Dr. Bryce Appelbaum -2022 recipient of The Future of Health Award

The VisionHelp Blog

Long standing member of the VisionHelp Group, Dr. Bryce Appelbaum, recently had the opportunity to present to 500 of the top functional medicine practitioners from around the world at the MindShare Leadership Summit in Scottsdale, Arizona. The title of his talk was, “The Misdiagnosis and Missed Opportunities of Vision:  Why Healthcare has it all wrong about the eyes.” 

His speech garnered a lot of interest and attention, which demonstrates Dr. Appelbaum’s passion to expand awareness of the importance of Vision Therapy to end the senseless struggle. It was so well received that Dr. Appelbaum’s speech was voted #1 and he was recognized as the 2022 recipient of The Future of Health Award.

Take a look at this amazing 4 minute presentation and see how Dr. Appelbaum “lights a fire” in the eyes of the attendees!

Keep your eyes open for Dr. Appelbaum as he “lights a fire” in the…

View original post 10 more words

Visual Thinking

The Hidden Gifts of People Who Think in Pictures, Patterns, and Abstractions

Temple Grandin

Temple Grandin is a well-known scientist and educator who has autism. She was born in 1947 when autism was poorly understood. She has written books on autism and animal science, teaches animal science at Colorado State University, and lectures on these subjects. She is also an advocate for our society and schools to recognize that everyone does not process information the same way or at the same speed. She is an advocate for schools to provide equal opportunities for students who are not primarily verbal learners and for those who need more time.

Temple Grandin had a very difficult time in school. She was late learning to speak and only learned to read due to concerted, prolonged, and insightful instruction by her mother. I got to know her a number of years ago when, as the education chairperson for the College of Optometrists in Vision Development, I arranged for her to speak at our annual meeting due to her interest in visual thinking and her insights into autism. Since that time, she has furthered her research on thinking styles, their strengths and weaknesses, and the advantages of having people with multiple thinking styles work as a team to solve problems.

Curricula which are designed for students who primarily process information verbally and ignore the needs of visual thinkers are not only a disservice to those students but are contributing to critical gaps in our workforce. Schools have spent decades trying to increase the number of their students who move on to college, whether or not that is the best option for them.

Temple Grandin is very aware of the differences between sight and vision. “People often confuse visual thinking with [sight]. We will see throughout this book that visual thinking is … about how the brain processes information; how we think and we perceive.” From her experience counselling people and from her exposure to optometry, she is aware of the many visual problems than can make reading difficult. For example:

“It is deep inside these circuits where things run smoothly or where developmental problems can occur. One example: Your eyes are always moving but the words on the page don’t jump around when you read. That’s thanks to the stabilization circuitry in your brain that keeps the words from jiggling. Poor circuitry can be responsible for visual distortion or bandwidth problems, as well as stuttering, dyslexia, and learning disabilities.”

“The legacy of the previous twenty years of federal education policy, from No Child Left Behind to the Every Student Succeeds Act, has created a culture that has simultaneously overemphasized testing and stripped our schools of multifaceted curricula. The goal of raising national academic standards through comprehensive testing decimated the classes that didn’t lend themselves to standardized testing…. Look at any group of kids in a classroom or talk to any teacher, and it’s obvious that one size does not fit all.”

“Mathematician Paul Lockhart writes, ‘If I had to design a mechanism for the express purpose of destroying a child’s natural curiosity and love of patternmaking, I couldn’t possibly do as good a job as is currently being done – I simply wouldn’t have the imagination to come with the kind of senseless, soul-crushing ideas that constitute contemporary mathematics education…. Research suggests, at the very least, we’re teaching algebra too early and too fast, that the road from concrete to abstract reasoning takes more time.”      

“We persist in an abstract approach to math education… Margaret Donaldon, professor of developmental psychology at the University of Edinburgh, believes that ‘humanly meaningful context’ informs our thinking. We need ideas to be connected to real-world examples in order to grasp and implement them…. And yet we persist in an abstract approach to math education. Donaldson uses the term ‘disembedded’ to describe things without a context or direct experience to ground them.”

Pendulums continues to swing in education due to unrealistic expectations. In his book, The End of Average, Todd Rose explains how cockpits had to be designed to the edges of the pilots’ physical measurements to accommodate all pilots. Cockpits designed to the non-existent average were dysfunctional. He calls classrooms the cockpits of our economy and says that they should also be designed to the edges of the ranges of the skill levels of the students, not to the nonexistent average. We need to overcome the groupthink that assumes that the right intervention will enable all students to do equally well with the same material at the same time presented the same way. As a high school dropout who now teaches in the department of education at Harvard University, Todd Rose has the perspective to both understand the problem and to know how to address it. There are 1.2 million high school dropouts in the United States each year and 4% of those students are intellectually gifted, but they do not fit in the cockpit.

