What Type of Eye Doctor is the Best for My Child? featuring Dr. Erin McCleary, OD

"Anything that's other than the typical development-wise, I'd  make sure we're getting eye exams...often, a child has an atypical congenital birth history or developmental history. They oftentimes have eyes and vision affected by that as well".

Today we welcome Dr. Erin McCleary,  distinguished optometrist and co-founder of Clear Horizon Eyecare She graduated Summa Cum Laude from UND and is the recipient of the Tole Greenstein Award for excellence in Pediatric and Binocular Vision.
Dr. McCleary has been recognized as both CAO Young OD and Optometrist of the Year, showcasing her dedication and expertise, and emphasizing the importance of quality and comprehensive eye care for all her patients. 

In this episode you’ll hear about:

(05:01) The role of a primary care optometrist in treating children's vision.
(06:42) The various tools and techniques used in pediatric optometry for assessing a child's vision, including preferential looking cards, retinoscopy, ocular alignment, and eye exam health.
(11:49) Common issues encountered in pediatric optometry, such as identifying benign findings like a freckle in the eye, referring out for more serious issues,
(26:03) and dealing with headaches and double vision.
(28:08) The importance of early identification and intervention to address vision problems in children,
(30:24) as well as the recommendation that elementary school children have an eye exam with a behavioral optometrist.
(37:40) The challenges faced when providing care for children with non-traditional caregivers,
(40:09) and the importance of advocacy and social change in improving access to care.

Resources & Links

Contact Clear Horizon Eye Care https://clearhorizoneyecare.com/contact/

Follow us at 4D Vision Gym on Facebook and Instagram @4dvisiongymvt for the latest news and updates. DM us if you have any Vision Therapy related questions - you may hear the answer in a future episode!

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Transcript

Dr. Juanita Collier: Welcome to the It Could Be Your Eyes podcast. I'm your host, Dr. Juanita Collier. Through my decades of work in the field of vision, I've met thousands of patients, parents, educators, therapists, and doctors searching for solutions to the seemingly unsolvable challenging traditional medicines new normal?

We'll uncover that the root cause isn't necessarily what you thought it might be. It could be your eyes.

Hi, and welcome back to the It Could Be Your Eyes podcast. I'm your host, Dr. Juanita Collier, and today have my co-host with me, Jessica Liedke. 

Jessica Liedke: Hello. 

Dr. Juanita Collier: And we are speaking with Dr. Erin McCleary, who is an amazing pediatric optometrist based here in Connecticut, and she really goes into how important that pediatric optometrist role is when it comes to making sure that your child has all of the skills that they need for academic success..

Jessica Liedke: This conversation was really cool because I know you, Dr. Collier and I know the behavioral optometry, uh, world, and we have a lot of friends in the primary care sphere that we don't get to talk to too much. We get to talk about our common friends, but you know, those kiddos have extra, special concerns. So now it's nice to talk about what is your typical kid eye exam look like and why is it important and, uh, what they can mean for those kids' lives.

Dr. Juanita Collier: Exactly. You know, because as a primary care, eye doctor for children, she's kind of seeing everybody with or without concerns. Where in our office, you know, I pretty much see only people who have concerns. So, you know, having her be able to see that full broad range of everything that can happen and then figuring out, you know, who she needs to send to whom, as far as the specialists are concerned, but also how she can help parents understand, you know, what their kids are seeing and how that can be negatively impacting their reading or athletic performance or their behavior and everything of that nature. So tell us a little bit about Dr. McCleary. 

Jessica Liedke: Dr. Aaron McCleary has been practicing advanced Optometric care in Connecticut since 2007 and is very active in the Connecticut Association of Optometrists or CAO.

Having served on the C A O Board of Directors since 2011, she completed her role as president of the C A O in October, 2020. She is at ease working with adults as well as infants and other special populations who may have differing abilities and needs. 

Dr. Juanita Collier: Okay, so now let's hear it from Dr. McCleary herself. .

I think you guys will enjoy this one. 

Jessica Liedke: If you could make a positive change in your child's reading ability and confidence with reading in just 20 minutes a day, he would jump at the opportunity right? Of course he would. The 4D Built to-Read program trains you the parent to become a junior vision therapist and provides you with tools, activities, and support.

You need to give your child a strong visual foundation so they can read, play, and take on whatever challenges they face. If your child is too bright to be struggling and getting low grades, or you've been told that in-Office vision therapy would help, but you just can't find the time to commit. The 4D Built to-Read program may be just what you're looking for at a fraction of the cost.

Visit 4d Built to-read.com or check out the show notes for a link to learn more.

Dr. Juanita Collier: Hi, Dr. McCleary. Thank you so much for joining us today. We're so excited to have you. 

Erin McCleary: Thanks for having me. I'm, I'm happy to be here. 

Dr. Juanita Collier: Great. So, can I know that we're, we just went through your bio, but can you tell us a little bit about what you do and 

Erin Mccleary: your practice? Yeah, absolutely. So I am a co-owner of a private practice in central Connecticut in Plainville.

