Worth 4 Dot

Worth 4 Dot

The worth 4 dot is simple tool for assessing suppression and fusion. The results oworth4dotf the quick assessment can give us clues to the function of the eyes. The worth 4 dot (W4D) test is is made up of a pair of red-green glasses and light with 4 dots, 2 green, one red and one white.

The patient puts on the glasses and the light in placed near (40cm or less) and asked how many lights they see.  It is then moved to distance (1 M) and asked once again how many lights are seen.

W4D Responses

There are 4 appropriate responses. Other responses should be considered a failure of the patient to understand the instructions.

  1. 4 lights, near and/or far indicate using both eyes. I will ask if the lights are moving or not to see if the fusion is steady.
  2. 3 lights or two lights- three light indicates suppression of one eye. Which eye depends on the red green arrange of the particular test one is using. They may suppress at near or far or both, so an answer of 3 close and 2 far would be appropriate.
  3. 5 lights- a response of 5 lights indicates the patient is having double vision at the range. It may be near or far or both.

The W4D is usually the first test I do as it gives me early clues what to look for as I begin looking at eye movements. This test can also indicate how a patient may do on stereopsis testing as suppression of of an eye could me reduced stereopsis.

Getting a Worth 4 Dot

Worth 4 dot is available from Bernell.com. There are several version but the idea is the same for all.

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The Binocular Vision Exam

The Child’s Special Visual System

Children’s eyes are amazing. They bring the world to an eager child and facilitate development of many skills.  The visual world influences posture and gait, fine motor development, letter recognition on to reading skills and many other areas.  The importance of good vision cannot be over stated.

The Pediatric vision exam

The vision exam for a child should include assessments not generally not performed on adults. Check out this post first to understand how we see up close. 

  • Cyclopelgic Dilation and Refraction- This allows for the doctor to completely exam the retina of a child for optic nerve problems and other congenital problems that child may have. The cyclopelgic dilation also relaxes the ciliary muscles which control accommodation (focusing of the lens within the eye). This allows the doctor to exam the true refractive error of the eye which can frequently be corrected by the accommodation of the lens.  This should be considered mandatory once a year.
  • Near Point of Convergence – This brief assessment allows for the doctor to assess how how well the eyes are working together when seeing up close.
  • Measured cover test- A cover test reveals the amount of effort needed for the eyes to maintain their position. It also shows subtle eye movement problems like strabismus.
  • Retinoscopy – in this assessment, the doctor can get an objective measurement of refractive error. This eliminates communication problems some children may have and makes for the most accurate solution for a child;s visual acuity.

Better or Worse

General optometrists and opthamologists may or may not perform these tests.  Without them, an important part of the assessment of a child’s vision has been left out. Eye movements can cause delays in gross and fine motor development and decreased reading performance and difficulty in sports, like hitting or catching a baseball.

Look for doctors that advertise being pediatric or binocular vision specialist. Look for doctors that members of the College of Visual Development or the Neuro – Optometric Vision Association.  These are doctors that specialized in the assessment of binocular vision skills.

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Dyslexia and Vision Rehabilitation

Dyslexia and Vision Therapy

Dyslexia is word frequently tossed about when children have problems reading or learning. Commons complaints that lead to the use of the word include letter reversals, poor reading comprehension and decreased reading fluency. These symptoms are also recognized as possible vision related problems cause by poor eye movement accuracy.

Is dyslexia a vision problem or a language problem?

Attempting to define dyslexia can be confusing. The origin of the word is vague: “dys” meaning difficulty with and “lexia”  meaning reading lends itself to broad interpretation.  The best definition for dyslexia, from the International Dyslexia Association says:

“Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

The research shows that the root cause of dyslexia is phonological processing, or how the brain processes sounds in language. Additionally, the prevalence of dyslexia is estimated to be between 5-20% of the population, according to the National Institute of Health: http://www.ninds.nih.gov/disorders/dyslexia/dyslexia.htm. *

Reading is a complex process involving language, speech, memory and other processes, but all of these processes assume that the collection of the information to be processed is accurate, ie that the eyes work correctly and move accurately. We do know that poor eye movements lead to poor processing skills because the data to be processed was not collected accurately.

Does vision therapy treat dyslexia?

This is also a very interesting question. In our vision rehab practice, we frequently get children referred to us that have common symptoms of dyslexia and visual processing difficulties like reversals and poor reading skills. Following the interventions, the children have reduced symptoms and most have improved reading fluency.

Some of patients do continue to have problems in reading although they show improved eye movements. At this point, we may further assess the patient using a dyslexia screening tool that can identify specific errors related to the processing parts of reading such as the decoding and encoding of words. When results indicate, we refer those children to specialists like our friends at Read-Write Learning Center at  that specialize in the treatment of dyslexia.

 

Does vision therapy treat dyslexia????

NO. Vision therapy cannot treat dyslexia. But it does improve the accuracy of eye movements eliminating many of the symptoms generally associated with dyslexia. With these eye movement problems gone, an accurate assessment of the visual processing skills and reading fluency is now possible, allowing for an accurate diagnosis of a visual processing or other reading and learning problems.

Here is a video case study describing the process.


*Special thanks to Hunter Oswalt, Director of the Read-Write Learning Center for her input on editing this post.

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Learn more about this subject in a live course and webinar presented by Robert.  Its now available as a webinar too!! Hosted by PESI Education

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Assessing Eye Movements

Assessing Eye Movements

Assessing eye movements should be a regular part of every therapists evaluation process. We get 75% of the information about our environment from vision and vision affects things like reading, handwriting and balance.

Before starting this evaluation, ask about the patients most recent eye exam. A patient not in best corrected visual acuity may have difficult time fixating and therefore show poor ocular motor skills. Every child needs a compete

Nystagmus

An involuntary movement of the eyes, called a nystagmus.  These are described as a congenital or acquired nystagmus and further described as jerky (faster in one direction than the other) or pendular (same speed in each direction).

Congenital Nystagmus

Assessing Eye Movements

Assessing eye movements is quick and easy and gives the therapist vital information on about the patient may be seeing the world . Its easy to do…just watch!!!

 

 

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Learn more about this subject in a live course and webinar presented by Robert. Hosted by PESI Education

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