July 27, 2021 - EyeClarity Podcast
Here is a lecture I gave a bit ago. Don’t miss it! Enjoy the show! If you want more, sign up for my newsletter at:Â www.drsamberne.com.
SUMMARY KEYWORDS
eye, visual, pupil, child, sensitivity, defensiveness, add, midline, vision, double, vestibular, reflex, therapy, prisms, practitioner, kids, response, patching, light, alternating
Hello, everyone, its Dr. Sam, I’d like to welcome you to my EyeClarity podcast. This is a show that offers cutting edge information on how to improve your vision and overall wellness through holistic methods. I so appreciate you spending part of your day with me. If you have questions, you can send them to hello@drsamberne.com. Now to the latest EyeClarity episode.
I think visual regard is a very important observational assessment tool. And the reason why I say that is because we get to see the child in their time space environment, you know, they’re outside of that clinical assessment, even, even when,you have an environment, that’s very supportive, but you’re doing like tracking stuff, and, you know, some of the more visual visual tests, it’s a whole different thing when you’re observing them as as it relates to their, you know, to their eye body coordination in space in real space. And that’s why in the testing, my eye exam is really all about, okay, how does this child move through space? What’s their proprioception capability, like the vestibular potential, and that’s why we put the prisms on and we watched them walk, and I’m really observing. In fact, visual regard that might be another interesting thing to add is to have them where the prisons and watch you know where what’s happening with their posture, their their feet, that’s always a big one. And you know, many other things going backwards. That’s, that’s a big one in my in my perspective. But I think that visual regard, I was so happy to see this in your, your testing. But like, for example, over focus child compensates with vision to coordinate body movements and move through space. So we do in our workshops, we actually ask the participant to over focus, please over focus, so we can watch you please. What’s under focus? What do you do when you under focus? And then the additional observations that you have here? Like, yes, putting the metronome on and having to bounce the ball to the metronome? Do they have a regard for their auditory processing? Or are they completely oblivious, and will even ask them, did you hear the metronome? No, you know, and just yesterday, I had a couple of assessments, where each child was unable to track the auditory part of the metronome while they were doing a visual motor task. And so that really showed me a lot around their, you know, their visual information processing. Also with the Marsden ball, like we’ll have them just hit the ball and then we’ll play the Simon says game, we may add the metronome to it. And it will see them fragmenting falling apart. Emily even I was working with a four and a half year old yesterday, it was a telemedicine and we were testing the Moro reflex. And we were doing the starfish and this boy, no matter what could not coordinate his arms with his legs and his head. And his diagnosis was moderate, a stigmatism in the eyes. And he they’ve been to two different eye doctors and they got these huge astigmatism corrections. He’s having no visual symptoms. But you could see how he was fragmenting things and how one side of the body was really different than the other side of the body. And I pointed out to the mom, this is where the astigmatism started. And of course, he was a forceps delivery. The the cord got wrapped around his neck, and he was really twisted up at the very beginning. And so now fast forward to four and a half. And they they put drops in his eyes, and they came up with this farsighted astigmatism correction. So we’re just going to do learning lenses with no astigmatism, and I think it’s going to go great. So that’s where you can actually trace it all the way back to those gestation birth and bonding situations. So I love this, that you’re including it. I don’t think I would add anything to it. But I think it’s a really important part and what I’ve shared here, some of the things of like, you probably see this a lot where kids are always bumping into things, or they’re spilling their drinks, or you know, they’re dropping stuff all the time. And this is that visual regard. I mean, they’re basically again, what I’m bringing to the table Able is can the child start connecting the eyes to the body? And you see in the evaluations, when we start doing that, then all this magic happens. And my hope is that you can really start doing that so that you can get that magic from session to session this session. And I think you can it’s just I’m spotlighting that for you.
