Let's Get Curious with Replenishing Soul
Let's Get Curious, a podcast where moms care for each other, tackling the conversations no one likes to have. We share insights on self-care and navigate parenthood, especially for those raising neurodivergent children, creating a supportive community for all moms. Join Lori & Dorothy as they share their professional expertise as healthcare professionals along with their personal stories of mom struggles. We are moms supporting moms.
Let's Get Curious with Replenishing Soul
Episode #6: Let's Talk Vision with Dr. Tina Schiller O.D.
In this episode, Lori engages in an enlightening conversation with Dr. Tina Schiller OD, FCOVD, the esteemed owner of Summit Vision Center in Issaquah, WA.
Lori shares her personal journey of working closely with Dr. Tina when her daughter's vision challenges began impacting her learning. With a deep passion for the subject, Lori emphasizes the importance of understanding the distinction between sight and vision, advocating for comprehensive vision evaluations for every child.
Unlike milestones like walking or talking, vision problems can be tricky to spot because kids often learn to cope with them. Dr. Tina adeptly navigates this difference, explaining why conventional eye exams at the doctor's office or school might not catch important issues. She also offers valuable insights on what to look for at different ages that could indicate potential vision problems in children.
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Resources: Quality of life survey (vision survey) and how to find a vision doctor in your area:
https://www.covd.org/page/QOLSurvey
Convergence insufficiency Symptom Survery: https://wowvision.net/wp-content/uploads/2014/08/CI-Screening-and-symptom-survey.pdf
Child Development time line:https://www.covd.org/page/Child_Timeline
Infantsee: https://www.infantsee.org/about-us?sso=y
A public health program offering free eye exams between the ages of 6-12 months old.
Disclaimer:
The information shared on this podcast is for informational purposes only and is based on the opinions and experience of Lori Dorothy and their guests. The content should not be used as a substitute for professional medical advice. Diagnosis or a treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you heard on this podcast
Welcome to let's get curious. The podcast for women and mothers seeking connection, support, and inspiration. We are friends, mothers, and therapists. Laurie, a physical therapist and Dorothy, a speech and language therapist. Together. We share our personal stories, including IVF birth experiences and navigating children's learning difficulties. Through our discussions, we uncover profound lessons for personal growth. Join us on this journey of curiosity, compassion and empowerment. Welcome to let's. Get curious.
Lori:This morning I have, Dr. Tina Schiller with me. She is a pediatric developmental optometrist, and I have had the privilege of working with you, through the experience of my daughter going through vision therapy. And, We had such a positive experience through vision therapy that I just felt that it was extremely necessary for me to get this information out, Dr. Tina, because I feel that a lot of people do not know what vision therapy is. And whenever I am talking to other parents about our experience, they always kind of say to me, how did you know to do this? So with this, I am hoping that I can just share this with more people and give people some different insight of what the differences between vision and sight and how this all works for, our children in school and how it affects their learning. So I would love for you to, tell us a little bit more about yourself and then we'll dive into all the good stuff. 1st, Lori, thank you so much. I'm so excited to have this opportunity to talk with you. And as we've chatted in the past, we could talk about this for there's tons of topics. We could branch from and talk so much about it. This particular topic is. So hugely impactful and can be so hugely impactful for our kids yet is really poorly understood and very limited in the how many people even know about it. So, I'm just really grateful for this opportunity and excited to talk about it. Just, I thought, 1st, a little personal introduction on me. I have 3 kids age, 5, 3 and. Um, just eight months and then my fourth baby is definitely my practice. And so I opened a pediatric and vision therapy specific practice in two years ago, almost, uh, in of weeks here and, and have been practicing in this area since my residency, which we'll talk a little bit about, which was in 2014 and 2015. Just a little bit of background, which I think is interesting and pertinent on how I became interested in optometry and specifically about pediatrics and vision therapy. In college, I think I changed my major six times, maybe more than that. I started as a biology major. I thought I was going to be a vet. I, I always loved math, science, animals, and people, kids specifically, wanted to be a vet. College, lots of twists and turns of, trying different things. And that's one thing, just as an aside, I, I found this because I asked a shadow. everyone and my parents encouraged me to shadow any kind of profession that I was interested in. But anyway, started as a biology major, interested in, Large animal veterinary medicine actually decided that wasn't for me took a big turn. I'm also a huge sports fan My actual major is business administration with an emphasis in sports finance, which is wild and realized again after shadowing that wasn't for me and At my college, so I went to University of Southern California, USC in Los Angeles, they had a program where you could do a work study and spend time in local elementary schools up to junior high schools and just extra help supporting the teachers there. And I did that for just over a year, probably was three semesters and I actually met a little girl. She was probably it was probably 2nd grade. And she was really struggling. So what my role was, was to, she would have pullout time and I would help her one on one and in knowing her, she got glasses. And at the time I didn't know anything about vision therapy, but I wore contact lenses myself. I am myopic or nearsighted. So I was familiar with optometry, but I hadn't really thought of it from a pediatric perspective. And anyway, so she got glasses while I knew her and just seeing her change with the glasses, she was actually hyperopic. So farsighted, meaning she had trouble seeing up close, which we'll talk little bit more about. Our kids world is up close. So near vision is incredibly important. But she got glasses and this. changed every aspect of her, how she was participating in the classroom, how she was working on learning, reading, writing for spatial organization, all sorts of things. Again, I knew nothing about vision therapy at the time, but this just sparked, why didn't I think about optometry kids? This is, I could link all the things that I like. And so I dove right in and I knew that I wanted to go into pediatric optometry. And so I specifically chose a program. I went to Southern College of Optometry in Memphis, Tennessee, because they have an excellent pediatric program and in learning about pediatrics, when you're in the optometry world, you can't isolate pediatrics from vision therapy. And so I learned about vision therapy after. I first started becoming interested in pediatrics and, then went to optometry school was four years. I went to Southern college of optometry in Memphis, Tennessee. And then I stayed there for my residency in pediatrics and vision therapy, binocular vision, and then finished my residency and then went on to get my fellowship in vision development in the college of optometrists and vision development, years later that requires, we can talk about that, but a lot of extra study and clinical time. But but it was just this one girl to see the impact of glasses, alone. And what we'll talk about though is much more glasses. And so that was just the initiation for me of understanding the importance of sight and vision.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Yeah, that's amazing. Well, and I think that's the piece where people think if we just have glasses, then that takes care of all the problems, but that is not the case. And so can you then elaborate for us, Dr. Tina on what is that difference between vision and sight? Because, I think a lot of times families have to also rely on going to their pediatrician or say, the school screenings, and it's like, okay, you can see 20, 20, but that's such a small piece of this. And so that's the part I really want you to dive in a bit and explain to us. Because, you know, yes, my daughter needed glasses, but That was just a tiny, tiny piece of the world that she was seeing that was affecting her reading, as well as her comprehension, and of course, then making us, have difficulty and struggles in school. And I think what I want to emphasize before I turn it over to you is, yes, my daughter has multiple things happening in her life, but, That piece where a lot of times we rely, too, on the teachers, they're doing their testing and they're at grade level, but, you know, yes, my daughter was at grade level, but at the same time, we had so many other things happening underneath the surface. And vision being one of those for her that was affecting her reading and her comprehension. So even though she looked okay, say on paper at school, she was working so hard and then having to come home and then losing it. And so you're kind of like, if we're at grade level, why are we Why are we melting down? Let's get curious, you know, and so I, there's that piece that I want to share with parents out there is that, our kids get seen in, in different, um, Different corners, the teacher lens, the parent lens, and it's putting these puzzle pieces together to, dive a bit deeper and, and just know that there could be some other underlying problems.
