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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
Summer is just around the corner (or at least that’s the rumor here in Wisconsin). If you have a child who is a struggling student, the break from school will be welcome – but it shouldn’t be squandered. Use the summer months to schedule a Functional Vision Test. It just might reveal why your child is struggling in school.
The American Optometric Association (AOA) recommends that children between the ages of 6 to 18 years of age who are experiencing eye or vision problems (or at risk for a visual impairment) receive an annual exam.
These eye or vision issues can include functional vision problems, which include issues with eye teaming, tracking and focusing.
Functional visual skills are based on your ability to see an object in space. They include seeing a ball fly through the air, or following a line of text on a page. Symptoms of functional vision problems that are often undetected include:
- Short attention span
- Excessive squinting, blinking and closing of one eye
- Headaches in forehead or temple
- Places head close to book when reading
- Burning or itching eyes, reddened in appearance
(For a complete listing of symptoms of functional vision problems, click here.)
Does your struggling student display any of these symptoms? If so, why hasn’t your child’s teacher or doctor said anything about it?
Functional Vision Problems Occur Even with 20/20 Eyesight
Functional vision skills are different from “20/20” eyesight. Eyesight refers to the ability to see the Snellen eye chart. This is a standard eye test, but most of the time it doesn’t detect functional vision problems.
Developmental optometrists are trained to effectively test for the full range of functional vision problems. Some of the skills a developmental optometrist tests for includes:
· Eye Movement Control
· Focus at Far
· Sustaining Focus at Far
· Focus at Near
· Sustaining Focus at Near
· Alignment at Far
· Sustaining Alignment at Far
· Alignment at Near
· Sustaining Alignment at Near
· Peripheral Vision
· Depth Awareness
· Color Perception
· Gross Visual-Motor Skills
· Fine Visual-Motor Skills
· Visual Perception
· Visual-Motor Integration
If you think your child might have a functional vision problem
and may require this type of testing, a Functional Vision Test is
highly recommended. But why the urgency to book an
appointment in the summer?
Don’t Let Your Child Start at a Disadvantage
Here’s the typical scenario for a student who has a functional vision problem.
The student struggles through the school year, and breathes a sigh of relief at summer time. Parents hope that a new school year will yield improvement, mainly because educators and doctors have not been able to pinpoint why their student continues to struggle.
The summer comes and goes, and the new school year begins. The student is now taking more accelerated subjects, and more homework is required. Instead of improvement, the situation gets worse. The student falls further behind, and behavioral problems start to arise.
Finally, after desperation sets in, the parents find out about vision therapy and get a Functional Vision Test as a last resort. If a functional vision problem is detected (which is generally the case), then therapy begins. Typical vision therapy, which includes activities that improve a patient’s functional vision, can last 3-9 months.
This is why we encourage summer visits. The sooner you can get your child started on correcting the functional vision problem, the less likely they are to fall behind in their schooling.
By testing early in the summer, you can also start on vision therapy during the months they’re not in school. Finding time for daily vision therapy can be difficult to balance with the books – the summer months provide much-appreciated extra time.
The summer is almost upon us. Enjoy the sun, enjoy the warmth, but don’t let an opportunity to help your struggling student pass you by. Schedule a Functional Vision Test today.
04/16/14 6:00 am
The following success story comes to us from Emily Baxter, who received vision therapy and syntonics treatment to help her recover from brain-related vision problems.
Vision therapy took me from being uncomfortable most of the day to being comfortable for most of the day doing many life activities I was not able to do before.
My quality of life is out-of-the-water compared to when I first started vision therapy. The worth of this therapy is beyond measure.
I had pulmonary embolism with secondary anoxic brain injury about two years ago, and after over a year of physical therapy, speech therapy and some occupational therapy, I was much improved but not anywhere close to back to normal.
I wanted to be able to actively recover – to do something to help my brain heal, but I did not know what to do. Most people said there was nothing more I could do, but then my occupational therapist who had heard of Dr. Knueppel recommended vision therapy for me. I am so thankful for that referral, because vision therapy has given back so much of my quality of life.