05:26
I think the overall umbrella would be how can you create a load on the child’s sensory motor system, and that you can keep doing add ons around the different activities that you’re giving them. You know, one of the things I love working with you is that in your, in your therapy, you do not shy away from the body and you don’t shy away from the vestibular stimulation, and the movement part of it. And I get so excited about that, because most vision therapy programs are so AI centric, that they they exclude the body. So what I’m saying for you is, can you then take that by saying okay, how can we add on these different activities to create more load to create more stress in a good way that will really stretch this child and grow this child. So that could be something like and this is where you can get creative. Like let’s say you’re doing the Marsden ball, and they can do it Alright, then put out put putting them on a rotation board or some kind of vestibular pillow where they’ve got to stand on it hit the ball, then maybe you put a beanbag on their head, maybe then you add the metronome or you do some singing or drumming or whatever, then you add the the eyepatch or the prison. And what I would say in the add ons, to really have a list of things that you could do visually to help them change their input, patches, Red Green glasses, prisms, you know, so that you’re really loading it up on as many different systems as you can and watching that, of course, you’re good at this, not overloading to the point where they get so frustrated that there’s an anger outburst, but that you keep loading them. There’s a term that we use called hormesis, which means that I am stressing the visual system, so that there can be more resiliency to grow from it. It’s a fitness type of technique where you’re stressing the person so that they develop more vibrancy and vitality. And so you’re just taking the things that you have and saying, Okay, I’m going to add a, then a, b, then ABC, then A, B, C, D, E, and you just keep adding on. And then of course, really, you know, either afterwards doing some kind of this is where the Beamer might come in, where you’re doing some relaxation thing afterwards, or color therapy, or you know, something where they get to have that integration period, so that you’re not just jumping from one activity to the other. But there’s a pause, there’s a rest, there’s an integration. So I think that could be built into the loading dose, as we call it. And so in your manual, to have a list of activities that you could draw from that and just think about all the system systems, you know, proprioceptive, vestibular, visual, tactile, and I would also add that there, if possible, the more sensitivity your practitioners can, have, can own can occupy in themselves so they can read the child to know what’s too much and what’s not too much.
09:35
Right now. I’m counseling a practitioner, and she doesn’t have that sensitivity to know how far to go. And, I don’t know even know whether you have to have that discussion with the practitioner. But that’s such an important point. That’s the art of it. How much can I give without overdoing it? You know, I can think of James James As an example, and when he’s to come up here, and I would load him up to the point where he would almost have a breakdown, I mean, it was, but his mom was saying, This is so great. And then of course, we’d wrap them up in a blanket, you know, and do the tortilla exercise, and she’d press on him and, and he would just grow from session to session, but I knew how far to push him. And you know, these kids are really sensitive, and they can break down. So the practitioner has the sensitivity. And this is where even Susan can come in with the craniosacral. Because I’m sure in the training, people have to really monitor their energy, and you know, how they’re interfacing when they’re doing cranial work. I know, in my training, that was such an important part. I remember this one time, where there was a woman who was really sexually abused, and our practitioner had us come in, and he just sat by the door for like, 10 minutes. And then he would tune into her and she would say, okay, you can move the chair a little closer, and then move the chair a little closer. And then eventually, he could sit like four feet from her, and he was doing energy work with her. And that’s as far as she would lead him. So the point of the story was, I learned, like, Wow, my energy can really impact a person and they can be very vulnerable in that. So that sensitivity in myself is something that I’m really tracking with these kids. And the whole attitude I have is on how can I honor this person, because you know, they’ve been through a lot, and my empathy is going to be very important. So and I haven’t really seen your practitioners not do that they seem to have a great sensitivity. But that would be a great conversation to have. Because it could be a game changer around just the energy of the practitioner. And this is affecting the mom, the parents. And you may notice when I do a session, I’m really tracking the parents and the child at the beginning. So that I’m entering very, very slowly like that one family, and the father was kind of skeptical about it. And in the end, I think I won him over. And part of it was I was just very slow around my energy and really creating a spaciousness for them to feel comfortable. And maybe that’s it, you know, we know what the fear of fear paralysis and Moro reflex, and coming in, you know, from birth, that holy cow there, this is a huge transition from coming out of the womb, these kids I feel still have that imprint that they’re dealing with, and how can we help them soften that imprint, that’s even almost as important or more important than the actual techniques. So that I think needs to be in the mix of our, you know, our therapies, and so that maybe that’s not in the manual. That’s something that you’re talking to the your practitioners about. And many of them understand that and I love Susan, because I know, she’s probably teaching that in her cranial sacral. training. So that’s, that’s my, that’s my feedback there. So one of the correlations I’ve made over the years with those initial primitive reflexes is that a very high percentage of those kids with those unintegrated reflexes have light sensitivity. Because there is a sympathetic nervous system. overdrive, like that would be another question to ask how many of these kids either are exhausted and just living in their parasympathetic nervous system state, or they are in the fight flight freeze response of the sympathetic nervous system. And,
