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About Hope Clinic and Vision Therapy
Meet Dr Kadet, Optometric Physician
FCOVD, FELLOW, COLLEGE OF OPTOMETRISTS IN VISION DEVELOPMENT
After many years of specialty Optometry practice, Dr. Kadet continues to be energized by his work at Hope Clinic. His commitments to helping children and adults gain confidence and self-esteem with reading efficiency and his work with Traumatic Brain Injury survivors recovering useful vision distinguishes Dr. Kadet in the eye care community.
For Dr. Kadet, retirement is out of the question. "Too many people need Developmental and Neuro-Optometry guidance in moving through life’s journey."
Dr. Kadet earned his Doctor of Optometry degree from Pacific University, located in Forest Grove, Oregon
He began his Optometry practice in Issaquah, WA . He became the charter Optometric Physician in the founding of Hope Clinic in 1983 and continues practice as the Director of Optometry and Neuro-Optometry. Professionally, Dr. Kadet is a charter Fellow of the College of Optometrists in Vision Development (FCOVD), the certification body for Developmental Optometry and Neuro-Optometry. He is a member of the Neuro-Optometric Rehabilitation Association (NORA) and a Clinical Associate of the Optometric Extension Program Foundation (OEPF). He holds membership in the Washington Association of Optometric Physicians and the American Optometric Association.
Dr. Kadet has been involved in nine publications concerning all aspects of Vision Therapy and Development
The subjects published are Vision Rehabilitation in Brain Trauma Injury, Vision and Learning, Optometry and Vision Development and a publication on Vision Development Optometric Vision Therapy, which was presented to the International Conference Association for Children and Adults with Learning Disabilities. Dr. Kadet has focused a large amount of his time toward the special needs community
Dr. Kadet has enjoyed being the Scoutmaster for a Special Needs Boy Scout Troop he orginated 11 years ago. One of his favorite scouting times is the one week of summer camp he spends with his 'special scouts' and his ukulele.
Dr. Kadet is a volunteer coach for the Special Olympics ski racing team and supports the Special Olympic Winter Games. He serves as a volunteer Doctor for the Special Olympics and the Healthy Eyes Program sponsored by the Lions Club. He provides vision exams and eyeglasses to Special Olympics athletes.
Dr. Kadet was nominated in 2002, for the Washington State Jefferson Awards for community service.
Dr. Kadet is married, has raised three children, and resides in Seattle WA.
Discovering Vision Therapy Blog
New technologies always produce unintended uses. For smart phones, you can now add “babysitter” to the list. From infants on up, parents are allowing children to use smart phones more and more – often impacting their functional vision in a negative way. Here are some tips to help you avoid big problems down the line.
First, let’s be clear about what “functional vision” is. Don’t confuse functional vision with your visual system’s acuity, the ability to see objects clearly. Functional vision is essentially your ability to accurately perceive visual space, or “see an object in space.” Depth perception, tracking an object, following a line of text – these are all examples of how you use functional vision, and they all involve the three-dimensional world.
To work effectively in this three-dimensional world, your eyes must have the ability to focus on objects near and far. They must also work together as a team, focusing on a single point on an object so that your brain can effectively combine the two images into a 3-D object.
When you’re constantly looking at a computer screen, your eyes are subjected to visual stress. Constant exposure to visual stress without breaks can cause a person with functional vision problems to become symptomatic (i.e. eyestrain, eye fatigue, headaches, blurry vision) or can cause a person with normal functional vision to develop a problem. We’ve touched on the increasing vision problems computer programmers are experiencing in Bangalore, India.
Smart phone usage is likely to increase, not decrease, in the coming years. Kids are going to use them, and so are parents. So what can we do to prevent functional vision problems from occurring, much like they are in Bangalore?
We can use these devices properly, in a way that won’t damage our functional vision.
Balance is the Key
According to Dr. Kellye Knueppel of The Vision Therapy Center, there are a number of guidelines parents should follow to ensure smartphone usage (and computer usage in general) won’t affect their children’s functional vision:
1. Use the Harmon Distance. If your four-year-old is going to use a smart phone, make sure they don’t hold the phone too close. Instead, they should use the Harmon Distance, which is measured by placing a closed fist under the chin, and then holding the smart phone at the tip of the elbow. The smartphone should not come any closer than that distance.
