Dr. Megan Petty: 00:00:00.116
They don’t know that what’s– how they see is different or abnormal. They think, “Oh, whenever everyone reads, they have a hard time with the words moving, or doubling, or they’re–” they read and they have no idea what they just read. And they get told, “Try harder, try harder,” and that’s– I mean, they’re already trying. Like you said, they’re not lazy and I agree. I don’t think kids are lazy. I think they’re just doing their best. [music]

Gretchen Roe: 00:00:25.445
Good afternoon, everyone. Welcome to this episode of The Demme Learning Show. This is Gretchen Roe. I am so, so, so excited to have Dr. Megan Petty with us today to talk to you about what you need to look for as a parent with children who may have vision issues. This is the elephant in the room for so many kids who struggle academically. And we’re going to get into the meat of that in just a minute. I would like Dr. Megan to introduce herself. And then, we’ll get started. Dr. Megan?

Dr. Megan Petty: 00:00:57.096
Hello, and thanks for having me and I’m so excited to be here. So I practice in Northwest Arkansas, one of the flyover states in the middle of the country. But I love it here. My husband and I have been practicing. He does general optometry and I do pediatrics and developmental vision for 19 years. So anyway, I’m just delighted to be here and excited to help anyone I can, just help you equip your child for what they need to be successful. So I’m just glad to be here.

Gretchen Roe: 00:01:23.526
I’m delighted to have you. And really, the genesis of this conversation is my 20 years of working with families with children who have different learning needs. And so very often, being the parent of two dyslexics, so often I find parents who have a dyslexia diagnosis, but they don’t have the whole picture because they have not evaluated their children’s functional vision. So as we begin this conversation, can you tell me the difference between a general optometric exam and a functional vision assessment?

Dr. Megan Petty: 00:01:56.787
Absolutely, yeah. So if I have a patient coming in who– well, all my patients because I do this with all of them, but we do– of course, we check your eye health, we check your vision. I mean, I care about if you see 20/20. We check for glasses, farsighted, nearsighted, all that stuff because that is the basis for vision. The problem is vision is not just 20/20. After that, we need to find out how are your eyes working together, something we call convergence, which is essentially the way that we kind of like incrementally cross our eyes slowly together to be able to use them up close, also tracking. So now that I’m using my eyes together, how do I now move them across the page whenever I’m reading or use them to track the baseball or the tennis ball? The things that I do in an eye exam actually test convergence and tracking on top of your regular eye health and vision part of the examination. If we find concerns, then– and we’re like, “We think that you may need vision therapy,” we’re going to recommend even more testing, which we can talk a bit more about if you want to. But there’s what we call it the developmental vision evaluation, which is an hour and a half of testing that they do specifically with the vision therapist, so not with me, but with my therapist who’s been trained to do these tests, which gives us all the visual skills, all the visual perception, even some auditory stuff if we feel like that’s necessary.

Gretchen Roe: 00:03:15.632
So Dr. Megan, can we talk a little bit from a parent’s perspective, “What are some of the behaviors I might see in my child that would lead me to believe that I don’t have the whole picture?”

Dr. Megan Petty: 00:03:27.112
Yeah, absolutely. So I would say most common for me are kids who skip lines or lose their place whenever they’re reading. That’s a big one. Headaches with reading, that’s another big one because it’s almost like the eyes are fighting to work together. So you’re using extra energy and that can cause a lot of eye strain. Those are probably two of the biggest ones, but just any frustration with reading, kids who need to use their finger to keep their place even after like 1st grade. 1st and 2nd grade is kind of where that transitions out. Kids that will read but not comprehend. So they can read it fine, but they don’t actually– they’re not able to comprehend it. That’s more of a visual perceptual issue. A common one that I get is a child who’s doing fine, learning to read. They get into second or third grade and all of a sudden they start struggling or they just start avoiding reading. Mom’s like, “They were a great reader; all of a sudden they’re avoiding it.” And here they’re in third grade. And sure enough, we do the evaluation and find out that they have convergence insufficiency, which is a pretty common one at that age. So those are probably the most common, although there’s, I mean, probably 50 different symptoms, I would say, that we definitely see on a weekly basis.

