The ABC's of Vision
Jen Simonson, OD, FCOVD
There are children who struggle to learn due to undetected vision problems. 80% of Learning happens through the Visual System
— 18 million children in American have not had an eye examination before entering school.
— One out of four children has an undiagnosed vision problem.
— 70% of children with a learning disability in reading have some form of visual impairment, such as ocular motor, perceptual, or binocular dysfunction.
•— Children with impaired vision have greater difficulty learning, playing sports, limited possibilities for employment, increased morbidity or mortality due to accidents, and difficulty with psychosocial development.
— What kind of vision problems are there?
— What is it like to see with a vision problem?
— How can you identify if a child may have a vision problem?
— How can vision problems be treated?
What are vision skills? VISUAL ACQUISITION: FIXATE, FOCUS, FOLLOW & FUSE
— Tracking - the ability to follow a moving object.
— Fixation - the ability to locate an object.
— Focus - Ability to see clearly.
— Depth Perception - ability to judge distance.
— Binocularity - the ability to use both eyes together and to fuse the information into one perception.
— Visualization - The ability to form mental image.
What we see
What we might think
What is actually happening
Loses Place when reading
"Not paying attention"
The eyes are jumping over words.
Skips words or lines
The eyes are jumping over lines of print.
Eye fatigue and frustration are avoided when not reading. This is a clever adaptation.
Has poor reading comprehension
"Not bright, not interested"
When words are skipped, the text does not make sense.
Discovering a Vision Problem
— A skilled observer can spot signs indicating that a child may have a visual problem.
— Your job is not to diagnose, but to know when to suggest a complete optometric examination. Note - This doesn't mean just a health check and glasses check! Not all examinations are the same!
¡ You want to suggest an office that 1) works with children and 2) tests for all visual problems, not just medical problems
¡ For example, some doctors do not see a child until they are dilated. These medications paralyze the focusing muscle and prevent testing of near vision skills.
The ABCs of Vision Difficulties
- Closing of an eye
- Eye turning in or out at any time
- Excessive blinking
- Poor attention Span
- Poor tracking
- Poor eye-hand coordination
- Poor eye teaming
- Confusion of Shapes
- Eye discomfort
- Double vision
School work requires VISUAL EFFICIENCY
Binocularity = Two-eyed coordination (teaming)
¡ Necessary to see CLEARLY, SINGLY, and COMFORTABLY
¡ Require maintenance of alignment and focus
¡ Typically identified due to a decrease in reading efficiency, comfort and comprehension. (they tire, complain, rub their eyes, and lose their place)
Problems most typically worsen as school demands increase. (Smaller print, No pictures, More words per page)
Signs & Symptoms of an Eye Teaming Problem: Gross postural deviations at desk work, Turning or tilting the head when doing near work, Covering or closing an eye.
Eye Movement and Tracking Problems
¡ Reading REQUIRES eye movements - smooth, accurate, voluntary movements (called SACCADES)
¡ Copying requires near to far eye movements
Signs & Symptoms of an Eye Movement Problem: Losing place easily, Difficulty copying from the board, Head turns as reads across the page, Skips words or lines unknowingly, Rereads lines of print.
How your brain reads:
I cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdanieg. The phaonmneal pweor of the hmuan mnid, aoccdrnig to a rscheear at Cmabrigde Uinervtisy, it deosn't mttaer in waht oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frist and lsat ltteer be in the rghit pclae. The rset can be a taotl mses and you can sitll raed it wouthit a porbelm.
Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Amzanig huh? yaeh and I awlyas tghuhot slpeling was ipmorantt! if you can raed tihs psas it on !!
Visual Perception = the ability to understand and remember visual information
— Includes many skills: form perception, visual discrimination, visual memory, visual sequential memory, visual closure, figure ground and directionality
Signs and Symptoms of Visual Perception Problems: Mistakes words with same or similar beginnings, Fails to recognize same word in next sentence, Reversals, Returns to drawing with fingers to decide likes and differences.
Incomplete Vision Development
- A child may not be ready for the visual demands of the grade.
- This is not typically "out grown"
- Development may be enhanced with optometric treatment and activities, but will still progress through normal stages.
What would you do if you had a Vision Problem?