Here’s an article we wrote on the Harmon Distance, which also applies to desktop computer usage and reading in general.
2. Balance Smartphone Usage with Playing Ball. Your kids can use a smartphone, but they must balance their usage with time spent engaging in activities to exercise not only their bodies, but their functional vision.
For every hour of screen time, kids should engage in ball-related activities such as Ping-Pong, tennis, baseball, Frisbee, football, soccer – anything in which an object is moving through space. It doesn’t have to be a competitive sport. Playing catch is ideal. We want them to use their functional vision to perceive objects moving in space.
Dr. Knueppel stresses it’s important that a child engage in something in which they can be successful 80+ percent of the time. You want them to do something that they can be successful at and enjoy, otherwise they’ll abandon it.
One note: If your child truly struggles at playing catch, it’s an indication that the child needs a Functional Vision Test.
3. Reading is Not a Substitute. What about the kids who don’t play on a smartphone, choosing instead to read all the time? Parents generally extoll kids to read as much as possible.
It’s great for the mind, yes, but as Dr. Knueppel points out, not necessarily for the visual system. Just like with smartphones, your eyes are being exposed to visual stress. The kid who does nothing but read may experience functional vision problems down the road, just like the smartphone users.
What’s Your Next Step?
We’ve listed some guidelines. Now the big question: How do you implement them with your kids? Here are some ideas:
- Explain to children how too much screen time can impact their visual system. We’ve touched on it in several articles on Computer Vision Syndrome.
- Set up a usage schedule, whereby they’re achieving a balance in their smartphone usage and functional vision. Stick to the schedule, and adjust the amount of screen time accordingly. Our suggestion is typically no more than 30 minutes a day of screen time, and they should balance any screen time up to 30 minutes with ball sport activities. Example: 20 minutes on iPhone = 20 minutes of catch.
- Review the Avoiding Computer Vision Syndrome flyer we’ve produced (click on the button at the end of this post to download). Use the Harmon Distance and other techniques mentioned in the flyer to ensure proper usage.
Smartphone usage is expected to increase over the coming years. Seventy-eight percent of 12 to 17-year olds have a cell phone, and 37 percent have a smartphone. Those numbers will increase, as will their usage. We’re saying if you can’t beat ‘em, join ‘em – but join ‘em in a healthy way.
03/05/14 6:00 am
Even someone who writes about vision therapy on a regular basis can miss the symptoms – or lack thereof – of a functional vision problem. This was the case of my son Sam, whom I’m proud to say is the latest of our vision therapy success stories.
My son was frustrated. A bright kid, he generally had to ask for extra time to finish a test, and he spent hours doing homework. Ironically enough, it was the same experience we’d had with my daughter eight years earlier.
At the time, my daughter Anna fit the profile of so many children (and adults) we write about on the Discovering Vision Therapy blog. She was bright verbally, but struggled with reading. Anna was diagnosed with a convergence insufficiency.
Fast forward to today, and my son Sam. While Sam has always carried good grades, he still struggled with test-taking and homework. This was partially due to his desire to turn in high quality work, but also because of what we always considered were some processing difficulties.
As I mentioned, Sam has always been strong academically, and he’s never complained of headaches, watery eyes, or displayed disruptive behavior. Without even one of the telltale symptoms, we never thought Sam could have a problem.
Nevertheless, we scheduled a Functional Vision Test at The Vision Therapy Center. The results? He had a convergence insufficiency, and would need several months of therapy.
I’ve been blogging for The Vision Therapy Center for years, and I’ve written countless article posts about what parents should look out for. So why didn’t a guy who writes about the stuff every day catch the problem?
The Vision Quiz and a Functional Vision Test
First things first: If parents think their child might have a vision problem, they should go to our website and take the Vision Quiz.
If I plug in Sam’s symptoms on the quiz, he gets a score of 8. If you get a score of 20 points or more, or the persistence of 1-2 symptoms, you need a Functional Vision Test. In Sam’s case, he had just a few symptoms, but they persisted. (We’re going to make that more prominent on our website, FYI).
When we took Sam in for a Functional Vision Test, they spotted the problem. It was an invaluable lesson that a regular functional vision exam is critical for your child’s test. Simply the depth and breadth of the exam, in which all aspects of functional vision are tested, ensures you’re covering all the bases.
