Dr. Juanita Collier on Vision-Related Learning Challenges and Racial Disparities in School Vision Care

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I am very excited to have Dr. Juanita Collier on today’s episode to have a very unique conversation about visual-related learning challenges; specifically how visual impairments diagnoses or lack thereof can affect our child’s learning journey. Dr. Juanita Collier, MS, OD, FCOVD is a leading behavioral optometrist, highly-sought children’s vision expert and founder of 4D Vision Gym, Connecticut’s largest and most accredited vision therapy practice; where she specializes in post-concussion care, vision-related learning difficulties, visual rehabilitation and visual development for patients of all ages.

Dr. Collier shares her own story of not getting diagnosed until she was twenty-five years old, and we discuss how race plays a part as well in getting the right diagnosis and the treatment they receive after. We also talked about the similarities between ADHD and visual disabilities, the impact that virtual learning has had and the changes that can be made at the school level to make sure that kids are getting the right diagnosis early on. This is a very informative episode that I hope will inspire you to take action for your children and for members of your community.

 

About Dr. Juanita Collier

Dr. Juanita Collier, MS, OD, FCOVD is a leading behavioral optometrist, highly-sought children’s vision expert and founder of 4D Vision Gym, Connecticut’s largest and most accredited vision therapy practice; where she specializes in post-concussion care, vision-related learning challenges, visual rehabilitation and visual development for patients of all ages. She is one of only a few Optometrists in Connecticut to have earned Fellowship status by the International Examination & Certification Board (IECB) of the College of Optometrists in Vision Development.

 

Things you’ll learn from this episode

  • What vision screenings are and how are they related to learning
  • How school vision screenings are under-serving students, especially students of color
  • The correlation between literacy rate and the number of inmates in prison
  • The similarities between ADHD and visual disability
  • The impact that virtual learning has had (and will continue to have) in the development of children’s visual systems
  • What changes can be made at the school level to make sure kids are getting the right diagnosis early on to address visual-related learning challenges
  • The importance of black parents advocating for schools to change the school-provided vision screening

 

Resources mentioned for vision-related learning challenges in school vision care

 

Episode Transcript

Juanita Collier  00:00

So if we go by the DSM 5 checklist for ADHD inattentive it’s essentially the same exact checklist as convergence insufficiency, which is a vision diagnosis. And so we’re looking at avoidance of near work, we’re looking at acting out we’re looking at the different behavioral issues we’re looking at to choosing other activities as opposed to reading all of those things can happen if what you’re looking at doesn’t look right or if the words are moving when you’re reading or if you’re seeing double when you’re reading.

Debbie Reber  00:31

Welcome to Tilt Parenting, a podcast featuring interviews and conversations aimed at inspiring, informing and supporting parents raising differently wired kids. I’m your host, Debbie Reber. I’m very happy to be having Dr. Juanita Collier on today’s episode to have a very unique conversation about how visual impairments, diagnoses or lack thereof can affect our child’s learning journey. Dr. Collier is a leading behavioral optometrist. highly sought after children’s vision expert. and founder of 4 D Vision Gym, where she specializes in vision related learning difficulties, visual rehabilitation and Visual development for patients of all ages. In our episode, Dr. Collier shares her own story of not getting diagnosed with the vision related learning disability until she was 25. And the way in which race plays a part in children getting the right diagnosis and the necessary treatment and support. We also talk about the similarities between ADHD and visual disabilities, the impact that virtual learning has had, and the changes that can be made at the school level to make sure kids are getting the right diagnosis early on. This is a new topic for the podcast and it’s a very informative episode that I hope will inform you to take action for your children and for members of your school community. Before I get to that, I want to give a quick shout out to Rachel Jacobellis and Joanne Ebihara, 2 new supporters of the podcast. Thank you so much for joining my Patreon campaign and helping me cover the costs of producing this show. If you get a lot out of this podcast and want to join Rachel and Joanne in supporting it, you can sign up with Patreon to make a small monthly contribution. To learn more visit patreon.com/tiltparenting. Lastly, if you want to dive deeper into these podcast episodes, please check out the show notes pages until parenting. For every episode, you’ll find a bullet pointed list of key takeaways. A full length transcript links to all the resources mentioned in a podcast player with the episode broken down into chapters. So if you want to go back and re-listen to a specific piece of the conversation, you can easily find it. This week’s episode can be found at tiltparenting.com/session272 or just go to Tilt Parenting.com/podcast and click on this episode at the top of the page. Thank you so much. And now here is my conversation with Dr. Collier.