Dr. Tina Schiller:I love the part
riverside_lori_raw-video-cfr_lori_yu's studio_0018:dive into that a bit for us with that vision
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:so much there. So much there. And I
riverside_lori_raw-video-cfr_lori_yu's studio_0018:I know, we could talk for hours, right?
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:much. Highlight one thing about what you said, which is, you know, grade level. She's at grade level, grade level, but you nailed it. What is, okay, but what is it taking for her to perform at grade level? What
riverside_lori_raw-video-cfr_lori_yu's studio_0018:is that output?
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:Yeah, what's the behind the scenes part of that? So exactly. So let's see. So, 1st, I think the 1st, part of of that that I do want to highlight is that difference between a pediatrician screening and a school screening and really what does a pediatrician and a school screening? What is it? First, I want to highlight that is a screening. Anymore. It's not surprising to me, but unfortunately, a lot of people believe that's even a exam or that is a, an eye exam, or even a vision exam, which we'll talk about. I vision very different things. But so the screenings that happen at a pediatricians office and at a school are just screenings. They are so helpful. But they're also just screenings for sight specifically, specifically at the pediatrician's office. They're looking at, can you identify a letter on a chart at a certain distance? This is important, but this is one tiny, tiny piece. So that's what they're looking at at a pediatrician's office. At school screenings, there was a huge push to incorporate near visual acuity. So not just can I see something at distance, but can I see something at near, which is amazing. But the actual implementation of that has been challenging over the last few years. So screenings at a pediatrician and through school, just look at sight. That's that 20 20 piece, which unfortunately gets labeled as perfect vision. That's perfect sight. That means, yes, I can see something with my central vision, something small, looking at distance, and then sometimes school screen looking at near, and that is an important piece, but that's just one small piece. And we'll talk about that. The other thing I want to highlight is what happens at. Oftentimes, at pediatricians and at school screenings, our kids brains will figure out a way to accomplish the task you're asking them to do, especially if they're being labeled pass or fail, you know, failed. I failed the school screening. That terminology just kills me because they didn't anyway, separate discussion, but, they will, especially if they're in a group setting. If the child can't do the task, they can't see the letter that someone's pointing to, or the shape that someone's pointing to, they're going to figure out a way to do it. So this specifically applies to what if I have one eye that sees well and one eye that doesn't see well. I'm covering this eye oftentimes with a hand. It's amazing. The tiny gap between my fingers that looks tiny when I hold my hand out, if I hold it up to my eye, I can see right through it. I can see right through the gap in my fingers. And so it might look like a child is covering an eye. Because, but this is their better seeing eye, the one they're covering, they can see right through that gap in their fingers, and it does not take but much, a tiny head tilt to see through your hand. So, I, it is amazing how many times I've seen families who they've passed, just on the sight part, they've passed screenings at the pediatrician, they've passed school screenings. And then they finally get into my chair, and they're just jaw dropping shocked, the parents, because, like, oh my goodness, how did I miss that they have one eye that doesn't see well? And the child will just nonchalantly say, oh yeah, that's my bad eye, that's my good eye, and the parent is just in total shock. So anyway, kids are so bright, they're going to find a way to do the tasks they're being asked, especially if it's in a group setting. Who is the person doing the testing, you know, so even the the screenings, they even when they're screening for something They can even miss eyesight things. So, again, those are just screenings. They look at sight They look at can I can I see something and oftentimes even then? They might miss sight things when it's just one eye compared to another I will highlight on that front too kids don't know to say what they're seeing They don't know if it's typical or atypical. You know, when we compare other developmental milestones, physical ones, motor, you know, gross motor, fine mo motor, which you're intimately aware of, but speech, all these other milestones that we think about as parents, we can actually hear them, see them. We really can. Um, it's more easy to identify is my child not progressing in a way that is supportive of them? And do, do I need intervention? Vision is very different. A child, first of all, doesn't know and can't see. It's not something that can be seen what someone else sees or how someone else sees. And so they don't know what is blurry. Well, it's all, it's all relative. I don't know because if I've always been blurry, but I also don't know. Are things supposed to move around? And we'll talk more about this, but are things supposed to be moving around when I look at them? Are they supposed to go in and out of focus? And is something supposed to float off the page? And so, all these things, kids, it's just very difficult with vision because they won't say that they're experiencing these things. So oftentimes parents won't know. And then it takes that extra, okay, well, what are these things I'm looking for? And I know we'll talk about that, but, that's just a side on screener. So screeners are amazing tools. And they are sometimes that kick to say, hey, we need to go investigate eyesight, but they do not replace comprehensive vision evaluations. And so that's the screening piece, the important jump between between to your next question about, you know, what is the difference between site and vision? Is understanding that and the importance of it is understanding specifically for our kids that 80 percent of what how we learn is through vision. We are meant to be visual learners. And when you really think about all the things that are required to learn and what our children do, it makes it a little bit easier to make that jump between. Okay, what is vision? So, sight is just, can I identify it? Well, now vision. So, vision, when we talk about input skills, I don't just have to see it with one eye. I have two eyes, and I have to coordinate them together. So, this is teaming. If both my eyes are not pointed at the same place in space, or if they are pointed at the same place in space, but I'm working really hard to keep them pointed at the same place in space, I can do that. So even if a child doesn't have an eye turn that's easy to see, they could be working so hard to keep their two eyes pointed at the same place in space, and that can cause an image to go in and out of focus. So, again, child that passes that screening, because sometimes it's in focus, but sometimes it's blurry. And you can imagine how distracting that would be if something goes in and out of focus. So that's teaming. Can I point my two eyes at the same place in space? Can I do it comfortably and can I hold them there all day and do it with stamina, right? Is it the same at the end of the day as it is at the beginning of the day? That's a big piece also. So that's teaming. Focusing, we'll talk about link between attention, I think, in a bit, but focusing is Can I keep something clear at distance and at near and shift my focus from far to near and back? Can I do that efficiently comfortably and again with stamina? And then we have tracking so my two eyes have to point and hold