In Sam’s case, he’s an amazingly hard worker, and determined to get through school as a straight “A” student. He’s always managed to overcome his processing issues by working diligently and for long hours. He fights through, like so many people with functional vision problems.
We never would have known unless we’d scheduled the Functional Vision Test. Takeaway:
1. When in doubt, take the Vision Quiz and be sure you
understand what the score means.
2. Schedule a Functional Vision Exam
Vision Therapy With a High Schooler a Different Challenge
It was time for another round of vision therapy for our family. My wife and I knew that Sam would be in for a challenge with his vision therapy. But it would be a decidedly different one than my daughter had experienced back in first grade.
For one thing, Sam was fully aware that his processing issues were causing him to score lower on standardized tests and take longer to finish his work. No one was more frustrated than he was, and he was eagerly in search of a solution.
Another difference was that because of Sam’s age and independence, the role my wife and I played in his treatment would be in more of an oversight capacity, and less hands-on with the activities.
Sam worked with the therapist and knew exactly what he needed to do for activities. My role was to remind him to do the activities on a regular basis (I wrote a post with some tips on how to do this effectively).
Unlike the struggles of getting a first-grader to participate in vision therapy, Sam has had his eye on the prize from the get-go. While he doesn’t exactly enjoy the activities or the 20-30 minutes it takes from his ridiculously busy schedule, he’s made the time. He wants to get better. He wants to improve.
And he has. Sam started vision therapy around the beginning of November. He’s worked diligently, and about two weeks ago, we achieved our first breakthrough.
Sam had a series of tests in different classes. In all of them, he either finished during the class or was not the last one to complete the test. He said he felt focused and was able to concentrate on the problems. He also scored at the top of his class on all the work.
While we’re declaring vision therapy a success based on the speed in which he’s now taking tests, we’re eagerly looking forward to June, when he retakes his standardized ACT scores. In the past, he’s done exceptionally well on the parts of the test he’s had time to finish. Because of his processing issues, he never finishes two parts of the test, and his score suffers.
I’ll report back in June, hopefully with even better news than this post. Regardless of those results, we’re happy Sam’s vision has improved. It also serves as an invaluable lesson to parents: Even one or two symptoms may be an indication your child has a vision problem. When it doubt, get a Functional Vision Test.
02/26/14 6:00 am
The medical community has its opinions about how to treat a lazy eye. But we think basketball actually holds the secret to helping us understand the proper way to treat amblyopia, otherwise known as lazy eye.
Before we get to the lesson basketball can teach us about amblyopia, let’s compare the differences between the sport and the eye condition.
Basketball is one of the most popular sports on the planet. According to FIBA, the world governing body of basketball, 11% of the world plays basketball. Over 450 million people play basketball on competition and grassroots levels.
Amblyopia is a relatively unknown visual condition. According to the American Optometric Association, 2 to 4 percent of children have amblyopia.
Basketball players are easy to notice. They generally have a ball, a basket, and make a lot of dribbling noise. If they’re particularly good at it, they may also be playing in an arena with 20,000 people, and being watched by millions on TV.
Amblyopia isn’t quite so easy to spot. The truth is, most parents don’t even know their kids have it. That’s because there may be no distinguishing feature, such as an eye turn. (That’s a condition called strabismus and involves an eye turn of some sort, such as a crossed eye).
What causes Amblyopia?
We know what causes basketball (ball, rim, net), but what causes amblyopia?
Amblyopia occurs when one of the eyes does not see as clearly as the other. This can be caused by a number of factors, the most common being an eye turn (strabismus) or anisometropia (a large difference in prescription between the two eyes). When the two eyes are significantly different, the brain stops paying attention to information in the non-preferred eye, which is usually the eye that is turned and/or has a significantly higher prescription.
There is some irony in the name “lazy eye,” as the amblyopic eye does not receive as much “work” by its own accord. Because it’s out of alignment with the other eye, the overall visual system essentially shuts down the signal. Kind of like a coach benching a player.
When the brain is only receiving images and a signal from one eye, it lacks binocular vision. That affects a child’s depth perception, among other things, and can lead to a variety of ambiguous symptoms: Headaches, poor study habits, clumsiness.
