Learning Disorders and Roadblocks
At High5, when we talk about vision we're talking about a complex process that involves not only the eyes but the brain as well. Specific learning-related vision problems can be classified as one of three types. The first two types primarily affect visual input. The third primarily affects visual processing and integration. Most routine eye exams evaluate only the first of these categories of vision problems — those related to eye health and refractive errors. However, as developmental optometrists who specialize in children’s vision problems and vision therapy, we offer exams to evaluate functional vision problems and perceptual vision problems that may affect learning.
More Than Just Eye Health and Refraction
Specific learning-related vision problems can be classified as one of three types. The first two types primarily affect visual input and deal with the mechanics of the neuro-visual system, while the third type primarily affects visual processing and integration with other senses. Unfortunately most routine eye exams performed by primary care Optometrists only evaluate the first of these categories, those related to eye health and eyewear prescriptions. As you'll come to know, that's simply not good enough for those struggling with learning. Our practice fills that gap and incorporates all three into our evaluations.
Eye Health and Refractive Problems
These problems can affect the visual acuity in each eye as measured by an eye chart. Refractive errors include nearsightedness, farsightedness and astigmatism, but also include more subtle optical errors called higher-order aberrations. Eye health problems can also cause low vision or permanently decreased visual acuity that cannot be corrected by conventional eyeglasses, contact lenses or refractive surgery.
Functional Vision Problems
Functional vision refers to a variety of specific functions of the eye and the neurological control of these functions, such as eye teaming (binocularity), fine eye movements (important for efficient reading), and accommodation (focusing amplitude, accuracy and flexibility). Deficits of functional visual skills can cause blurred or double vision, eye strain and headaches that can affect learning. Convergence excess and insufficiency are two specific types of functional vision problems that affect the ability of the two eyes to stay accurately and comfortably aligned during reading.
Perceptual Vision Problems
Visual perception includes understanding what you see, identifying it, judging its importance and relating it to previously stored information in the brain. This means, for example, recognizing words that you have seen previously, and using the eyes and brain to form a mental picture of the words you see.
Eye Health and Refractive Problems
These problems can affect the visual acuity in each eye as measured by an eye chart. Refractive errors include nearsightedness, farsightedness and astigmatism, but also include more subtle optical errors called higher-order aberrations. Eye health problems can also cause low vision or permanently decreased visual acuity that cannot be corrected by conventional eyeglasses, contact lenses or refractive surgery.
Functional Vision Problems
Functional vision refers to a variety of specific functions of the eye and the neurological control of these functions, such as eye teaming (binocularity), fine eye movements (important for efficient reading), and accommodation (focusing amplitude, accuracy and flexibility). Deficits of functional visual skills can cause blurred or double vision, eye strain and headaches that can affect learning. Convergence excess and insufficiency are two specific types of functional vision problems that affect the ability of the two eyes to stay accurately and comfortably aligned during reading.
Perceptual Vision Problems
Visual perception includes understanding what you see, identifying it, judging its importance and relating it to previously stored information in the brain. This means, for example, recognizing words that you have seen previously, and using the eyes and brain to form a mental picture of the words you see.
Symptoms Of Learning-Related Vision Problems
Your typical routine exam covers those first two bullet points with glasses and contacts being prescribed to help your blurry vision and eye strain, but look at everything else that's getting missed. Many corporate Optometrists are limited in what they can evaluate by constraints of time, training or policies. So this is why we educate parents and educators what to look for, that these can be symptoms of visual problems and that a Developmental Optometrist is trained to address these with rehabilitation and vision therapy.
Vision and Reading
"Show me a family of readers, and I will show you the people who move the world" - NapoleonNormally a combination of deficits, rather than just one, are at the root of a child's reading difficulties
Often vision related reading deficits are overlooked due to children not complaining about how they see, maybe they've passed a school vision screening which has given them an "OK" on their acuity. Visual acuity is the ability to see objects clearly. It is usually the only skill assessed in a school vision screening. The typical school eye chart is designed to be seen at 20 feet and measures how well or poorly the child sees at that distance. Reading requires the integration of a number of different vision skills: visual acuity, visual fixation, accommodation, binocular fusion, convergence, field of vision and form perception.
Signs of Vision-Related Reading Problems
Symptoms of Vision-Related Reading Problems
Treating Vision-Related Reading Problems
An optometrist will examine the above visual skills and determine how well the child is using them. When a vision problem is diagnosed, he or she can prescribe glasses, vision therapy or both. Vision therapy has proved quite effective in treating reading-related vision problems through individualized programs designed to help a child acquire or sharpen vision skills that are necessary for reading.