My focus has to point and hold and then I have to move my eyes in small eye movements from word to word if i'm reading Or from board to desk if i'm in a traditional classroom or from screen to screen Whatever the setting is the jumping eye movements called tracking Are a hugely important piece. So teaming, focusing, tracking are things you've heard me talk about all the time, but those are the big, I call them the big three of, okay, not just site, but how do I actually acquire visual information? Can I do it comfortably without extra effort and with stamp sustain? Do I have that, that stamina piece? I like to label those as visual input skills. As you know, there's a whole host of, and this could be a completely another. Podcast is now that I've acquired the visual information, what does my brain do with it? So this is called visual information processing, or you'll see it, excuse me, called visual perceptual skills. These are, how our brain interprets and analyzes visual information. So we just talked about, can I acquire visual information comfortably, but then can I also analyze and interpret it? So these are things like how different does something have to be before I know it's different. What about reversals? We'll talk about that in a little bit. Do I identify, really easily my own right and left? That's a foundational skill to then be able to know in space directionality. letter reversals. So can I really easily identify the difference between a B and a D and a P and a Q? How about even sixes and nines? Things like that. Those are all visual information processing skills. Do I do well with different fonts? Do I mistake similar words? Visual closure, visual discrimination, again, a whole different, a whole, we could talk so much about visual information processing
riverside_lori_raw-video-cfr_lori_yu's studio_0018:opening up a rabbit hole here!
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:I know vision is so much more than sight. Yeah. My big takeaway is to understand that. Vision is so much more than sight, and what most people think of when they think of vision is just sight. And that is how lots of kids can slip through the cracks of they have a hugely impactful, a visual problem that impacts learning. It's amazing. So 1 in 10 is the published statistic that you'll see. 1 in 10 kids have a vision problem significant enough to impact learning. I'll argue just clinically that that's probably a little bit higher than that. I think it's probably more like 2 to 2. 5 out of 10. But even if it's 1 out of 10, right, that's really significant. And so 1 in 10 have a vision problem significant enough that it impacts learning. Yet 50 percent of vision problems are missed in screenings. So this kind of links the two things together. We, we missing these vision problems in our screenings. Because they're just looking at site, of course, and they're hugely impactful. So, just really important to understand that difference between vision and, and site and how we can get a sense of false confidence from, from a vision screening and even from an eye exam. So, kind of going one step further, and I might be jumping ahead, Lori, so interrupt me, but if you have anything to clarify.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:my notes. We're good. We're good. Mm
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:It's pretty amazing then to understand, okay, if you understand the basis of sight versus vision, you might just from your own experience going to an eye doctor, be confused and think, okay, but. Now, I'm at my eye doctor. How are they testing for these teaming, tracking, focusing, depth perception, visual processing skills? Well, for an adult routine eye exam, they're probably not, um, exactly.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:They don't. I can tell you. Yeah, I just had one to get me in for my insurance and get my contacts renewed. But no, they don't look at any of that stuff.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:Yeah, and or you've certainly seen the difference between the evaluation when it's from the developmental front, meaning. Are we looking at the functional visual skills in addition to the sight? So right, a traditional eye exam that most people are familiar with looks at looks at eyesight just more in depth than the screening, of course, has extra tools for an adult, you know, we're asking the questions of which is clear one and two in kids. Just so you know, I have so many parents who are like, my, my. How can we really trust what they're saying? Because do they even understand what you're asking them? And, I actually don't need any of their subjective responses to be able to evaluate sight and vision. I can evaluate even on an infant and we'll kind of talk about ages and stages in a little bit. So I think that's what happens is adults think, Oh, well, first of all, my, no way my five year old could do this exam I just had. And also this isn't making sense. None of these things are tested at my exam. So a traditional eye exam. Looks at eyesight in depth to prescribe glasses or contact lenses and looks at eye health. Oftentimes with eyesight, it doesn't even look at it with two eyes together. It might just look at it, one eye blocked, the other eye blocked, and then that's kind of it. But certainly doesn't look at all at the, how do the eyes team at distance, at near, Depth perception, how are they tracking? So we have, a thorough battery of tests that I can do again. It looks different for every age and phase and every no kids at the same age are, are the same, certainly. So it looks different for every child, but have a whole battery of testing that takes me about an hour to administer, that really looks at. All of the things we're talking about. So this looks like me presenting two eyes, each eye with a different image and asking and seeing where, where are the two, the two images lining up and can the child control this from distance to near and what ranges do they have to do this comfortably? And what is the 3d vision like? And I use lenses to simulate the change from focus from desk to board. We use all sorts of tools to evaluate these skills, but You've probably never seen me ask, which is clear one or two. I don't think I've ever. So it's just very, it looks very, very different. And it, it has to go much, much past the, which is clear one or two and not even include that quite, quite honestly, we, I can do that with different tools with kids. And so, it just looks completely different. And until you see it, it's a little bit hard to even verbalize how it looks, but, you would know, a difference because the child usually thinks it's pretty cool too. Like I'm making them see double. They're seeing two of things and they're seeing one of things. Then it's blurry. Then it's clear. We're looking at eye movements, body movements. I'm asking them questions while we're testing eye movements. So it's not even just the testing that's done. It's the way that it's done. I don't care if they get, well, I certainly care. I want them to move their eyes free from their head. And I want them, after age seven, to be able to process information while they're moving their eyes. So, do they have to focus so hard on moving their eyes that they can't even talk to me about something basic, like telling me about the name of their dog? So anyway, I'm, I'm doing all these things that oftentimes the parents don't even, They might just think, Oh, you're having a conversation with my kid. I am, but I'm looking to see, okay, after I remind them to keep looking at my target, can they still look at my target and talk to me about their brother, their sister, their dog, their sports, you know? So anyway, it just looks quite different. It's much longer, much more time, with a doctor and it's evaluating those teaming, tracking, focusing, depth, perception, those, those visual skills that. are certainly not evaluated in a screening and and very often not evaluated in a regular eye exam.