See to Achieve
Dr. Jen Simonson & Dr. Gina Gabriel
August 18, 2009
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.
Letter Reversals and Reading
The panq was going to blay in the qark. Bodqy's father blayep the prum in the qanb. When the danb started to dlay, it pibn't sounp goop. The qrum was off the deat. The danp stoqbed dlaying. Then Bopdy's father lookep bown detween the qrums. There was Bodqy with a dig sqoon helding his father dlay the prums!
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.
WHERE IS IT?? - Dorsal stream processing to the parietal lobe. (Direct connection to the motor system)
WHAT IS IT?? - Ventral stream processing to the temporal lobe. (Direct connection to the auditory system)
Visual demands: reading, copying, communication, comprehension
Eye Movements in the Classroom
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
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
Delayed or 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.
- "Amblyopia" or "lazy eye" is a severe form of reduced visual development. Vision therapy is the only possible treatment. (This includes active patching, the most commonly known form of vision therapy)
- Strabismus "eye-turn" = Strabismus is a severe problem of two-eyed coordination in which the two eyes do not line up. They point in different directions and do not work together normally at least part of the time.
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
Treatment of visual problems by procedures called "orthoptics" or "vision therapy":
— 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.
Vision and Learning
An inefficient visual system may contribute to inattention, reduced classroom performance, and learning problems.
q Enlarge print
q Allow Visual Breaks
q Allow Additional Time
q Use Visualization techniques
q Chunk information into smaller units
q Make sure printed materials are of good contrast
q Reinforce with multi-sensory input
q Harmon's Distance and Posture
q Good lighting
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:
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
Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children. Archives of Ophthalmology, Vol. 126 No. 10, October 2008
- Bowan MD. Learning disabilities, dyslexia, and vision: a subject review. Optometry 2002; 73:553-75.
- Ciuffreda, Kenneth J. The Scientific Basis for and Efficacy of Optometric Vision Therapy in Nonstrabismic Accommodative and Vergence Disorders. Optometry 2002; 73:735-62.
- Cooper J, Burns C, Cotter S, et. al. Optometric Clinical Guideline: Care of the Patient With Accommodative or Vergence Dysfunction. American Optometry Association 1998.
- 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.
- Maples WC. Visual factors that significantly impact academic performance. Optometry 2003; 4:35-49.
- 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.
- http://www.visiontherapy.org/vision-therapy/vision-therapy-studies.html (includes 141 resources)