VISION...physical therapy for your vision, but it’s not just strengthening your eye muscles....

You see, there is a direct connection between our eyes and our behavior. Our job at Rising Star Optometry and Vision Academy Optometry is to bring well-being into focus. We do this by helping children and adults identify and then understand how their eyes do much more than just see something clearly.

Using state-of-the-art testing and precision training based on 40 years of our dedication to optometry and vision breakthroughs, we help optimize learning

and function for our patients young and old.

We serve children with developmental delays and developmental eye problems, poor readers, underachieving students of all ages, athletes wanting a competitive edge, and adults and children with visual discomfort.

Medical vs. educational optometry explained.Think of educational optometry as teaching your eyes to work more efficiently and comfortably for you, and medical optometry as using glasses or contacts to see accurately and for monitoring overall eye health.

RSO’s educational focus is our hallmark. Why? There is a direct correlation

between how our eyes and brains coordinate and our overall reading efficiency and handwriting. When we have weaknesses in eye tracking, focusing, how both eyes work together (binocularity), peripheral vision or vision perception (depth, memory, discrimination), many things manifest. Children and adults complain of poor attention, fatigue with reading and homework, headaches and visual discomfort, poor sports performance and eye-hand coordination, and a host of other behavioral issues.

We teach you how to strengthen your eyes and brain to vastly improve your quality of life.

As optometrists, we offer primary care management of eye disease and the precision fitting of contact lenses and expert prescription of glasses for young and old.

We are one of the few practices in the Bay Area →

O P T O M E T R YV I S I O NE X P E R T S

“Vision training has

restored peace to our household.

”

RISING STAR OPTOMETRY VISION ACADEMY OPTOMETRY

361 3rd Street, Suite CSan Rafael, CA 94901Office: 415.459.2020Fax: 415.459.2021

3401 Mission StreetSan Francisco, CA 94110Office: 415.459.2020Fax: 415.459.2021

fitting children with specialized contacts to halt the rapid progression of nearsightedness, including one that is worn only at night yet provides clear vision throughout the next day without wearing any correction.

We also know that understanding eye health starts from birth. That’s why we offer free 15-minute screening eye exams for infants and children up to 2 years old. We are proud participants in the national InfantSEE program, which is promoted by the American Optometric Association.

Our office is welcoming, fun, positive and nurturing. As educators we love questions, and we take the time to answer them all throughout the treatment process.

Let us guide you toward clarity.

David Grisham, OD, MS, FAAO Jeremy Shumaker, [email protected]

Optometry Vision Experts

25 percent of school-aged children have visual issues that affect learning.Simply put, visual efficiency refers to how well – and how comfortably – we use our vision. It impacts our lives at home, school, work and even on the sports field.

This is why, for most of our children and adult new referrals, we like to start with a Visual Efficiency Exam (VEE). This is our extensive baseline optometry examination and it clearly identifies to us how your eyes may be affecting your educational, workplace, personal or medical life. It defines and outlines concerns. Once completed, we write a report with diagnoses and recommendations.

For children who are having difficulty reading or have

any developmental vision disorders, a Visual Efficiency Exam is the gold standard for formulating a plan to help address these problems.

A VEE is a complete 1.5-hour eye exam. We start by measuring visual acuity.

Can you see things clearly? Does it vary depending on the distance? We find out the smallest symbols you can read on an eye chart at far and near. We then uncover any refractive errors to optimize your vision with glasses or contacts if necessary. (Eye drops may be required to determine the full refractive error, and the patient is usually scheduled for a second, shorter visit.)

More specialized assessments follow. How do your eye muscles balance at far and near? Is there an eye that crosses in

or turns outward? Do your eyes track smoothly? We precisely monitor and analyze your eye movements while you read with specialized equipment. We examine your near focusing and fusion skills, as well as your convergence (the ability to cross your eyes) and refined depth perception. Perceptual screeners give us clues to whether there may be a higher-level cognitive difficulty, such as dyslexia or an auditory processing delay.

Based on the findings from this examination and consultation, we will create a personalized plan. If Vision Therapy is recommended, then our doctors and vision therapists will coordinate with you and any other specialists working with you to create a personalized home and office-based program, which will help improve reading, learning and visual comfort. →

H I G H L I G H T I N G V I S U A L

E F F I C I E N C Y





Highlighting Visual Efficiency

Visual Efficiency Exam:Begins with an extensive personal history.