Others saw me as looking/seeming pretty normal a year after my cardiac arrest/brain injury, but I would still fatigue so easily and had such a hard time processing what I heard and saw. My brain would shut down quickly to the point where I could not remember much of what I heard. I could not read fluidly or comprehend text well, and I felt jumpy at anything that moved. Even in a silent room, I would have to re-read sentences to comprehend them; and even then, I would forget much of what I read in a matter of a day or less so I would have to start over several times and take notes.
The more sensory stimulation in the form of noises or visual cues (especially moving objects), the faster my brain would fatigue and shut down. It was hard to speak then because I had difficulty finding words because my brain was busy just being aware of the objects, people, and noises around me.
The world seemed to be always moving, and I did not know it then, but after having it corrected by syntonics and vision therapy, I realize I had to tunnel my vision to focus on anything. The area surrounding what I was looking at would go dim so my brain could pool all its effort into processing the item of interest whether it was a word on a page, or the face of someone speaking to me.
After just two weeks of syntonics, I felt my vision open
up. This made me so much more calm because I was so much more
aware of the world around me, and my brain was more freed up to
think about other things like speaking and listening. That is
when driving became so much easier.
I was beyond happy to be able to see in a way I had not even remembered I could see before. I did not even realize my vision was so limited and so tunneled until it wasn’t anymore! It is truly an awesome gift to be able to take in so much of the picture at once! I hope I never forget how I saw before vision therapy, because I never want to take my vision for granted.
Among many vision problems resulting from brain injury, I had convergence insufficiency. Dr. Knueppel said my brain was not correctly telling my eyes where to look in space in order to focus on an object. Many of the eye exercises assigned to me in vision therapy helped me with this issue, and everything I do is easier because of having done/doing those exercises.
Over the past nine months of vision therapy, I have made tremendous progress in recovery and have been able to do things I am not sure I would have been able to do without having had the experience and benefits of vision therapy. I am tearing up thinking about this because it means so much to me.
My symptom changes that I noted at my first progress exam (about 3 months into vision therapy) included:
- Less clumsy!
- Less jumpy!
- More aware of surroundings!
- More comfortable driving
- Can drive longer
- Eyes are less itchy
- Better reading comprehension (but still not great)
- Reading time lengthened
- Can handle much more stimulation
- More comfortable in every environment
Greater endurance with everything I do –don’t need a nap!
[after a year and a half of needing a nap every day since my
Don’t need as much sleep at night (need 10 hours now as opposed
to 12 hours I needed before)
- Auditory processing has improved (I think because I have to listen less to my environmental noises/cues because I am visually more aware of my environment – and just a more recovered brain in general)
Three months later at my next progress exam, I reported two big milestones/accomplishments since the first progress exam:
Started working again – 4 hours/day, Monday-Friday, as a small
group reading/math teacher. [I was a teacher when I had my brain
- Drove from Milwaukee to Madison by myself. Longest drive time to date by far. Felt ready to tackle this goal. Even did part of it in the dark.
Now three more months have gone by, and I still have a list of life-changing improvements to report to Dr. Knueppel:
- I feel comfortable! Not all the time, but I do feel it now! Especially at home in the quiet. I feel it in my eyes, head, and neck (not tense or hurting or stiff) and in my cognitive awareness. I think I had a constant headache after brain injury but didn’t know it until I felt what it feels to feel comfortable.
- Unless really tired or overstimulated, driving is quite comfortable too now! (in daylight anyway – driving in the dark is still tricky for me)
- Extraneous noises bother me a little less.
- I feel much more comfortable in a restaurant trying to talk to people or in a store trying to pick out groceries.
- I was able to teach two full days (subbing) this month! –also have subbed for an hour within my regular four hour day
- Still have itchy, dry, burning eyes but now only at night/when tired instead of all the time and to a much smaller degree!
- Able to read music better lately
- Able to read more smoothly again!