Gretchen Roe: 00:04:38.845
I often have this conversation with parents, particularly because as Demme’s special needs consultant, I will consult with parents who have a child with a diagnosis or a suspicion of a diagnosis. And one of the things I ask parents is, do you have a student with messy handwriting? Do they mix up or in lowercase letters? Do they have trouble staying on even lined paper, staying on the line? And probably the most telling for me is, do you have a child who is emotional? Do you have a child who all of a sudden is zero to guns and you don’t know how you got there? And that to me is huge. When that kind of thing happens, we need to get to the root cause of it. And often I’ll have parents who will say to me, “My child’s just kind of lazy. They just really don’t want to work hard.” And I’m here to tell you there’s no such thing as a lazy child. There’s an impediment to their ability to learn. We got to figure out what that is. So when a child comes into your office, or if a parent reaches out to you, what are the kinds of questions you ask to guide them appropriately?

Dr. Megan Petty: 00:05:49.885
As far as like once they make their appointment?

Gretchen Roe: 00:05:52.418
Or to make an appointment, I guess, because I’m in the role of convincing a parent they need to make an appointment, so.

Dr. Megan Petty: 00:05:58.683
Oh, right. Yeah. So our front desk is trained to answer a lot of questions just initially over the phone. And we actually have a special appointment time for these kind of like developmental vision exams because I do a lot of just general [inaudible] eye exams or infant eye exams. So they’re asking questions like, are they struggling with reading? Are they missing a lot of school because of headaches? Are they coming home from school at the end of the day with headaches? Do you feel like your child is brighter than what their grades or academics are showing? That’s a big one. So those are all really common questions for them to ask to say, we need to put them into one of these specific exam times to give me a little bit more time to spend with them in case we need to do some more testing.

Gretchen Roe: 00:06:41.631
You’re in Arkansas, and not all of our audience members are in Arkansas. So can you offer for our attendees and people who will view this webinar a resource? Where can I go to find out if I need to find out more?

Dr. Megan Petty: 00:06:57.202
Yeah, absolutely. So there’s a couple of different organizations that really help train doctors like me who finish optometry school and say, I want to do vision therapy. I want to help kids. The biggest one, I think, that has the most resource for parents and the one that actually fellowships doctors– well, there’s now a second one, but they’re new. They just started fellowshipping and they’ve been a good resource for doctors, but I feel like they’re kind of becoming informational for parents too. But the big one is called– used to be called COVD, so College of Optometrist with Vision Development, their website, you can actually go on there, and I got on yesterday just to test it. And there’s a big space that says find a doctor, locate a doctor. There’s like three different places to find that. So if you go there and put in your zip code, it will put you exactly somebody in your area. You can put 50 mile radius, 100 mile radius. In our stay, I think we have four of us been doing vision therapy and all fellowship through OVDRA. But for the most part, I mean, some of the bigger states have quite a few more. So you may end up needing to drive a little bit to get to somebody will say the process to become a fellow is pretty stringent. And if you find someone who’s fellowed, they’re very likely qualified to do vision therapy. But you have to practice so many years before you can even become eligible for fellowship. So just because you’re on that website and you don’t have your fellowship doesn’t mean you’re not qualified. You could just be in the process of getting your fellowship. So don’t discount somebody because they don’t have fellowship after their name, although certainly if you find somebody with fellowship after their name, I mean, we have to even keep up CE. So even after you finish your fellowship, we have extra continuing education on top of our medical that we have to keep up with. So we do a lot of school trying to keep up with everything.