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Right. So what would be some kind of Uh, red flags that parents could possibly maybe start asking their children, or be looking for, even at home and just kind of checking in because, you know, I mean, I said this in my very first podcast that, the kids reality is their reality. So if they've only ever seen blurry, that's all, that's their normal, right? And even in my, you know, daughter's situation, she was reading. She was reading and, and following along on the, you know, the papers and stuff, and not really missing words per se. But then it came a point, and it was so interesting because we were just about to start vision therapy, but then she started to say to me, Mom, the words on the page are moving. And I was like, well, this is great because we're going to vision therapy. But then even going through that full assessment with you, what I was also amazed by is that she also had peripheral vision deficits. And, again, you know, I'm, I'm a therapist myself, and to your point, like, yeah, we know, like, yeah, I'm watching these gross motor movements, and are we on target for this, and the fine motor, and everything. But she was never my kid, Dr. Tina, that would bump into a wall, right? Where I could be like, oh, there's some, we're missing, we're not seeing something, or you throw a ball and she's missing it all the time, right? Off center and whatnot. So those larger movements that I would have been able to pick up even as a therapist. Those weren't happening in our world, but yet she had these peripheral, vision deficits and one of the exercises that, was prescribed for us is she had to, you know, look at my nose and I just, and she had to just keep looking straight at me and I had to move my hand in just different positions on the side of her and she had to slap my hand and, um, She would of course, you know, miss it. But then the more that we practiced it, bam. I mean, like even now to this day, we'll still do these homework assignments and just fit them in and just to reassess and see where she is. And it's like, bam, bam, bam. It's like as if nothing happened. And, what I also thought was amazing by all of this is how quickly um, That brain eye connection was happening in this homework, and that's one thing I want to emphasize is, yes, it was commitment every day we did something for her, homework, but it was Three minutes here, five minutes here, you know, it was just easy things to fit in and it was amazing to watch her go from just not being able to even hit my hand on the side to then us putting the ball up in the garage. And her walking into the ball and out of the ball and of course not having to get, not trying to get hit as she's reading, the colors or the numbers on the, the pages that you guys had given us, um, and even like chewing bubblegum, you know? So it was, it was a challenge at first and she'd get hit by the ball and then we'd have to restart. And then by the end she was just in and out of. That string back and forth whipping out these colors and the progress happened so quickly. So back to my question is what are some things that maybe parents could be asking or looking for? Because like you said, a lot of this stuff you miss it because they don't have the words and you can't see. And, even with my skill set, I missed that with my daughter because like I said, she wasn't bumping into walls. It wasn't clear to me that we were having peripheral deficits because they were there, but of course they weren't super severe, right? But they were severe enough that could be, observed through your testing. So if you can give us some clues of what we should be looking for and possibly asking. Based upon age too.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:and just before I jump into those, I have to, you brought up a critically important visual skill that I had not verbalized at all, which is the idea, just briefly, of central peripheral. So, Lori, when you mentioned peripheral, that's like our side vision. So certainly your daughter's side vision is Structurally, excellent, right? It's not that she couldn't see what was in her side vision, whether we're talking about side vision close to us or side vision really far away. It's, can I attend to it and attend to it accurately and appropriately? Vision is so attentional. Meaning, we know that like if we're driving, you, you're driving to a familiar place, you're driving home and you get there and you might, you were thinking about something else and you think. Oh my goodness, I don't even remember what stoplight happened and you were using your vision. You just weren't attending to it at the moment. Um, vision is attentional and our central peripheral integration, how we use our side vision is critically important to so many things. But if we're speaking of learning, reading specifically, we have to plan our next eye movement. There's amazing now brain studies. So you can use the new scans and technology that we have. And they've looked at efficient readers are using their peripheral planning to plan the size of their eye movement jump. So essentially our brain is seeing the size of the next word and what's coming to the right of where, you know, in the English language. And that's something interesting, right? Not every language is left to right. That's a whole different thing. The eye movements for reading are learned and developed, which. You've alluded to so fast forward. This is all this is the exciting part. This is not structural. This is all this can be developed. But anyway, the central peripheral piece just can't gloss over that because that is so hugely important. Again, something else we could talk so much more. This is everything from. critically important for reading, but also, can a child find an item in a busy room? Is this someone that, you know, you say, go grab your, your shoe and the shoe in question is in the middle of a, a basket and have a really hard time finding a piece of information. And how are they using that finding aspect of the vision? There's so many ways that this could play a part, but, to the question of kind of what to look for. I do just want to highlight that, this definitely changes depending on age, and I, want to emphasize that even in toddlerhood, we can do evaluations on toddlers. My expectation and what I'm looking for is going to be drastically different in a toddler than in a, in a 7 year old than in a 10 year old. Um, but I can evaluate and, and know. How closely do I need to watch? What do we need to do? Is there any interviewing to do? Even at toddler. But, specifically talking about school age kids, so in school age, some big things to look out for, that are very common are reversals past the age of seven. So I mean, either struggling with reversals with handwriting or with identifying. So whether it's the output of writing or identifying. For instance, B's, D's, P's, Q's, that past the age of 7 would be a, a, a red flag of that visual processing skill that we talked about. Another huge one is the use of the finger to read past the age of 7. So if I'm Still using my finger past the age of seven, to read or to keep my place like at the front of a line. And then the next one is just more, a big one, but one that I really like to highlight big by meaning, it's not anything you're going to see defined in a study, but it's, hey, does my child get past that graphic novel phase? Or do we have a child that loved graphic novels and did really well when. There were some pictures involved or words were larger and space, the spaces between the words were bigger. But when presented with something in a paragraph and we're trying to get to that next phase, what, what happened? What changed? That's it. I, that is when I hear every single day is my child loves graphic novels, but falls apart on anything that's more dense. The text is more dense. So, In terms of other big things to look at, there are actually two really great symptom survey lists because you mentioned things that you didn't experience but that are actually really common. Clumsiness, that's a big one I hear is just, gosh, they don't see something, you know, right in front of them and they trip, they trip continuously, um, inappropriate spatial distances like personal space, am I not judging personal space well, am I using a lot of my tactile because I don't rely on my vision, so a child that is really tactile or sensory seeking? Am I touching everything? Well, why is a child touching everything? They're touching everything, sometimes, it could be, because their vision is not giving them accurate information. And so they have to use the motor or tactile feedback to learn about things. And so they're going to, this is going to be the child that just touches everything. Anyway, going on a tangent,
