Ready Set Go – Let’s go to Kindy!

Emma* will be starting kindergarten in 5 months’ time and her parents want to make sure she is properly prepared for school.  She already wears glasses for all close work and when her eyes get tired at the end of a big day.

Her parents were concerned as they noticed a few changes.  Emma is fidgeting more when reading and she squints when watching television, especially in the middle of the day.  Emma needs to concentrate more when trying to learn sight words on flashcards.

History

Emma has had a larger left pupil from birth, and this becomes more obvious in brighter light.  She has a strong history of middle ear infections and her mother had tracking difficulties as a child.

Emma has other family members that require glasses due to poor tracking and reading skills.

Behavioural Optometrist findings

Dr Nick carried out a clinical examination of Emma and found her able to carry out all age-appropriate tasks, focus on tasks and respond well to instructions.

Dr Nick discovered Emma under converges her eyes (called Convergence Insufficiency), where she has difficulty coordinating her two eyes to point to an intended position in space.  To compensate, she uses excessive effort to maintain near focus, which causes her to strain.  This over focusing causes blurry vision when she looks up towards more distant objects such as the television.  To overcome the blurriness and try to regain focus, she will squint.

The high level of stress in her focusing system will contribute to difficulty following the words on a page (poor tracking), shaky or double vision and delays in visual information reaching her brain.  These symptoms may affect her learning to read next year when she starts school.

Recommendations

Dr Nick designed glasses to enhance her ocular co-ordination.  These glasses are to be worn at home for indoor tasks and at school.

Emma’s inability to constrict her left pupil in response to light is known as an Adies Pupil.  This is not associated with eye disease.  This condition will cause a higher sensitivity to both indoor and outdoor glare.  A digital coating was added to her glasses to reduce indoor glare sensitivity and good quality sunglasses were recommended for outdoor use.

A strong history of middle ear infections may have developed auditory delays.  If Emma continues to struggle to sound out words or difficulty blending sounds when learning to read, then a Speech Pathologist should be consulted.

First follow-up session

In 5 months, the glasses have significantly improved Emma’s under convergence.  She is wearing them at school and has found she enjoys reading more.  She says there is less blurriness when she looks up from close work.  Her parents have noticed Emma is less irritable now that she is wearing her glasses.  Emma is squinting less but will squint when she is tired and watching TV.

Dr Nick’s assessment found Emma can follow the words on a page and is reading words at a faster pace.  There is a noticeable improvement in her visual posture and a reduction in her squinting

Emma’s Dad says ‘I have noticed Emma can concentrate far more easily when working on tasks close up.  Even just watching her with flash cards, the difference is amazing.  I feel confident sending her to school now.’

Second follow-up session

In 7 months from the first follow-up session, Emma is continuing to wear her glasses for home-schooling and finds she needs them when reading to help her track the words.  Her focus is good, and she is enjoying reading more.  Her parents have noticed she is squinting more when watching TV than last visit.  She is less irritable but has been coming home from school tired.

Dr Nick’s assessment of Emma found her to be more relaxed and there was less stress on her visual system.  Her increase in symptoms was due to her improved ability to relax her eyes, which is the first step to long term improvement.  Dr Nick adjusted her spectacle prescription to eliminate these symptoms to improve her ability to learn and to encourage further development of her visual system.

Is your child ready to start school?  Have a chat with Dr Nick on 4369 8169, to see if your child needs an assessment.

*All names have been changed to protect the identity of the patient.

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