Gretchen Roe: 00:08:39.722
And I think that’s really important. I refer families to that website all the time because I love the quality of life survey that is there. It gives you an aggregate score. It gives you a wide variety of questions to ask your student. Things that our kids don’t know. If the words are wiggling on the paper, kids don’t understand that they don’t wiggle for us as adults. They assume we all see the same way. So being able to ask those kinds of questions, I find to be an excellent tool to help parents parse if something is going on. Now, with one of my kids, my youngest son, he was a voracious reader. He was that kid who I had to go in and say, give me the flashlight. Give me the book. You got to go to bed until he hit puberty. And then he just quit reading altogether. And frankly, I blamed his device. And it wasn’t his device. It was the fact that the hormones of puberty had caused his eyes to get out of their ability to track together. And so we were able to use that survey, and the irony for me was I’ve told families– I had this phone conversation all the time with families. I had this conversation and I say, how old is your child? Have they been through puberty? Because sometimes, and do you see this? Sometimes, kids have to revisit vision therapy when puberty rolls around because of the way the hormones affect the muscles of our body.

Dr. Megan Petty: 00:10:21.277
Absolutely, yeah. And that’s one of the questions I think that you had sent me yesterday was can you regress after vision therapy? And that’s obviously a loaded question. But one of the things I’ll tell parents is, yeah, at puberty, we’re going to see significant changes in how your child is able to use their eyes. We have huge developmental growth that happens at that point. So sometimes, that doesn’t happen for them or if they have a new demand. So you’ve had a child maybe they’ve been doing homeschool for a while and they’ve been doing some computer work, but now they go to college. And there’s a different intensity to that work. Or some of my other school kids who are maybe in middle school, but they’re going to be going to high school. So that can change. So we definitely recommend even after vision therapy that you still have exams every year. And it’s tricky for me because I have a lot of patients who referred to me. A lot of optometrists around here will refer patients because they don’t do vision therapy, but they believe in it. And so I will see them. We usually check them once for follow-up, and then we send them back. But I always tell them, if anything changes, you know where I am. But obviously, we also don’t want to be taking everyone’s referred patients. We want to send them back whenever they’re all better.

Gretchen Roe: 00:11:27.144
Absolutely.

Dr. Megan Petty: 00:11:27.879
A sign of a good doctor is somebody who isn’t– I’m not trying to just, get patients. I’m trying to take care of them, take care of the issue, help them as best we can, and then take them back to their regular doctor because they have relationship with them and the whole family goes to that doctor. And that’s what we want to support and to encourage.

Gretchen Roe: 00:11:45.681
Absolutely. And I think that’s also the hallmark of a good therapist is they know they’re lane, and they stay in it. When my youngest son came to me and said, I think I have some vision issues, he’d heard me recommend this quality of life survey and he went and took it all by himself. I didn’t even know he was taking it. And when he came to me and said, “I took this survey and I scored a 36, you did not.” And that indicates some significant need there. And we verified that by visiting a vision therapist. And he would tell at 19 that that seven months that he spent in vision therapy was imminently valuable because now he reads for pleasure again. It really wasn’t his phone, even though I was blaming his phone. So it made a tremendous difference. We had so many questions, and there’s a couple of them that I want to make sure, even in these very beginning moments that I ask you about. And that is, do children outgrow vision issues? Or if there is a vision issue present, is that going to remain with them until you get some sort of resolution?

Dr. Megan Petty: 00:13:04.328
So as far as like, if we think about glasses prescriptions, I think a lot of parents maybe think, “Well, when I was young, maybe I wore reading glasses and I grew out of that.” That’s not uncommon if you wear glasses for magnification, like reading lenses. They can grow out of that, the need for that over time. And I still recommend reading glasses for young children when they need them. And then as they get older, we reevaluate and sometimes take them out, you know, once they get a little older. As far as things we would usually recommend vision therapy for, they’re not going to grow out of it. It is a developmental process. So I mean, you can’t on your own without help speed up your development. Now, with help, you can speed up your development. And I like to think of it as like, there’s a gap between where you need to be and where you are. And so as you get older, you might get a little bit better, but where you need to be also is going to get higher. So unless something comes in to close that gap, then you’re never going to close the gap. That doesn’t mean that your tracking might slowly improve without help, but you’re never going to be tracking as you should for your age. So it’s always going to bring your reading down. So yeah, generally not things that you would grow out of. And in my experience, I’ve seen that because we see kids whose parents are like, “Well, I can’t afford it now.” We don’t have the time now, but we measure the problem. And so we wait. And sure enough, a year later, it’s still there. Now, they may have gotten a little better, but that gap is still there.