And while we see all ages in the practice, my subspecialty is pediatrics, so I see lots of little kids from. Several days old, all the way up, uh, school age. And that's where my passion is and where I get my joy. And that's, uh, the big bulk of my practice. 

Dr. Juanita Collier: Great. And what's your practice name so 

Erin Mccleary: people can find you?

Oh yeah, that'd be important. Clear horizon. I care. How 

Dr. Juanita Collier: long have you guys been in practice? 

Erin Mccleary: So the practice itself has been around since 1984. My co-owner, uh, started it back after he graduated from optometry school. I joined the practice unofficially in 2014, and then, um, I became a practice owner in 2016.

So, uh, now currently co-owned and looking to be a hundred percent owner in the next few years. So, lots of excitement. 

Dr. Juanita Collier: Yeah, that's very exciting. 

Jessica Liedke: So what is your role, as I understand it, you know, you are kind of like a primary care optometrist for these little guys. What do you do as a primary care optometrist?

Erin Mccleary: So much like a primary care physician, your medical doctor. I'm kind of like the gatekeeper of their vision. So fortunately we get to, obviously we're following up on. Vision, screenings, failures, any concerns? Um, we also do primary health vision assessments, right, for kids, parents who just want their, their children to get their, you know, eyes evaluat to make sure they're healthy and ready to perform well in school.

But in addition to that, um, if we're identifying any concerns, whether that's. Visual or um, pathology. Then certainly I'm gonna treat where I'm able to, much like glasses or medications or monitoring, special testing, but ultimately like your primary care doctor, if it's something that needs specialty care, then I will refer them out to receive those extra services or additional testing by someone who specializes in that.

So, you know, nuts to bolts. We, we get 'em in, we make sure everything's healthy, and if it's not, we treat and if it's beyond our scope or something needs additional help, then we, we get 'em to the right person. 

Dr. Juanita Collier: I know a lot of our patients ask like, oh, well how can you do an eye exam on babies? And so, how do you do your exam?

Like, I know how I do mine, but how do you do yours? 

Erin Mccleary: Oh, those are some of my favorite exams. I don't know about you. Um, I'm actually an infancy provider with the, uh, the American Optometric Association. The infancy program for our listeners is a program that gives free complimentary vision eye health assessments for infants between six and 12 months, regardless of the ability to pay.

And I volunteer my time to do those exams in. They're seriously the highlight of my day. And my staff stay because these infants are adorable. But my favorite age is that like eight to 10. But to your question specifically, Dr. Collier is, um, we use a lot of objective testing. So, for example, that means I get all of my information without the patient, in this case, an infant being able to tell me anything of their own.

So this means that to check their visual acuity, we'll use something called preferential looking cards, which may have a plain gray card versus a card that has black and white stripes on it. The, uh, various striped cards will go down in thickness and. Visibility so that the child can, they'll like look whatever's most visually interesting.

So if they look at a gray card versus the other one, they can't really tell a difference. But if they're like, oh, I like the black and white stripes. We know, we can see the spaces between, and so we can check visual acuity that way. And then we use some techniques called retinoscopy. Retinoscopy is a special light that we use that can assess the prescription of the child's eyes.

It's the same technique we would use for an adult who maybe be a stroke victim or non-verbal adult who has special needs, um, the exact same way we can check prescription there. We check ocular alignment using very similar techniques to what we would use for an adult or any other age person. You have a.

A fun fixation target. It's something that they like to look at. Controlling head movement. And then for the eye exam, the health portion. Very similar things that we do with an adult, but you have to be creative and have fun things to look at. Lots of funny noises. Sing songy voices and bright lights. So same tools in those instances, but just modified for the, the audience, so to speak.

Jessica Liedke: I know in Dr. Collier's office, she has a, a dancing, singing. Pirate Teddy bear. 

Dr. Juanita Collier: Yes. 

Jessica Liedke: What does he sing? 

Dr. Juanita Collier: I can't even remember. I think I try to block it out when I don't have to have it on. Yeah. Loud. 

Erin Mccleary: Yeah. I think that the best tools to trade. I've got a fuzzy eyeball. I have a squishy frog of a quacking pen.

Um, I got like, you know, those things that used to get at the circus with the bright lights, so mm-hmm. We, we pull out all the fun stuff when the little ones come in. 

Jessica Liedke: Yes. How can families prepare their kids? You know, if you're, well, I mean, a baby is just gonna go wherever mom and dad tell them to go, right?

I miss that age. But when they get a little bit older, and how can families prepare their children to come to the eye doctor? You know, they might hear the word doctor and, oh, am I gonna get a shot? Am I gonna be, they're gonna poke, they're gonna proud. How can we just make our kiddos ready for that kind of exam with you?.

Erin Mccleary: You're absolutely right. I think that's the biggest concern, right? They're always worried about the shot. So I think first and foremost at the eye exam, you can always just reassure the child that there are no shots here. I think being honest is always super important for building credibility and good responses from young children.

