Tag Archives: dyslexia

Dyslexia-or-Learning-Disability-Diagnosis

Dyslexia or Learning Disability Diagnosis? Get a Second Opinion from a Developmental Optometrist

The Visual Learning Center offers
developmental optometry & vision therapy
in Olney, Maryland,  near Silver Spring.

Has your child been diagnosed with dyslexia or a learning disability? You may want to get a second opinion from a developmental optometrist.

When a child has trouble with reading, learning, or test performance, teachers and parents often suspect a learning disability or dyslexia. However, what appears to be a learning disability might actually be an undiagnosed learning-related functional vision problem that can be treated successfully with vision therapy.

Although parents would rather their child not have to face the challenges of living with a learning disability, sometimes a diagnosis can come as a relief. Now that you’ve identified the problem, you can begin working with specialists who can help your child develop healthy and productive coping strategies.

But if your child’s diagnosis is not correct, they could be struggling unnecessarily with a condition that is treatable with vision therapy.

Here’s why so many children are misdiagnosed:

  • Standard eye exams and vision screenings will not detect learning-related vision problems. So, unfortunately, many children are misdiagnosed with learning challenges without ever undergoing a comprehensive vision exam by a developmental optometrist trained in functional vision care.

  • The signs and symptoms learning-related vision problems practically mimic dyslexia and other learning disabilities, sometimes with only subtle differences.

  • Most teachers, educational specialists, and occupational therapists have never been trained to recognize the symptoms of learning-related vision problems. They receive training in detecting possible learning disabilities and other special needs. However, the majority of education professionals are unaware of how common learning-related vision problems are.

A learning disability is a neurological disorder that indicates a person’s brain is “wired” differently. Children with learning disabilities are no less intelligent than their classmates, but they may have difficulty learning through conventional teaching methods. A child with a learning disability may struggle with reading, writing, math, organizing information, memory, or with reasoning skills.

Examples of learning disabilities include auditory processing disorders (difficulty understanding spoken language), dysgraphia (difficulty with writing), dyslexia (difficulty understanding written language), dyscalculia (difficulty with math problems and concepts), and nonverbal disabilities (difficulty with spatial and facial cues).

Learning-related vision problems may present almost identically to some learning disorders. But many vision deficiencies and disorders can be significantly improved or even eliminated permanently with vision therapy.

Both a child with a learning disability and a child with a vision deficiency may:

  • Transpose, omit, substitute, and reverse words and letters when reading and writing.
  • Appear restless, fidgety, or distracted in a classroom setting or while doing homework
  • Have difficulty staying on task, paying attention, zoning out, and daydreaming
  • Have poor coordination or fine motor skills
  • Struggle with reading, writing, spelling, comprehension, and memory
  • Seem bright, articulate, and may have a high IQ, but they are unable to read, write, spell, or perform as well as expected on exams and standardized tests 
  • Learn well through hands-on experiences; dyslexics tend to be helped by being able to observe and use visual aids, but those with visual deficiencies do better with oral coaching.
  • Have difficulty with time; dyslexics have trouble with sequences and time management; those with vision problems have trouble telling time on a clock dial.

But your child might not need to learn differently. Instead, your child may need to undergo a treatment program to train and reinforce vision skills, with lasting results.

To be clear, vision therapy does not cure dyslexia, developmental delays,  or learning disabilities unrelated to vision. A child with an undetected vision disorder may be misdiagnosed with a learning disability; but a learning disability such as an auditory or language processing disorder, cannot be treated with vision therapy.

Additionally, it is important to note that many children who have learning disabilities and developmental delays also struggle with vision problems. If your child has been diagnosed with developmental delays, and they are not making expected progress from working with an occupational therapist or in another type of learning developmental therapy, it could be due to an undetected vision problem that can be treated with vision therapy.

The only way to rule out a vision problem is with a comprehensive vision exam by a developmental optometrist who specializes in functional vision care.

For a comprehensive exam and vision therapy in Olney, Maryland or Silver Spring, schedule an appointment with Dr. Philip Nicholson’s Visual Learning Center.

Register for an upcoming webinar here.

letter reversals

Letter Reversals: Is it dyslexia or something else?

 

When parents notice a child reversing letters, they often suspect that the child could potentially have dyslexia. Dyslexia is a language-based learning disability that causes difficulty with reading, writing, and spelling.