÷ AVOID (unmotivated)
÷ ADAPT (auditory learning, hold book closer, move head to read, close an eye, tilt head)
÷ COMPENSATE (reading lenses/bifocals)
Remediation of Vision Problems
¡ To compensate for a refractive error such as myopia, hyperopia or astigmatism
¡ To relieve stress on the near focusing system
¡ To prevent stress on the near focusing system
¡ Training lenses
¡ To compensate for an eye teaming problem such as a wandering eye or vertical misalignment
¡ To change a person's posture
¡ Training lenses
— Vision therapy is like physical therapy for the eyes and brain. We see with our brains and minds, not just our eyes.
— Vision Therapy is that part of optometric care devoted to developing, improving, and enhancing people's visual performance.
— Vision therapy involves medically supervised programs of therapeutic procedures and the use of medically regulated devices, such as lenses and prisms.
What Can Teachers Do?
1. Enlarge Print
2. Allow Visual Breaks
a. Set up a reasonable contract to go out to recess
b. Heavy computer demand requires completely getting away for 15 minutes every two hours.
3. Allow Additional Time
a. Powerful for spelling and comprehension
b. Teach to see the word "on the chalkboard in their mind"
c. Good preparation for sports and tests
d. Useful for creative writing
5. Chunk it down
6. Bookmarks, finger tracking along print, raised lines on paper
7. Reinforce with multi-sensory input
8. Teach the correct pencil grip
9. CORRECT READING DISTANCE = Harmon's distance (knuckle to elbow)
10. Observe your blackboard or dry erase board from different angles in the classroom to see if there is glare
11. Avoid having students sit on the far edges so they have look at the board from the side
12. Take into account the size of your writing on an overhead projector
13. Be aware that some colors of markers are hard to see for some students
Vision and Learning
An inefficient visual system may contribute to inattention, reduced classroom performance, and learning problems.
1) The Colorado Vision and Learning Forum: www.vision-learning.org
2) The College of Optometrists in Vision Development: www.covd.org
3) The Optometric Extension Program Foundation: www.oepf.org
4) Parents Active for Vision Education: www.pavevision.org
5) Vision Therapy.org: www.visiontherapy.org
6) Binocular Stereo "3-D" Vision: www.vision3d.com
7) The American Optometric Association: www.aoa.org
•1. "Vision on Learning and School Performance" Oregon Optometric Association, 1992
•2. "Educator's Guide to Classroom Vision Problems" Optometric Extension Program, 2000
•3. Your Child's Vision: A parent's Guide to Seeing, Growing, and Developing by Richard S. Kavner, OD, 1985
•4. Thinking Goes to School by Furth and Wachs, OD, 1972
•5. Vision, it's Development in Infant and Child by Arnold Gesell, MD, 1970
•6. "Vision and Human Development in Infant and Child," COVD Applied Concept Course, 2003
•7. Anomalies of Binocular Vision: Diagnosis & Management by Rutstein and Daum OD, MS, 1998
•8. Classroom Visual Activities: A Manual to Enhance the Development of Visual Skills by Regina G. Richards, MA
•9. Current Ophthalmology Vol. 4r3, No. f March-April 1999, "A Survey of Vision Screening Policy of Preschool Children in the United States"
•10. AOA Optometric Clinical Practice Guidelines
a. Learning Related Vision Problems 2000
b. Accommodative & Vergence Dysfunction 1998
c. Strabismus: Esotropia & Exotropia, 1996
Vision Therapy Research Information:
1. Mayo Clinic researchers, as part of a nine-site study, helped discover the best of three currently-used treatments for convergence insufficiency in children. Children with convergence insufficiency tend to have blurred or double vision or headaches and corresponding issues in reading and concentrating, which ultimately impact learning. http://www.newswise.com/articles/view/545210
2. Ciuffreda, Kenneth J. The Scientific Basis for and Efficacy of Optometric Vision Therapy in Nonstrabismic Accommodative and Vergence Disorders. Optometry 2002; 73:735-62.
3. Cooper J, Burns C, Cotter S, et. al. Optometric Clinical Guideline: Care of the Patient With Accommodative or Vergence Dysfunction. American Optometry Association 1998.
4. Cooper, Jeffrey. Summary of Research on the Efficacy of Vision Therapy for Specific Visual Dysfunctions. Adapted from The Journal of Behavioral Optometry 1998; 9(5):115-119.
5. Kushner Burton J. The Treatment of Convergence Insufficiency. Archives of Ophthalmology 2005, 123:100-101.
6. Maples WC. Visual factors that significantly impact academic performance. Optometry 2003; 4:35-49.
7. Borsting E., Rouse M.W., et al. Association of Symptoms and Convergence and Accommodative Insufficiency in School-Age Children. Optometry 2003 Jan;74(1):25-34.