The one thing I will say is never tell them that, like if you're getting an eyedrop or something like that in the office, never tell them it's not gonna hurt because the drops that we use, or in my case I use an eye spray depending on the child, they do sting a little bit. And I feel I am always very upfront with the kiddos that if we use something that's gonna go on the eye, I explain exactly what it's gonna feel like.

So a lot of times you just use it in kid appropriate terms, right? Things that aren't scary. So you say this spray might feel a little minty, it's gonna feel like a candy cane, right? Like you don't wanna ever say it's like water because it doesn't feel like water. So I try to be as honest with the children as possible, but a lot of times for the parents in prep for the exam themselves, I would say, you know, you're probably gonna sit in a big chair.

We're gonna look at lots of pictures and lights. The Dr. May touch something on your face, your eyelids or your eyelashes. Lots of flashlights. And ultimately, I think an eye exam for a child is a lot of. So I think just to reassure them that it's not scary and a doctor who works with pediatrics, right?

Someone who works with lots of small children, they're gonna be comfortable and confident in what they're doing, and they're gonna make it a pleasant experience for the kiddo. So lots of reassurance for the most part. 

Dr. Juanita Collier: Yes. I find that it's the parents who are always like, oh, don't worry, it's not gonna hurt.

Mommy gets it all the time and I'm like, Hmm, well you lied to your kid. I didn't like 

Erin Mccleary: all the time. I know. And that, that's the thing. And I actually will in the exam chair. So you bring them up really high in whatever story you're telling the kiddo. For example, if, uh, before I started using a spray technique, when you use the eyedrops, it's all about the story that you build around it sometimes.

So like we would use in our office, um, the magic eyedrops that taste like ice cream and candy. Because you're like, they go in feeling minty, but then they're gonna taste like your favorite ice cream. What's your favorite flavor of ice cream? They're like, chocolate. I'm like, okay, well let's see if you're lucky today.

And like nine times out of 10 you put the eyedrop in the kids' eyes. You're like, oh, I got chocolate. Excellent. Right? Um, those are for the little kids, right? Those are the ones who are like between two and four. Once they get higher than that, they're little too savvy. And then, then you have to like do other techniques.

But, um, And then the spray technique too is a little bit different, but absolutely, you're right. The parents are always like, it's not gonna hurt at all. It's just like water. I'm like, oh, it might feel a little different. And I'll tell 'em, actually, no. It might feel a little minty, but, but they'll be okay.

It goes away super, super fast and we have lots of stickers to pick from afterwards. So, you know, you always have that good distraction technique and, and they'll be fine. Exactly. Stickers can move mountains. 

Jessica Liedke: So when you're taking care of their eye health and saying, okay, let's say that something does pop up.

Let's say that something is found that is a little less than expected or a little out of the ordinary. How do you explain to a child and then to their parents? What is up without sounding the alarms and whatnot? 

Erin Mccleary: Right? The answer to that question is gonna depend a little bit on what you're finding, right?

It will depend on if it is something that truly is concerning or if it's not. I think the, to start with the easy stuff. When you find things like, for example, freckle on the inside of the. Right. That's a very benign finding. It's healthy. It, it's usually of zero concern, but it's something, right? It's a thing in the eye.

Um, and I think a lot of times parents instantly think, oh my God, it's a freckle. We're gonna get cancer in the eye, right? So I think, uh, usually the verbiage that we would use for them and say, Hey, I found this really cool little freckle in the inside the eye. And I'll show them a freckle in my arm and say, it's just like that.

You see how I don't feel anything? Again, you don't feel anything in your eyes, just something cool that we get to look at. Or a lot of times you'll tell the kiddos that, you know, you have something unique. So certain findings in like, uh, teeny tiny congenital cataracts that have no bearing on their vision, you might say, Hey, you have stars in your eyes.

Isn't that really cool? And obviously you, you might kind of then turn around to, to the mom and, and very simply give them the basic anatomy and information, but again, reinforcing, I'm not worried about this whatsoever. So you don't need to be worried about it either. I think conversely, if you find something, for example, things that I see pretty frequently in my office might be optic nerves.

That are kind of swollen or appear to maybe be swollen. That's the, the biggest concern that we'll get in small people Sometimes, a lot of times it can be congenital variation or of normal, but you know, in the instances it's not, it can be very concerning. And so, you know, we're like, we look in the back, we're like, you know what?

Your optic nerve has a little different appearance today. That just means it looks a little different than what we're used to seeing. I'm not really too worried about it right now, but you know what? We're gonna make sure that we're, we're gonna get a special test to make sure that everything's healthy.

And if it's not, then we'll make sure what we need to do to. So I think very basic. Whenever you have something like that, that's scary stuff for the parent. Sometimes it's an opportunity to have, Hey kiddo, you wanna look at this cool thing over here? And then have a little side conversation with the parent.

Again, wailing, any major traumatic response as much as possible and reinforcing the fact that, hey, you know, it's a little different, but let's make sure we get good information before we make any decisions, because that's gonna tell us what we really need to.

Dr. Juanita Collier: I love to take a quick look at the parent's eyes if I see anything that looks like that.