Because reading problems usually have multiple causes, treatment must often be multidisciplinary. Educators, psychologists, optometrists and other professionals must confer and work together to meet each child’s needs. The optometrist’s role is to help the child overcome the vision problems interfering with the ability to read. Once this is accomplished, the child is then more capable of responding to special education efforts aimed at treating the reading problem itself.
Often vision related reading deficits are overlooked due to children not complaining about how they see, maybe they've passed a school vision screening which has given them an "OK" on their acuity. Visual acuity is the ability to see objects clearly. It is usually the only skill assessed in a school vision screening. The typical school eye chart is designed to be seen at 20 feet and measures how well or poorly the child sees at that distance. Reading requires the integration of a number of different vision skills: visual acuity, visual fixation, accommodation, binocular fusion, convergence, field of vision and form perception.
Signs of Vision-Related Reading Problems
- holds book or paper too close
- frequent eye rubbing during reading or homework
- loses place or rereads lines, which often gets worse with time
- omits or substitues words
- uses finger to read
- homework is slow
- reading comprehension decreases with time
- slow reading speed
- avoids reading
- tilts or turns head
- closes or covers one eye
- squints or blinks during reading
- red or watery eyes after reading
- crossed or drifting eye
- clumsy, poor depth perception
Symptoms of Vision-Related Reading Problems
- headaches, worse later in the day
- eyestrain, sore eyes
- tired, burning or itchy eyes during reading
- double vision
Treating Vision-Related Reading Problems
An optometrist will examine the above visual skills and determine how well the child is using them. When a vision problem is diagnosed, he or she can prescribe glasses, vision therapy or both. Vision therapy has proved quite effective in treating reading-related vision problems through individualized programs designed to help a child acquire or sharpen vision skills that are necessary for reading.
Because reading problems usually have multiple causes, treatment must often be multidisciplinary. Educators, psychologists, optometrists and other professionals must confer and work together to meet each child’s needs. The optometrist’s role is to help the child overcome the vision problems interfering with the ability to read. Once this is accomplished, the child is then more capable of responding to special education efforts aimed at treating the reading problem itself.
Vision and Dyslexia
"A phonics problem, not a problem with reading or writing letters and words backwards"Vision problems do NOT cause dyslexia
Dyslexia is a frequently overused term, and is often mistakenly thought of as reading or writing letters backwards. But the main problem with dyslexia is persistent difficulty with phonics – the ability to attach sounds to letters and blend the sounds into words. Decoding or phonemic awareness are also terms sometimes used to describe phonics ability. Most dyslexic individuals show difficulty with phonics and other aspects of language function. Dyslexia can also make it more difficult to remember sight words.
Having a reading problem does NOT equal dyslexia
All children with reading problems are not dyslexic. Vision problems can affect reading, but they do not cause phonics difficulty, which is the hallmark of language based dyslexia. Vision problems can also make reading more difficult, causing problems with fluency, speed and comprehension. But vision problems do not cause dyslexia. Vision therapy is not intended to treat dyslexia, as is discussed in the American Optometric Association’s position paper on dyslexia and vision therapy. Children with actual language based dyslexia need intensive reading tutoring like the Wilson or Orton-Gillingham methods.
What should I do?
Children with reading problems need a thorough vision evaluation to determine whether there are any vision problems affecting their reading. Your developmental optometrist will conduct a thorough assessment of eye health and visual functions and communicate the results and recommendations with you. If it is a vision-related problem, we will discuss how our management plans can improve these deficiencies. If it is dyslexia or something else, we will make sure to refer you appropriately.
Dyslexia is a frequently overused term, and is often mistakenly thought of as reading or writing letters backwards. But the main problem with dyslexia is persistent difficulty with phonics – the ability to attach sounds to letters and blend the sounds into words. Decoding or phonemic awareness are also terms sometimes used to describe phonics ability. Most dyslexic individuals show difficulty with phonics and other aspects of language function. Dyslexia can also make it more difficult to remember sight words.
Having a reading problem does NOT equal dyslexia
All children with reading problems are not dyslexic. Vision problems can affect reading, but they do not cause phonics difficulty, which is the hallmark of language based dyslexia. Vision problems can also make reading more difficult, causing problems with fluency, speed and comprehension. But vision problems do not cause dyslexia. Vision therapy is not intended to treat dyslexia, as is discussed in the American Optometric Association’s position paper on dyslexia and vision therapy. Children with actual language based dyslexia need intensive reading tutoring like the Wilson or Orton-Gillingham methods.
What should I do?
