Welcome To Yealy Eye Care's Pediatrics Center
Children Succeed with Healthy Vision.
Vision is all about the way our brains and eyes interact. Whether it’s reading words on the board, catching a ball, or tying our shoelaces, we depend on our visual system to work properly in order to succeed at any of these tasks.
This is because vision isn’t just what we see, it’s how we interpret and interact with that information. In fact, you can have perfect visual acuity―able to rattle off all the symbols on the reading chart―but still struggle with dyslexia, poor focus, hand-eye coordination, or vision conditions like strabismus, amblyopia, or convergence insufficiency.
Dr. Natalia Yealy and Dr. Lynne Glinsky often work with child patients with special needs, which vary from ADD/ADHD, cerebral palsy, Downs Syndrome, to even learning disabilities. We also work with patients who are unable to give a subjective response.
We have experience in helping with lazy eye (amblyopia), eye turns (strabismus), traumatic brain injury (concussion, whiplash) and special needs populations. Research has shown that 20% of children have a vision issue that affects their learning.
What is Amblyopia?
Amblyopia, commonly referred to as “lazy eye” is when there is a significant difference in power between the eyes. This is often, but not always, caused by an alignment or eye-teaming problem such as strabismus.
Some common symptoms and problems associated with lazy eye:
- Poor depth perception
- Head tilting
- Social stigma
- Slow reading*
*According to a study published on November 2015 by the Journal of the American Association for Pediatric Ophthalmology and Strabismus, children with amblyopia read slower 42 words per minute than children without amblyopia that read 81 words per minute.
At What Age Can We Treat Amblyopia?
An old axiom that is still held by many Lancaster County eye doctors is that amblyopia must be detected and aggressively treated before the age of 8 or 9. In reality, treatment for amblyopia or lazy eye is effective for adults as well as children. A child’s visual system is more malleable at a younger age, making treatment quicker at a younger age. However, adults with amblyopia or “lazy eye” tend to be more motivated patients. Improved eye teaming is nearly always achievable.
What is Strabismus?
Strabismus, often referred to as “Crossed Eyes”, “Wandering Eyes”, or “Wall Eye” is a condition where the eyes fail to properly align. Beyond the social stigma, strabismus often results in other vision and visual processing problems such as diplopia (double-vision), amblyopia, and problems with depth perception. A major concern for developmental optometrists is that strabismus is not as simple to diagnose as a visual check. In fact, you can have strabismus without any obvious crossing or eye turn.
There are four kinds of strabismus, two horizontal and two vertical:
- Esotropia: one eye may turn in relative to the other {try and find images for these, commons domain}
- Exotropia: one eye turns out relative to the other
- Hypertropia: one eye turns up relative to the other
- Hypotropia: one eye turns up relative to the other
Treatment for Strabismus
All too often, parents are told "don't worry, your child will 'grow out of it'. This is a mistake. In most cases the problem does not improve as the child grows, and meanwhile strabismus leads to significant difficulties with reading and learning. Treatment varies depending on the cause of the eye-turning, and may include:
- Eyeglasses
- Prism
- Eye muscle surgery
Eye muscle surgery can sometimes make the eyes appear to others as if it is straight, but it rarely aligns with the other eye, and the amblyopia continues. Our program for children can restore visual function and the ability to use the two eyes together as a team.
What is Convergence Insufficiency?
Convergence Insufficiency is a neuro-visual condition where the eyes fail to come together (to converge) enough to enable proper visual perception. The condition is particularly related to near-vision or near-center and visually demanding activities. This can result in:
- Poor school performance and behavioural problems
- Eyestrain
- Blurred vision
- Diplopia (double-vision)
- Asthenopia (eye strain and fatigue)
- Difficulty making eye contact
- Fatigue
- Headaches and migraines
- Difficulty reading and concentrating
- Avoidance of “near” work
- Poor sports performance
- Dizziness or motion sickness
A study of almost 700 5th and 6th graders indicated that convergence insufficiency is much more common than many assumed with 13% of students having CI, as well as demonstrating that of the children who showed three signs of CI, 79% where classified as being accommodative insufficient as well.
Treatment for Convergence Insufficiency
Eye coordination problems such as convergence insufficiency and convergence excess generally cannot be improved with eye glasses or surgery. Likewise, research demonstrates that the traditional focus exercise often called "pencil pushups" are ineffective. Our pediatrics program will improve eye coordination abilities and reduce symptoms and discomfort when doing close work.
Dyslexia, Learning Disabilities & ADD/ADHD
What Is Dyslexia?
There is no consensus on the official definition of dyslexia. Often referred to as a “learning disorder”, dyslexia is typified with difficulty reading or interpreting symbols in the correct order or syntax despite the sufferer having at least average intelligence. "Dys" means "not". "Lex" means "read". Dyslexia therefore literally means not being able to read.