Another example of groupthink appeared in the August 6, 2019, issue of the Wall Street Journal entitled, Toddlers Don’t Have to go to School.

“Every year brings more books about how stupid we are. Apparently, humans are impulsive, gullible, and prone to making all sorts of bad decisions. Researchers at the University of Virginia discovered that 31% of kindergarten teachers in 1998 agreed that children should learn to read in kindergarten. By 2010 that number had risen to 80%. This is not because 2 ½ times more children were now developmentally ready to read at age five. It was due to a policy change that became more accepted over those 12 years. It was also due to the replacement of older teachers with younger teachers who have less developmental background.”

I am pleased to report that our local school districts are working to expose students to the world outside the classroom starting in elementary school, but they are still stuck with unrealistic expectations for reading which takes a disproportionate amount of instructional time and causes many children to be failures who could be learning to read on the same timeline that their parents learned to read.

I Contain Multitudes

The Microbes Within Us and a Grander View of Life

Ed Yong

This book is well-written, accepts complexity, is forward-looking and largely positive, and is balanced and realistic. The evolving science and its potential relevance to our lives stands by itself and doesn’t need to be promoted with sensationalism. It is naturally sensational.

The following passage is about the “overselling the microbiome award.” It is presented to the person who has gone to the extreme to exaggerate the ability of the microbiome to cure all ills. “The award is an online plaque meant to (dis)honour any scientist or journalist who exaggerates the state of microbiome research and presents speculation as fact.” Jonathan Eisen, who presents the award, “is concerned that the pendulum of scientific attitudes is swinging from germophobia, where all microbes must be vanquished, towards microbomania, where microbes are heralded as the explanation for – and the solution to – all our ills…. There is a long-standing urge in biology to search for unifying causes behind complex diseases starting with the Ancient Greeks and the four bodily ‘humours’…. Scientists will talk about Occam’s razor – the principle that favours simple, elegant explanations over convoluted ones. I think the truth is that scientists, like everyone else, find simple explanations psychologically soothing. They reassure us that our messy, confusing world can be understood, and perhaps even manipulated. They promise to let us eff the ineffable, and control the uncontrollable. But history teaches us that this promise is often illusory…. When you move away from the one-microbe-one-disease model and into the messy, multifaceted world of dysbiosis, the lines of cause and effect become much harder to untangle.”

Complex problems are frustrating, but assuming that they can be simplified may make people feel better creates more problems. Many visual problems, and reading problems related to vision, are like that. They can be treated, but the complexity and individual variety make the process messy.

Learning about the microbiome and the roles of microorganisms in nature is fascinating and adds depth to our understanding of what is happening to the environment and the foods we eat. This field holds great promise, but…

Consider the following.

“All zoology is really ecology. We cannot fully understand the lives of animals without understanding our microbes and our symbioses with them.”

“There are fewer than 100 species of bacteria that cause infectious diseases in humans; by contrast, the thousands of species in our guts are mostly harmless. At worst, they are passengers or hitchhikers. At best, they are invaluable parts of our bodies: not takers of life but its guardians. They behave like a hidden organ, as important as a stomach or an eye but made of trillions of swarming individual cells rather than a single unified mass.”

“Mammalian milk contains special sugars that infants cannot digest, but that certain microbes can. When a human mother breastfeeds her child, she isn’t just feeding it; she is also feeding the child its first microbes, and ensuring that the right pioneers settle inside its gut.”

“Our microbes control the storage of fat and the creation of new blood vessels. Obese individuals have different gut microbes than lean individuals.”

“Every beewolf has the same strain of Streptomyces in its antennae which she puts on the eggs that she lays to protect them. Streptomyces are microbes that excel at killing other microbes; this one group is the source of two-thirds of our own antibiotics.”

Photo by Pixabay on Pexels.com

“Bacteria have been carrying out horizontal gene transfers (HGT), for billions of years…. They can exchange DNA as easily as we might exchange phone numbers, money, or ideas… They can rely on viruses to move genes from one cell to another…. In this world, genes aren’t just heirlooms to be passed on vertically from one generation to the next, but commodities to be traded horizontally, from one individual to another…. HGT is one of the most profound aspects of bacterial life. It allows bacteria to evolve at blistering speeds…. This process can instantly change microbes from harmless gut residents into disease-causing monsters, from peaceful Jekylls into sinister Hydes…. They can also transform vulnerable pathogens that are easy to kill into nightmarish ‘superbugs’ that shrug off even our most potent medicines. The spread of these antibiotic-resistant bacteria is undoubtedly one of the greatest public health threats of the twenty-first century, and it is testament to the unbridled power of HGT.”