Cause it's like you might see like, oh, like father, like son, and then you're good. Like, you know. So I like to have that little comparison there too, if possible. 

Erin Mccleary: Yeah. And, and every parent's different, right? Like you'll have some parents like, oh, okay, you're telling me not to worry about it. I'm not gonna worry about it.

And then you'll have other parents who will be instantly on the internet, like the moment they step out of your room. And those parents, like, I can tell, I can see that anxious nervous energy sitting in the chair. They're like already vibrating. I'm like, you know what? I do not want you to go looking up stuff online for this.

Like I will tell him, I'm like, just trust me of a lot of experience in this, in especially in those instances, if you're referring them out, you're like, you know what? You're gonna see a great doctor. They know exactly what's gonna be going on, and I'm gonna ask you to trust us on this one. And I don't want you get nervous by looking online because more often than not, anything you find online is way scarier than anything that's really going on.

Dr. Juanita Collier: Yes, the internet is a very, very scary. You can find, you can diagnose yourself with anything on there. 

Erin Mccleary: Oh yeah. Dr. Google man, he needs his license revoked. 

Jessica Liedke: What kinds of things do you refer out for? So obviously there's, there's eye health concerns like retinal things, and what other sorts of anomalies are you looking for that you would refer out for?

Erin Mccleary: I mean, there's several. I think you can probably go to down to enough on the handful, specifically retina. You know, if we have atypical retinal findings, inclusive of optic nerve, they might go to two different specialists for that. Rarely, we might send out to a corneal specialist. We don't see that too often in younger children, but that has happened.

May send out for a specialist for, um, specific misalignments of the eye. Strabismus is the technical term, but if a, if an eye is misaligned and is not able to be fixed by anything I can do, or a vision therapist like Dr. Collier, then sometimes surgery is indicated and that would be a specialist that we would do.

Systemic, we sometimes refer back to the primary care doctor or some of their other subspecialties like rheumatology, um, neurology, specific genetic workup sometimes for some of those kids looping everybody back in, um, to the primary care. And I kind of alluded to vision therapy. That of course is another thing that we refer out to specifically if a child needs, um, hands-on training, coordination, vision, perceptual testing, if they're having difficulties with reading that isn't vision related, that I'm fixing with glasses, if we need to have eye muscle coordination.

Sorts of therapy. That's where we definitely will refer out for. I'm pretty well versed in binocular vision in my own practice. I come from a good background of it, so I, I know enough to get myself in trouble sometimes. One, I know I'm getting a little too deep where I don't have the time or resources within my own practice, and I they pass it off over to this specialist.

Jessica Liedke: Yeah, we've had some friends in common, I believe. So that's, you know, it's, it's always. And so from your perspective, what's the difference between vision and eyesight then? You know, if you're thinking about how vision impacts their learning and performance in all the things that kids like to need to do, what's the difference from your perspective?

Erin Mccleary: I literally just gave a talk to school nurses Wednesday and had this discussion. Oh, great. Yeah, so like, um, for example, the, some of our specialties, optometry and ophthalmology, I think we have very different philosophical background differences in how we view eyes and vision. Specifically, some doctors will view the eyes as an organ and something that purely is designed to have you see, so.

And that's the the vision aspect, right? Being able to see a tree clearly in the park, being able to see the page clearly up close, and that's a focal point issue. That's vision. Being able to see things singly in having the eyes aligned. Those are the anatomical important first structures of vision. But as we all know, that is not the whole story.

The. Site would be clarity singularity, right? Clear and single vision, but truly visual perception in how we see the world around us and how our brain makes sense of that is very different in addition to how it functions. We see this, especially in pediatrics, in the whole reading, learning to read, reading to learn if things aren't working right.

There's a misconnect between either the clarity of the vision, the ability to change focus, having the eyes align where they need to, having the eyes move, coordinated well on the page, things are gonna move around, they're gonna jump. You lose your spot. You can't make sense of what you just read. You can't retain it.

No comprehension your fluency. Those are all the bigger aspects of vision and functionally how it impacts your educational career. So very different, right? My job right in my office is to one a number one, and what every parent comes in wanting to make sure is that the kid can see, right? That's the, the site part.

They wanna make sure, can they see the board, can they see the page, can they see the baseball, right? That's what they wanted to, to make sure it's functioning. And often we're having that conversation in the exam. When we do identify deficits that no eyesight and vision are more than what you think it is, and this is why, you know it's impacting their daily life in other ways and their schooling, and this is what we have to work on.

So my job, first of all, is make sure, yes, they can see. They got glasses. Give 'em glasses where they need it. If they have a hard time focusing or changing their vision from distance up close. Okay, I can fix that with glasses sometimes, right? Sometimes it's a teeny, tiny misalignment of the eye that needs to be fixed with glass.

Those are all very easy, and then sometimes we need more. Whether or not that's additional testing to see where the deficits are, or, hey, we really need to make those eye muscles stronger, they need to work better together. Or they're having a hard time figuring out what's the important stuff on the page versus the not important stuff, and that's a processing issue.