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Love it. No, keep it coming. Ha ha
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:can look so different in every child because one child might just, and I say just, but imagine how impactful and annoying that would be if the words are floating, moving on a page, that might be the thing, but for someone else, it might be, It might be that clumsiness. Um, it might be poor spatial judgments. It might be difficulty with eye hand coordination because, you know, I, I want to play baseball, but I'm getting really frustrated because I'm just, I can't track that ball and I'm not making my, maybe my depth perception is affected. So it can look different for everyone. And, there are amazing, two amazing, oops, excuse me, two amazing, Symptom checklists that are really easy to quickly look through. One of them is called the, COVD quality of life survey. And I'll give you this so you can all,
riverside_lori_raw-video-cfr_lori_yu's studio_0018:we'll put these in the show
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:notes, but. The quality of life symptom survey is really excellent and it's available through COVD and then the convergence insufficiency symptom survey, CISS is another excellent one. And one thing we haven't, we, I've kind of glossed over but haven't talked about specifically is when you're talking about what are some things that parents can look out for, In addition to what we've talked about, any child that is struggling with, or there are concerns regarding attention, that is number one, must have a developmental functional vision evaluation, because there was a Study that just kind of reinforced what we see clinically all the time that, retrospectively looked at 300 or something children that were diagnosed with ADHD, and those that were diagnosed with ADHD were three times more likely to also be diagnosed with convergence insufficiency. If you actually look at the diagnostic criteria for both ADD and ADHD. And then you look at the symptom checklist for convergence insufficiency, they overlap on all but like three of the diagnostic criteria for ADD and ADHD, meaning that the symptoms and the signs of convergence insufficiency are very similar to those with ADD and ADHD. So, it is absolutely possible that a child is misdiagnosed as having ADD or ADHD when it's actually a vision problem. And this is substantial. And I will clarify, it can be truly, you, you address the vision problem and then, wow, we don't have vision. We don't meet the criteria anymore for ADD or ADHD, but they both can coexist too. So we can truly have ADD and ADHD and have a vision problem. The vision problem can be developed and addressed once we develop that convergent skill, two eyes coming together up close. That is the most common binocular or eye teaming problem in kids and adults. Is difficulty with pointing our two eyes up close? Where is kids worlds up close? Where do kids learn up close? That, where do we read? Where do we write? So if my two eyes are struggling to both point up close and the words are looking like they're moving, coming in and out of focus, floating off the page, and it's making me tired, my eyes are hurting, maybe a headache, I'm feeling a pulling, a tension. And I'm seeing some shadowing or doubling. Of course I'm not going to continue to pay attention to what's in front of me. I'm going to avoid it. I'm not going to do it. I'm going to be fidgety. I'm going to move. I'm going to look like I'm having an attention problem. When really, I am having an issue paying attention, but it's because this is so uncomfortable for me to look at this up close, I'm, I'm going to show, I'm going to demonstrate these other behaviors. So, any child that's having attention difficulties, always want to rule out, is there a visual component that is presenting that is causing the child to present with what you see and what a parent or teacher will observe as attentional difficulties? Because that just can be hugely and the earlier, you know, if that's at seven, that's just so any ages is impactful. We do vision therapy with adults that have convergence insufficiency. But the, it just impacts the child's confidence and all sorts of things. So if we can reach this child at age seven, it can affect how they're even identifying themselves is I'm not a reader versus, you know, I can do this. I just want to make sure throw that out there. But the 2 symptom surveys are really helpful because, in general, It's like headaches, eye rubbing, especially at the end of the day, fatigue at the end of the day. Obviously, we all are more tired at the end of the day, but really big differences in stamina, where I just come home exhausted from school, can absolutely be visual based. Words running together when they're reading, skipping, repeating lines, a head tilt, closing or covering one eye, a hand over an eye. Avoidance, skipping small words, mistaking words for a similar word. So, you know, having a word and then the child says a different word, even if maybe they just said the correct word on a previous page or something like that. Writing is a big one, writing uphill or downhill, difficulty with spacing of letters, in, you know, inappropriate letter size spacing, just poor reading comprehension, working distance. So really close or really far. Usually we see really close, really close to a page, a child that gets kind of closer and closer. attention span, taking longer to do things just at the time it takes to do something. And that's, again, this is usually parents intuition of, gosh, this just doesn't match. I, especially too, Hey, if I tell my child this out loud, a child that loves audio books, but hates to read, right. That's a huge red flag is, Hey, you can say this, or maybe it's even a math problems. I just saw a little one who. out loud, verbally can do the timed math just quick, quick, quick, quick, but then presented with the same math, the same math problems on a page can't perform in the same way that they cognitively can. So parents are saying, what is happening? They know this, but then Now the teacher has all these concerns because when they're presenting them on this busy page, well think about that busy page. Now we have to track, we have to look at the appropriate problem, we have to have figure ground, meaning can I identify the piece of information visually that I'm supposed to focus on and ignore all of the rest? And so a child that struggles with any of the areas we've talked about, especially if it's looking like it's moving, if I'm having trouble knowing where to point my eyes, that's going to be totally overwhelming. So, um, this can be where the parent's intuition comes into play. If, gosh, I just. The amount of effort my, my kid is putting into this, or this isn't making sense. They, they can talk it through with me. I can, I can tell them this and they've got it. And then they read it themselves and they, they're just lost. That's a huge difference between visual and auditory. That's a huge indicator for what's going on visually that that's contributing to