Science is an amazing process. We cannot image our world without it. We can’t give up on the process because knowledge evolves, changing what we knew to be true to another truth. It may be frustrating at times and tell us things that we would rather not know, but that is the nature of science and of life. Truths, especially in the biological sciences and in complex systems, evolve. Decisions must be made based on what is known at the time. That is the best that we can do. We also need to be careful before we criticize what was done in the past. It takes time for new information to be disseminated and more time to be accepted, but there are also many examples of progress being stalled by intransigence. Being aware of that history has the potential to help us be more openminded.

Ed Yong takes many pages to talk about Antony van Leeuwenhoek, his microscope, the importance of curiosity and imagination, and how his discoveries have changed the world. This process continues. I see patients daily who are living better lives due to the evolution of knowledge and medical possibilities just during my years in practice.

Sounding It Out

I have the following observations on the article, “Sounding it Out”, which appeared in the Sunday, October 9, 2022, edition of your paper. It repeatedly uses the term, “the science of reading” as if this is the first time that reading pedagogy has been investigated scientifically and that this research is the final answer. It is not. Almost all research on learning to read supports the importance of phonics, but most research recognizes that there are many factors involved and that reading does not become proficient until all these factors are consolidated. Decoding is much more difficult for the emerging readers’ brains than it is to us as experienced readers. Even if this method successfully teaches decoding to many students, decoding is not sufficient to develop efficient reading for information.

The first problem is the assumption that reading can be taught in one way so that all children are reading on grade level by fourth grade. Reading is complex and everyone cannot learn to read at the same speed. Children are not “normal”.  They are not all at the same average, and if they were, they would still be behind current expectations for reading. As Nancy Carlsson-Paige, Geralyn Bywater McLaughlin, and Joan Wolfsheimer Almon state in Reading Instruction in Kindergarten, “While the timetable for children’s cognitive development has not changed significantly, society’s expectations of what children should achieve in kindergarten have. A recent two-year study by the Gesell Institute in New Haven found that ‘children are still reaching important developmental milestones in much the same timeframe as they did when Dr. Arnold Gesell first published his data in 1925.’” 

Also, Maryanne Wolf states in Proust and the Squid: The Story and Science of the Reading Brain: “They found across three different languages that European children who were asked to begin to read at age five did less well than those who began to learn at age seven.” Additionally, in his article “The Tyranny of the Normal Curve: How the “Bell Curve” Corrupts Educational Research and Practice” from Groupthink in Science; Curt Dudley-Marling writes: “no educational intervention has been found to be effective for all students”.

It has long been recognized that switching to a new reading program usually causes a temporary improvement in outcomes due to the coordination of focus and renewed enthusiasm, but teachers rarely completely give up the old for the new. Experienced teachers tend to hold on to the things that they learned work for them in their classroom. Becoming a Nation of Readers: The Report of the Commission on Reading states: “An indisputable conclusion of research is that the quality of teaching makes a considerable difference in children’s learning. Studies indicate that about 15 percent of the variation among children in reading achievement at the end of the school year is attributable to factors that relate to the skill and effectiveness of the teacher. In contrast, the largest study ever done comparing approaches to beginning reading found that about 3 percent of the variation in reading achievement at the end of first grade was attributable to the overall approach of the program. Thus, the prudent assumption for educational policy is that, while there may be some “material-proof” teachers, there are no “teacher-proof” materials.”

The statement in the article, “The other weakness, experts say, is assigning texts based on a student’s reading level rather than exposing them to challenging, grade-level books that build knowledge and vocabulary in a range of subjects.” is false for most children. Children do not tend to learn new information when they are reading at their frustration level with too many unknown words. This is not “a solid path to improving literacy at an early age”. Marilyn Jager Adams calls it “gagging on print”. Daniel T. Willingham states the following in The Reading Mind, “Just how much unknown stuff can a text have in it before a reader will declare mental overload! and calls it quits? This quantity surely varies depending on the reader’s attitude toward reading and motivation to understand that particular text. Still, studies have measured readers’ tolerance of unfamiliar vocabulary, and have estimated that readers need to know about 98% of the words for comfortable comprehension.”