You can’t really “see” amblyopia, although people with strabismus may have amblyopia, too. This can be particularly frustrating to a parent, because unless you’re familiar with amblyopia, you probably have no idea why your child is performing poorly in school.
And here’s where we get to the similarities between basketball and lazy eye. If someone is bad at basketball, they get better the same way a child with amblyopia does: By improving their skills, and learning to work with the team. Let’s explore that a little further.
Patching Alone Not the Answer
A common approach to treating lazy eye is patching. The philosophy by doctors who prescribe patching alone is “Let’s get the ‘lazy eye’ to start working again.” By making it work, and shutting off the signal from the other eye, the amblyopic eye will become stronger and return the visual system to its normal function.
However, success from patching may be short-lived. The weaker eye may eventually see clearly, but that doesn’t guarantee that the eyes are going to start working in tandem. For that to truly happen, the visual system must be retrained to establish efficient binocular vision.
Now consider the basketball player who is struggling at the game due to poor passing and shooting skills. The coach instructs the player to practice on his own for two hours a night. After two months of developing his skills, the player returns to the team. The coach is confident in his player’s improvement, and so he inserts him into the starting lineup of the next game.
Unfortunately, the result is not good. The player flops. He fails to score. He looks out of sorts with his other teammates, and his timing is off.
The coach’s mistake? Even though he improved the player’s skills, he never improved his ability to work as part of the team.
Basketball is a sport that requires all members on the floor to work together as one to be truly successful. Vision is no different. Both eyes must work in tandem, along with the rest of the visual pathways and the brain, for a child to overcome amblyopia.
What if the basketball player worked on his passing and shooting skills on his own, and practiced with the team? Wouldn’t he improve his personal and team skills at the same time? Of course he would.
The same is true for amblyopia. As we’ve indicated on many previous posts, the most effective treatment for amblyopia is a combination of patching and vision therapy, which uses visual activities to improve binocular function.
I’ve touched on the tip of the amblyopic iceberg here, but I think the basketball analogy is probably the easiest one to think of when it comes to the relatively unknown condition of amblyopia. And just like in basketball, when you play as a team, you’re going to win.
02/19/14 6:00 am
As irrational as it sounds, many parents blame themselves for their child’s functional vision problems. Did they miss a symptom? Should they have asked the doctor more questions? You could drive yourself crazy asking these questions, which is why parents have to focus on the present if they want to help their child.
Parents always think about the “should haves” when it comes to vision problems. They lose sight of the fact that they eventually discovered the child’s vision problem, and instead beat themselves up. Here are the typical “should haves” we hear:
- I should have noticed the symptoms earlier. Symptoms of a functional vision problem - headaches, watery eyes, lack of focus – could be linked to a wide range of problems. Unless you’re familiar with functional vision problems, these could easily be confused with allergies, attention deficit disorder, or a number of other issues.
- I should have kept looking for someone who knew what the problem is. If your child's physician and/or educators didn’t consider a functional vision problem, don’t blame yourself. In fairness, teachers and doctors have many issues they have to consider; hopefully from this point forward, they’ll improve their knowledge of functional vision problems so they can help the next struggling student.
- I should have paid closer attention to my child’s complaints. This is a tough one, because children of all ages come to mom and dad with their complaints. Don’t all kids complain about homework? And if they do, should you immediately rush the kid to a developmental optometrist? It’s not until those complaints become a sustained pattern that a parent should sense a problem. Until it does, it’s hard to tell if the child is just being typical, or if there’s something else at work.
- I should have known about functional vision problems. Really? How could you? It’s not a subject typically discussed among parents, educators and physicians, although we really wish it were. The important thing is that you found the problem, and now you’re taking action.
- I couldn’t afford vision therapy. It’s tough to make ends meet in today’s economy, and when vision therapy isn’t covered by medical insurance, you’ve got a tremendous uphill battle. However, we are seeing more financing options for parents. We hope insurance companies will begin to take note of the efficacy of vision therapy.
- I wish I would have been more diligent about scheduling eye exams. This is a fairly typical reaction, although many parents don’t give eye exams the same gravitas they do a visit to the dentist. Plus, it’s easy to think your child’s vision is fine when they pass a typical school screening with flying colors. Note that even some optometrists and ophthalmologists are not entirely familiar with functional vision problems. Even if you had scheduled that exam, there’s a chance the problem might have been missed anyway.