Debbie Reber  03:12

Hey, Dr. Collier, welcome to the podcast.

Juanita Collier  03:15

Thank you for having me. 

Debbie Reber  03:17

This is going to be an interesting conversation, and one that we haven’t had on this show before through this specific lens. But before we get to that, I always ask my guests to introduce themselves in their own words beyond the formal bio and tell us a little bit about your why for the work that you do in the world.

Juanita Collier  03:34

Okay, so my name is Dr. Juanita Collier, and I’m a behavioral optometrist. So what that means is that I kind of do like physical therapy for the eyes. And so we work primarily with children who have visual developmental delays, or learning difficulties all the way up to adults who have suffered concussions, traumatic brain injurues, strokes. And what we do is we help them develop their visual systems or rehabilitate their visual system so they can have success in their activities of daily living. And it’s amazing because we get to see so many changes happen so quickly, for people who kind of felt like there wasn’t anything that could improve. How did you get into this work? So when I was a child, I actually had one of the vision issues that we treat every day. And so what happened for me was that my eyes would drift out quite a bit when I was reading, and I would see double, but I didn’t realize that was a problem. And I didn’t realize that was not normal, because you know, it’s kind of how I see just like you know, how you see is very personal. It’s kind of like you just assume everyone else sees that same way. And I went to the eye doctor and I told them that I felt like I saw weird, but they always said oh you have 20-15 vision. You’re like an eagle and everything and when I went to college, then things started to get a little bit tricky because I was seeing double a lot. And they gave me reading glasses which actually made things worse because the vision condition that I had was actually mistreated. And by the time I got to optometry school, I was seeing double for up close and for distance. And so that’s when I was finally diagnosed. And thankfully, I was able to, you know, use my auditory processing system and everything like that to make it through. And I still graduated at the top of my high school class, and I graduated from University of Pennsylvania early and went to a computer school, so I was able to compensate for it. But I needed to compensate a lot more than I should have. And so my whole Why is to have it so that other kiddos who are having the same thing, don’t have to compensate for it, especially if compensating might be more difficult for them.

Debbie Reber  05:40

I can’t believe that you went that long without kind of really understanding what this challenge was impressive. And we know that so many kids do overcompensate, kids with learning disabilities and other ways to and that can be kind of, you know, their stealth dyslexia, their stealth learners who don’t get the support that they could have used. Gosh, I you know, I just wonder, do you think about that, like, what would my childhood have been like? Or how different would it have been had I had this information at an earlier age?

Juanita Collier  06:11

Well, that’s what I tell my mother all the time, like, I could have been big, Mom. But it’s actually interesting, because so many of these things run in families. So through having my practice, my mother learned that she had the same exact diagnosis, too. So she ended up correcting hers when she was in her 60s. But you know, she had come up with different compensations that she taught me to do when we were studying. And that’s kind of how we made it through. But for other kiddos, sometimes it’s kind of just like, they start to feel like they’re not as smart as their peers. And then you kind of get into that whole other life layer of things that negatively impact academics. So I’m here to make sure that the kids that I interact with don’t have those issues, and then hopefully, to get the word out to everybody so that nobody has to struggle with those things.

Debbie Reber  06:57

So great. And honestly, when I first learned of your work, I had never heard of a behavioral optometrist. So I’m sure many of my listeners have, but that hasn’t been part of my specific path. So it wasn’t on my radar. So I’m super interested in that. And I’m wondering if you could tell us a little bit more about vision screenings and how they are related to learning because it makes sense that they’re connected. But I’d love to hear more about that.

Juanita Collier  07:24

Exactly. So right now, the standard of care for vision screening is just to check your distance vision. And most of learning does not happen at a distance. Most of it’s happening out close, because we’re learning to read, we’re needing to take notes, we’re needing to decipher what’s the important information. And most of that’s not happening on the smartboard at this point. And now with everything switching to more of a digital area. And that kind of being how we’re going to be going going forward and kiddos having like, you know, the Chromebooks in the classrooms, so much is happening up close. But that’s not checked. So usually, you don’t check near vision on somebody until they’re 40. Because that’s when it’s expected that your near vision starts to decline. It’s assumed that children can see up close without a problem. And in many cases, at least in my practice, that’s not what’s happening. So if you’re having difficulty seeing a close, your parents can’t really detect that. Whereas if you’re having difficulty looking far away, they’ll see you squinting, and things of that nature, but up close, it’s harder to know how somebody is actually seeing.