Learning to read is complicated. If pointing to each letter in a word in sequence and saying its sound solved the problem, this answer would have been discovered decades ago. My background is working for fifty years with children whose visual problems interfere with their ability to learn to read and coordinating with the educators and parents to address each child’s specific problems. 

Sweet in Tooth and Claw:

Stories of Generosity and Cooperation in the Natural World

Kristin Ohlson

We have been indoctrinated to think about competition in nature which is epitomized by Herbert Spencer’s summary of natural selection as “survival of the fittest”. But Charles Darwin recognized that competition and cooperation are both factors in natural selection. While competition has received more attention in the past, there is an increasing interest in the importance and prevalence of cooperation in nature from the smallest organisms to the largest. There is evidence that there are more examples of cooperation in nature than competition and arguments that it is more important to being the winner in natural selection. Kristin Ohlson believes that being more aware of the many examples of cooperation has the potential to change our outlook. “I’m convinced that if we can learn to respect, not ravage, the rest of nature, we’ll also become more generous and nurturing with each other.”

As was emphasized in Spoon Fed, nature, and our interaction with it, is complex. The loss to the environment of what was growing on the soil before it was repurposed is often overlooked, but it is important to consider the impact of that destruction in combination with the consequences of its current use. For example, “Forest soil loses half of its carbon when it is clear-cut. The carbon emissions from deforestation comprise a fifth of global emissions, higher than those from transportation.”

“When we see mushrooms, most of us don’t realize that these are just the fruits of an organism that weaves a vast underground tapestry of fine threads called hyphae.” “Mycorrhizae – meaning “fungus roots” – is a composite structure formed by the fungi and the roots. Some 90 percent of land plants are colonized by these mycorrhizae. Although scientists originally thought that fungi were stealing the sugary carbon fuel that plants make during photosynthesis, they’ve known since the 1880s that in many cases plants are trading their carbon fuel to the fungi – which cannot make carbon through photosynthesis – in exchange for water and nutrients. Beneficial partnerships like this between different species are called mutualisms, and they occur in all ecosystems and probably involve every species on Earth.”

“Accumulated studies show that the mycorrhizal network works to offer trees and some other plants more than just carbon, water, and mineral nutrients. They also function as a forest early-warning system: when attacked by insect or fungal pests, trees emit a sort of chemical scream into the underground networks, prompting other plants to produce chemicals that make them less appetizing targets for the pests.”

“Leguminous plants like clover, peas, and alder trees release chemicals that invite bacteria living in the soil to set up shop inside lumps in their roots called nodules. There, the bacteria convert atmospheric nitrogen into a form that plants can use in exchange for root exudates – sugary carbon liquids derived from the phloem, like nectar. Nitrogen comprises some 78 percent of our atmosphere and is the key limiting resource for terrestrial plants. Until the industrial era and modern fertilizer, the form available to plants was created solely by lightning strikes or bacteria performing this particular magic – a mutualism that has been around for some sixty million years (also from guano and urine).”

Eukaryotic cells developed from coalescing single-celled bacteria. “Those eukaryotic cells went on to form symbioses to become multicellular organisms. Every bit of our bodies, as well as those of other animals, plants, and fungi, are made of eukaryotic cells – these miniscule bundles of cooperation that transformed Earth more than anything except for the emergence of life itself.”

“We now understand that all of us macros are like meat and vegetable floaters in an incredibly vast broth of microorganisms. We are swathed to each other and the rest of the natural world by an invisible cloud of bacteria and other living things – including things so tiny and weird that they make scientists argue about the definition of the word ‘alive’. These microorganisms are critical to the functioning of just about every habitat – from that of a mountain stream to the ones in our tear ducts – and it’s become clear they must be part of our every consideration, whether we’re building a hospital or replanting a forest or simply making dinner. The new understanding of their presence and impact is driving scientists to reconsider everything they think they understand about the natural world, which, of course, includes us. As late as the 1970s, science was largely clueless as to the role, volume, and astonishing diversity of the microscopic life in and around us.”

“Scientists now find that just about every complex plant, fungus, and animal hosts a dynamic microbiota – a community of bacteria, fungi, viruses, protozoa, and other microorganisms that live in us and on us and are essential to our health, just as we are essential to theirs. We are not individuals but ecosystems, each of us hosting a whirl of organisms busily interacting with us and with each other in a complex web of connection. Our personal microbiota comprises some thirty-five trillion bacteria – we have around the same number of human cells as bacterial ones – as well as fungi, protozoa, viruses, and other microorganisms.”

