Narrative Medicine

Narrative Medicine

In the October 6, 2018, Wall Street Journal, Suzanne O’Sullivan previews her new book, Brainstorm: Detective Stories from the World of Neurology. She explains how technology can deceive us with its wonderful images into thinking that it can provide all the answers. It does not. Continue reading



David Wright wrote this autobiography about the influence of deafness from the time that he became deaf until he graduated from college. He was born in South Africa in 1920 and became totally deaf in 1927 due to scarlet fever. He states that he was fortunate in many ways. At seven, he was old enough to have learned to speak and to read, but he was still young enough to focus on mastering his disability and not become a victim. Continue reading

Reader, Come Home


Marianne Wolf
Reader, Come Home is about the importance of deep reading. It discusses the consequences of the decline in reading deeply on important issues. It explains what is necessary to develop and apply the ability to read deeply. Continue reading

Visual Perception and Who We Are

In The Mind is Flat, Nick Chater uses our flawed intuitions about how we see to question the veracity of the intuition that we have a cognitive subconscious. My review will focus on what Mr. Chater calls “the grand illusion”; our belief that we see much more than we do. Our thoughts and actions are dependent on our perceptions. What we have perceived in the past influences our present perceptions as our current perceptions continue to create who we are and how we will perceive in the future. Illusions can cause us to believe that we are seeing what we know cannot be true. I cannot express this better than the author’s words. Continue reading

Signs and Symptoms of Visual Problems in Children


When an adult with a visual problem comes to the office they usually present with symptoms. When a child with visual problems comes to the office, they rarely report symptoms. This is true for children who have other issues which they readily make known. These children, however, frequently show signs that their vision is inadequate for the demands of the classroom. The most common sign is the one most easily overlooked; they avoid tasks that are visually difficult or uncomfortable. Since there are other reasons that a child may avoid these tasks, the possibility that the primary cause is visual may not be considered.

Taking a good history is critical, but it is difficult when children are young and when they have not experienced seeing any other way. It may also be that the change has developed gradually as the visual demands have increased. Adults who develop visual problems usually recognize the change. Open-ended questions such as “do your eyes bother you or do you have any problems seeing?” invariably result in a simple, impulsive response of “no”. But specific questions may cause them to answer an equally misleading “yes”. Fortunately, the history continues throughout the exam. Observations are often made during the evaluation that enable the doctor to predict what the child experiences. When this is confirmed, doctor-patient-parent communication is enhanced.

Children come into the office every week who have not complained but have visual problems that are affecting their ability to perform to their potential. The experience of a young lady who came into the office last week prompted me to share this information. She reported, in retrospect, that she has had visual problems that have made reading difficult since she started reading. She did well in school until her junior year when the reading demand increased and her grades plummeted. That summer, an occupational therapist helped her discover that her symptoms were reduced when she put a dark blue overlay on the print. Prior to this, she assumed that everyone saw print as she did – moving on the page – but that it did not impair their reading. While the overlay helps, she still has poor tracking and reads slowly. She is an excellent candidate to have her defective visual skills treated through optometric vision therapy, but she was leaving for college exactly two weeks after our appointment.

Confused_young_womanThe reading demands of college, despite accommodations, are going to be a challenge. How different this story could have been if this problem was diagnosed and treated early in elementary school.
It is fortunate when children realize that they can read better when they use a finger or ruler under the print and are willing to do so, but this would not be necessary if they had adequate visual skills. And, no one can read efficiently when they must use props to help them keep their place. The act of reading should be subconscious. It should not waste attention that is required to process information, using that attention to keep our place or to move our finger under the words to see the print word-by-word. Some adaptations, like getting close to read or write, while a natural response, make the task more difficult, more stressful, and more fatiguing.

The Convergence Insufficiency Symptom Survey (CISS) was developed by a National Institutes of Health research team. Its scores correlate well with the presence of visual problems related to reading. Children who score 15 or above should have an examination which includes the evaluation of focusing, eye teaming, tracking, and visual information processing. I recommend the same for children who are receiving special assistance or accommodations in school, those children who are not performing to the expectations of their parents and teachers, and for any child whose parents’ intuition tells them that something is not right. Understandably, these populations have a high incidence of visual problems. We should not miss the children who are working hard to do adequate work who should be doing well with much less effort.
Vision screenings and most examinations do not assess these skills. Examinations for children typically assess their visual acuity at far and their eye health. You should find out before you schedule an appointment if the examination will include an assessment of these skills. You can look at the office’s website, contact their office, or find out if they are a member of the College of Optometrists in Vision Development (COVD) or the Optometric Extension Program Foundation (OEPF). You are more likely to find an optometrist who specializes in this area than an ophthalmologist.


Assessment of Silent Reading Efficiency

RightEye: Computerized Assessment of Eye Movements



Solutions for your child who struggles in school starts by knowing what to ask your eye doctor

A critical question for every school-age child who struggles in reading

Convergence Insufficiency

Concussions and our Kids


Superforecasting The Art and Science of Prediction

Philip E. Tetlock and Dan Gardner

We cannot avoid forecasting. Everything that we do is based on what we expect the outcome to be. Some forecasting is short-term and primarily preconscious such as planning a movement while taking into consideration the positions and movements of others around you. We have been making these kinds of predictions for millions of years and we apply the same processes to skills for which we have not evolved such as driving. Continue reading

Assessment of Silent Reading Efficiency


“The Decline of Comprehension-Based Silent Reading Efficiency in the United States: A Comparison of Current Data with Performance in 1960” appeared in Reading Research Quarterly in 2016. While there are endless debates about reading pedagogy, there is consensus that the best way to assess silent reading efficiency is by measuring eye movements. Continue reading