Debbie Reber  08:28

Yeah, that’s super interesting. And, you know, I understand that, while school vision screening tests only for nearsightedness, that is something that mostly affects white children. And that issues like farsightedness are much more likely to impact black children and that those aren’t typically tested for. So can you talk more about that discrepancy there and the challenges that that creates?

Juanita Collier  08:52

Exactly. And this is actually something that’s been well documented and well researched as well. And so there was a study that was performed on fourth graders. And what that showed is that while parents of the different races had noticed that all of their children had been screened for vision issues. There was an overwhelmingly higher number of white children that had already had glasses at that point. And most of the black children pass the screening because they’re testing just for distance vision. So for the white children who are having difficulty seeing far away because they’re nearsighted, that’s actually a benefit for near work because you can see better up close. And then for the black children, when you’re farsighted, it’s easier to use the muscles inside of your eyes to make things clearer far away. But then you need to use those muscles even more to see clearly up close. And that a lot of times is too hard. But that won’t make you fail a vision screening.

Debbie Reber  09:48

Yeah, fascinating and new information for me. So let’s talk about that. Then what does that actually lead to? That’s obviously a huge issue for black children for children of color who are not getting the support that they need.

Juanita Collier  10:02

Exactly, exactly. And really what’s what that leads to and even how it starts is we can go back to preschool with it. And so there were preschool studies performed that showed that uncorrected farsightedness is actually associated with blurry near vision, decreased that perception and worse performance on early literacy tests. So we’re saying that these issues affect how you’re going to perform later on in reading, and that they can be detected in preschool. Then we have some major, major things that we can actually make some headway on, if we are doing these vision screenings that actually test for these issues. earlier in life. The American Association of optometrists says that you should have your first eye exam at six months old, your next one at three years old, and the one after that is six years old, right before first grade. And the reason for that is because we can detach these things so early. However, most people don’t even realize that that’s what’s supposed to happen. And at a pediatrician’s screening, again, they’re just checking for distance vision.

Debbie Reber  11:07

So how does that change, then? I mean, it seems like this, it’s a no-brainer that this is something that needs to be changed, a policy change, or just the way that pediatricians practice.

Juanita Collier  11:18

Exactly. And the New York Times had that big series of 1619 Project where they were talking about the disparities in health care, the racial disparities in health care. As a result of that last year, I was asked to speak at the governor’s mansion in Connecticut, to go over, you know, what’s happening as far as the racial disparities and vision are concerned, and my focus was on children, because you know, if we can kind of get things to change at a state level, men eventually can be a federal level, then we can have the screenings change more easily. And when we have done vision screenings in the school, what’s happened is, they take longer, so right now, you know, you have the entire class go in, and the nurse has you read the lowest line that you can, it takes about a minute a child, when we were doing the screenings, it took five minutes per child. So where is for me, I would think that that’s, you know, for extra minutes that are worth that, depending on the school system, that might be an issue. And that’s the issue that people are kind of leaning on. However, if that’s going to cause these difficulties later in life, then I feel like those are four minutes that really need to be invested in our children.

Debbie Reber  12:28

Yeah. 100%. And so you talked about preschool and not catching those things. And it can change performance on early literacy tasks. And so can you talk us through a little bit what, how that kind of plays out over the course of a child’s academic career? Yeah, just what their experience could be like by having that diagnosis missed?

Juanita Collier  12:49

Yes, exactly. So when you’re learning to read, obviously, we need your eyes to be able to point at what you’re looking at, to be able to see it clearly. And for you to be able to look at it long enough with both eyes together for you to understand what it’s saying. Now, if what you’re looking at is too blurry, or it’s double, then how you’re learning to read is going to then be skewed. And your ability to read is going to be skewed. So until around third grade is like pretty much the cut off is what we say is like when you’re learning to read and you make that transition to reading to learn. One of the superintendents that we were working very closely with let me know, which I had not known before, that they determine how many jail cells to put in a certain geographical area based on the literacy rate at the end of third grade.

