic patients using base-in prism resolved symptoms of ocular surface disease, a study found.

“In convergence insufficiency, there is an overlap of symptoms [with ocular surface disease]. Just because someone complains of burning, dryness and ache does not mean they have ocular surface disease; it could be related to convergence insufficiency,” Bruce A. Teitelbaum, OD, FAAO, told PRIMARY CARE OPTOMETRY NEWS here at Academy 2010.

The randomized, double-masked study enrolled 26 presbyopic patients with symptomatic convergence insufficiency who participated in a previous study to determine the efficacy of base-in prism. Patients were randomly assigned placebo glasses or treatment glasses and quantified the severity of their ocular surface disease symptoms on a scale from 0 to 4.

The ocular surface disease symptoms in the treatment group “dramatically” improved from baseline as compared to the placebo group, the study authors said. The treatment group reported a total symptom score of 2.69 compared to the baseline score of 6.42.

“Many people treat dry eye just by the symptoms. What we’re saying is that some of the symptoms may be driven by a binocular problem,” Dr. Teitelbaum said. “If therapy isn’t working in cases of mild dry eye and objectively a patient does not appear to have a dry eye, perhaps this is something to think about.”

Early intervention for CI

Early intervention critically important in children’s vision problems

September 7, 2010 by D Fortenbacher, O.D.,FCOVD

When is it OK to “wait and see” if the problem goes away on it’s own?

What if your 6 year old child has been diagnosed with a binocular vision problem that appears to be interfering with her learning to read? You are seeing behaviors that look like she can’t concentrate on books. Her teacher is spotting some signs of trouble but can’t be sure that it is “her eyes”. You take her to an eye doctor who makes the diagnosis of a binocular vision problem called convergence insufficiency but dismisses treatment “for now” and opts for monitoring the problem. But, is it really ok to just wait and see?

As strange as it may sound, an outdated approach often recommended by many eye doctors when faced with a young patient (often 4-7 years old) diagnosed with certain forms of eye coordination problems, such as convergence insufficiency, is to simply monitor the condition and see if it goes away it’s own. In other words, no treatment is recommended.

In response to this and other vision problems in children, the University of Oregon Brain Development Lab has just produced this video on vision and the developing brain. See what the neuroscientists and the research is showing about the importance of early intervention.

Then check out the story of a mom (below) who wouldn’t accept ”NO” for an answer when told that her 6 year old daughter (with convergence insufficiency) was too young to be treated.

Find out how a persistent mom dealt with this problem with her own 6 year old daughter. Read the heartwarming and inspirational story from Paige Melendres in Albuquerque, who was not comfortable with the “wait and see” recommendation by her first doctor.  Her story can be found by clicking on  CI:The Private Eye Goes Public -Part 1 and scroll down to comment #8. Her story has a happy ending and good advice for parents who may have a child who is struggling.

Treatment for Lazy Eye

Older Children Can Benefit From Treatment For Childhood’s Most Common Eye Disorder; lazy eye!

 Surprising results from a nationwide clinical trial show that many children age seven through 17 with amblyopia (lazy eye) may benefit from treatments that are more commonly used on younger children.


Mayo Clinic MN says best treatment for CI is

Mayo Clinic researchers, as part of a nine-site study, helped discover the best of three currently-used treatments for convergence insufficiency in children. Convergence refers to the natural ability of the eyes to focus and align while viewing objects up close. Children with convergence insufficiency tend to have blurred or double vision or headaches and corresponding issues in reading and concentrating, which ultimately impact learning. The findings, published today in the journal Archives of Ophthalmology, show children improve faster with structured therapy sessions in a doctor’s office, with reinforcement eye exercises at home.



Brian Dennis at a vision therapy session in Bethesda, Md.

Published: March 10, 2010

If you’re the parent of a child who’s having trouble learning or behaving in school, you quickly find yourself confronted with a series of difficult choices.

You can do nothing — and watch your child flounder while teachers register their disapproval. Or you can get help, which generally means, first, an expensive and time-consuming evaluation, then more visits with more specialists, intensive tutoring, therapies, perhaps, or, as is often the case with attention issues, drugs.

For many parents — particularly the sorts of parents who are skeptical of mainstream medicine and of the intentions of what one mother once described to me as “the learning-disability industrial complex” — this experience is an exercise in frustration and alienation.


Samantha Contis for The New York Times