Writing letters in reverse is one of the most well-known and recognizable signs that a child may have dyslexia. So when a child is experiencing difficulty learning to read and also reverses letters, it’s reasonable to speculate that dyslexia could be to blame.

However, many parents and educators are unaware that letter reversals are also a common symptom of vision problems, such as eye movement disorders and visual processing deficiencies.

Click here to learn more about how vision problems interfere with learning.

If you notice that your preschooler through first grader is reversing letters, there’s no reason to be concerned. When a child is learning to read and write, confusing left with right and writing letters backwards is a perfectly normal part of the early development process. But if you notice that your child is still reversing letters in second grade and beyond, it’s time for a proper evaluation — a comprehensive vision exam by a developmental optometrist who specializes in functional vision care and vision therapy.

Typical vision screenings do not test for the learning-related vision problems that have similar symptoms to dyslexia. An exam by your family eye doctor usually only evaluates clarity of vision at a distance. So it is important to note that children with 20/20 eyesight may also have a vision disorder.

In addition to reversing letters, children with learning-related vision problems face many of the same challenges as children with dyslexia. They may confuse left with right and transpose words, have messy handwriting, experience and experience difficulty with peripheral vision and depth perception. Many struggle with reading comprehension. Some also have trouble staying on task and paying attention.

transposing letters and letter reversals

 

There are subtle differences between the symptoms of some vision disorders and dyslexia. Even a professional trained to recognize dyslexia may not suspect a vision deficiency without specific awareness.

Whereas dyslexia is a lifelong learning disability that many people learn to cope with successfully, functional vision problems can be treated and overcome. That’s why if you suspect dyslexia, it would be in your child’s best interest to rule out a functional vision problem that can be treated successfully with vision therapy.

To be clear, vision therapy does not cure dyslexia, but learning-related vision deficiencies that have symptoms similar to dyslexia can be improved and even eliminated by vision therapy. 

See our vision therapy success stories.

This video demonstrates a vision therapy activity that can improve letter reversals in children with vision problems:

Click here to learn more about this vision therapy activity.

To schedule a comprehensive functional vision exam and to learn more about vision therapy in Olney Maryland or Silver Spring, Maryland, contact Dr. Philip Nicholson’s Visual Learning Center.

boy with glasses

What Vision Therapy Can and Cannot Treat

Vision therapy helps children with vision problems develop or improve visual skills, abilities, and efficiencies. If your child is diagnosed with a functional vision problem or visual processing disorder, an individualized vision therapy treatment program, under the supervision of an optometrist trained in developmental and functional vision care, can significantly improve or correct the visual deficiency.

Some visual conditions cannot be treated adequately with just glasses, contact lenses, patching, or surgery. When appropriate, these conditions are best resolved through a program of vision therapy.

Effective vision therapy is an individualized treatment program designed to correct visual-motor and/or perceptual-cognitive deficiencies. Sessions include procedures designed to enhance the brain’s ability to control eye focusing, eye teaming, eye tracking, or visual processing.

Click here for 9 Signs Your Child May Have an Undiagnosed Vision Problem

Here are are just a few examples of conditions that affect vision and interfere with learning, which can be treated successfully with vision therapy:

Accommodative (focusing) dysfunction

A child with an accommodative disorder has trouble using his eye muscles appropriately to bring an object into focus clearly or to maintaining focus for a sustained period of time. The muscles that focus the lenses in our eyes have to adjust quickly (and often) to see various points of visual interest clearly, or sustain that clear focus over a period of time, without vision becoming fuzzy or blurred. Vision therapy can treat accommodative disorders successfully.

Amblyopia (lazy eye)

A child with amblyopia has reduced vision in one eye because normal and healthy connections between the child’s eyes and brain did not form correctly during developmental stages. The deficiency causes the brain to favor one eye over the other and suppresses images from the affected eye. Vision therapy can treat amblyopia successfully.

Strabismus

Strabismus is a condition in which the eye is either constantly or intermittently turned – usually inward or outward (often the cause of amblyopia). In a child with strabismus or other similar alignment problems the eye that points straighter becomes dominant. In severe cases, surgery may be required, but vision therapy can treat strabismus successfully.