Ironically enough, hindsight is 20/20 when it comes to functional vision problems. Instead of dwelling on the past, you need to put all your effort toward ensuring your child’s vision therapy. Look to the future and focus on the following:
- Keep your child on schedule with their at-home vision therapy. It’s easy to let this slip during our day-to-day lives, so use some of these scheduling tips we mentioned in a previous post.
- Work with your child’s teacher to create classroom accommodations. Communication is key, so be in touch with teachers, principals, coaches and trainers about your child’s needs. Pass along our Vision and Learning Guide to ensure they’re aware of important classroom accommodations.
- Help us spread the word. If you are still harboring feelings of guilt after reading this, then help us spread the word about functional vision problems. Forward our Vision and Learning Guide link to your friends, and make sure you "Like" our Facebook posts and retweet our Twitter posts. Social media is a tremendous tool for helping us spread the word about functional vision problems.
No one is perfect, and no one expected you to detect a functional vision problem any earlier than you did. But now that you know, use your newfound knowledge to improve your child’s vision and help others who may be suffering from a similar issue.
02/13/14 12:20 am
Just as fashion trends start on the coasts of the US, it makes sense that a vision problem caused by heavy computer use should start in Bangalore, India. The number of new computer vision syndrome cases in India’s technology hub serves as a wake-up call for heavy tech users here in the states.
Ever since Thomas Friedman’s landmark book The World is Flat , Bangalore has been known as the high-tech outsourcing hub of the world. Home to highly-educated computer programmers and analysts, it became common practice for American companies to outsource their tech work to India to shave costs.
Bangalore’s workforce has been spending a lot of time focused on its computer screens, and it’s starting to impact the visual system of many young techies. A recent article noted an increase in computer vision syndrome, a topic we’ve blogged about in the past.
“According to ophthalmic experts, the maximum number of patients walking into their chambers are techies, mostly in the age group of 23-35; and, worryingly, the numbers have doubled in the past five years,” reported the website DNA Analysis.
Prolonged Computer Usage the Problem
The cases described by Dr. Rohit Shetty involve “an alarming rise in the number of computer-related eye problems among young adults.”
The symptoms include minor eyestrain, redness of eye, dry eye, and sleep disturbance. Spending long times at a computer screen can also result in a deficiency of vitamin B12 and vitamin B, which can affect night vision.
Shetty recalls one incident where a patient had been working 10-12 hours a day in front of the computer, and then experienced problems when driving and staring into the glare of oncoming lights. He nearly had two fatal car accidents.
The increase, especially among young people, has to be cause of concern for parents here in the United States. Our society as a whole has become increasingly absorbed by the computer screen, and even more so by our mobile phones.
Smart phone usage has skyrocketed, especially for web surfing and social media usage. In this revealing infographic about smart phone usage, one statistic jumps out: 50% of mobile phone users use mobile as their primary Internet source.
With increased mobile usage, we can expect the trend we’re seeing in Bangalore to only get worse.
Practicing Good Visual Skills is the Solution
Computer vision syndrome has already begun to affect the population of the United States. “It’s something we know is happening,” said Dr. Brandon Begotka. “We see two and three year-olds playing with smart phones. We’ve got to think about this as not only a current issue, but one that’s going to become more pervasive.”
Dr. Begotka himself experienced eyestrain, and recently began wearing what we refer to as 21st century reading glasses. Read about them here.
The key to getting your children (and yourself) to avoid Computer Vision Syndrome is to practice good visual habits. We created a chart detailing what to do to reduce visual stress when using the computer. Some recommendations include:
- Avoid viewing computer screens, iPads or smart phone while lying down.
- Sit on a chair with feet flat on the floor and legs at a ninety-degree angle.
- Look away from screens every fifteen minutes, and focus on an object at least 20 feet away for 20 seconds.
Download all the recommendations by clicking on the link at the end of this post.
None of these recommendations are very difficult, but they require a change in your approach and your habits. For example, you may have to use a timer to remind yourself to look away frequently, until it becomes habitual.
Our habits are not going to change on their own; we’re going to have to alter them. Start by downloading our tip sheet on how to avoid Computer Vision Syndrome, and if you know any computer programmers in Bangalore, be sure to forward them the link.
02/05/14 6:00 am