- Feel so much more independent now that I am able to do activities on my own that require cognitive endurance (like drive to work and back or to a friend’s house to visit).
Besides prescribing daily syntonics (light therapy), weekly office visits to learn eye exercises (to do daily at home) and in-house vision activities, Dr. Knueppel also helped me overcome the difficulties of brain injury-related vision problems by applying tape to part of the lenses of my glasses to eliminate some of the visual input (and thus cognitive stress of having to process it all). This is called binasal occlusion because the tape occludes part of the visual field on either side of the nose.
I am so glad Dr. Knueppel knew to do this, because it has helped me see better, think better, and overall function better for the last nine months. I wear contacts just when I go swimming, and I get fatigued much more quickly because I do not have the binasal occlusion then.
I am grateful to the person who referred me to vision therapy and everyone at The Vision Therapy Center, from the welcoming receptionists to the dedicated therapists to the doctors themselves, especially Dr. Knueppel who knew more about me in my brain injured state than I did, and whose knowledge guided me to an incredibly better quality of life.
A special shout-out to Beth who was my therapist for the majority of my weekly appointments and who helped me with difficult exercises and decisions and celebrated with me in all my improvements and accomplishments!
Thank you from the bottom of my heart. My husband, family, friends, and employer also thank you for helping me get better.
To Prospective Patients:
I recommend vision therapy. If you are wondering whether it is worth the cost, time, and energy—just do it and you will see in a very short time that the answer is yes. After the whole process, you will probably feel indebted to the people at The Vision Therapy Center because the gift (of better functioning vision and the resulting increased quality of life) you receive from their efforts is so great.
04/09/14 6:00 am
We should be getting used to this by now, but yet another research paper has ignored the impact of vision therapy on the treatment of amblyopia, or lazy eye. In fact, some of the statements regarding the study made us, well, cringe.
The study came from the Pediatric Eye Disease Investigators Group (PEDIG) and was published in Ophthalmology. It found that increasing patching from two hours to six hours a day effectively treats persistent amblyopia.
Those findings may be true, but it’s the comment that we read from David K. Wallace, M.D., professor ophthalmology and pediatrics at Duke University School of Medicine and lead author of the report, that we found frustrating.
“We didn’t know what to do when a child stopped improving after patching two hours a day,” Wallace said. “With this study, we now have clear evidence in support the practice of increasing the duration of patching to six hours a day for stubborn amblyopia.”
You didn’t know what to do after a child stopped improving from patching? How about integrate vision therapy into the treatment plan?
Integrating Binocular Vision Therapy with Patching Improves Performance
We grow frustrated when physicians don’t acknowledge the research regarding the positive impact of vision therapy on amblyopia. Even worse, by focusing only on patching, they’re missing the root cause of lazy eye.
First, let’s take a look at some of the research. Back in 2011, Dr. Dan Fortenbacher, a developmental optometrist, noted in a post on the blog VisionHelp that there is a body of research that indicates “it is better to treat the amblyopic patient with binocular vision therapy in conjunction with a more limited amount of occlusion (patching) therapy.”
Dr. Fortenbacher referred to several studies, including a review of an important study on eye-hand coordination skills in children with and without amblyopia, and a list of 105 scientific papers accessible in PubMed.gov, the US National Library of Medicine National Institute of Health, showing the evidence-based research on the topic of binocular vision in the treatment of Amblyopia.
What’s particularly noteworthy about the study on eye-hand coordination is that it was published in Investigative Ophthalmology and Visual Science. It concluded: “Restoring binocularity in children with amblyopia may improve their poor hand action control.”
Which brings us to our second point: Understanding the root cause of amblyopia.
Why Binocular Vision Must Be Restored
In amblyopia, or lazy eye as it is commonly referred, one of the eyes does not see as clearly as the other. A number of factors can cause this, including an eye turn (strabismus) or anisometropia (a large difference in the prescription between the two eyes).
When the two eyes are significantly different, the brain stops paying attention to information in the “non-preferred eye” – this is usually the eye that is turned or is more far-sighted.