Convergence insufficiency

Convergence is the ability to aim one’s eyes at a near distance, and children with a healthy visual system are able to aim their eyes naturally and easily.Convergence insufficiency is a medical condition in which the brain has trouble accurately, efficiently, and comfortably coordinating the eye muscles to see properly for a prolonged period of time at reading distance. Vision therapy can treat convergence insufficiency successfully.

Visual Processing Deficiencies

Normal visual processing requires a complex system of neurological activity to be developed and functioning properly. Many children lack good visual processing skills. Because of a delay in development or disorder, their vision system has trouble computing visual input, leading to problems with visual-motor integration and speed, visualization, visual memory, and more. Vision therapy can treat visual processing problems successfully.

Unfortunately, a lot of children continue to struggle unnecessarily due to undetected vision problems that can be treated successfully with vision therapy. However, one reason so many vision problems go undiagnosed is that they often resemble similar problems that cannot be treated with vision therapy. As parents discover the remarkable results achieved in vision therapy programs, it’s important to understand that vision therapy is not a miracle cure for untreatable conditions.

Some examples of conditions that vision therapy does not treat include:

Myopia, Hyperopia, Astigmatism

Vision therapy does not treat nearsightedness (myopia), farsightedness (hyperopia), or astigmatism. Children with these common condition, which blur vision, are prescribed eyeglasses or contact lenses to optically correct the problem, by altering the way in which light enters the eyes. Myopia, hyperopia, and astigmatism are all caused by an irregularity in the length of the eyeball itself or curvature of the cornea, and therefore cannot be corrected by vision therapy. (Note: Vision therapy is sometimes confused with the Bates Method or the See Clearly Method which do not have the same scientific basis or reputation as vision therapy.)

Dyslexia

Vision therapy does not cure dyslexia. the signs and symptoms of dyslexia and learning-related vision problems practically mimic each other, with subtle differences. Even a professional trained to recognize dyslexia may not suspect a vision deficiency without proper awareness. Dyslexia cannot be cured, though many learn to cope with it well and succeed; however, learning-related vision deficiencies that have symptoms similar to dyslexia can be treated and even eliminated by vision therapy. Click here to learn more.

Unrelated Learning Disabilities or Developmental Delays

Vision therapy does not eliminate developmental delays or learning disabilities unrelated to vision. A child with an undetected vision disorder may be misdiagnosed with a learning disability; but a learning disability such as an auditory or language processing disorder, cannot be treated with vision therapy. Many children diagnosed with learning disabilities and developmental delays also struggle with vision problems. If your child has been diagnosed with developmental delays, and he or she is not making expected progress from working with an occupational therapist or in another type of early learning developmental therapy, it could be due to an undetected vision problem that can be treated with vision therapy.

Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD)

Vision therapy is not an antidote for ADD/ADHD, as it does not directly treat impulsivity, hyperactivity, or inattentiveness. However, some children are misdiagnosed with attention deficit disorder when the symptoms they display are actually related to a vision disorder. Teachers might describe your child as distracted or antsy, report that your child daydreams in class, stares out the window, or looks around the room when he should be focusing on his paper or the board. You may have noticed that your child has a short attention span, difficulty staying on task, or following instructions. If the child has a vision problem, he may be diverting his eyes to avoid strain, “acting out” due to frustration, or coping by avoiding tasks; but if the problem is unrelated to vision, vision therapy will not help.

Test Performance in Children with Healthy Vision

In the competitive environment of an educational system that relies heavily on standardized testing, some parents look for creative methods to give their child an edge. You may have learned that vision therapy has helped a friend’s child improve test scores or grades and wonder if your child’s performance in school could be boosted by vision therapy too. Vision therapy does not improve performance in school or tests for children who do not have vision disorders. However, many children could benefit from following these tips to ease eye strain.

When your child is having trouble in school or difficulty learning, it can be confusing and troubling for you as a parent.

Learn more about how vision affects learning by watching this webinar for parents.

Fortunately, vision therapy addresses and treats learning-related vision problems that might be holding your child back. But the first step is always to determine if your child does indeed have a vision problem.

So check for these 9 signs; and if you suspect a problem, schedule a comprehensive vision exam by an optometrist who specializes in functional and developmental vision care right away.

If you are located in Olney or Silver Spring, Maryland, contact us for an appointment.

dyslexia or vision problem

Is it Dyslexia or a Visual Processing Problem?