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Right. And I think that also goes back to what we first started this podcast of, if you're at grade level, they could be having these other skills. So auditorily they're good, but then visually they're not or vice versa. So yes, it just. Food for thought for all of this stuff. And, you know, that's the other piece too. We start to see a lot of these differences, I think, between third and fourth grade, right? Because they go from learning how to read, now to read to learn. And if you're working so hard to keep your eyes focused on a word or trying to get that word in focus, you're not remembering what you're reading.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:right.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:And so then we start to see difficulties with the comprehension and that's why I do, I always go back to, when kids are struggling in school and misbehaving, what are we missing? What are we missing? So I hope there's teachers that will be listening to this podcast and just another, you know, food for thought of what might be happening to, with that student in the classroom, because
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:Yep. And truly any, any, their classroom is visual. Learning is visual. So even if it's just a child that is struggling in the classroom, that's, that's signed enough that,
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Roll it out,
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:uh, Exactly, just rule it out because then, and rule it out again, difference between not with a screening and not, not even just a typical eye exam, but go one step further and just make sure you've looked at the functional visual skills and you know whether or not they're, they're a piece.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Yes. Yes. And we'll post this too, and I could probably say this for the end, but I'll just do it now since it's fresh in my mind. For those, uh, just living wherever it is that they live, and they have to look for a developmental optometrist, is there, a, a website that they could go? Does that exist for your profession of finding specifically the developmental, pediatric, optometrist? Not just, we don't want just an optometrist. We want that developmental, piece to it.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:Yes. Yeah. The best place to go is C O V D. So that's V like Victor, D like dog. org and right on their main page. It's a find a doctor. You click on it and then you'll put in your address or zip code and it will pop up. I will let you know that there's a little feature where you can click fellowship. So, the doctors that come up that are listed there are generally going to be providers that have an interest in vision development and developmental vision. You can go even one step further and check or look for a doctor that is fellowship trained, so that has their fellowship in the College of Optometrists and Vision Development. To get the fellowship, a doctor needs to have a minimum of 1, 000 clinical hours in vision therapy and vision development and complete the fellowship. Gosh, nine different case reports and a multiple choice test and an oral board interview. And it's a whole multi year process. And so that's how you can really, you can find someone who is, know, has the experience and the background in vision development. Having said that doctors, there are plenty of doctors. It is a long process. So there's a lot of doctors, you know, myself, young family. I got my fellowship. Oh gosh, years are funny. 2021 or something, but it was. several years after I was eligible, but it was just a, I had babies and other things. So anyway, just go on that website. Look, look, put your zip code. Anyone that pops up would be a great resource. A fellowship trained optometrist is, would be a really excellent resource if you have that by you.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Wonderful. So now, you know, you've kind of taken us through things to, to look for at home. What an, a comprehensive evaluation looks like. So then if somebody or a child does need vision therapy, what does vision therapy look like? Yeah, walk us through the homework, the commitment, all of it.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:that's the really exciting piece about this. And that is why this whole conversation is important is because, okay, so what we've identified this. Well, what does that Well, we've identified this and this is something that is. We can develop. This is something that children, adults, humans can develop. So we're not talking about weak muscles. This is, that's a misunderstanding or misinterpretation. We're talking, it's not, yeah, that is a hugely important piece to differentiate. We are not treating or diagnosing weak muscles. It is all around the now really, a hot topic and which is exciting for us of neuroplasticity. So vision is learned. Vision is developed much like and very intertwined with our motor development. Vision is just an output of our motor is an output of our vision. But we're not treating the muscles. So what is vision therapy? Vision therapy is retraining the learned aspects of vision. Through neuroplasticity, which means all we're doing is providing a child or an adult with experiences through activities and exercises. I like the word activities better because exercise to me comes with that connotation of muscle that we're not strengthening muscles. That's not what we're doing. There's not a structural abnormality here. We're providing experiences for a child to learn to do something that they didn't learn to do in the most efficient way. And so we are retraining and forming those, neural networks and reorganizing those connections through these experiences. I'll go back to one thing you said where we did it five minutes, you know, five minutes here and there. Okay. Great. Because that's hugely impactful. It doesn't take that much time at home. So kind of to go backwards. Okay, so what is vision therapy? Vision therapy is a series of activities with also the use of equipment. We use lenses, prisms, filters, 3D TVs, colors, balls hanging from the ceiling, all sorts of different tools, um, charts to create these experiences for a child to change the way their brain acquires, analyzes, and interprets visual information. So what does that actually look like? In vast majority of cases, it's once a week. There are some exceptions to that. For instance, if you do live in an area that there is just not a provider around you, there are some offices which will do less frequently in office just because of commute, just the drive aspect. But if you do have someone in a reasonable location to you, it's going to be once a week. Very few offices do twice a week, but mostly once a week. Most sessions are somewhere between 30 minutes and an hour in office once a week, one on one with a vision therapist and the vision therapist is going to be a hugely critical piece of this because the feedback is very important. So this isn't something that can be done passively. This isn't something that. We do give you home activities, but we have to teach you what you're looking for and what to do and how you can load them and unload them and how you know when to move on. And then we give you new activities next week. So anyway, in the office once a week, generally 30 minutes to an hour, and then, uh, Every office is going to also prescribe home practice for the days in between when you're not in the office, because again, Neuroplasticity, we're changing the brain's connection. We're changing the way the brain controls vision. So again, not eye therapy. It really is vision therapy, and this is brain's control of these visual skills. And