Patching helps get that amblyopic eye working “again.” By patching the preferred eye, you’re effectively redirecting the brain to use the only eye available, the lazy eye. Over time, the hope is that the brain will become more accepting of using this eye.
Until, that is, the patching comes off, and the eyes are forced to try to work together again. Because of the eyes' ability to work together as a team, “binocular vision” has not been restored, and the brain may once again stop using the non-preferred eye. We often end up right back at square one.
Patients Improved – But For How Long?
Dr. Wallace’s solution was to increase the duration of patching. It yielded positive results – but for how long?
The report indicates that after 10 weeks, “children in the six-hour patching group could see an average of 1.2 additional lines of an eye chart with the affected eye.” That’s great, but what happens after several months, when you’re no longer patching?
We’d love to see the results measured at that point and also compared to a group treated with vision therapy, because patching alone won’t address the root of the problem: Poor binocular vision. We believe that unless the patients have received binocular vision therapy, the amblyopia is very likely to return.
We are not dismissing the findings of this report. On the contrary, if Dr. Wallace were focused solely on the effects of patching, then this is valuable insight. But the statement that the doctors “didn’t know what do beyond the patching” is cause for concern, especially when so much research and clinical data suggests that the addition of vision therapy can produce significant improvements.
04/02/14 6:00 am
In school, Jack Coakley would often look away from his desk and gaze out the window. His teachers thought he wasn’t paying attention. It wasn’t until he visited The Vision Therapy Center that his parents and teachers realized this apparent lack of attention was really a functional vision problem.
Jack, now fourteen and a freshman in high school, had been having problems in both school and sports for a number of years, according to his mother Kathy. “He had a hard time paying attention in class,” she said. “He would look off into space, and he had a hard time following along.”
Believing the problem was Attention Deficit Hyperactivity Disorder (ADHD), the Coakleys took Jack to Dr. Lori Pyter, a clinical psychologist. She ran a gamut of ADD tests, and then reported some surprising results to the family.
“She told us that while she wasn’t a vision expert, she suspected Jack might have a vision deficiency,” Kathy recalled. “So she referred us to The Vision Therapy Center.”
The Coakleys took Jack in for a Functional Vision Exam. Afterward, they discussed the results with vision therapist Lisa Dudzinske. She asked Jack if he found himself looking away from his paper, and then back to it after a while. “He was trying to rest his eyes, and bring them back into focus,” Kathy said.
One by one, Lisa listed symptoms, and described how functional vision problems can cause them. “At one point, she slid a box of tissues to me, because I had begun to cry,” Kathy recalls. It’s a common reaction we see from parents when they finally find an answer to their children’s struggles.
Jack Didn’t Know He Had a Problem
The Coakleys learned that Jack was suffering from Intermittent Alternating Exotropia. In this condition, one eye or the other drifts out at times. Because of this, Jack’s eyes weren’t always aimed at the same point in space, which is important to see clearly, comfortably and accurately.
As the family learned more about the condition, Jack’s symptoms began to make sense. In sports, for example, he complained his contacts were bothering him, and he was having trouble seeing the lacrosse ball.
When told about Jack’s complaints, his optometrist reported that his eyesight was fine, and that he was seeing 20/20. But 20/20 eyesight is merely a measure of how clearly you can see at a specific distance. It does not take into account depth perception, eye tracking and teaming, and other functional vision skills.
Jack embarked on a six-month vision therapy treatment. Kathy noticed he quickly became dedicated to the program. At seven o’clock every Friday morning, he would visit The Vision Therapy Center for in-office therapy with vision therapist Brian DelFosse.
“He never complained,” Kathy recalled. “He was committed do the program, and he was seeing results.” Every three months, Dr. Brandon Begotka would perform an evaluation, and Jack could see how he’d progressed.
Soon, Jack graduated from vision therapy, and the results were extremely positive. “His grades improved during the first semester of his freshmen year, and we attribute some of that to better focus and concentration,” Kathy said. While noting that not many 14-year-olds “love” school, his first year at high school was better than ever. Jack is now also able to study for longer periods of time.