Review of other professional reports.

Standardized tests follow:Visual acuity at far and near

Refractive error

Eye muscle balance at far and near

Smooth tracking

Tracking eye movements in reading

Near focusing skills

Convergence, fusion and eye-teaming skills

Depth perception

Color vision testing

Rapid eye movements for sports

For students with learning difficulties:

Screening of visual and auditory perceptual skills Readalyzer analysis of reading eye movements

Your eyes and brain have a critical partnership.

We hear this sentiment quite often. People just don’t understand how our eyes and brain partner together to do so much more than just make sure that we can see 20/20. In fact, learning and livelihood can be seriously impacted even if our eyesight is perfect.

What we all want is efficient vision, and in order for that to happen we must have good visual acuity, but

also full binocular coordination of the eyes, accurate tracking, normal eye focusing and convergence for near viewing, good depth perception, visual stamina, and full coordination with the sensory and motor functions of the body.

Visual Skills Therapy is how you get efficient vision. It is a process of learning to use and then extend your visual skills to the highest level possible. We point out that it is a process, because as doctors we can’t cure a visual problem by ourselves. Our patients must consistently and correctly do the exercises and activities we prescribe, mostly at home. We guide and direct through weekly office visits, but the responsibility for improving or

curing these visual issues is with the patient.

Visual Skills Therapy is like physical therapy for your vision, but it’s not just strengthening your eye muscles. It’s improving the brain’s control and coordination of your entire visual system, which includes your eyesight, the visual pathways for eye movements and higher perceptual processes, and finally seamless coordination with gross and fine motor skills.

When this visual system is not functioning perfectly, a whole host of things can happen. Students are easily distracted and tired, and may complain of headaches. Words may come in and out of focus or the act of reading can cause eyestrain and tired eyes. →

M A S T E R I N G V I S U A L

S K I L L S

“Had I known that my eyes

were at the root of my problems, I would have

started this a long time ago.”

They may talk about words moving on the page, or they will skip words and lines when reading. Schoolwork seems harder than it should be. Adults who spend hours on the computer have many of the same visual complaints.

You can imagine that if the brain is working so hard just to do the job of seeing, comprehending what is being seen is often difficult.

So children who work terribly hard to simply sound out the words then cannot adequately comprehend what it is they are reading, or the subtleties needed for academic discussion. When visual skills are mastered and become totally automatic through practice and repetition, learning is so much easier.

Patients who have completed Visual Skills Therapy often feel more outgoing, have improved self-esteem, and are significantly more confident to try something new.

Homework is easier to complete. Grades improve for grade school and college students, sports performance improves, headaches go away.





Mastering Visual Skills

Here is what to expect with Visual Skills TherapyA typical program consists of about three months of weekly office visits and a commitment to do exercises when at home.

During office visits, we re-assess visual skills, troubleshoot any issues with the home therapy, make adjustments to the home program, and finally do important in-office training.

Home treatment is critical to success. We expect a commitment of about 20 to 30 minutes of various eye exercises five days a week.

Our practice utilizes cutting-edge virtual reality training software and contemporary computer-based vision therapy techniques for home and office training sessions designed both for children and adults.

Our Track and Read software builds a patient’s tracking speed, accuracy and stamina for better reading efficiency. Other software is used to a build a patient’s ability to coordinate the two eyes together as a team, so moving from the blackboard to a book is effortless and efficient. These computer games are enjoyable to play, reduce visual symptoms and enhance performance in the classroom, at work and on the sports field.

We also utilize therapeutic lenses, prisms, filters, patches, electronic targets with timing mechanisms and balance boards to promote visual development and integration with our patient’s bodies.

We believe in the integration of the whole body for true well-being, and we have devoted years to post-graduate education to deeply study how to improve the function of the entire visual system and its integration with the rest of our body.

80 percent of a child’s learning in school is done through vision.There are fundamental visual perceptual skills that are critical for children to learn to read, write and do math. In other words, the eyes and brain need to be working together efficiently in order for optimum learning to occur.