so, you know, Even doing five minutes of home practice makes a huge difference. You're reinforcing that new connection and reinforcing the skill. We ask for, our goal is 15 minutes a day of home practice, and we're reasonable. We realize that it might not happen every day for every family. And we'll see gains without the home practice. It just takes longer. So sometimes, if a program otherwise would be finished in seven months, it might take nine or 10 months if we have no home practice. So it just might take longer to get to the gains if the home practice is less. And that's, just life, but it is a commitment. That consistency is important for building those new connections and learning a skill. So once a week in the office, home practice. In general, the length of vision therapy, it drastically varies based on age of the child and exactly the visual diagnosis and visual problems that we're developing and that we're tackling. Learning related visual case, meaning, not a child that has an eye that's turning, not a child that has one eye that doesn't see as well as another, what's amblyopia, what people generally call lazy eye, if those things are not a piece of the picture, and it's a learning related visual problem, a visual problem that's impacting learning, on average, that's going to be it. six months minimum to nine months. That's going to be a six to nine month program of vision therapy. Important to note that you will see gains in the things you're talking about. You know, I'm doing the central peripheral activity. I'm seeing her improve on this. But it takes a while for most parents, to notice something translate into life. We don't usually see that until three months in or so, where it's, oh, wow, now they're, you know, doing this XYZ that they weren't doing before. And so it does take, there's trust there. Uh, Knowing, okay, I, I'm seeing these little wins, these little progress, and then it will translate into life. We've got to develop the skill, then we have to integrate the skill, meaning a child doesn't have, they can't be thinking about doing it. And then it will translate into their daily, they have to change the way that they're doing something. Did that, did that answer your questions about the actual program? Okay.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Yeah, well I know even, you know, for us there were, depending, like if it was, we moved on and it was still a challenge, then sometimes, yeah, it would be like five minutes here, and then as that task got a bit easier, we were able to spend a longer amount of time on it, just because fatigue was setting in, and so, that was the other thing that I could always see progress with, what took us? We only had the stamina for five minutes, now we're able to do for ten minutes, but I mean, in our experience, every week we were coming home with pretty much a new activity, because of just being consistent, And it did, it made a, a huge difference. And I found the work to be fun and so did my daughter. Like looking, you know, trying to find five pumpkins and can I chew my gum and pop in and out of this like moving ball? It's actually fun stuff, for the kids. So, which I think is super helpful, because being a physical therapist sometimes things are not so fun. Laughter.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:And that is really important to us. To be in that place of neuroplasticity, of making these brain changes, we have to, we make it as fun and
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Mm hmm.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:And the kids have to be in a positive mind space about it. If they dread coming, we're not going to see the changes. It's very important to us to make it be. To make it be something that's fun. Kids enjoy, they really enjoy coming. They develop awesome relationships with the vision therapists and they enjoy coming. And that's very important to me and to the success of the
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Mm hmm. Absolutely. And then there is a kit, usually, right, that people would have to purchase, the Vision Kit.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:we're home. Yeah, so there's tools. There's some tools that you just keep and then there's some tools that we check in and out based on, that that are bigger tools. But yes, they're equipment. There's pieces of equipment that you will need at home and all offices. That will be. A part of the program you're not expected to get something from somewhere else. Everything would be provided to you through the office of what the equipment that you need.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:And then I'm sure people have the question, is this covered by insurance?
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:Yeah. The only part of my job that I do not like is insurance and vision therapy. So there is no insurance plan in existence that completely covers vision therapy. Insurance and vision therapy are very frustrating on the vast majority of insurance plans. Vision therapy is either an exclusion or there are significantly limited diagnoses. Um, convergence and sufficiency being the top one for in terms of coverage. And when I say coverage, there is nothing that covers it completely. There are some plans that contribute a small amount. For a certain number of sessions, and that's the most I've ever seen is 32 sessions. And that's that's an excellent coverage. And again, a partial we're talking, in the most in the realm of, like, a 3rd 1 3rd of the actual vision therapy fee, but most of them. Have an exclusion significant limitations, and then even if they do have a benefit, it's for, for instance, 12 sessions, which is not 12 sessions is not impactful. At that point. It's just not even that's not going to create change is in 12 sessions. And so, no, I like to tell families to kind of put it in their mind like orthodontics it's not fully covered. There is no insurance that fully covers it. The contribution is really small. They It's either going to be an exclusion, or there's going to be significant restrictions, but any office should be able to help you by providing the exact diagnosis, the codes, and then you can contact every plan is so different. So can contact the plan and figure out exactly what the reimbursement through your plan would be for that reason. A lot of offices. I don't know the statistic, but I feel like it's got to be well, more than half, if not more than three quarters of offices that provide vision therapy are out of network with insurances. And there's a lot of reasons behind that. The main one is because of all of the restrictions that they place.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Yeah.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:For me, I'll speak for myself. I can't provide the quality of care that I have to, to be able to support the kids and adults that I see, under the restrictions placed on me by insurances. So even just the amount of time I spend in the, that's a big difference. I spend an hour and 15 minutes on my initial evaluations and an hour with my progress, you know, with the, all the progress evaluations, and I would never be able to do that under the restrictions of the insurances. So, you will find that that the vast majority of vision therapy providers are out of network with insurances. They will give you the information that you need to seek reimbursement for any out of network benefit that you have. But that's just a heads up of that. That's the expectation I would go into it with. And they'll be very, they'll be able to answer all the questions on that.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Well, it's, it's definitely worth the money. That's for sure. I can speak for that. And is there a time where say, you know, somebody goes into vision therapy, they, they graduate and then will it hold or do you have to come back?