Debbie Reber  13:35

If you could see my face right now  …that is incredible. 

Juanita Collier  13:39

Yes, it’s staggering. So it’s kind of like, okay, well, if we can say that the literacy rate is directly proportional to what’s going to happen as far as the safety of the society is concerned, then that’s something that we really need to focus on them. So with that being said, they’ve done a million juvenile delinquent studies, and they’ve shown that uncorrected. farsightedness is one of the major issues that they’re finding in juvenile delinquents. And they’ve also shown that doing vision therapy, which is what we would do to correct these item issues and things of that nature have reduced the recidivism rate. So that means that once they correct these vision issues in the juvenile delinquent delinquency detention center, they’re able to not go need to go back again. And so if these things are there, we have the research to prove it. How about we start at preschool and have it never happened in the first place? And that’s why, you know, that’s what I’m really advocating for.

Debbie Reber  14:40

Wow, I read research about kids in the juvenile system and also in jail systems as an adult. There’s a very large percentage who have learning disabilities and, and things like that, but the connection with uncorrected or undiagnosed farsightedness. But it’s just fascinating to me and frustrating, right. Just like with dyslexia and other things like, there’s a way to figure this out at quite an early age, and it’s not that hard to do. And it can completely change a child’s life to have that information.

Juanita Collier  15:15

Exactly. And what’s interesting when we go back to the racial piece of it is most of these issues are not affecting white children. So the impetus for change is a little bit reduced. However, when we, you know, bring it out to what happens to society as a whole as a result of this, then hopefully, that can spark it in people to say, okay, these changes should happen. Like, even in my practice, you know, where I really work with children who have these vision issues, be at the uncorrected farsightedness, or the eye teaming issues with seeing double when they’re looking at close and those things. Most of the people that are referred to my office are not black, they’re essentially all white. And for my particular experience as a black woman, when I had these vision issues, when I was younger, my eye doctor did not do anything about them until I demanded something in college. And then he gave me the wrong glasses. However, he now refers patients from his office to me to fix the exact diagnosis that I had. And he has yet to refer a black person. So it’s very interesting, like even how doctors are looking at different people. And so you know, at the time, my mother could have had this corrected, she was doing the right thing by having me go get an eye exam every single year, even though I had the 20-15 vision. But my doctor didn’t, didn’t refer me appropriately.

Debbie Reber  16:38

Yeah, so we’ve done shows on just I had Maria Davis Pierre, who runs a wonderful podcast and organization called Autism In Black about the late diagnosis of black children with autism. Also, ADHD, we know is diagnosed pretty late, if at all, right? Because often in, especially black boys, it’s kind of chalked up to bad behavior. That’s kind of the default. You said that vision issues, or maybe I read this on your site, vision issues can display similar symptoms of ADHD. So can you talk more about that and how things are actually received versus what’s really going on?

Juanita Collier  17:17

Exactly. So if we go by the DSM five checklist for ADHD inattentive, it’s essentially the same exact checklist as convergence insufficiency, which is admission diagnosis. And so we’re looking at avoidance of near work, we’re looking at acting out, we’re looking at the different behavioral issues, we’re looking at to choosing other activities, as opposed to reading all of those things can happen if what you’re looking at doesn’t look right, if the words are moving when you’re reading, or if you’re seeing double when you’re reading. And so the fact that those checklists overlap so much, if it’s a division issue, it’s something that’s very, very easy to take care of. And there was a study done at the University of Pennsylvania, my alma mater, and in 2008, where it showed that children who were black that who had the same profiles as children who were white, the white children were actually labeled as ADHD and the black children were labeled as emotionally disturbed. So ADHD, children get services that are going to help them academically when emotionally disturbed children get managed. So it’s kind of like okay, and we’re starting out from such a young age. And then what is the trajectory of life after that? So we’re starting the disparity so young and then looking at it from the top down and saying, like, where’s what happened? And what happened is we knew these things were going on, these studies have been out for forever. And let’s correct them.