Visual perception is essentially pattern recognition of forms, such as words. We must process and interpret visual information in many varied and challenging environments. Without these important perceptual building blocks, success in school is nearly impossible. No traditional reading and math intervention will be completely successful.

These perceptual skills can be successfully improved by working with Rising Star Optometry and Vision Academy Optometry. Dr. David Grisham is a nationally known expert in this work. This is

why we stress that a child having learning difficulties should get our Perceptual Skills Assessment (PSA) and consultation. Through this, we can understand exactly where the processing difficulties lie. We can then formulate a roadmap toward success, which often includes working with our reading therapists.

Dr. Grisham administers the baseline tests in a 1.5-hour session. If necessary, he may request an additional hour of testing to fill in any gaps.

Before interpreting all the scored results, Dr. Grisham will review any other professional reports that have been submitted by parents to create a holistic picture of the student. He will then provide a 30-minute in person

or phone consultation reviewing the results and his impressions, along with any recommendations of activities and programs that will help with perceptual remediation.

We also include suggestions for helping manage schoolwork. A detailed written report may also be requested if needed for applying for accommodations or communicating impressions and recommendations to other professionals. An additional fee is applied. →

V I S UA L P E R C E P T I O N

B A S E L I N E

Perceptual Skills Assessment:Begins with an extensive personal history.

Standardized tests follow:Visual-motor integration

Fine-motor dexterity and accuracy (pencil skills)

Visual perceptual speed

Spatial concepts

Vision perception

Reversal confusing of numbers, letters and words

Sentence copying skills

Sight word memory

Auditory perception and processing

Short-term visual and auditory memory and sequencing

Readalyzer (computer-based infrared eye monitor) detailed analysis of reading eye movements

Dyslexia testing for presence, type and severity

Attention deficit screening

Reading eye movements using infrared eye-tracking monitor and computer analysis





Visual Perception Baseline

A majority of children in special education have visual processing issues. Once a patient has gone through our Perceptual Skills Assessment (PSA) and comes out with a diagnosis of perceptual-motor dysfunction or immaturity, our next step is creating a roadmap to success through targeted Perceptual Skills Therapy.

Someone with this diagnosis will have trouble with reading, writing text on a page, math, drawing or eye-hand coordination. They often skip words and have trouble remembering known words. They may have trouble finding objects in a jumbled drawer. Left and right are confused, and puzzles are frustrating.

We diagnose children as young as six and adults of any age with this condition, and often remedy it with therapy.

Our Perceptual Skills Training program specifically improves visual-motor integration, visual spatial skills, visual memory and visual perceptual sub-skills. Dr. David Grisham specializes in this work, and is beloved for his ability to make children and adults comfortable and excited about their own care.

This is training for the more than twenty visual centers in the brain, and just like any training, it must be done repeatedly over a period of time. Patients come in once a week for an in-office session that lasts 45 minutes and then must complete 20-30 minutes of home activities up to 5 days a week. We use computerized perceptual training games when indicated,

designed by doctors and fun for kids.

The more consistent the student is at practicing – and we have found that the parent is a huge part of helping with this consistency – the shorter the program lasts and the better the outcomes overall. →

M A S T E R I N G P E R C E P T U A L

S K I L L S

This therapy works on:

Visual discrimination, which helps to see the difference between a p and a q, or to pick out differences or similarities in objects based on size, color and shape.

—

Form constancy works to help a student understand that the word “table” written small in a text book is the same as the one written large in thick red magic marker.

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Visual memory helps to recall visual traits of an object and is critical for reading comprehension and copying from a board or book.

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Visual sequential memory is used to recall a sequence of things in the right order, which is critical for spelling.

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Visual closure is when you can recognize an object without seeing the entire thing. We use this skill to read and comprehend something quickly.

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Visual-spatial relations is how we can recognize locations of objects based on the ideas of left and right and “in front” or “behind” or “under.” Letter reversals happen in children with weak visual-spatial relations.

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Visual figure ground skill helps to locate an item in a busy background, which can be a toy box, a junk drawer, or a busy worksheet.

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Visual timing errors between symbol processing and eye movements.