Gretchen Roe: 00:14:23.405
And I think that that’s really important. And we did have several questions about how vision issues affect behavior. And I wonder if you could talk a little bit about that, because sometimes for me, that’s the clue to the challenge. It’s not the struggle in front of the student. It’s how the student’s behaving.

Dr. Megan Petty: 00:14:45.361
Absolutely, yeah. And I think the biggest thing would be frustration. So these kiddos, like you kind of had alluded to, they don’t know that how they see is different or abnormal. They think, “Oh, whenever everyone reads, they have a hard time with the words moving or doubling they read and they have no idea what they just read.” And they get told, “Try harder, try harder.” And that’s, I mean, they’re already trying. Like you said, they’re not lazy. And I agree. I don’t think kids are lazy. I think they’re just doing their best. And so, yeah, I’d say behaviors as far as frustrations can come out and that can come out in their behavior or their attitude towards school. A lot of times if I have a hard time looking at something because my eyes can’t focus on it and I’m seeing it kind of split apart, maybe like doubling or just like kind of smearing or dancing, as some kids will say, whenever I’m trying to read, then I’m not going to want to attend to that for very long as well. So certainly visual problems can mimic some of the symptoms of attention deficit disorders. And so I know a lot of pediatricians recommend an eye exam before they’ll put them on medications for that. But that eye exam may be just a general exam. And the doctor may be like, “Oh, yeah, you’re 20/20, your eyes are healthy, you’re fine.” In reality, they didn’t do the kid enough justice. They should have checked their tracking, checked their convergence. And some doctors do check it, like I mentioned earlier, and then refer if they feel like there’s a need for referral. But so many times, unless you ask specifically, are you checking my child for eye teaming or convergence or tracking, they’re saying those kinds of words to a doctor. Even if it’s a general optometrist, they may be able to test or say, you know what? I don’t really know how to test. I don’t feel comfortable, but I have this colleague who can.

Gretchen Roe: 00:16:23.283
And I think that’s so valuable. My now seven-year-old granddaughter, when she was six, her parents had complained to me about her emotional dysregulation. It’s interesting because both parents are very, very steady Eddie and their daughter was a little bit dramatic is what they referred to her as. And so, we finally had a conversation, and I said, “Get her functional vision tested, see if her eyes teamed together.” And sure enough, that was a problem that needed resolution. And she had six months of vision therapy and came up two grade levels in reading. She was ready to be put on an IEP in her second-grade classroom and now reads above grade level as a third grader. So, huge difference maker. We have a question from Rita, and it is, how long can we expect headaches from vision issues? They’ve done two and a half years of vision therapy.

Dr. Megan Petty: 00:17:27.185
If the headaches are vision related, then I would say the vision therapy should be helping them at this point. Sometimes I find– I mean, we don’t want to always think we have a tool, we can fix every problem that way. And something that we had spoken about before was there’s a lot of times prism lenses that need to be used. And it may be that your child has improved their visual skills to a certain point. But sometimes it’s like you still need a little help with that gap that you still– like when they get tired, that they’re still going to have issues, which is where like some lenses with a little bit of prism could come into play. Doctors have been using prism in the developmental realm for years and years, they actually have some newer technology with lenses called neuro lenses, which can be really helpful from those more like daily headaches or like migraines, the people who get motion sick a lot. Those are actually showing to be really, really successful. And we’ve been fitting them for about a year and a half, and I fit maybe a dozen kids with them and have seen some really good results. Now, my colleagues at my office who don’t do vision therapy also use them for adults. But specifically with kids, I do have a couple kids I’ve put in them and then we start therapy and they’re able to get out of the lenses. But then I’ve had a few that have said, I still like to have my lenses because if I don’t wear them, I’m going to end up with a headache. So, sometimes there’s just like vision may be doing as much as it can, or your child just may not have registered goal yet, but sometimes even having a lens, having a conversation with a doctor could be helpful.