“We can further damage and diminish our microbiota with antibiotics, which are chemicals based on ones produced by bacteria in nature. Some scientists believe that in their natural state, these chemicals are not the weapons of mass bacterial destruction that they become in our highly concentrated medication; rather they are instruments of communication, ways for bacteria to tell each other to back off or to stimulate some other behavior from a neighboring bacterium or colony.”

“And, of course, there is the daily impact of the modern world’s version of food and shelter. The great majority of our food is raised in outdoor factory farms in which the natural partnerships between microorganisms, plants, fungi, and animals have been destroyed and the managers of these factories try to replace the benefits of these partnerships – like fertilization and resilience to pests and disease – with synthetic chemicals. These debased foods then enter the vast maw of mass-market manufacturing, which processes them and mixes them with more synthetic chemicals, rids them of any microbial life – they might spoil! – and burps them out in one packaged product after another. It’s hard to think of these products as actual food. As Michael Pollan says, they are merely ‘edible food-like substances’. The average human in industrialized societies spends around 90 percent of their time indoors, which further impoverishes their microbial community.”

This sounds overwhelming. We cannot change everything at once but being aware is a first step to making changes to improve our health and making changes to lessen our negative impact on the environment.

Spoon Fed

Tim Spector

Tim Spector was a practicing rheumatologist when he decided to change careers, got a graduate degree in epidemiology, and began a new career doing research and teaching at the King’s College London. He started studying twins 30 years ago and has ongoing data on 1400 twins to investigate the relative influence of genes and environment, especially to our microbiome. Mapping the human genome has not answered all the questions about health. This is the largest study of its kind and has yielded valuable information about the effects of diet which he has presented in numerous books. As a rheumatologist, I can only imagine his concern and frustration about the increasing number of autoimmune diseases that he saw in practice.

Epigenetics is a relatively new field which studies why certain genes are turned on and others are not based on their environment. Perhaps the most obvious example of this that some cells with the same genetic code develop into a kidney and the others develop into skin. We are just starting to learn how our microbiome turns genes on and off.

Tim Spector reveals examples of false advertising and false information from the big players in the food industry, but our government is also not a reliable source of information. He explicitly warns us not to trust food labels.

Along with the direct effects on us from eating ultra-processed food, he is also concerned about the effects that food production is having on our environment. Many of the changes in the environment from food production, packaging, and transportation are shocking.

It is his goal to rid people of the simplistic assumptions that we all react the same way to the foods that we eat, and that exercise will enable us to eat what we want and lose weight. Todd Rose warned us about simplistic assumptions in The End of Average. Even the microbiomes of identical twins vary significantly early in life. Consider the following:

Diet is the most important medicine that we all possess.

Our microbiome is a community of tiny organisms which together weigh as much as our brain. The microbiome consists of a mix of up to 100 trillion bacteria, fungi, parasites and 500 trillion mini viruses, outnumbering the number of cells in our body. Each microbe is capable of producing hundreds of chemicals, which act as mini factories regulating our immune system, providing many of the key metabolites and vitamins in our bloodstream, including brain chemicals that can affect our mood and even our appetite. When we consume food, it is as much for the benefit of our gut microbes as it is for us.

Normal people can vary tenfold in their blood sugar responses to identical foods.

99 percent of us don’t conform to some artificial average of the body’s response to fat and sugar.

Kellogg’s Corn Flakes was the first major brand of processed cereal, invented in 1894 initially as a health product and now eaten by the millions of bowls worldwide each day. Made of refined corn, they have a high GI of 81 (causing your blood sugar to rise suddenly which is a detrimental stress to the system).

As we gain a better understanding of the different components of food and how they interact together, some calorie-content estimates are emerging as inaccurate or outright wrong. How the body uses and stores the energy gained from a food as difficult to digest as corn on the cob is very different to how it uses energy from corn bread or from cornflakes processed by superheating, pressurizing and roasting. Yet the simplistic calorie intake theory treats the energy gained from each as the same.

The ultra-processed nature of modern food generally means that the complex structure of the plant and animal cells is destroyed, turning it into a nutritionally empty mush that our body can process abnormally rapidly.

We now know that our liver naturally produces most of the cholesterol in our bodies and that cholesterol in food doesn’t alter its levels in the blood to any extent. For over seven years, 135,000 people from eighteen countries were followed and the results showed that people eating dairy and higher saturated fats were associated with lower mortality than those eating more carbohydrates.