14:18
you know, because that’s also correlating to dilated pupils. And also, those fear, paralysis, more reflex. So those are the correlations, also a tight neck. So some neck issues around possibly the birth. So I’m connecting the dots here around the pupillary response. And the other thing about a dilated pupil or a poor constricting pupil, is that their peripheral vision is probably going to be tunneled. When they have a dilated pupil, there’s going to be some by non ocular vision. problem, there could be some digestive or biochemistry issue. And this is affecting their dietary absorption. And there may be some trauma involved in that lack of being able to constrict the pupil. So sometimes it’s just in asking the question, sometimes it’s actually observing the pupil response, but the pupil response can tell you so much about the health, the autonomic nervous system, where that’s at? And secondarily, where are the reflex with the morrow and the fear paralysis. And you may not pick it up, because you are in a pretty supportive environment with the, you know, the natural lighting. But I suspect that there might be a higher percentage of kids who have, maybe this needs to be graded and, you know, low, moderate high amount of people response, and the term that I use, if they have a dilated pupil, or light sensitivity is called Alpha Omega. And Alpha Omega pupil response means that
16:27
they are in a state of pretty constant dilation in their pupil, like they’re not able to constrict the pupil when they go into bright light. So it would be something again, I’m bringing more awareness to you. Maybe you have to ask the child or ask the parent, are they sensitive to light? It’s that same question. Hey, Johnny, do you ever see to have things Oh, yeah, all the time. And mom says, Wow, I never knew that. Same thing with the light sensitivity, are you sensitive to light? And I suspect that there is also some physical defensiveness, if you stick start shining a bright light into the child’s eyes. And this is this is what triggers the PTSD in ophthalmologists’ office, when the ophthalmologist is dilating the pupil and then using kind of a miner’s light, where they’re shining this really bright light into the eye to look for eye disease. And so if they’ve had an optimal logical examination, that might be good to know. Like, for me, whenever I’m doing some kind of light into the eyes, I am asking, Is it okay, if I shine this light towards your eyes, that response tells me something. So I’m asking permission, because it could be very invasive, to just take the light and go right into the eye. And that can trigger you know, all kinds of things as well. So I use the questioning, subjectively, I asked permission first. And then I enter it very slowly. And I’m looking at when I shine the pupil, and I usually come from below, so that I becoming below the face, like where the chin, the mouth, and then I come up under the eye. And I’m angling the light, this light source into the eye, maybe about three to four inches away. And I’m looking for how much integrity, that pupil is constricting. And a lot of times, I might not see it constricting at all, I might actually just see it for a moment, it will constrict a little bit, then it rebounds back even to more dilation. And then I compare each eye and you can do it with the lights on full. Sometimes I like in my room where you have me do the evaluation, I’ll put the indirect light on, and I’ll do it that way as well. So there’s lots of different ways to do it. Another thing to look at is doing like the vestibular ocular reflex or vestibular activity and then doing the pupil response. A lot of times, there’s even more problems with the pupil response after you’ve stimulated vestibular early. So there’s a lot to this particular response. Obviously, yes, the same size and the shape is something secondarily to look up that’s going to be more of a neurological question that there might be some neurological disease or some inflammation or toxicity going on in the eyes. When the size is different in the shape is different. But The speed of the constriction, the, the ability to hold the constriction. Remember, this is all reflexive. And if a child has a really high integrity, solid autonomic nervous system, they’re able to have a rapid constriction and they’re able to hold the constriction. So if there is a sluggishness in one or both eyes, and they don’t return to the baseline, that’s probably going to suggest, you know, really looking at those early reflexes, looking at the peripheral vision, looking at the binocular stability. And it’s telling you that on a autonomic nervous system level, they’re either right in the flight Fight, fight freeze response, or they’re so depleted that they’re just in the parasympathetic nervous system state. So the pupil is a really great portal, from my perspective, to really evaluate a lot of aspects of the vision.