When you notice your child reversing letters or words, your initial suspicion might be that your child has dyslexia. The truth is, reversing letters is common when children are first learning to read and write. If you notice letter reversals in Kindergarten or first grade, there is no reason to be concerned, because reversing letters, confusing left with right, and mixing up words are normal behaviors in the learning and development process. If a child continues to reverse letters and struggle with reading in second grade and beyond, it is time to start paying closer attention to other signs and symptoms.

If you suspect dyslexia, have your child evaluated by a reading specialist and your family doctor, who may refer you to a cognitive psychologist or another professional for testing. There is not one simple test to diagnose dyslexia, but instead a series of comprehensive evaluations and the systematic elimination of other problems.

Visual processing skills deficiencies and oculomotor disorders are sometimes overlooked, because awareness about how closely their symptoms overlap with dyslexia is not as widespread as it should be.

Determining whether your child has dyslexia or a vision problem is critical for your child’s well-being. Dyslexia cannot be cured, though many learn to cope with it well and succeed; however, learning-related vision deficiencies that have symptoms similar to dyslexia can be treated and even eliminated by developing skills through an individualized intensive vision therapy program.

Only an optometrist trained in developmental vision care can diagnose a learning-related vision problem through a comprehensive functional vision exam.

In both dyslexia and learning-related visual processing problems, children:

  • May confuse left with right, while dyslexics might also be ambidextrous and just as often confuse over with under.
  • Have difficulty with writing and messy handwriting; dyslexics may also grip their pencil in an unusual way and tend to have illegible writing.
  • Have problems with depth perception and peripheral vision; but dyslexics are also known to have keen and observant vision skills.
  • Tend to have trouble reading with little comprehension.
  • Transpose, omit, substitute, and reverse words and letters when reading and writing.
  • Have difficulty staying on task, paying attention, zoning out, and daydreaming.
  • Complain of dizziness, clumsiness, nausea, and headaches while reading, playing sports, or while doing fine-motor visual tasks.
  • Seem bright, articulate, and may have a high IQ, but they are unable to read, write, spell, or perform on standardized tests on grade level; those with vision problems will have trouble with other visual tasks that do not involve words or numbers.
  • Tend to be called lazy, careless, or labeled with behavioral problems. Struggle with low self-esteem get emotional about testing and school; dyslexics are known to cope by covering their weaknesses and compensating or distracting with other talents and skills.
  • Learn well through hands-on experiences; dyslexics tend to be helped by being able to observe and use visual aids, but those with visual deficiencies do better with oral coaching.
  • Have difficulty with time — Dyslexics have trouble with sequences and time management; those with vision problems have trouble telling time on a clock dial.

As you can see, the signs and symptoms of dyslexia and learning-related vision problems practically mimic each other, with subtle differences. Even a professional trained to recognize dyslexia may not suspect a vision deficiency without proper awareness.

If you are in the Olney, MD or Silver Spring, MD area and suspect your child might have a learning-related vision problem that has similar symptoms to dyslexia, contact Dr. Philip Nicholson’s Visual Learning Center to schedule an appointment.

summer reading

Summer Vision Screening: When a Bright Child Struggles in School Summer is the Season to Discover Why

As your child wraps up another school year, now may be a good time to reassess his or her progress and struggles. You might be asking yourself some of the following questions and wondering what you can do to help set your child up for success as a student:

  • Did my child advance this year or seem to fall behind?
  • Is my child reading on-level, or still having difficulty keeping up with classmates?
  • Did my child’s behavior disrupt his learning environment this year?
  • Does social awkwardness or clumsiness seem to be interfering with my child’s happiness or self-esteem?

If you are concerned about your child’s performance in school, or perhaps in social interactions and sports, summer is the season to focus on getting to the root of your child’s difficulties and finding the best available help.

If you and your child are dreading making your way through the summer reading list, it may be time to figure out why what could be an enjoyable activity has become such a chore.

When a child struggles in school, summer can be a welcome break from suffering through long days in the classroom and tackling difficult homework assignments in the evenings. Without the daily stress of school, summer can also be the best time to schedule assessments for learning disabilities, attention deficit disorder, perceptual deficiencies that could be interfering with learning, and start treatment.