Debbie Reber  18:45

So I mean, obviously, this is systemic, like, these are systems that need to be changed here. So can you talk more about where that work needs to happen? I imagine there’s also work that has to happen within the black community in terms of making sure to know what we should be asking for and what you should be advocating for and pushing for, especially if pediatricians are treating people differently based on their ethnicity, their color. So can you talk more about like, where you see the main points where we need to be improving or where the work needs to be done?

Juanita Collier  19:19

I think at the school level, changing the vision screenings. So if we had envisioned screening that added checking for farsightedness and checking for near I’m checking for double vision when you’re seeing up close. So many of these issues would be taken care of immediately. And that would be the biggest, easiest thing to incorporate to just have the nurses know what to look for. That would be the first thing on a parent level. I think that what we can really do is ask the pediatrician to ask them you know how is their near vision like that? It would be helpful to pediatricians. We’re pulling out the near card as well, because that’s something that’s very easy to do that their technicians can do and it won’t really add time to the exam. And then as far as from an educator’s perspective, or from a doctor’s perspective, having vision screenings happening at the preschool level would be really wonderful. And that’s where I started, I started doing a lot of preschool vision screenings, because that way, as far as an optometrist, you know, there’s less red tape to get into a preschool essentially, and to really go in there and do like free vision screenings, whereas with the school system, you have to go through the different layers of things to get there. And yeah, some people don’t feel that vision plays as much of a role in learning as it does, which doesn’t make sense to me, because when we’re learning most of what we’re doing, is it seeing, you know, 80% of learning is visual in nature. So we would think that people would really expect that to be a hindrance. And the distance vision piece of it is not the issue, but that’s the one that was checked for. And so we can change it on those different levels, if we can change it at the pediatricians office, if we can change it at the preschool level, or the school nurse, like any of those levels would make a big impact in what’s in what’s going on, because all of these children are going to school. And so having school screening be different would be amazing.

Debbie Reber  21:18

Yeah, and I think, you know, we’ve done an episode on auditory processing issues. And that seems to be a question that is asked more frequently, right? If a child is inattentive, or it’s kind of spacing out, or zoning out or whatever, it’s like, Oh, is there a hearing issue going on. But I think, again, we don’t often think it’s a visual issue. So this is such great information. And, I hope that listeners are thinking about their school societies, and how they can be a vocal proponent and try to make sure that these screenings are happening.

Juanita Collier  21:49

And with that, I think that a lot of schools do refer out for an eye exam. However, it really depends on where you’re getting your eye exam to. So is your eye doctor looking for how your child is functioning up close, because like I said, my eye doctor wasn’t. And he does for some patients, obviously, because he sends them to me for treatment, but he didn’t for me. And you know, if you’re going to an eye doctor who doesn’t specialize in children’s vision, they may not be looking for those things. So when you go to an eye exam, and they look at your distance vision, and they dilate, ill and they give you glasses, that’s not the eye exam that we’re looking for. We’re looking for a full eye exam with a sensorimotor evaluation. And that’s the big part for parents to take home to call when you’re scheduling the appointment, ask if they do sensorimotor testing? 

Debbie Reber

What is sensorimotor testing exactly? 

Juanita Collier

So what that is, is looking at how that patient is taking in information from the world and how they’re processing it and then outputting it. So what we’re looking at is can they see it at different distances? Can they use their eyes appropriately? Like meaning? Is there flexibility of their visual system? Is there endurance of the muscles of their, of their visual system? And once that information goes into their brain, how are they processing it through the different lobes of their brain to make sense of it for the output. So there’s a lot of different levels that we’re looking at as behavioral optometrists that other eye doctors are not looking for, because it’s not their specialty. And so there’s a place for everybody. Obviously, if you need surgery, then you need surgery. So you go to a surgeon, if you need primary eye care, then you go to optometrist, but if you really need to see how your child’s using their visual information for learning, then you would need to go to a behavioral or developmental optometrist.

Debbie Reber  23:33

Is that something that most people would be able to find in their town?

Juanita Collier  23:37

In their town? Probably not, is really we’re very specialized. So in our state of Connecticut, there’s five of us. Wow. Okay. So, in bigger cities, obviously, you’ll find more in areas where there’s an optometry school, you’ll find more, but there’s definitely you know, optometrists who do this in every state, but really making sure that you’re going to somebody who does specialize in this because this is a very specialized field. And the best place to find an eye doctor for that is the website covd.org. It’s the College of optometrist and vision development. And then you can just put in your zip code, and they’ll show you where the closest one to you is. And that’s where you’ll find the doctors who actually really specialize in this.