Children with reading problems need a thorough vision evaluation to determine whether there are any vision problems affecting their reading. Your developmental optometrist will conduct a thorough assessment of eye health and visual functions and communicate the results and recommendations with you. If it is a vision-related problem, we will discuss how our management plans can improve these deficiencies. If it is dyslexia or something else, we will make sure to refer you appropriately.
Vision and ADHD
"One of the most common neurodevelopmental disorders of childhood" - Centers for Disease Control and PreventionWe do not diagnose or treat ADHD, but we address the VISION problems
The signs of ADD/ADHD and vision problems overlap. Children with vision problems can show poor attention with classroom work and homework. Teachers and parents will often notice children taking frequent breaks, avoiding reading or becoming fidgety as their eyes fatigue.
Vision Problems do NOT cause ADHD
Vision problems do not cause ADHD, but they can be mistaken for ADHD. Vision issues should be ruled out in children where a diagnosis of ADD/ADHD is being considered. Vision issues such as farsightedness, eye teaming and focusing problems can affect a child's ability to sustain attention during reading and desk work. Research has shown that children with convergence insufficiency are more likely to have a diagnosis of ADHD and score higher on the Conners Test even when they don't have ADHD.
The signs of ADD/ADHD and vision problems overlap. Children with vision problems can show poor attention with classroom work and homework. Teachers and parents will often notice children taking frequent breaks, avoiding reading or becoming fidgety as their eyes fatigue.
Vision Problems do NOT cause ADHD
Vision problems do not cause ADHD, but they can be mistaken for ADHD. Vision issues should be ruled out in children where a diagnosis of ADD/ADHD is being considered. Vision issues such as farsightedness, eye teaming and focusing problems can affect a child's ability to sustain attention during reading and desk work. Research has shown that children with convergence insufficiency are more likely to have a diagnosis of ADHD and score higher on the Conners Test even when they don't have ADHD.
Visual Processing
The brain, not the eyes, processes the visual world, including things like symbols, pictures and distancesIf your child passes a vision test but can't see the difference between a triangle and a square, the eyes aren’t the problem. The issue is visual processing.
Weaknesses in these brain functions are called visual processing disorders or visual perceptual disorders. With most children, visual processing develops normally without any special attention or intervention. In some children however, the development of visual processing skills does not keep pace with their growth in other areas. This lag of development can lead to difficulty acquiring a sound foundation in reading, handwriting, and math skills in the early grades.
While there are ways to help kids compensate for those weaknesses, visual processing issues present lifelong challenges if not addressed. They are not considered a learning disability, however are farily common in kids who have learning issues. They also impact their ability to do ordinary things like sorting socks or playing a simple game of kickball. They can also lead to problems with socializing and self-esteem. Some kids may become frustrated and withdrawn.
What types of Visual Processing problems can occur?
Symptoms of a Visual Processing Problem Include:
Weaknesses in these brain functions are called visual processing disorders or visual perceptual disorders. With most children, visual processing develops normally without any special attention or intervention. In some children however, the development of visual processing skills does not keep pace with their growth in other areas. This lag of development can lead to difficulty acquiring a sound foundation in reading, handwriting, and math skills in the early grades.
While there are ways to help kids compensate for those weaknesses, visual processing issues present lifelong challenges if not addressed. They are not considered a learning disability, however are farily common in kids who have learning issues. They also impact their ability to do ordinary things like sorting socks or playing a simple game of kickball. They can also lead to problems with socializing and self-esteem. Some kids may become frustrated and withdrawn.
What types of Visual Processing problems can occur?
- Visual Discrimination: Difficulty seeing the difference between two similar letters, shapes or objects
- Figure-Ground Discrimination: Not being able to pull out a shape or character from its background
- Sequencing: Difficulty in being able to tell the orders of symbols, words or images
- Visual-Motor Processing: Difficulty in using feedback from the eyes to coordinate the movement of other parts of the body
- Long or short-term visual memory: Difficulty recalling what has been seen
- Visual-Spatial Awareness: Difficulty being able to tell where objects are in space
- Visual Closure: Difficulty identifying an object when only parts are visible
- Letter, number and symbol reversal: Switching or reversing letters or numbers when reading, writing or speaking
Symptoms of a Visual Processing Problem Include:
- Reversals of letters, numbers or words
- Sloppy handwriting, poor spacing of letters, can't stay on a line
- Difficulty copying from the board
- Doesn't complete tests or written work
- Poorly organized written work
- Overwhelmed with crowded pages or worksheets
- Difficulty with scantron answer sheets
- Responds better verbally (especially with spelling words)
- Poor fine or gross motor skills
- Confusion of similar words when reading
- Poor retention of visual material (sight words)
- Poor attention during visual tasks
- Better auditory learner