What you may not have considered is that one possible culprit behind your child’s struggles could be a vision problem. Learning-related vision problems are often over-looked because symptoms sometimes mimic or appear similar to learning disabilities, dyslexia, or attention deficit disorder.

Register for an upcoming webinar here.

Children with vision problems that interfere with learning are often found to have “20/20” eyesight when they undergo typical vision screenings at school or with the family eye doctor, so parents and teachers may not suspect a problem with vision. A more thorough functional vision exam is needed to uncover visual processing deficiencies.

When a child’s vision system does not work efficiently, visual skills deficiencies can contribute to learning problems. For the learning process to work as it should, your child must first be able to see, then use what he sees to understand. The ability to see letters on a chart for an eye exam is not enough — 20/20 is just the beginning.

Symptoms of vision problems include, but are not limited to:

  • Squinting while reading near or far
  • Rubbing red, irritated, or watering eyes
  • Rubbing temple or forehead and complaining of headaches
  • Complaints of dizziness or motion sickness
  • Skipping words or losing place while reading
  • Confusing similar words
  • Reversing letters
  • Being easily distracted, inattentive, unable to stay on task
  • Disruptive behavior, especially after expressing frustration with work
  • Poor hand-eye coordination, depth perception, or awkwardness and clumsiness
  • Performing noticeably better on oral vs. written demonstrations of learning

If you or your child’s teacher have noticed any of these symptoms, take your child to an optometrist that specializes in developmental and functional care for an in-depth vision screening this summer. If your child is found to have a problem with eye focusing, eye teaming, eye tracking, or visual processing, you could be one step closer to having answers you need to improving your child’s performance in school and self-esteem.

The good news is, with an individualized vision therapy program, significant progress can be made within a relatively short period of time, even in time for next school year.

If you live in or near Olney, MD, contact Dr. Philip Nicholson, O.D. and his staff at the Visual Learning Center. Call 301-570-4611 for a comprehensive assessment and to see if your child might significantly benefit from vision therapy this summer.

Is vision therapy a “proven therapy” or is it “quackery”?

Vision therapy is a proven therapy that is well-documented in medical journals, scientific literature, and supported by the National Institutes of Health (NIH) in Bethesda, MD, not far from our center.

Despite vision therapy’s solid reputation in the scientific community, awareness about learning-related vision problems and vision therapy’s effectiveness is not widespread. Lack of familiarity sometimes creates a healthy dose of skepticism, which we discuss regularly with parents.

When you learn about something new that challenges previously held beliefs, it is natural to view it with a critical eye. If a child has considerable difficulty reading or writing, your first thoughts are likely to suspect a learning disability or dyslexia. If a child has attention or behavioral problems, popular opinions point to attention deficit disorders (ADD/ADHD).

Learning-related vision problems may be new on your radar; and as a parent, caregiver, teacher, or pediatric occupational therapist, it is your duty to scrutinize new information and work in a child’s best interest.

Obviously no doctor or practice ever wants to be accused of quackery or placed in the same category as a snake oil salesmen. Vision therapy is sometimes confused with “the Bates Method” or the “See Clearly Method” which do not have the same scientific basis or reputation as vision therapy, which is known in the medical literature as Orthoptic Therapy.

Rest assured, vision therapy has been proven effective in treating visual processing problems.

The NIH published results of a study, which proved vision therapy’s efficacy for the most common problems we find in students struggling in school. The Journal of the American Optometric Association has published articles about vision therapy’s effectiveness citing more than 260 peer-reviewed journals.

The reason you are not more familiar with vision therapy is simply that you have not read the studies and journals, and the information has not been picked up by the media or distributed through other outlets. As practitioners of vision therapy, it is our job to inform you about it, and you will find many helpful resources on our website about it.

At the Visual Learning Center, our vision therapy program is based on the latest scientific studies, and we have a proven track record of vision therapy success. Learn more about visual processing skill deficiencies and vision therapy by downloading this guide and watching this webinar.

We offer vision therapy to children and adolescents with learning-related vision problems in our Olney, MD, office, which is convenient to families in Silver Spring.

child reverses letters while writing at a desk

Common Causes When a Child Reverses Letters

When parents notice a child reversing letters, they often assume that what they are observing is a sign or symptom of dyslexia.