We wildly overestimate the benefits of supplements and underestimate the risks. Virtually none has been proven to work, and the evidence increasingly points towards their doing more harm than good. People think that because studies have shown favorable effects of eating foods like fruits, vegetables, and oily fish on our health, consuming a few of the chemical components found within these foods as supplements will bring about the same health benefits. We know from large clinical studies that this isn’t true. 

Despite the industry denials, all the evidence suggest that artificially sweetened beverages are far from inert and are definitely not a healthy substitute for sugar in drinks or other processed food products.

Nearly two-thirds of the food purchased in the US is ultra-processed with over $250 billion spent on fast food each year. 80 percent of ultra-processed food is made up of just four ingredients – corn, wheat, soy, and meat, with plenty of additives but barely any fiber. Regardless of body fat, junk-food diets with few vegetables lead to less microbial diversity and more inflammation markers in the blood, which increases the risk of multiple diseases.

Livestock for meat and dairy accounts for 83 percent of all land use. Around 95 percent of all mammals on earth are domesticated in farms for human consumption in just a handful of species. Of all the domestic animals, cows bred for beef are the most inefficient in terms of proteins productions and emissions, being on average (globally) about seven times less environmentally efficient than pork, and around ten times less efficient than chickens, and about thirty times less efficient that the equivalent protein from nuts or tofu.

Common concerns about drinking coffee relate to its effects on our toilet habits. Caffeine stimulates the bladder to produce urine more quickly than usual. You might need to rush to the loo more often, but there’s no evidence to suggest it actually dehydrates you. Polyphenols aren’t the only beneficial component in coffee – a mug of coffee is a reasonable source of fiber, with each cup having around half a gram. So drinking a few cups throughout the day gives you the same amount as eating a bowl of cereal or small banana.

Most of our energy expenditure is determined by our genes and is largely preset. Although there is no evidence that exercise in normal amounts helps weight loss in most people, there is good evidence it is invaluable for many other common conditions and should arguably be our number-one prescribed drug.

While we don’t know the cause of Alzheimer’s, the main type of dementia, we are realizing it is not just caused by a buildup of plaque in the brain as we thought until recently, but is more a defect of the immune system and is exacerbated by a poor diet.

Ironically, the countries that buy the most bottled water have some of the safest, most tested and controlled tap waters on the planet. We should all turn our attention to the environmental impact of bottled water production. Producing bottled water uses 2,000 times more energy than the equivalent volume of tap water. Worse still, it takes about 7 liters of water to purify a single liter of water and over 10 liters to make the plastic to carry it. Add to that the thousands of miles the bottled water travels to get to the cities like London or New York, where the demand is high. Exclusive brands such as Fiji Water claim to be ‘carbon neutral’ because they re-invest 1 percent of sales in environmental projects and try and plant trees in Fiji. But these small gestures cannot counteract the enormous energy costs and plastic wastage incurred; the maths don’t add up.

Response to “The Great Reading Rethink.”

The following is the letter that I sent to TIME in response to an article in the August 22 – 29, 2022, issue entitled, The Great Reading Rethink by Belinda Luscombe. I am concerned that the article continues to oversimply the very complex tasks of learning to read and developing the ability to read efficiently. I am also concerned that the roles of vision in reading are overlooked.

                             Gary J. Williams, OD

Reading is complex. Phonics is a necessary, but not sufficient, factor in learning to read. The best way to teach reading will never be resolved if it is assumed that there is a best way for everyone. All readers need the same skills but not everyone needs the same emphasis to develop those skills. Outcomes will not improve until there is more individualization of instruction. Children from disadvantaged environments are at risk, but they, too, are not all the same. The most robust determinant of how well a child will learn to read is their reading readiness when they enter school. Many children who are having difficulties with reading would be doing fine if they were not expected to read in kindergarten what their parents were expected to read in first grade. Also, children who are diagnosed with dyslexia do not all have the same constellation of problems.

            The book, Reading in the Brain by Stanislas Dehaene is referenced in the essay. It is an excellent resource on the science of reading. The summary in this essay misrepresents the complexity explained in this book as demonstrated in the following excerpts.

A written text is not a high-fidelity recording. Its goal is not to reproduce speech as we pronounce it, but rather to code it at a level abstract enough to allow the reader to quickly retrieve its meaning.

In dyslexics, the left occipito-temporal region does not seem able to simultaneously recognize all the letters that constitute a word – an anomaly that readily explains their slow reading and the persistence of the influence of the number of letters on reading time. This length effect often remains present in dyslexics when it has vanished in normal readers.