21:10
We added that little yellow section at the bottom there, yes, there anything around the pupil, that we would notice that you would say this is something that you need to refer out to? Because it is more neurological?
21:25
Yes. So it would be if the pupils were unequal. Or there’s a deformed deforming shape. Or one pupil is different, a different size than the other? So those would be the reasons why you would read refer for a neurological but before I would do that, I would take a more extensive history, head trauma, inflammation, you know, any other neurological signs like a droopy eyelid?
22:02
Or,
22:04
you know, has there been a head trauma? So, and also even asking questions like, you know, does it run in the family where there could be some neurological disease, you know, going on. So there is a genetic piece that I would add. So when when I see those differences, that’s when I have to ask more questions. And then once I get more questions, if you want to run it by me, you can always do that. And then at that point, to say, okay, you’re going to need either a neural ophthalmologist exam or a neural neurologist exam, but taking a deeper history into it, if you see those things, and then make the determination, okay, yes, we are, we’re going to watch it. These are the reasons why, you know, it’s interesting things like inflammation and toxicity can trigger this kind of neurological situation. So those things can be addressed. And then, of course, the head trauma, that is a huge one around this difference in the size and the shape of the people. And I would add a couple more things, the color therapy, so you could use like the blue, green, the blue, the violet, that’s really helpful for the light sensitivity. And that when you use those colors, you’re stimulating more of the ease calm, parasympathetic response craniosacral, with the Beamer because those things are going to really bring forward that that parasympathetic response. And then the other thing to consider possibly would be the learning lenses. And if it’s really severe light sensitivity, this is again, where you could bring me in, and we could maybe put a tint on the lenses. You know, I’ve had kids over the years where the light sensitivity has been so extreme that we actually initially having started wearing tinted lenses. And that’s very helpful as a relief. I can think of one boy where we did that. And now he’s out of the light sensitivity. It’s not but it triggered him so badly that he had no resources. So by giving him the tinted lenses when he goes outside, it gave him some relief in some control, and then doing all the other things we were doing Eventually, the light sensitivity went away. There may also be a biochemistries p assuming there usually is. So if you can do your kinesiology like I would say that would be something I would add if there’s light sensitivity, because there are things that you might be able to give that that you find in the, in the kinesiology that could also balance out the nervous system. So because there is a systemic echo going on there that’s creating the sympathetic parasympathetic response in the eyes. So the Hershberg test is a really good great test to measure eye alignment by looking having them look at a penlight or a target. And with that, you can see the alignments. So you have esotropia you have exotropia, you have the vertical, which is great. Again, I think that just noting, you know the type of strabismus. However, the thing about the Hershberg is it’s a static test. And so let’s say for example, with this, you know with this situation when you get the say constant strabismus on one side, what’s accompanying that is usually amblyopia because there’s unilateral constant strabismus on that side. That means the child is either in double vision or has decided to suppress the eye that’s turned. I think a question you can ask if you pick that up? Are you seeing double?
