Beyond 20/20 Eyesight

by: Richard L. Pozil, o.d., f.o.v.d. & Alan C. Brodney, o.d., f.o.v.d.

Nine year old Sally passed the eye screening at school with flying colors, yet she reported that she saw words move around on the page and the print go in and out of focus. Sally was probably told that she had 20/20 eyesight, but her vision was not perfect. The Snellen eye chart does not detect all visual problems. This Visual Acuity Test measures how clearly someone can see at a distance of twenty feet. It has no relationship to a student’s performance at the reading and writing distance.

Vision is more than 20/20 eyesight. Vision encompasses over twenty visual abilities, and more than 65% of all the pathways leading to the brain. Nearly 80% of what a child perceives, comprehends, and remembers depends on the efficiency of his visual system.

Third grader Sally had major school problems that were getting worse. Teachers thought she might have Attention Deficit Disorder because she was easily distracted in the classroom. Sally complained of being tired when it was time to complete her assignments. She was observed to lose her place while reading and did not comprehend what she read. Usually she had to re-read. Her parents spent endless hours assisting her with her homework. She was not working up to grade level.

Sally’s difficulties are characteristic of a child with an undetected vision problem. Some 25% of all school-age children have vision problems significant enough to interfere with academic performance in the classroom.

Sally was later given a complete Comprehensive Learning Related Vision and Perceptual Examination. This examination tested these visual abilities: eye movement control, focusing near to far, sustaining clear focus, eye teaming ability, depth perception, visual motor integration, form perception and visual memory. The results of this testing indicated that Sally had extreme difficulty coordinating her two eyes so that they could see together.

Because of this difficulty, Sally had to put an excessive amount of effort and energy into the use of her eyes on near point tasks like reading and writing. This, combined with poor visual memory, caused labored reading and reduced comprehension.

The good news was that there was something wrong that could be fixed. Two recommendations were made. The first was to give Sally stress relieving lenses to wear for all near point work. These glasses optically move the print further away, allowing eye muscles to relax and move more fluidly. There was an immediate change when Sally read with her glasses. Her reading speed and fluency increased dramatically.

The second recommendation was a program of Optometric Vision Therapy. Twice weekly office visits were scheduled when Sally would work on tasks and activities to teach her how to control and coordinate her eyes and increase her visual memory.

Within a period of six weeks Sally herself noted that the words on the page did not move around when she read, and school work was getting easier for her to complete. Her parents commented that her homework was going faster and that Sally was now working at home on a more independent basis.

When Sally’s Vision Therapy Program was completed, Sally’s teacher said that She was staying on task and was more focused in the classroom. She was also reading at her grade level. Both Sally’s parents and teacher noted that Sally had more self-confidence and was reading for fun and enjoying it now.

The best way for parents to detect a vision problem in their child is to observe the child carefully. Use the following list of behavior symptoms of a vision problem as a guide. If your child has one or more of these signs he should have a learning related vision examination.

  1. Often loses place while reading
  2. Needs finger to keep his place
  3. Short attention span
  4. Letter or word reversal after the first grade
  5. Confuses similar words
  6. Difficulty copying from the chalk board to the desk
  7. Poor handwriting. Misaligns numbers
  8. Book held close to eyes
  9. Inconsistent or poor sports performance Be aware that not all eye care specialists practice the developmental approach to vision care. To find one who does, make sure that your doctor answers “yes” to the following questions.
  • Do you test for learning related visual problems?
  • Do you provide vision therapy in your office, or can you refer me to a colleague who does?