It is striking that one of the most sensitive tests for the detection of dyslexia consists of measuring the speed at which children name digits and pictures – a task that does not specifically target phonological processing. Across large groups of children, phonology and fast naming tests explain separate parts of the differences in reading scores – a finding which implies that while a majority of children predominantly suffer from phonological deficits, the difficulty in others comes from another source, perhaps the automatization of the links between vision and language.

Visuospatial attention is of paramount importance to the normal development of reading. Good decoding skills do not arise from associations between letters and speech sounds alone – letters must be perceived in their proper orientation, at the appropriate spatial location, and in their correct left-right order. In the young reader’s brain, collaboration must take place between the ventral visual pathway, which recognizes the identity of letters and words, and the dorsal pathway, which codes for location in space and programs eye movements and attention. When any of these actors stumbles, reading falls flat on its face.

In conclusion, we should perhaps question the very idea of a single cause for dyslexia. I therefore think it very likely that dyslexia arises from a joint deficit of vision and language.

            Learning to read and reading efficiently are excellent examples of complex challenges that cannot be solved with universal or simple solutions. Each child with reading difficulties deserves an individualized, comprehensive evaluation including their visual skills, including more than just visual acuity.

COVD 2022

Dr. Williams pictured with three COVD past presidents after presenting the Distinguished Service Award to Dr. W. C. Maples

Dr. Gary J. Williams, Irene Anderson, COVT, and Sarah McDowell, OVT attended the 51st annual meeting of the College of Optometrists in Vision Development (COVD) on April 5 – 9 in Columbus, Ohio. Education highlights were a two day presentation on the advances in treating strabismus and amblyopia and a presentation by a neurosurgeon from Stanford University on how the brain is changed by concussion, whiplash, ADHD, and autism. Visual conditions are present in these conditions which can be objectively assessed using computerized eye tracking instruments. Research has confirmed that treating the visual dysfunctions also treats the underlying conditions. Dr. Williams is a past president of COVD and was the chairperson for continuing education for 18 years.

The Man Who Tasted Words

A Neurologist Explores the Strange and Startling World of Our Senses

Guy Leschzinger

Part 2

This installment, about visual processing and the effects of visual problems on perception and performance, only makes sense after you assimilate the counterintuitive reality of how our perception works as presented in the first installment.

The integration between top-down and bottom-up processing, the role of our expectations, the effects of our experiences on our expectations, and our continuing neuroplasticity is important to understand visual processing problems and how to arrange conditions for visual development and rehabilitation. The most common example of a dysfunction in visual perception is wearing a pair of glasses with a new lens prescription. A change in lens prescription not only changes focus, but it also changes the perception of size, distance, and shape. Most people adapt to these changes relatively quickly and automatically which demonstrates their neuroplasticity. 

A more dramatic example of visual perceptual distortion is when a person has a turned eye. In most instances, the brain suppresses the bottom-up visual and proprioceptive input from the deviated eye. In other instances, the brain’s filters do not suppress the double vison. For some people, the deviated eye is deviated constantly. In other instances, the deviation is intermittent. What effects does this have on perception, spatial judgments, visual motor skills, and the perception of who they are?

Children can have intermittently blurry vision, variable degrees of difficulty maintaining eye alignment, inaccurate eye movements, or amblyopia in which vision is compromised in a healthy eye due to faulty development. They are not usually aware that this is not how it is for their classmates. While there are differences in individual perceptions, these problems are beyond the normal ranges of perceptual variation, as being “color blind” is beyond the normal ranges of color perception.

These problems can be treated through optometric vision therapy, but even after treatment, function may still not be “normal”, and, even if it is, the effects of the inconsistent and distorted visual input prior to treatment cannot be eliminated. The perceptual expectations developed through experiences prior to treatment can be updated but the influence of prior experiences on expectations persist. As new habits may replace old habits, old habits are not extinguished. We have all experienced instances when we reach for a light switch that was moved years ago or an item whose home was moved. This is particularly prone to happen when our bandwidths are being stretched by cognitive activity – when our enhanced visual skills may be most important.

How does this affect vision and the brain as children are learning and embedding letters, numerals, and words? How does his affect the speed and accuracy of vision and the brain as prediction machines? What is the effect when the hand doesn’t automatically follow the eyes’ directions? Adults with an amblyopic eye report that the amblyopic eye’s vision is not blurry, but things don’t look right. It is not a problem with focus. It is a problem of automatic control and processing. They do not perceive letters as well with that eye. They confuse similar letters, read them out of order, and have more difficulty reading the letters in the middle of the line where the shapes appear to be crowded together even though they don’t have the same degree of problem with their other eye.