26:56
You know, do you ever see two of things? Or it may be then you have to go further in the unilateral strabismus by exploring Do they have amblyopia? Do they have double vision or suppression? The other thing that this test doesn’t do is this situation just on one side or is there an alternating situation. And in the alternating situation, you won’t have amblyopia because each eye takes a turn at the fixation. So this is where you learn a test called the cover test. And the cover test is a dynamic measurement of eye alignment. And that might be something that I teach you how to do. And basically what it is, is you get an occluder or you use something that you can cover an eye, you have the person look at a target. And then they look at the target and you cover one eye, and then you quickly cover the other eye. And you watch the movement of the eye that you’ve uncovered. So like say on an exit proper if I’m covering the right eye, and then I immediately take the cover away from the right eye, the right eye is going to swing in towards the target. And then I go ahead and cover the left eye and I swing in and cover the target, I swing in and I uncover the left eye and the eye will swing in as well. So you’re looking at the movement when you take the cover away? Well, I think that and you might make a note of this. So you can remind me, but instead of using the charts, what I would use is a special flash flashlight. And it’s called the worth four dot, and that’s the number four and then the word dot. And I could get this for you through our you know through the vision therapy website with the arrow, it would be the flashlight with four to five little dots to four or five dots in the flashlight itself. So wouldn’t be the arrows. It would be dotted and two of them would be red, two would be green, and one would be white. And so when you hold that flashlight towards the red-green glasses towards the eyes, let’s say he’s seeing red Over the right and green over the left, he should say I see two red to green. Or you might say I just see two red, I don’t see any green. So that means the left eye is suppressing. Okay, so the target may need to be more focused than the red greens, I mean, you, you should be able to get some. Now this would be older kids too, because the younger kids may not be able to respond, they might respond better with the word for dot, that’s what I tend to use. But you need to have like a more specific target with the red and the green, I mean, you could use the Brock string with the red green glasses. And that could also tell you now another way outside the red greens would be and I’m working on this to get you a some kind of a scope, like mine that you can look through, and you can put a picture up there. And that’s a great way to measure suppression, which I will bring bringing August 6. But the pig is on the left side, the dog is on the right side, oh, I only see the dog, the pig is disappearing. I mean, you’ve seen that many times. So I think that there’s some other testing that you could do around the suppression. And it sounds like the red green charts, are not giving you enough data to really support is their suppression or no suppression. Yeah, they can’t figure it out. It’s something new to them, and you’re just presenting it. And it is true. With the charts, they can, they can kind of compensate. So once again, make a note on that what you need for me like the worth for dot
31:55
flashlight. And of course, then the scope because eventually with the scope, I want you to be able to, to have them look at the pictures. And also do the vo star test. I mean, that’s another way that you can see suppression as well, because the child might even say, Oh, one of the lines is disappearing. Or you can see how one side is you know, working much more than the other side. In terms of the drawing, you actually see a space on one of the sides, let’s say the left side where there’s actually a hole in the drawing itself. But I do think you want to go more deeply into, you know, by an ocular vision suppression, double vision, alternating. And that’s what’s missing. In the Horsburgh, it takes a real kind of skilled person to actually see the alternating, I mean, the way you can tell subjectively is if you measure their acuity, and the right eye and left I have similar acuities. But there’s a strabismus, then it’s an alternating situation. Most of them have what we call convergence insufficiency, where they can’t come into midline with both eyes. And this goes all the way back to the Moro reflex. I can’t tell you the number of kids who I’ve diagnosed with convergence insufficiency. And one of the best ways to reduce it is by helping him develop a better midline on a body level through the starfish through, you know, other exercises. So it’s a midline problem. And sometimes it goes all the way back to the prenatal period in the notochord. When that starts to develop the spine, they don’t have a healthy sense of their middle. And so it shows up visually because you’re giving them something where their visual development is not ready to see the detail up close to read to write. So their midline visually is going to break down, which is that convergence insufficiency. And not that there are other conditions. But that one seems to be primarily what’s showing up with these kids. They just don’t have a midline sense. And I guess you could probably pick that up other ways. You know, again, if you had to evaluate thinking of all the kids, what would you say about their midline development? Do you have any, any comments about how, how well they’ve developed their midline? Well, I can tell you with with those problems, they’re going to have a confusion in their visual midline. There’s going to be some by an ocular instability, because the foundation isn’t there. So when they try to use their eyes or they’re being asked to use their Because the body midline is not there, the crossing of midline that’s, that’s going to be a big problem. And so then, you know, bringing in the left right prisms are really great for activating Oh, I even have a visual midline. And you know, so there’s a lot of ways then you can start to stimulate that. And this is why if you get any of these kids, where the doctor has said patching eight hours a day, stop it immediately. Because when you patch, there’s no development of the visual midline, it actually makes it harder to develop a midline when you’re doing that kind of constant patching. And, you know, maybe I need to come in and talk to the parents about it. I’ve done a lot of social media presentations on why it’s not a good idea to do long-term unilateral patching. It’s really, it’s really what is being taught in the schools to you know, patch, unilateral patching for long periods of time, it’s going to bring up the reflexes, more the trauma more, the child is going to feel more confused and disoriented. The vestibular system is going to shut down. I mean, it’s all so negative. And yet, if you went into a standard doctor’s office, and there was amblyopia, that’s what you would be given. So it’s not even just in the big cities, it’s everywhere. So, okay, so Well, let’s move to it, let’s move to fixation. Okay, so I think what you have here is really good.
