This article is adapted from Learning Magazine

Written By: Mitchell Scheiman, OD, FCOVD

Richard, a 12-year old in your 7th grade class, is a verbal child. From what you’ve seen early in the year, you expect him to be an above average student. But gradually, you realize that he is struggling just to maintain average grades. Looking at his past records, you see the same pattern: strong language and verbal skills, but marginal performance. As you try to figure out what could be wrong, you notice that Richard is easily distracted. He almost never completes in-class silent reading assignments and consequently does poorly on answering the follow up questions. On homework, if the task is creative writing, he does well. But if he has to read for understanding, he seems lost.Watching more closely, you also notice that Richard often rubs his eyes when he’s reading. Sometimes he complains that he has a headache or tired eyes.

Visual Efficiency Problems

Richard’s behavior is characteristic of a child with an undetected vision problem. And there are many Richards. Experts estimate that 10% to 15% of school-age children have vision prob­lems significant enough to inter­fere with academic performance. For children with learning prob­lems, the figures are as high as 30% to 60%. And many of these children have passed the annual school vision screening with flying colors.Do you have a student with an undetected vision problem? The charts on the next two pages may help you discover why a student you think should be doing fine is failing. If one of your students exhibits some of these symptoms, make sure he gets tested by a professional as soon as possible. Help that could dramatically improve his school performance is available.These kinds of sight problems interfere with a child’s ability to clearly and comfortably see and take in information for sustained periods of time. Many of these problems don’t surface until the upper elementary grades or junior high, when children are required to cover significantly more reading material. Visual efficiency problems include nearsightedness, farsightedness, astigmatism, and problems with focusing, tracking and eye teaming. Nearsightedness is the condition most commonly detected by the traditional school vision screening. But nearsighted children tend to be some of the best readers, and the traditional screening doesn’t necessarily identify any of the other problems.

Vision and Learning

Most people think that a child who has passed the annual school vision screening has “good vision” and can see the board and his textbooks clearly.Unfortunately, this is a serious misconception because the traditional school eye exam doesn’t test aspects of vision required for reading. And sadly, the perception that everything’s okay can mask significant learning-related vision problems.The key to understanding the relationship between vision and learning is realizing that vision is more than just being able to see the letters on the 20/20 line of a chart placed 20 feet away. Visual problems can be divided into two broad categories – visual efficiency and visual processing.

Nearsightedness (Myopia)

The inability to clearly see things in the distance

Symptoms:

  • Squints
  • Gets close to board

Farsightedness (Hyperopia)

The inability to clearly see closeup things

Symptoms:

  • Rubs eyes
  • Has watery eyes
  • Complains of blurred vision

Astigmatism

This condition causes blurred vision for distant and closeup things

Symptoms:

  • Complains of blurred vision
  • Holds book at close distance

Eye Teaming disorders (Binocular Vision)

A variety of conditions in which the eyes tend to drift inward, outward, or upward

Symptoms:

  • Has intermittent double vision
  • Closes or covers one eye
  • Says letters or words appear to move
  • Loses place
  • Is inattentive
  • Rubs eyes
  • Has watery eyes
  • Has poor reading comprehension

Eye Focusing disorders (Accommodation)

The inability to contract or relax the eye focusing muscles to allow for clear, stable vision

Symptoms:

  • Has blurred vision when looking from board to book or book to board
  • Holds things very close
  • Has headaches when reading
  • Is tired at the end of the day
  • Is inattentive
  • Rubs eyes
  • Has watery eyes
  • Complains of blurred vision
  • Has poor reading comprehension

Eye Tracking disorders (Saccadic Dysfunction)

Inadequate ability to scan along a line of print and move the eyes from one point in space to another

Symptoms:

  • Moves head excessively when reading
  • Loses place frequently
  • Skips lines when reading
  • Uses finger to keep place
  • Has poor reading comprehension
  • Has short attention span

Visual Processing Problems

These problems have to do with the child making sense of incoming visual information. They include difficulty with laterality, directionality, visual form perception, visual memory, and visual motor integration.In contrast to visual efficiency disorders, many of which surface in the middle grades, visual processing problems tend to sabotage learning for children in the early grades even kindergartners. Children with visual processing problems may be difficult to teach because they fail to understand and grasp basic concepts and ideas.

Visual Issues Impact Learning

Directionality and Laterality Problems

Poor development right/left awareness

Symptoms:

  • Has trouble learning right and left
  • May read either left to right or right to left
  • Reverses letters and words
  • Has trouble writing and remembering letters and numbers

Faulty Visual Form Perception

The inability to discriminate among different shapes

Symptoms:

  • Confuses likenesses and minor differences
  • Mistakes words with similar beginnings
  • Can’t recognize the same word repeated on a page
  • Can’t recognize letters or even simple forms
  • Can’t distinguish the main idea from insignificant details
  • Has trouble learning the alphabet recognizing math facts, and learning basic math concepts of size, magnitude, and position

Faulty Visual Memory

Inability to remember what is seen

Symptoms:

  • Has trouble visualizing what is read
  • Has poor comprehension skills
  • Has trouble learning new material
  • Is a poor speller
  • Has poor recall of visually presented material
  • Has trouble with tasks that require more than one step
  • Has trouble with math concepts
  • Has trouble with  sight vocabulary

Faulty Visual Motor Integration

The inability to process and reproduce visual images by writing or drawing

Symptoms:

  • Has sloppy writing and drawing skills
  • Can’t space letters or stay on lines
  • Has poor copying skills
  • Erases excessively
  • Can respond orally but not in writing
  • Seems to know material but does poorly on tests

Treatment

A full evaluation by a professional who has the expertise to test for both visual efficiency and visual processing disorders is the only way to detect some vision problems. When one of these hidden problems does exist, treatment involving eyeglasses, vision therapy, or both can correct it. Glasses are generally effective for nearsightedness, farsighted­ness, and astigmatism. They can also correct some types of focus­ing and eye teaming disorders. In fact, 85% to 90% of people with vision problems are treated with glasses. However, the other 10% to 15% require vision therapy. This therapeutic approach involves a series of treatments that includes using special instruments and activities under close supervision.The education and clinical training of optometrists stresses both eye health and eye function. This makes them uniquely qualified to detect and treat vision problems that interfere with school performance.To find an optometrist qualified to treat learning-related vision problems, visit the College of Optometrists in Vision Development (COVD) at www.covd.org. COVD can provide a list of its fellows in any area of the United States.It is important to understand that optometrists don’t specifically treat reading or learning problems. But along with extra help or tutoring from parents and teachers, an optometrist can correct the vision problems that may be blocking the possibility of learning.


Nebraska Visual Integration Center is a Vision Therapy office in Omaha, Nebraska that specializes in the diagnosis and treatment of visual efficiency (visual skills) and visual processing issues that impact school and learning. If you think you or your child may have a hidden visual issue impacting learning, please contact our office at (402) 502-0043 or email at [email protected] We enjoy seeing lives change by taking care of visual issues that block learning and we would love to help you.

How Accurate are Vision Screenings?

If you have a child in school they have probably had a vision screening. These are generally performed by a pediatrician, or a nurse if done at school. It’s important to note that these are rarely performed by a vision specialist or optometrist.  A vision screening is usually part of a school general physical. This is an opportunity to note any physical issues and may lead to a referral to an eye doctor, although they do not offer a diagnosis or treatment plan.

The Good and Bad of School Vision Screenings

The American Optometric Association says:

  1. Schools screenings provide <4% of the vision tests needed to help a child see.
  2. Miss up to 75% of children with vision problems.
  3. Of the children found to have eye problems through screening, 61% never visit the eye doctor.

School vision screenings are limited, but are typically able to detect issues such as myopia (nearsightedness) and amblyopia (lazy eye). Amblyopia is a visual issue that requires an optometrist with specialty training. Vision screenings often fall short diagnosing visual issues that have an impact on learning, reading and classroom performance. Issues like hyperopia (farsightedness), binocular vision (eye teaming) disorders, eye tracking and eye focusing can have a significant impact on visual functioning for learning.

What to do after a Vision Screening

Your child has had a vision screening so what now?

If your child has failed any portion of the vision screening, it’s necessary for them to see an optometrist or other eye care specialist. If there is suspicion of a visual issue impacting learning, your child may likely need to see an optometrist who specializes in vision therapy and binocular vision. Optometrists who specialize in treating visual issues that affect learning are called developmental or functional optometrists.

What does a Developmental Optometrist Do?

A developmental optometrist specializes in vision therapy. Vision therapy has been scientifically proven to treat and remediate a number of learning-related vision issues. COVD is a website dedicated to the advancement of vision therapy and the prevention, enhancement, and rehabilitation of functional visual issues.

Below you’ll find the full article on vision screenings and how they are insufficient in detecting a number of significant visual issues.

HPI American Optometric Association Issue Brief: “Vision Screen: Should Be Called “Amblyopia Screening” 

Vision is more than seeing clearly! It’s the ability to obtain meaning and understanding from what we see with our eyes. Vision is a complex combination of learned skills including eye movement coordination, binocular fusion (eye teaming), accommodation (eye focus), and visual form perception.

Visual Skills for the Classroom, Learning & Life

Eye Tracking – the ability to keep the eyes on target when looking from one object to another, moving the eyes along printed page, or following a moving object like a thrown ball.

 

Eye Teaming – the ability to coordinate and use both eyes together for spatial orientation and to be able to judge distances and see depth (3D Vision).

 

Eye Focusing – the ability to quickly and accurately maintain clear vision when looking from the board to the desk and back. Eye focusing allows you to easily maintain clear vision over the time like when reading a book or writing a report.

 

Eye-Hand Coordination – the ability to use visual information to monitor and direct the hands when drawing a picture or trying to hit a ball.

 

Visual Perception the ability to organize visual images and ideas and to understand what is seen by the eyes.

 

 


Please feel free to contact our Omaha Vision Therapy office at (402) 502-0043 with any questions. We love to explain how vision goes way beyond 20/20.