And that's when I send out to, to folks like Dr. Collier, we wanna make sure that we're working on those things. And those require therapy. They require a hands-on training and they require practice at home. And those are things that I don't necessarily do in my office. 

Dr. Juanita Collier: And so, Obviously, like we do essentially just vision therapy.

So I am pretty much a referral only practice, and I get referrals from, you know, eye doctors like you, and so you'll kind of see a much broader range of kiddos than I do because most kiddos don't actually need vision therapy. Most kiddos are just, if they need something, it's like a little bit of distance, glasses and like, you know, make sure their eyes are healthy and they're on their way.

What sort of questions should parents kind of think about before they come to you? Or like, what sort of things should they ask their children before they come to you so that they have those answers and kind of have an idea of how to relay what's going on with their kiddos? Cause most children aren't actually gonna be complaining about anything.

Oh, so you know how, what probing questions do you recommend parents ask their kiddos before they come to see you so that you can best point them in the right direction? 

Erin Mccleary: I will say that oftentimes I am the one in, and I'm gonna answer that question in a circle here in a second, but 

Dr. Juanita Collier: I asked it in a circle, so you know, 

Erin Mccleary: so, so I basically write, because as you're doing the examination, you're identifying the little clues, right?

I'm identifying the little breadcrumbs and then, A lot of times parents don't come in with any symptoms. They're like, oh, hey, they, you know, it's like they were seeing 2030 on the chart and that's the only thing that made him come in from his vision screening. And, um, I'm like, as I'm doing my assessment, oh, so my first question's like, are they getting any reading help at school?

How are they doing a reading in school? That's always my first question. Oh yeah, no, he's been seeing a reading specialist for like two years. I'm like, okay. The other big one, uh, is headaches or eye fatigue. Inability to keep on task, right? Like if they have a hard time kind of focusing and you know, sticking their nose into their book and doing their homework for 10, 15 minutes, if they can't even do that, you know, obviously there's something going on whenever you have parents who say, oh yeah, he's not a reader.

His sister was a reader, but he's not a reader. I'm like, okay, well there might be a real good reason why he's not a reader. 

Dr. Juanita Collier: They also say that for athletics too. They're like, oh, he's just really clumsy. It's like, okay, yes. He also sees double, so, yeah. Right. 

Erin Mccleary: Yeah. So I think I, I'm, I'm thinking more from the academic side, right?

So I think right off, those are the big things. Uh, um, having reading. School, having the, uh, headaches are always one inattention. I will also say that I always follow up questions and things that parents can be aware of is just behavior in general, right? So, um, I find, uh, in my practice so often, A good example of something that's super easy fix with glasses and isn't necessarily even in your wheelhouse, but um, specifically it's just under corrected hyper ropes or kids who are farsighted.

So often a child has a significant amount of farsightedness where they will pass every single screening they have in school because they can see far away no problem, but the moment they have to focus up close, it's d. And if we can't maintain that vision at near, what do they do? They wanna live out.

These are the kids who can't sit still. They're maybe labeled a D H, adhd, A d D, and they're thrown medications before they ever had an eye exam. So I always say if there's any sorts of underlining things that you're gonna get meds for, for psych stuff, you may make sure you get an eye exam too, because oftentimes that can be an underlying issue.

But certainly to your point, um, Dr. Collier with the. Sports as well, if they're having a hard time hitting the ball in baseball or, or tracking. I'm not from the New England area, so um, I'm not familiar with lacrosse, but I know that's big out here. So, you know, like small high velocity targets, things like that.

For sure. So I think as a parent, I would say outside of just seeing the things in school or the page behavior, headaches, quality of vision, any other assistance that they're requiring, anything else. And also I might add any time a child is receiving any kind of services, birth to three, if they have any hearing deficit.

If they have any, uh, congenital anomalies, if they have, uh, their preterm infant, anything that's other than the typical development-wise, I would definitely make sure we're getting eye exams because so often a child has an atypical congenital birth history or developmental history. They oftentimes have eyes envision as affected by that as.

And twins too. 

Dr. Juanita Collier: Yes, very true. For our parents, we definitely ask them to, you know, inquire about double vision because usually parents find out for the first time that their child's seeing double when they're, you know, in my exam chair. Mm-hmm. And the kiddo's like, oh, but I know which one's the real one.

And so it's like, you know, that's like really hard for a parent. It's like, why didn't you ever tell me? They don't realize that how they're seeing isn't. How you see, because vision is like such a personal experience.

Erin Mccleary: I will say too, to that point, a lot of times children don't have the words to articulate what they're seeing.

Two parts to that. One is they don't think it's, you know, that's their life experience. So they don't realize that what they're seeing or what they're not seeing is not how every other kid is or is not seeing either. So oftentimes when you. Like someone who just needs a really high powered pair of glasses and like the parents are always dumbfounded and they're like, but they can see like everything.

Like, or they're functioning right? They're high functioning in school. And I'm like, yeah, but they've never known anything different. They couldn't tell you that, you know, they don't have an experience of clarity to tell you like, this is blurry, right? This is their life. So they don't even know that they have a problem.