36:52
You know, in terms of, you know, grasping the new objects with their eyes, you can look at the pupil response, you can look at the facial tics. And you can, again, the maintaining or sustaining visual attention. social contact, eye contact, tells me a lot about the Moro reflex and where that’s at what the bonding was, like. The defensiveness, like the visual defensiveness that’s actually up is partly due to the low visual attention. And is that defensiveness visually, also showing up on a body level. So the more I can help soften the body, defensiveness that could actually help the visual attention, defensiveness, and you know, depending on the age, I mean, 20 seconds with distraction? Yeah, that’d be great. If I can just get five seconds, 10 seconds. That’s really great. And my son, my question is always when I’m working with the kids is, how can I invite the child to feel safe enough in the activity where they can start to come forward with their visual attention, I find with the Marsden ball with the flashlight, lying on their back, you know, making it fun making it low impact in terms of their fight flight freeze response, because that gets in the way of the visual attention. Those are some of the things in the eye therapy that I’m, you know, constantly thinking about, how can I help them move forward by softening the source the cause of why they’re not feeling safe. So it’s a, it’s kind of a safety issue, and maybe a trauma issue. And then there’s the biochemistry part of it as well. So it’s all interrelated and met a mesh together, around the fixation. And one of the things in the eye care is they separate the fixation from the person, and you don’t do that. But if you’re seeing poor fixation to kind of trace that back to Okay, is it the fear paralysis reflex? Is it the Moro reflex, you know, even the tonic Labyrinth reflex is a place where I start working with fixation using a sticker on their thumb or something? Can they follow? You know? So, those are some of the things I’m thinking about with fixation and if they have poor fixation, to try to teach them how to read. Oh, my God, that’s really they’re not ready for that. It reports seeing that they have a pretty strong binocular instability. There’s a strabismus that you’re going to need to identify Is it an eso? Is it an EXO? Is it a hyper And how much of the time are they seeing too? are they seeing too only at near? Are they saying to only at the end of the day? Some kids will say, Yeah, I see too, but I can make it go away, or I can make it. Go back to one. So I think to be able to identify that that double vision signal requires much more investigation on is it all the time? You know, and
40:34
again, these different circumstances that it comes up? Do I wake up with double? Or is it more of an end of the day kind of thing? Does it just happen on school days, and on the weekends, I don’t have it. And sometimes if it’s an adept child, you can say, Show me with your fists, how you see the double is it horizontal is a diagonal is a vertical, and which eye is high, which eye is low, or which eyes on the right, because they can close or cover each eye. So that they can start to understand the projection of which eye sees which object out there. So then at that point, in terms of the double vision, this may be a referral to me, because at that point, then, you know, a lot of the exercises you may have to do will be working with the patch initially, or maybe working with the bass down yo prisms, that would be the one that’s going to give them the most peripheral vision potential. And you get certainly experiment with trying different yo prisms on them to figure out well does the double get better does it get worse, I mean, that could even be part of the therapy that you’re doing. But usually if there’s a constant double, we have to start by doing a lot of the activities with each eye separately. One more point I’ll make about the double vision that in craniosacral therapy, sometimes the sphenoid bone, the occipital cortex, the cervical spine, if you do some of those things that can reduce the double. Could you say those three areas again the cervical spine, the occipital cortex, and the sphenoid bone that that in the cranial train and cranium session by maybe improving those communication links, sometimes the double the double vision will go away. There’s a correlation between those three areas in the head and strabismus in the eyes. And then you have maybe investigated was their head trauma at some point did they fall? Was it a birth trauma? You know, when did the double vision start showing up? You know, is this a new thing or has it been there for a while or you don’t know, but the cranial work can be very helpful at resetting the eyes.
Thank you for listening. I hope you learned something from the EyeClarity podcast show today. If you enjoyed the episode, make sure to subscribe on iTunes or Spotify and leave a review. see you here next time.
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