Gretchen Roe: 00:18:56.832
You mentioned sometimes we see kids at third grade who start to complain of vision issues. I have the privilege to work with a PhD reading specialist alongside her. And one of the things that she taught me is somewhere between third and fourth grade, the font size reduces significantly in all of our reading materials. And it’s sometimes that font size reduction that sets kids off and causes issues. So, if you see that happen, then that can be an indicator that we need to see someone like you.

Dr. Megan Petty: 00:19:33.673
A lot of kids nowadays want to read the graphic novels that are like the comic books tile because the little bubbles are this big and there’s like just maybe three or four words on a line. So, there’s not a lot of tracking that has to happen. And so, that’s really common. I’ll hear parents say, “Well, they used to read, they can read, but they would prefer to read graphic novels.” And so, two things for me, they could be having a tracking problem because reading a whole bunch of words on one page is overwhelming for their tracking system, or it could be that they have a hard time imagining the story. And I tend to kind of always want to check the visual skills first, how their eyes are actually taking information in that input part, but also the visual perception matters too. Those of us who read and enjoy reading, we see the movie in our brain. So it’s not just we’re reading the words. We actually see. It’s like whenever I read The Hobbit, I’m watching The Hobbit, the movie. But not all kids are like that and not all people are like that. So there’s a visual perception or visual perceptual concern there. So I would definitely want to check that child’s visual perception. So those are two, but graphic novels have become really popular and that’s great. But if that’s all they want to read, that could be a red flag as well.

Gretchen Roe: 00:20:42.956
I think that’s a really good thing for us as parents to recognize because sometimes we think, well, at least they’re reading. They’re reading something. But if that fatigue factor is so high that they can’t hang in there for more context, then we need to do something about that. What are some other things that you would tell parents who are scratching their heads with a child that’s not performing the way they think they should be performing? You said something that was really interesting just a minute ago, and that says asking, does your child perform at the level you think they should perform or somewhere beneath that? Can you talk a little bit more about that?

Dr. Megan Petty: 00:21:30.747

Yeah. Absolutely. I would say– and thinking specifically about my homeschool families, I have quite a few who are like, “When I read to my child, they get it. They have wonderful comprehension. But when they have to read it, their comprehension goes down significantly.” Once again, red flag for me. It’s the input, getting the information in. So in that case, their visual perception is good. They see the story when mom reads it, but they’re having a hard time being able to actually see it whenever they’re reading. So it’s like they can’t do both at the same time. They can only do one or the other, in which case patient therapy would come into play. So that’s a big one for me. And the other one is just parents like, “I know my kid is bright.” I mean, I know you don’t get grades as much in homeschool, but still you’re seeing how much they’re taking into the information, and you know they know it. But when they have to actually do the task on their own, their work does not reflect how bright you think that they are. And parents are right. I mean, parents know. I mean, especially my homeschool families. I mean, if you maybe go to public school, you may be just getting like, oh, they’re at a one or two or three, whatever, these kind of more vague. But when you are a homeschool parent, you’re in tune with your child’s education and where they’re at. So I’ve never had a homeschool parent who’s not known where their kid was because you are their teacher.

Gretchen Roe: 00:22:44.778
Tell me a little bit about when you have a parent who comes in and you suspect something is off, but sometimes it’s hard to get the kids to even sit still for the diagnostics. You mentioned ADHD. Sometimes that’s a mitigating factor. So when you’re doing this lengthy exam, how do you keep a child who is exhibiting those kinds of symptoms engaged so that you can evaluate them?