And to your point, your example that you gave with, uh, double vision. A lot of times double vision is not as simple as one and two, you can have that one image that's just slightly fuzzy on the edges, right? It's not that high deaf image, right? And so you have teeny tiny diplopia or double vision and not even really know that it's truly happening.

It could just look blurry. And so I think, yeah, trying to find clarity. Words in vocabulary can be difficult depending on the age group that you're working with too. 

Dr. Juanita Collier: And also to circle back on your statement about like under corrected hyper ops, so those kiddos who seem like they can see fine for distance and then, and that's really all that's checked for at the pediatrician's office and mm-hmm.

You know, at a school screening, but then up close, it's like too much for them to try to like ramp that up all the time. There's so many juvenile delinquent studies mm-hmm. That, you know, link. Their juvenile delinquency to uncorrected hyperopia because it's like, it's too hard to focus academically. So it's kinda like, well, let's do what I'm good at or something, you know?

Let's do other things. 

Erin Mccleary: It's like we're sharing a brain, Juanita, because I literally, during this talk I had on Wednesday, I talked about the studies that have like incarceration rates. In how so many people who are incarcerated come from childhood juvenile delinquency, which is all stemming from uncorrected refractive air glasses or visual function.

And it's insane. Like if you look at the percentages, yes. 

Dr. Juanita Collier: Exactly. We were working with one superintendent, um, when I first started practicing, and she was saying that they determine how many jail cells to have in an area based on the literacy rate in third grade. Mm-hmm. Like, that's so crazy. But it's,

Erin Mccleary: it's so sad.

Dr. Juanita Collier: It is

Erin Mccleary: and so many of those things are fixable with the right resources and the right professionals. Right. If you get in. 

Exactly. So it's like if they know this, if they can like link whatever's gonna happen in the future based on your literacy late in third grade, then how about we get them more literate in third grade?

Like how about we do that instead of building more jail cells? You know, that's a hundred percent what we're doing now. Right? One pill at a time. 

Well, and that's the thing too, I think about that, that part too with advocacy, right? And I think. Information and education for the appropriate people. And I think one of those, in addition to like having talks with school nurses and the early identifiers and talking about how.

Eyesight and vision are not necessarily the same in function, right? That's one in, but you're already in the middle school or elementary schools. But even getting pediatricians on board that, hey, a screening sometimes isn't enough, and then subsequently letting legislators know, Hey, just in 2020 in the distance is not enough for successful education.

Like you should be having mandated eye exams. This should be what we should be looking for in all states. I mean, some of our state colleagues are doing it, but we're, we're not quite there yet here in con. But I'd love to see that changed. 

Jessica Liedke: We just learned that in Connecticut, talking about like school screenings that it's required.

What did Kim say? It was like required for kindergarten, first grade, third grade, fourth grade, fifth grade. But like they skipped second grade for some reason. Isn't that right? 

Erin Mccleary: Yeah. They skip second and then they don't do anything in middle school and beyond. 

Dr. Juanita Collier: Second grade is like where everything like goes crazy cuz in third grade is when you get your glasses.

So it's like, you know, like the weekend

Erin Mccleary: always. Yes. I got my glasses right. 

Jessica Liedke: Yeah. I was just, my, my son is in first grade and uh, we had his parent teacher conference last night and I was talking to his teacher about in first. They're expected to jump seven reading levels, but in second grade it's only like three because they're very intense reading levels.

So if that's the time that we're not checking to see what's happening visually, like, oh gosh, 

like it makes. Me just really concerned as a mom, like, oh, how am I gonna make sure, well I know on our side we're fine, but how am I gonna make sure all my son's friends are gonna be okay? You know? That's just, it's so much for these little systems to take on.

Mm-hmm. And then I really love your point, Dr. McClary, of like advocating at the state level, really making it known, making everybody aware how important this. 

Erin Mccleary: Well, and that's the thing, right? These laws are made by people who are not physicians. They're not, you know, um, early learning education. I mean, they're talked to, they're tried to be educated by these professionals, but ultimately they're not the ones who are making the laws.

So it's so important for professionals to be actively involved in all of those things. 

Dr. Juanita Collier: So parents often ask me, you know, at what point should somebody see a behavioral optometrist? And for me, I say like, you know, I think that every child in elementary school should have at least one exam with behavioral optometrist.

So we can look at everything soup to nuts. I know that a lot of parents like to take their kids to their eye doctor. So for what you see as a, as someone who specializes in pediatrics, at what point do you think. A parent should make sure that they're checked by a pediatric optometrist, or do you think that, you know, only if the general optometrist is finding something or how do you explain that?

Erin Mccleary: Hmm. That's kind of tricky because I, I consider myself, you know, obviously subspecialized in pediatric, but because I do all ages, right, so it kind of depends on the doctor, I think. Right? Because there are some doctors who. Who may be a hundred percent comfortable seeing children and doing everything that I do in my exam room and just don't consider themself, right.

A pediatric, they're like, okay, I see like a four year old every once in a while, or I see a two year old. But they can, they have the skillset set to be able to do it, but I, I definitely feel like if they don't pick up a retina scope in the exam room, you needed to see me. Um, like if, if they are prescribing off of an artery fracture, they needed to see me.