In sports, he also experienced his best year of downhill ski racing. “He’s able to see the race gates with greater depth perception and clarity,” Kathy said. In lacrosse, Jack was able to pass, receive and shoot much more accurately. “He can also see the ball more clearly,” she added.
The Coakleys believe it’s a shame more people don’t know about vision therapy. “When I talk about it to other people, I often hear parents say that their child might be suffering from the same problem,” she remarked.
It’s not surprising, considering 1 in 4 children suffers from a functional vision problem that affects their ability to learn. If you can help us spread the word about Jack’s story and functional vision problems, hopefully we can help other children, too.
03/26/14 6:00 am
In this amazing video, two optometrists show teachers what students who have a functional vision problem experience in school. It’s an eye-opening experience for these educators, who now understand why we refer to vision issues as the “hidden learning disability.”
Functional vision problems are termed the “hidden disability” because they are often undetected. Due to the dramatic negative impact that can have on a child’s education, we believe a more accurate term should be the “hidden learning disability.” The teachers in this video now understand what we mean.
The video is entitled “20/20 Isn’t Everything.” It’s extremely well-produced and features Dr. Richard Maharaj and Dr. Chris Schell demonstrating the kinds of functional vision problems we see children struggling with in the classroom.
What’s unique about this video is that teachers get to experience firsthand what these functional vision problems actually feel and look like from the child’s perspective. The doctors use prisms and contact lenses to simulate amblyopia, astigmatism, near-sightedness and convergence insufficiency in the teachers. Watch how dramatically it affects their classroom performance.
Did you notice the reactions of the teachers, particularly Tanya? She became extremely frustrated as she struggled to keep pace with the other teachers.
Imagine children who experience these functional vision issues, but are unaware that there is a problem. This is the way they’ve viewed the world their entire life, so they don’t understand their vision is impaired compared to their peers. They’re frustrated as other kids perform in ways they can’t.
So what can a teacher do about functional vision problems?
- Watch out for telltale symptoms and take the Vision Quiz. If you see a child struggling in school, then take the Vision Quiz. The Quiz includes the typical symptoms of a functional vision problem. If a child is experiencing a number of the symptoms, or one or two symptoms persistently occur, then a functional vision problem may be present.
- Suggest a Functional Vision Test – not a just a typical school screening. Many school screenings include reading an eyechart, which tests only for acuity, or your ability to see clearly. Children with functional vision problems need to see a developmental optometrist who can conduct tests designed specifically to detect issues such as poor depth perception, eye teaming, and tracking.
- Make accommodations in the classroom. Following the diagnosis of a functional vision problem, you can make accommodations for your student. While many of these will be based on the type of visual problem, here are some of the typical things we recommend teachers implement:
- Make larger print available.
- Allow for visual breaks during sustained near point work.
- Allow children more time copying from the board.
- Provide “fat” pencils or crayons with special grips.
- Provide a slanted reading surface.
- Encourage the student to maintain the Harmon Distance when reading. This is measured as the space from the elbow to the knuckle on the hand.
- Allow for more time when taking tests.
- Pass along our Vision and Learning Guide. Probably the best thing you can do is help educate parents on functional vision problems. Provide them with this link, from which they can download our guide that provides a comprehensive explanation of the types of functional vision problems, and how vision therapy can help correct them.
- Spread the word to your teaching colleagues. Teachers are known for sharing good ideas. Please share this post and the video with your fellow teachers. A child struggling with vision problems can be an extremely disruptive force in the classroom, impacting not only their own education, but also the education of those around them. Getting help for kids suffering from vision problems will help these afflicted students, and benefit your educational community as a whole.
The most important thing to keep in mind is how disruptive these vision problems can be. No matter how fantastic a teacher you are, your efforts will be severely diminished if your student has a functional vision problem. Just ask the teachers in this video.
03/19/14 6:00 am