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Letter, number and word reversals in reading and writing

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Visual motor integration and sight word memory





Mastering Perceptual Skills

A remedy for those children with a visual dyslexia diagnosis.Dyslexia is a relatively common reading disability. It affects a student’s progress in reading, spelling and writing from the early years of school. Unchecked, it can limit educational progress throughout life.

Students often think they aren’t smart because they cannot understand why they are having such a hard time reading and writing when their peers seemingly don’t. Parent’s fret about how a child will cope long term.

Dr. David Grisham specializes in how the eyes play a critical role in helping dyslexic students who have the visual sub-type of dyslexia, medically referred to as dyseidesia. This type of dyslexia is caused in large part by a spatial timing error between information processing and the eye guidance system used when reading. Dr. Grisham has created a systematic approach to helping these readers become better –

and more joyful – readers.

We do this by using state-of-the- art optometric techniques and the latest perceptual training educational technology developed by Dr. Teri Lawton, PhD, to resolve the visual and integrative processing deficits that are often at the heart of dyslexia and other reading and learning difficulties.

After an initial Reading Dynamics Assessment, the program begins. Graduates of the Reading Dynamics Clinic tell us reading is so much easier for them. They experience less reversal confusion and are much more efficient in how their eyes process the information on the page.

We track progress by using standardized testing to assess reading levels

throughout the program. In most cases, reading becomes much less laborious and much more enjoyable. All students who complete our course of therapy have improved their reading fluency and sight word recognition, many to grade level and beyond.

A little hard work lasts a lifetime.These gains do not happen overnight. But the benefits of doing it will last a lifetime and are profound. A typical treatment program lasts 4 to 6 months. Students must do home exercises with printed materials and computerized fluency practice three days a week for 30 minutes, and come into the office once or twice a week for 50-minute training visits with our therapist. Periodically, we check their progress with a standardized test. The work done here also enhances the effectiveness of any work the student does at school within remedial reading programs. →

DY S L E X I AR E A D I N G

R E M E D Y

This clinic focuses on these specific areas: Synchronizing transient and sustained visual pathways in the brain (Matching information processing with eye guidance)

Sight word recognition and memory

Reversal confusion of letters, numbers and words

Fluency training (speed and accuracy)

Comprehension and visualization





Dyslexia Reading Remedy

Myopia has increased 66% in the U.S since 1971. When things further away from you are blurry, while objects up close are not, you have a condition called myopia. More commonly called nearsightedness, it is caused by a longer eyeball or a cornea that is too curved. Instead of light focusing on the back of the eye at the retina, it focuses more towards the front, giving you blurred vision.

This is a staggeringly common issue. With more time spent indoors reading and looking at screens, the incidence of nearsightedness is increasing dramatically. By 2020, it is estimated that more than a third of the world’s population will be myopic. By 2050, the number rises to 50%.

Dr. Jeremy Shumaker is a specialist in controlling myopia, with a focus especially on children and teenagers. And there is good reason why. When

myopia starts at an early age – usually after age 6 – it can progress rapidly and further degrade distance vision. If left un-checked, it can double the risk for serious visual health problems, such as glaucoma, cataracts, retinal detachments and other vision loss that can lead to blindness.

The positive news is that our doctors are on the leading edge of research in myopia control that has now proven that specialty soft and rigid contact lenses can significantly slow the advance of nearsightedness.

One such contact lens treatment, orthokeratology, stands out as having the most powerful effect. OrthoK utilizes a small, breathable, FDA-approved contact lens that is only

worn at night as you sleep. That’s when it gently re-shapes the front of the eye. When you wake, you will maintain clear vision throughout the entire next day without any correction at all.

This is a fantastic, healthy and non-surgical way to correct nearsightedness for both children and adults, at a fraction of the cost of LASIK. It dramatically reduces the future costs of glasses and soft contact lenses. But perhaps the greatest benefit of all is that these lenses have now been proven to significantly limit future change. In many cases, progression of myopia is halted entirely.

S T O P M Y O P I A

P R O G R E S S I O N

Visual skills make a profound difference in sports performance. Sports vision training is a focused program for athletes of all levels to train their eyes and brain to work together. We take your specific sport, and customize a program to build your visual skills necessary for peak performance.