So I, I think certainly. If there's any question at all, if there's any baseline concern or if there's a failure or, um, out of norm, and if the the doctor isn't able to get to a satisfactory explanation or treatment plan, then they should probably have a follow up or a second opinion. I will say that fortunately in our community in Connecticut, our optometric community, We tend to be pretty good at self referring to our colleagues who we know specialize in things that maybe we don't see all the time, um, or don't have the skillset or the time to deal with.

So we're pretty fortunate here, and I will say, because I see everybody all ages, I love seeing family members and then subsequently seeing the kids or how it usually goes as I see the kid first and then I see all the family members later because so often you are uncover. Those familial and genetically linked things that you're seeing on a regular basis?

I know it's kind of a tough question for me to answer specifically for when to see pediatric versus not. I think it's just their skillset and comfort level. 

Jessica Liedke: So since you see all ages, what is your favorite part about working with kids? 

Erin Mccleary: I think that my favorite part now, and this is not what actually the eye doctor should be answering, right?

But my favorite part is the, the creativity and enthusiasm, right? Like that's the best part of seeing little kids. They wanna tell you about this cool Lego thing that they made and they're showing you their new sneakers and their favorite animals like that. That's the fun thing. That's what teachers love about seeing little people, right?

So it's the same. I think that's universal from the optometric vision side. I think the, the fact that I can make a really big important. Very early on for these children. For example, the nine month old who has, um, you know, an eye turn and is a plus nine prescription, and I give them that first pair of glasses and all of a sudden they can see the world and their eyes are straight, right?

Like, those are the ones you don't see every day, but they're super impactful. Or if you have a child who. Anytime you, you give glasses to a kid who's underperforming in school and they come back and the parent's like, oh my God. They either, they went up four reading levels in six months since they got their glasses.

And you just think what an impact that's gonna have on that child's entire trajectory. And if they hadn't seen me, Where would they be? They hadn't gotten that care. And I think also outside of vision too, some of those other kids are symptomatic with like headaches. Like I see that too sometimes, where like kids are non-functional, they're getting daily headaches, sick to their stomach, had one recently and gave her a special pair of glasses and they came back four months later, like she hasn't had a headache in four months.

And like she's a different kid, right? Her whole life is different because she's feeling good and she can function and interact with her friends how she wasn't before, so. I think when you can make a, a difference in a kid's life early on and you know that it's gonna impact things down the road, that that's the best thing about seeing pediatrics outside of all the fun stuff that you get to do.

And you get to be a little bit of a kid yourself, right? You get to be goofy and I get to sing all my songs and makes silly voices and noises and it, it breaks up the day, makes it a lot more enjoy. Definitely. 

Dr. Juanita Collier: So a little bit about like Erin, the person. So do you think that, cuz I know for me personally, and I think that Jess has said this before too, once I had children, how I interact with children in my exam room has been like so different.

And it's like I feel like I get them Before it was like a concept and it's like, oh, you like hang out with your friends' kids sometimes, but like I feel like it definitely changed how I practice. So do you feel like that's been the case for you?. 

Erin Mccleary: Oh yeah. Well I think and, and I'll even take it a step before, right?

The premo and the after mom doctor, right. So for what it is, I think just being a female optometrist, we get a leg up with families anyway for whatever reason. I think that nurturing classical stereotypes, I think a lot of times kids sometimes just feel like you're less threatening. You families kind of connect with you more.

Taking care of their small children. It's easier. And I think we're lucky in that sense, in that you don't have an extra barrier to work through. We're. A little bit more approachable, and I'm short in stature, so for me too, and I'm not like this big tall person. Uh, so I have to raise the chair up really high, you know, so, so I think beforehand I had always an easy time kind of connecting with kids for the most part, but a hundred percent once I had my own children who are now eight and 11.

Um, and you've walked through every developmental. Level with them. You have so many more things that you can kind of talk to the kids and the parents while, and you can like, I can really connect with them, right? Because I know what cartoons are you into at certain ages? Right. And I've experienced that child going from pre-K through kindergarten in the magic of reading that happens in kindergarten.

Like kindergarten is the most magical year academically. You have kids who start and they. What, five site words, 10 site words, and by the end of that year, they're reading these little books. Right. And that's amazing. And I think kindergarten teachers are way underpaid. So I think absolutely you can relate with them so much better.

And I think as a parent, It makes it so much easier to have those conversations with the parents of the children that you're seeing. Yeah, because for example, if you're recommending glasses or therapies, things that you need to do at home, right? You're like, I know there's not a lot of time. I get it. You can identify where those pockets of time might be when you have small children at home.

And you know, as a parent too, I think the things that would be scary for you and, um, you feel it in a different way than just being a simple healthcare provider in identifying as a compassion based patient, right? You can say, oh, as a parent, this would really scare me or freak me out, or, oh, that, that's so much more reassuring.