What effects does this have on children who are learning to read compared to children who do not have these problems? This is the second anniversary of COVID being declared a pandemic.  The pandemic has been frightening and frustrating and has made life even less predictable. People have resorted to irrational explanations that ignore science and incorrectly place blame but are more acceptable than living with life’s uncertainties. Children are generally less resilient than adults. School work can be frightening and frustrating. It can be particularly unpredictable to children with inconsistent and unreliable vision. The explanation assumed by many children who have visual problems is that they are stupid even though there may be a great deal of evidence that this is not so. This is devastating to the children’s lives and devastating to see.

The Man Who Tasted Words

A Neurologist Explores the Strange and Startling World of Our Senses

Guy Leschzinger

          This is another wonderful book written by a British neurologist which explains how we perceive and how our perceptions affect who we are and what we do. The miraculous function of our senses is inherently interesting because it is about us, a subject which most of us find to be fascinating. How our senses function is important for understanding many visual problems. We are fortunate to be living in a time in which so much more is known about vision and the brain through science than was true just a few decades ago.

          Guy Leschzinger uses personal stories about individuals and the dysfunctions that they live with to explain “normal” function. Stories more effectively provide a feeling of what it is like to live with these maladies than are dry, clinical descriptions. His primary goal is to convince the reader that our senses do not function as we “know” they do. As he writes in the Epilogue, “Our minds construct a simplified or codified world to enable us to survive. Even as I write this sentence, it seems bonkers, totally ridiculous, no matter how many times I have read or heard this hypothesis, because it is so counterintuitive to what I ‘know’, what I experience on a daily basis.”

          This review and commentary will in two installments. This week will be about our sensory processing in general. The next will be about how this pertains to vision.

          “What we believe to be a precise representation of the world around us is nothing more than an illusion, layer upon layer of processing of sensory information, and the interpretation of that information according to our expectations…. The translation of these basic inputs into experiences with conscious meaning is a process of utmost abstraction, simplification, and integration, invisible and undetected by us.”

          “As ever in the world of neurology, it is through understanding the system when it goes wrong that we gain insight into normal function.”

          “Our state of mind influences our experience of pain…. It shows us that the act of sensing our environment is not simply the act of passively absorbing information, not just the flow of impulses from the external world into the internal. It also illustrates that information also flows in the opposite direction, that the interior has an important influence on the transmission of data from the outside in.”

          “And this aura of migraine, like that of epilepsy, is the spread of a change in electrical activity crawling across my visual cortex, activating and disrupting my vision at the level of the brain. But it is the nature of that electrical change that differs in migraine. Rather than the rapid, highly disorganized discharges of epilepsy, in migraine this is more controlled, spreading more slowly, activating the neurons in a different way. The slow burn of a candle wick versus a spark touching gunpowder.”

          “So for normal vision, it is not just seeing that is important. The process of making sense of the visual world requires integration with other cognitive processes, other areas of the brain.”

Photo by David Cassolato on Pexels.com

          “Sensation is not simply a process of gathering information from the periphery and funneling it to the brain, but that actually the brain can influence the data being captured. This is referred to as bottom-up and top-down processing, respectively. When it comes to understanding our world, there are three major flaws in the system that Nature has provided us with. The first is that the quantity of information that we are constantly bombarded with is simply too vast for our limited nervous systems to be able to process. When we perceive our world, it is like trying to stream an HD movie over a slow internet connection. The bandwidth is too narrow for all the data to be transmitted reliably. The second issue is that we are essentially living in the past. Due to the make-up of our nerves, spinal cord and brain, and the connections between neurons – the synapses, which are reliant on the release of chemicals to send signals from one nerve cell to another – there is an inherent delay in our perception of the world…. The third and final problem we have is the intrinsic ambiguity of any sensory information.”

          “Illusions demonstrate something fundamental about ourselves. They give rise to the notion that the brain is not simply an absorber of information. It is a prediction machine. Our perception of the world is based upon predictions of how we expect our world to be, a necessary shortcut to deal with those three flaws, of data capacity, inherent delay, and ambiguity…. Within our brains, we have a model of the world as we understand it, based upon our previous experiences. For everyone on Earth this model is slightly different, based upon our genetics, upbringing, and life experiences to date. The model is constantly being refined and adjusted, based upon the experiences of the day.”

          “Try as we might to deny it, there is randomness in life. The course of our existence can pivot on a pinhead.”