A substantial number of individuals with dyslexia actually have other visual problems that make the problem greater. All too often, an undiagnosed vision problem is the reason the individual was diagnosed as having Dyslexia to begin with. If a vision problem affects learning, it can sometimes be misidentified as dyslexia because there are similarities between the two.
Most people are familiar with vision problems that eyeglasses address; nearsightedness, farsightedness and astigmatism. These are called refractive conditions.
A learning-related visual problem directly affects how we learn, read, or sustain close work. Because difficulties with reading and learning affect the child's ability to focus, vision related learning problems are often misdiagnosed as ADHD or other behavioural issues.
Visual problems in any of the following areas can have a significant impact on learning:
- eye tracking skills - eyes following a line of print
- eye teaming skills - two eyes working together as a synchronized team
- binocular vision - simultaneously blending the images from both eyes into one image
- accommodation - eye focusing
- visual-motor integration - eye-hand coordination
- visual perception - visual memory, visual form perception, and visualization
Vision and learning are intimately connected. Someone may have a learning problem that is caused by an underlying vision problem. A child with a vision problem can be misdiagnosed as having Learning Disabilities, ADHD, or Dyslexia. There are various reasons for this misdiagnosis. For example, children who have learning-related visual problems cannot sustain their close work at school or home, showing signs of Inattention or Hyperactivity. A child may be misdiagnosed as ADD or ADHD because children with ADHD also can't sustain attention on their work, and inattention and hyperactivity are the two of the three main symptoms for the diagnosis. Same behaviors, different diagnosis.
It is common for children who have Learning Disabilities to have vision problems that contribute to these learning problems. Pediatric Eye Care does not correct learning disabilities, but correcting the underlying vision problems through our program often solves many of the obstacles that make learning more difficult than it need be.
Attention Deficit Disorder (ADD) is a widespread problem. If a child has a short attention span, the common assumption is that the child has ADD and should be on medication. If a child has behavior problems, then the assumption is that they have ADHD, Attention Deficit Hyperactivity Disorder.
At times, an underlying vision problem further complicates matters. Addressing the vision problems reduces the symptoms of ADD and sometimes eliminates them entirely.
If a child has difficulty pointing their eyes in to read material (convergence), if they can’t physically focus (as you would focus a camera), or if they can’t sustain those activities, that then makes it difficult for the individual to maintain attention. More energy is needed for the visual system and there is then less energy to concentrate on reading. This then leads to a short attention span. If someone can’t physically maintain concentrating for whatever reason, they may be then labeled ADD.
A child who cannot focus because of a vision problem will not be able to sit still and do as instructed. Furthermore, a child with these kinds of vision problems is not able to point their eyes and focus on the amount of time needed to complete assigned tasks and homework. In this case, medication will not be effective. As the child develops the visual ability to correctly physically focus their eyes, they are then better able to attend and concentrate, maintaining their mental focus for longer periods. They are then able to complete their work.
Before a diagnosis of ADD/ADHD is made, (or even once it has been made) and medications prescribed, parents and teachers should first consider a comprehensive eye examination with our developmental optometrists for their children. Much is at stake in the event of a misdiagnosis.
For more information on ADD and the connection with Convergence Insufficiency please see https://www.ncbi.nlm.nih.gov/pubmed/16361187
Pediatric Eye Care For Children with Special Needs
Vision problems are very common in individuals with developmental disabilities such as autism. These problems or stims include:
- lack of eye contact
- staring at spinning objects or light
- fleeting peripheral glances
- side viewing
- difficulty at maintaining visual attention
People with autism and other developmental disabilities often have trouble efficiently and accurately processing visual information, often combined with difficulty coordinating between peripheral and central vision. Following an object (eye-tracking) is also a typical problem. There is usually a preference to scan or glance at objects from the side instead of looking at it straight on. Eye movement disorders and crossed eyes are common in the autistic spectrum.
Patients with Down Syndrome overwhelmingly require eye care, with 70% requiring glasses and 45% of people with down syndrome have strabismus. Furthermore, there are a variety of ocular diseases associated with Down Syndrome patients such as tear duct abnormalities that can lead to severe discomfort, keratoconus (misshapen cornea) and congenital cataracts. A patient with down syndrome will also require specialized glasses made for their unique facial features.
Children with Cerebral Palsy will most likely have visual conditions that require correction with glasses and in many cases a comprehensive pediatric eye care program. Child patients with Cerebral Palsy will often have Strabismus, or, “crossed eyes”.
Meet Our Doctors
Dr. Yealy provides primary eye care, diagnosing, treating and managing conditions and diseases of the eye and visual system and also specializes in pediatrics. Dr. Yealy was born in Colombia and is fluent in both Spanish and English.
What Our Patients Are Saying...
Excellent practice!!! Great Doctors that really care. They were even wonderful with my children! I would recommend them to family and friends!
My child was comfortable with the process of the exam and interaction with staff." Good place for kids...2019-08-29