If your sport involves a ball of any size – a golf ball to a football or volleyball – then sports vision training can help you become a better athlete. Just ask Steph Curry.

Simply put, sports vision training improves your ability to process what you see. This plays a big part in accuracy, coordination, concentration and balance. Those who can see the stitching on a baseball will know where the pitch is going. Basketball players with great peripheral vision can track multiple players at once. Tennis players who quickly determine the

direction and speed of the ball will be in position to hit the “sweet spot.”

Healing from concussion with vision therapy.We also are deeply involved in helping athletes who suffer from a concussion. Dr. Shumaker is the Chief of the Sports Vision & Concussion Clinic at UC-Berkeley, where he works with student athletes and the community to prevent concussions proactively with vision training, baselining athletes, and vision rehabilitation to deal with the visual consequences of concussions. He brings that wealth of experience with him to Rising Star Optometry and

Vision Academy Optometry.

He is also conducting research at Cal studying how the eyes and brain are impacted by brain injury and how vision therapy can help heal the brain. Working with world-renowned vision scientists, Dr. Shumaker is helping to develop better tests to diagnose and manage concussions through precisely monitoring and analyzing eye movements.

Sports vision training is effective for all athletes.The first step in improving sports performance for all athletes is often being fit with proper eyewear or contact lenses. Once we are sure the athlete is seeing better than 20/20, we move on to vision training.

We start with basic visual skills. Eye tracking exercises improve your ability to “keep your eye on the ball.” →

A L LE Y E S

O N S P O R T S

Lack of attention is often thought as the culprit, but it is actually a visual skill that allows great athletes to track a ball consistently. Eye focusing exercises help your eyes to maximize clarity at all distances in a dynamic environment. Training depth perception improves your ability to quickly and accurately judge the trajectory of a ball.

Integrative skills are next. We improve visual-motor integration with eye, hand and body coordination exercises. We train peripheral awareness, to help you see people and objects “out of the corner of your eye” when your attention is elsewhere.

Finally we work on visualization, another secret of peak performance. The brain does not know the difference between thinking and visualizing hitting the perfect forehand, and actually hitting a perfect forehand.

Using the mind’s eye to pre-play boosts confidence and performance. We often combine all of these skills together, because athletes are constantly asked to perform within a challenging visual environment.

Any athlete will benefit from sports vision training. But be sure to come in if you practice your sport regularly but are seeing little improvement, or if your coach says you need to improve your eye-hand coordination.





All Eyes on Sports

Why we don’t take insurance or Medicare ...We take great pride in how efficient and effective we are in helping our patients, including our willingness to spend whatever time is needed on treatment. Unfortunately, insurance companies set parameters that do not have your best interests in mind and often do not provide reimbursement for vision therapy services. For these reasons, we do not contract directly with insurance carriers and we have opted out of Medicare.

... but how we can help you get reimbursed by your provider. We will help as best we can to facilitate your submission for any “out-of-network” reimbursement for which you might be eligible.

After your (or your child’s) first eye examination, we can produce a “superbill” that includes the amount you paid to us and the relevant ICD-10 diagnostic codes to help your insurer determine your eligibility for reimbursement. The superbill will also include the relevant examination, procedure, and/or material codes for which you were charged. You can use this information to work with a representative from your insurance carrier to determine whether they will reimburse you for future vision therapy services (if necessary).

If vision therapy is done, we can provide you with another superbill at the end of each visit that outlines the

charges, procedure codes, and diagnostic codes that should be submitted to your insurance carrier for reimbursement.

It’s helpful to know that insurance carriers can be divided into two main categories: Vision Plans (VSP and EyeMed) and Medical Carriers (Kaiser, Blue Shield, Aetna, United, etc.) The initial eye examination could potentially be submitted to either your Vision Plan (if you have one) or your Medical Carrier. If vision therapy is recommended, those visits would nearly always be submitted to your Medical Carrier. In rare cases, VSP offers vision insurance plans that include vision therapy.

We’ve also seen that patients with an HSA card or a flex spending account are often reimbursed by their insurers. Even if insurers won’t provide reimbursement, costs can go towards your deductible.

O U RI N S U R A N C E

P O L I C Y

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VISION...physical therapy for your vision, but it’s not just strengthening your eye muscles....

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