Dr. Megan Petty: 00:23:12.422
Yeah. Absolutely. I have become the art of getting a lot of information quickly. I mean, when you have a two-year-old, you kind of have to. So you get as much as you can for the minute. And then sometimes I tell a kid, “Hey, let’s stand up and let’s do some jumping jacks,” or if they’re in therapy doing their full evaluation, which takes, like I said, about an hour and a half, my therapist knows, get the trampoline out. Let them jump on the trampoline for a little bit. So we call it get the wiggles out. So having them sit maybe in a chair that is an exercise ball rather than sitting in a chair at the back, for her, those are great things that she does. We have these little tea stools. It’s like a stick and then like a piece of wood that’s a lot bigger than my fingers, but they sit on that. So they have to keep it very balanced. So having to keep that input actually gives them more energy, more interest because it’s kind of keeping them more alert but the big thing for the vision therapist are breaks. For me, I’m usually like, I have– my tests are pretty quick that I’m doing with them. And I might do the test and think, well, that didn’t feel like 100%. So, we’ll stop. We’ll talk about something they’re interested in, kind of get them engaged. I’m like, let’s do that again really quick. And then we’ll just kind of repeat the test and see if we can get– if we get the same result, then they actually were engaged the first time. And then if we don’t, I know which one I’m more confident about. But certainly, getting as much information in a short amount of time is really important. And I think, for me, I just love my patients. And so, when I talk to them, I try to talk about things they’re interested in. And doing something for this long, in 19 years, you know how to engage kids for the most part. There are still some teenage boys that grunt at me, but for the most part, [laughter] most patients, I mean, they like coming. And part of my exam I have, I need to look at the end of the room at the visual acuity chart, used to be in our day like the projector. And now we have the computer screens that act as that. I’ll put a YouTube video up and say, what’s your favorite YouTuber? Or do you watch Bluey? Do you watch Paw Patrol for the little kids? And then have them watch that to work on some of this stuff. And then it kind of gives them like a mental break too. Kind of like reset back to like, okay, that was fine. Okay, now I can focus again. So, we’ll do that as I do some of those activities, and I don’t need them to respond to me.

Gretchen Roe: 00:25:18.941
What thoughts would you have in closing for our listeners?

Dr. Megan Petty: 00:25:23.131
Yeah, I would just say, thanks for listening and thank you for having interest. And just thanks for doing what you do and taking good care of your kids. And I would love for you to share this with as many friends as you can. Talk to your colleagues or your friends who have kids who are doing homeschool as well because you guys are a support group with each other. And maybe you have a friend who has some similar issues with their child and just don’t know. So, you could be a huge advocate for that. But yeah, I’m just super grateful that you guys all showed up and taken such great care of your kids and thanks for loving them because we, as optometrists who work with kids, we love our patients so much and it’s so nice to have families that support each other as well as the homeschool community does.

Gretchen Roe: 00:26:07.629
I just want to thank you so much for being here, for being willing to take an hour out of a busy practice to have this conversation with me. And I hope parents find merit in this. I have a lot of parents who are saying thank you. And we want this message out there because we want the best for your children. And this is just a huge message that needs to be shared. Thank you so much for your time, Dr. Megan. I appreciate it.

Dr. Megan Petty: 00:26:33.294
Yeah, thank you.

Gretchen Roe: 00:26:33.969
Take care.

Dr. Megan Petty: 00:26:34.542
You too. Bye-bye.

Voice Over: 00:26:37.806
Thanks again for joining us. We’re glad to be a part of your educational community. You can help us grow our community even more by rating, reviewing, and subscribing to the show wherever you may be hearing this. Don’t forget that you can access the show notes and watch a recording at demmelearning.com/show or on our YouTube channel. We’ll see you again next time. Until then, keep building strong foundations for lifelong learning.

[music]