Debbie Reber  24:22

Such a great resource. Thank you. And yes, it does seem so specialized. So I feel better now that I hadn’t really known of this as a field because it’s not that common. So thank you.

Juanita Collier  24:34

Exactly.

Debbie Reber  24:35

So I’m just wondering, are there signs that parents can be looking out for like, how would a parent know if this is something that might be going on with their child?

Juanita Collier  24:46

Well, I would definitely recommend for everybody have children at six years old, have an exam with a behavioral optometrist, because that way you can see what’s going on right now and what might be coming down the pike as we have more news work being piled on their visual systems, we want to make sure they’re strong enough to handle it. As far as what to look for if your child is past that age, is when they’re reading do they kind of put their head their head on their hand, because like a lot of kiddos will read like this, like, you know, they’re kind of covering one eye, or they’ll like lay their head down on the desk when they’re writing, a lot of times, that’s because they’re seeing double. So they’re able to cover an eye that way. I’ve had kiddos who will refuse to put their hair in a ponytail, and they always want their hair over their face. And their parents think it’s a sensory issue. So they go to occupational therapy, but it’s actually they’re seeing double, and their hair takes the double vision away, then we have a lot of kids who rub their eyes excessively, so they got a lot of size on their eyes. And if your child is getting size repeatedly, that’s probably for them seeing double, because they’re trying to like rub the double away. So just those few things, right. There are things that parents see and a lot of kiddos because when you see pictures of classrooms, you see at least one child with their head down. And it’s kind of like, okay, well, that kid has a vision issue, you know, so you can kind of see what’s going on. But just knowing what to look for in those instances, some children will report headaches, but usually they won’t, unless it’s been going on for a really long time. And then even in my exam room, when I’m talking to the child, I’ll ask them after I look at their I see their eyes for you know, five minutes, I’m like, Oh, tell me about when you see double, and like, oh, just when I read, but I know which one’s the real one, like, Oh, okay. And their parents, you know, they’re, they’re crying. And they’re like, they never said this to me before. But they had no reason to complain, because they don’t know that you don’t see double tail, you know. So it’s kind of like really asking them the right questions. And the earlier a child starts reading, the more likely they are to do this. Because when you read earlier, you’re using visual skills that your body has not had time to develop yet. So my daughter, she’s five years old, and she’s reading and she’s been reading for like the past year or so. And we were on vacation the other day. And I looked at her. I’m like, Oh, my goodness, her eyes are out. And I was like, Oh, my Addison, do you see double right now. And she’s like, Yeah, and then she’s like, but I can fix it. And I’m like, Oh, my goodness, that means she’s had it long enough to know how to fix it. And I’m an eye doctor. And she just had an eye exam. But she had an eye exam right before she started learning to read. And now she’s a fluent reader. And during that time, her body figured out how to compensate. And so she has the same diagnosis that I have. But she’s getting it fixed at five, I got to fix it. 25. And my mother got it fixed at 60. So it’s, you know, like, she’s getting it so much earlier, because I knew what to look for. And having other parents know what to look for is really my goal.

Debbie Reber  27:39

So fascinating. Well, hopefully, this podcast episode is getting the word out to a lot of people. So you know, you talked about that, that screening at age six, but it sounds like based on your experience, and your mother’s experience, like this is something that can always be addressed. And so I’m just wondering, what do you do? Like how do you support kids who have this, these challenges and fixing them?