Dyslexia is a language-based learning disability that causes difficulty in writing, reading, and spelling. Children with dyslexia often reverse letters; however, while letter reversal in writing can be a symptom of dyslexia, this does not mean that every child who reverses letters has dyslexia.

A child may reverse letters in the early stages of learning. As a child begins to practice writing, they will make mistakes or their motor skills might not be well developed yet. Parents and teachers should continue to observe and see if the child makes improvement with guidance and practice.

Children who do not improve letter reversals within the first two years of schooling should be watched more closely and evaluated by a professional. The child could be dyslexic or have another learning disability.

But there is also a another lesser-known cause that could explain the child’s tendency to reverse letters, such as ‘p’ and ‘q’ or ‘b’ and ‘d’ when writing. Learning-related vision problems interfere with the visual processing system and cause affected children to reverse letters. Without detection, diagnosis, and vision therapy, the child will continue to reverse letters and struggle with reading, writing, and spelling.

Research indicates the major causes of letter reversals include the following:

  • Poor visual memory:  the ability to recall a visual image
  • Poor visualization: the ability to create a mental image
  • Poor visual-motor integrations:  the ability of the visual and muscular system to reinforce each other
  • Poor visual association: the ability to link what you see with something you saw, heard, or felt in the past.

If a child is lacking ability or skills in the areas of visual association, integration, visual-motor, and recall skills, he will be more likely than his peers to continue reversing letters when writing. Intensive vision therapy will strengthen visual skills, and with training and practice, letter reversals can be eliminated.

“Parents are often told the child will outgrow it. And this can be true. Continued exposure to letters and numbers will reduce reversals; but if the underlying causes are left untreated, learning will still be slow and school performance will suffer.” – Dr. Philip Nicholson

Without knowing and addressing the cause of letter reversals beyond the initial stages of learning development, a child will not automatically improve.

Assuming the child is dyslexic may not help, unfortunately, because the methods used for helping a dyslexic child learn are different from the methods used to improve visual processing in a child who has learning-related vision problems.

If your child is reversing letters beyond second grade or 8 years of age, we recommend screening for dyslexia and vision problems. Learn more about learning-related vision problems by downloading our free guide here and watching our webinar here.

If you live near Olney, MD, schedule an appointment with the Visual Learning Center for a thorough vision assessment.

Do Children Who Reverse Letters Actually See Them Backwards?

Children are introduced to letters when they learn to read, spell, and write. And although most children are able to differentiate between similarly shaped letters, such as b and d, or q and p, early in the learning process, some students struggle with reversing letters as they read or write them.

Difficulty with letter reversals is not uncommon; however, when parents notice that their child is having a problem with letter reversals, sometimes it causes alarm.  Many parents assume letter reversals are automatically signs of dyslexia or a learning disability.

In many cases, reversing letters early in the learning process is simply a matter of trial and error while acquiring a new skill.  Imagine looking at an alphabet through a young child’s eyes and trying to remember what each letter looks like and sounds like. It’s easy to make mistakes, including letter reversals. A ‘b’ simply looks similar to a ‘d‘ for a new learner.

With practice and coaching, most children will quickly improve. In some cases, children who reverse letters persistently actually have dyslexia, and parents will need to seek proper professional help. But in often-overlooked cases, children are reversing letters because of a learning-related vision problem.

Does this mean children who reverse letters because of a vision problem actually see the letters backwards?

Not quite. Children who reverse letters and numbers do NOT actually see them backwards.  Letter reversals are a symptom of poor laterality and directionality concepts.  This means their vision is not yet trained to process the letter in one particular direction, and they may require vision therapy (also known as vision training) to correct the problem.

Parents should also note that just because a child writes a letter correctly does not mean the child is processing the letter accurately and easily. Children with symptoms of letter reversals often do not reveal these symptoms through their handwriting; sometimes, only when asked to decode and identify letters, will children show poor ability. 

It is possible that weakness in laterality and directionality, which manifests in reversing letters, can slow work down and cause confusion of word meanings. Poor eye tracking is also linked to problems with letter reversals.  So while children who struggle with letter reversals are not seeing letters backwards, they are having trouble processing the letter visually, which contributes to learning difficulties. The good news is, vision therapy or vision training usually results in rapid improvement.

If your child is reversing letters, click here to see if he or she might benefit from a comprehensive exam, or contact us to schedule an exam in our Olney, MD office.