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:Yeah, that's very different. So for vision related for, excuse me, learning related vision cases, like we've, the bulk of this has been discussing, um, those, those are just a one time. We, once you develop those skills, once you develop teaming, tracking, focusing, central peripheral, these visual processing skills, they don't. There's not a risk of them regressing or going away or going backwards. So those cases are just a one time, that's that, you know, upfront.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:hmm.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:They're not, there's not a concern of regression. Very different. If we have a child that has an eye that turns, this is a child that actually looks like when I pointed out towards the wall or when I clasped in towards their nose. That is a very different case. And it depends on their age. Especially the younger they are, the more likely they're going to have 2 rounds. You know that they would we would address everything. We can, in the toddlerhood years. But then there's only so much we can do based on the, the abilities of a toddler. And they're likely going to need another additional treatment as a more, you know, older elementary school child. And those are the ones we watch really closely for any changes in the future. So those that don't have eye turns, I have zero concern with regression. And we would, you know, Set that stage on the front end of anyone would be able to answer that on an individual basis of this is something that might take two different, you know, separated in time by a couple years versus no, this is just a one time once it's developed and learning related cases, teaming, tracking, focusing. That perception, um, central peripheral, all the visual processing. Those are one time. Those don't regress.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Okay. Good to know. Before we wrap it up, I do have to ask about this, because you could have somebody can be, have no issues, and then what happens if somebody experiences a concussion? Can that change visual?
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:yes. Oh, my goodness. So, um, we have everything we've been talking about is developmental vision. So this is vision that for a myriad of reasons didn't develop as efficiently as as it could and concussion. can then induce acquired visual dysfunctions of the exact same type as all the things we've talked about. The two top areas are convergence insufficiency, meaning difficulty pointing both eyes up close, and accommodative insufficiency, meaning focusing difficulty. I can't now clear something up close comfortably. Huge other things, light sensitivity, there's all sorts, motion processing difficulties, concussion is a, um, but yes, concussion and There's so much that goes on with concussion, but now the visual aspect of concussion is absolutely a part. Any concussion specialist now recognizes the visual impacts that concussions have and vision rehabilitation. So instead of vision therapy, we call that vision rehabilitation just to differentiate between We are now rehabilitating a skill that someone had and then lost or was affected. And the same aspect of neuroplasticity, a concussion, those connections have a shearing, the shearing force of a concussion. Um, this means this is something that is not going to pop up on a, uh, a stand, right? An MRI, but has been damaged by the, whatever it is, the whiplash, all the things. And now those neural connections were affected. They're not operating the same way, and so those control how we use our vision. So yes, anyway, whole nother discussion, but oh my goodness, I'm so glad you brought it up, because this applies not just to kids, to adults. Adults with concussions suffer, and this can be five years later. I'll see adults five years after concussion, and they never got an answer. They, and they're still symptomatic. They're still very light sensitive. They have difficulty with screens. They're having headaches, and it can be a visual piece. And so any age, Yeah, very important in any any age range with after concussion
riverside_lori_raw-video-cfr_lori_yu's studio_0018:pretty much, then, if we, if there's any change in vision for anybody, kids or adults, it would be best to then find an optometrist who does vision therapy like yourself and have a full, thorough exam. Yeah.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:Yeah, and I would even say yes. Yes. Definitely post concussive. Absolutely. And the things that you don't necessarily associate with vision to, again, motion. Am I having issues with dizziness that I never had? Am I having issues with car sickness that I didn't have? Is my balance different? This can be post concussive is a major. We work as a team with all ages. So whether that's occupational therapy, frequently with, with kids, uh, speech therapy, auditory processing things, but in the concussion realm, it's a whole team approach of we've got physical therapy. We've got vision therapy. We've got all sorts of different everything. Their whole team, their headache team. It's a big, big team approach. But yeah, there's things that people don't, people don't even necessarily associate headaches with vision. And, that's a headache alone would be a reason to just make sure there's not a visual component to the headache.
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Wonderful. It makes sense. Is there anything else you'd like to say, Dr. Tina, before we wrap up?
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:The only thing that I have to say before we wrap up is, I have to make a plug for what's called the infancy program. We're talking about vision and its impacts in elementary school years. But vision starts developing in utero, but through birth, through pregnancy and birth. And there is an amazing program called infancy and infancy providers are all across the country. I can give you that, that link separate for how you find an infancy provider. These offer no cost vision evaluations for all babies between age six months and 12 months, six months and a year. And, it is an awesome. First step to making sure that your child is set up for success visually, um, we at that point are screening for big things that will impact development one eye that has a much different prescription than the other, or both eyes having a much different prescription or a problem with the structure. But if we can catch and identify these things in infancy and toddler hood. It just changes the whole trajectory of visual development. And so, infancy is a such underutilized and not well known program that exists all over the country. And so that's infancy vision. Vision evaluations should start even in the infant years. So that's the last I have
riverside_lori_raw-video-cfr_lori_yu's studio_0018:wonderful. I did. Yeah. I did not know about that. Well, and that's the thing. I mean, on my Instagram, I actually have videos of my daughter doing her visual exercises. So if people aren't sure exactly what it is that we're talking about, or they want just a little bit more of a visual of what it looks like, they can always come to my Instagram page, which is, replenishing soul. But, um, in the Washington, Seattle area, if you do live in that area and you're listening, you could always find Dr. Tina at Summit Vision out in, Issaquah. Yes.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:yep. We are Summit Vision Center in Issaquah, and my partner and I, Dr. Katie Hash, are there every day of the week, and we have an awesome team of six vision therapists, and, we are very lucky, and, um, we are happy also to facilitate, I'm, I use the COVD locator first, but through my residency and all my experiences, I know people with COVID 19. People all over so I'm happy to connect or answer questions. Um, can always email to through our website. That can be directed direct to me. And so I'm happy to answer questions. Um, I, I'm, I'm happy to help. If someone has a has a
riverside_lori_raw-video-cfr_lori_yu's studio_0018:Wonderful. And I will put all that stuff in the show notes. Yeah, so thank you, Dr. Tina. I know you were super busy between your personal life and your professional life, but I thank you for sharing this just wealth of information with me because, like I said, it needs to get out there. It is so important. So important. So thank you.
riverside_tina_schiller_raw-video-cfr_lori_yu's studio_0019:think I love talking about it. So thank you for having me and I really appreciate it.
The information shared on this podcast is for informational purposes only and is based on the opinions and experience of Lori Dorothy and their guests. The content should not be used as a substitute for professional medical advice. Diagnosis or a treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you heard on this podcast