Juanita Collier  28:02

Exactly. So there are foundational skills that are necessary for reading. So there are certain building blocks that we need to build in order. And so what we’ll do in therapy is we’ll start with the basics. So we’ll go all the way down to what’s called fixations. So that’s that ability to look at something long enough to take the important information from it, then we look to see how well you can use the muscles inside of your eyes to make things clearer. That’s what I was saying that the farsighted people really depend on in order to even see for distance. So we want to make sure that that muscle is strong enough and flexible enough to see clearly at different distances, then we want to look to see how the two eyes are working together. And so both eyes need to point at the same point in space, all the time when you’re reading or things are going to turn double. A lot of children when they’re reading, you know those larger books with the larger font there, okay, because the words are so big that they can tell which are the real letters and which ones aren’t. But as the font gets smaller at around third grade, those letters just start to overlap. So then a B and A D look very, very similar, because it’s just a line with a circle on it. So if that circle is moving from side to side, that can be either letter, the same thing with a Q and A P. So those are the letters that get reversed the most. And so if parents are noticing children having those letter reversals of those specific letters, a lot of times that can be a vision issue as well. And then we look to see how the patient is using all those systems together, and how they’re making sense of it in their brain. And so we broke it down to essentially six foundational skills. And we really work on those. And by rebuilding them from the beginning, we can get their visual system strong enough to be built to read. And that’s what our goal is so that the children can actually just take on that academic information and be dedicating their energy to learning as opposed to seeing.

Debbie Reber  29:55

So fascinating, and I’m just wondering if because of Covid and screen time, I mean, all our kids are on screens all the time anyway. But it’s obviously in the past year and a half that has increased for most children because of remote learning. So has that changed the number of kids who are struggling with these kinds of challenges,

Juanita Collier  30:17

It has definitely accelerated it. So prior to COVID, we were noticing an increase because children were on their parents smartphones a lot more. So they had them. But a lot of times with the phone, like parents won’t have them have it for too long, because they need it back. But now with COVID, they’re on the screen for the entire school day. So we would have kindergarteners who are on the screen for the entire school day, and their eyes just can’t handle that. So then a lot of parents would have the modifications with the teachers up, oh, can they turn their screen off? And can they, you know, have different modifications of that nature, because they knew something was going on, but weren’t really able to pinpoint what exactly it was. So now that parents are starting to see like, okay, their vision isn’t isn’t functioning how it should, we’ve gotten a lot more patients coming in with these issues, we’re seeing the base of the breakdown of that foundation there. So it’s foundational skills haven’t had enough time to develop, but we’re putting the weight of a computer all day, on their visual systems, whereas many adults have complained about vision issues after being on a screen all day, and their visual systems are completely developed. So for a child, we’re actually changing how they’re developing and, and hoping for the best and essence. And so let’s not do that anymore. You know, that sort of thing?

Debbie Reber  31:34

Well, before we say goodbye, I mean, I definitely want listeners to know where to learn more and to connect with you. But is there anything that we didn’t cover in our conversation that you want to make sure that listeners are aware of, or know, or maybe a last thought for them?

Juanita Collier  31:48

I think really just to reiterate that, you know, we are our children’s best advocate. And so if something looks strange, and the doctor that you go to says that everything’s fine, like as, as a parent, you kind of know that it’s not. And so like, you know, keep looking. And really, now we know, you know how to find a behavioral optometrist, because every child of learning age should have an exam with a behavioral optometrist. So let’s look at their vision, since that’s their primary sense as far as learning is concerned. And also, whatever we can do to kind of rally to get the school systems to change that we can have the nurse’s vision screening change, those would be my two big take homes, because if we can change what the nurses are looking for, and we can change what the parents are looking for, then we can change how our children see and how they function in life, because we all want our children to have the best life that we can give them. So this is a major area that we can make some improvements.

Debbie Reber  32:42

Yeah, that’s great. Thank you so much. So tell us where we can learn more about your work and any other resources you want to share.

Juanita Collier  32:51

Yeah, so my practice is in Cromwell, Connecticut. And obviously, that’s not accessible for everybody. With the rise in these vision issues, we’ve actually developed a digital program where we’re training parents on how to help their kids develop those six foundational skills. And it’s called built to read. And so you can just go to our website and have that program there for you accessible, so that you can go through the training program on how to how to take away these issues for your children, even if they don’t have them just to make sure that their visual systems are strong enough for the academic careers that they have ahead of them.

Debbie Reber  33:26

That’s fantastic. I love that. Well, I just want to say thank you so much. This has been so insightful, very educational for me, and I love learning new things. So I really appreciate you sharing this and I have a feeling that they’re going to be a lot of listeners who are going to be researching on the COVD website trying to find a developmental or behavioral optometrist in their area. So thank you so much for this and for sharing everything with us today.

Juanita Collier  33:53

Well, thank you so much for having me. I really help hope that this helps some parents out there.

Debbie Reber  34:00

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