So, I use my parenthood with the kids when I'm doing like eye spray or an eye check, I'm like, oh, hey, I have my kids' pictures on my desk, right? So I'm like, oh, that's Aubrey and that's Henry. And oh, he's the same age as you, or He did this when he was your age. I'm like, you know what? Anything we're doing today, I've done to them.

And I would never hurt my kiddos. I would never scare them. So we're not gonna do anything like that to you today too. Right. So I think it helps build extra trust with them as a patient, but also with the parents as well. 

Dr. Juanita Collier: And I think that a lot of parents come in, especially like the ones who've been referred to me, it's like they have a lot of that guilt around like, why didn't I see this before?

And all of this stuff. And you know, and I think. After I became a mom, it was much easier for me to be like, no, really? Like he's alive and his clothes are like semi clean. Like you got this. Like, 

Erin Mccleary: I think one of the best things I ever learned when I was in rotations for optometry school and I, I do this every single day when every single patient.

But to that point, right when you, you can see the mom there, she's tearing up. Yeah. Like, oh my god. Right? And she feels so horrible. So first of all, the good thing. There is always a good thing in that nothing else other than you are here today. Today we are identifying it. We're gonna find it, we're gonna fix it.

Right? So this is the best you could have done. We're here, we're gonna, you know, we're gonna make it better. And I think even if that's the only good thing we got going on that day, there is something, and I think to reiterate that to the parent, For sure, especially in those instances where maybe they didn't see a pediatric doctor at first and they're seeing me when they're nine and they're a plus four and one eye and a plus one and one eye.

And I'm like, oh my God, why didn't they see me like five years ago? You know? So I'm like, okay, well you know what? This is what we got. We're gonna work with it and moving forward. Exactly. But yeah, I mean, you're doing the best you can sometimes. And I think, you know, this whole discussion we've been kind of talking about.

Maybe more of that traditional family network too. Right. And I, I think we can't also, um, identify the children who come from a various home setting. Mm-hmm. Right. They, they may be going through, uh, DCF foster homes, they may have non-traditional caregivers, grandmas taking care of them, and those situations bring up other stress.

And other variables that can make getting the appropriate care at the right time very difficult. And so, you know, he is just identifying, you know, the, the stumbling blocks that we have to work with. And I think I see that too. I'm not sure about, maybe your, your practice base is a little different, but getting follow-up care can be really hard for some of these children as well because the kid can't drive himself to my exam.

So I'm really reliant on their caregivers. And sometimes if you have an unreliable caregiver, that makes it really tough and I think that's the hardest. Of my job is the, you know, that the parents, one who aren't on board have other priorities than their child's vision and function in school, or just being there to get them the care that they need.

That's, that's the hardest part. 

Jessica Liedke: Yeah, I think it's definitely. A hard thing because whenever you're dealing with a child, you're not just dealing with a child. You are dealing with their family and everything that comes along with that family and everything that comes along with that home and everything that comes along with that community.

There's a lot of different barriers with different things. You know, it could be a language barrier or it could be just like Mom is a single mom who's working, you know, 60, 70 hours a week and she would love nothing more than to be able to sit with her child and give her child the care that he or she needs, and then life gets in the way.

That's just how it is and, and it's kind of like, you know what you were saying, Dr. Carly, you're like, well, you're here and you're wearing pants. 

Good job. You know, you can ming it this one time. It's okay. 

We're good. We got you. And so some of what we've been talking about today is all about our social change, our social climate.

We need to advocate. Everything is so systemic, you know, we need to advocate for more awareness of how important vision is for each. For education, for criminal justice and social wellbeing, but also we need to be able to provide the social support systems for our families to be able to access the care.

Mm-hmm. We have a lot of financial barriers. We have a lot of insurance barriers in the therapy world. We have huge insurance and, and financial barriers. Yes. And. A giant challenge that we're, we're trying to be very creative to overcome, but then it's wonderful. We have programs like infancy, where regardless of income, regardless of family circumstances, we can provide care to the youngest citizens.

We would just love to see that continue to help identify, right. Those other problems that could come on. So then if you get that early awareness, then that helps. Woo. We're gonna change the world. I don't know about y'all. 

Dr. Juanita Collier: There you go. Let's do it. 

Erin Mccleary: I hope... it's nothing better, for sure. Right?. 

Dr. Juanita Collier: Well, this was so great.

Thank you so much Dr. McClary, for joining us. Can you just tell our listeners again where to find you and where they can have an exam with you?? 

Erin Mccleary: Oh, absolutely. So, um, at, Clear Horizon Eyecare in Plainville, Connecticut. So, uh, close to, you know, the center of the state and, uh, more than happy to, to help all the littlest people that we can.

Dr. Juanita Collier: Great. Well, thank you so much for joining us today. We hope to have you back soon. 

Erin Mccleary: Love to. Yeah. I could talk kids all day, every day. Awesome. 

Jessica Liedke: Thank you for tuning in to this episode of the It Could Be Your Eyes Podcast. 

To schedule an appointment with Dr. Collier, visit us@4dvisiongym.com To train your vision at home, visit us at 4D Vision therapy@home.com.

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