requires children to accurately use all of their language, decoding, phonetic,
and visual skills to successfully recognize words and gather meaning from the
written text. Unfortunately, about 20% of school-aged children struggle to
read. Some of these children suffer from learning disabilities or dyslexia,
the inability of the brain's verbal language or auditory processing centers to
accurately decode print or phonetically make the connection between the word's
written symbols and their appropriate sounds. However, a large portion of
children struggling to read are not dyslexic at all; their phonetic awareness
and language processing skills are fine. It's their vision that is interfering
with their ability to read.
plays a vital role in the reading process. First of all, children must have
crisp, sharp eyesight in order to see the print clearly. School vision
screenings routinely check children's sharpness of vision at
distance--measured by the 20/20 line on the eye chart--and refer children for
glasses if they have blurry far-away vision and can't see the board from the
back of the room. Unfortunately, this is all school vision screenings are
designed to check, and children's vision involves so much more.
success in school, children must have other equally important visual skills
besides their sharpness of sight, or visual acuity. They must also be able to
coordinate their eye movements as a team. They must be able to follow a line
of print without losing their place. They must be able to maintain clear
focus as they read or make quick focusing changes when looking up to the board
and back to their desks. And they must be able to interpret and accurately
process what they are seeing. If children have
inadequate visual skills in any of these areas, they can experience great
difficulty in school, especially in reading.
who lack good basic visual skills often struggle in school unnecessarily.
Their "hidden" vision problem is keeping them from performing at
grade level, yet teachers and parents often fail to make the connection
between poor reading and the child's vision.
following information summarizes each of the major areas which can interfere
with a child's school performance.
eyes are designed to work as a team, but each eye functions independently.
When we look at something, the right eye records the image and the left eye
records the image. Then the two separate images are transmitted up the
optic nerves to the brain, which combines them into a single picture.
For the visual system to work correctly, each eye must aim at the exact same
point in space so that the images being recorded are identical. This
allows the brain to combine, or "fuse", the two incoming images for
clear, comfortable single vision.
However, if the eyes aren't aiming together, then the images being recorded
are slightly different. If the disparity is great enough, the brain
can't combine the two pictures. The result is double vision.
about ten percent of school-aged children have eye teaming problems--
technically, called convergence insufficiency or convergence excess. At
the close up distances required for reading, children with eye teaming
problems are only able to aim their eyes together correctly for short periods
of time. As their ability to accurately aim their eyes breaks down,
their eyes end up pointing at slightly different places on the page. The
result is a great deal of visual strain and eventually blurred, scrambled, or
course, reading and comprehension become increasingly difficult as the child
strains to aim both eyes at the same place to keep the print from blurring,
jumping, or splitting apart like this:
addition, children with eye teaming problems can be highly distractible,
finding it difficult to concentrate and remain on task when the strain on
their eyes is so great. (In fact, many of these children are often
misdiagnosed with attention
deficit disorder.) Other symptoms of eye teaming problems include loss of
place as the print "swims" and moves, eyestrain, fatigue, headaches,
keep from seeing double, many children with eye teaming problems end up
suppressing an eye. In other words, their brain "turns off"
one eye by neurologically blocking its visual input. This allows allows
them to maintain single vision because they're just using one eye. While
suppression helps the child cope, but it's extremely tiring and robs the child
these children have always seen this way, their vision seems normal to them.
They don't recognize that they're fighting their eyes harder than anyone else
just to maintain a clear, single picture. Very rarely do children realize
something is wrong and report transient double vision or the eye strain and
fatigue which usually accompanies suppression.
undiagnosed and untreated, eye teaming problems can appear to be a learning
disability or dyslexia. They are not. Eye teaming disorders are visual
problems, not language-based reading dysfunctions. The symptoms, however, are
similar and only a complete eye exam by an developmental optometrist trained
to diagnose and treat eye teaming problems can determine for certain if vision
is the basis of the child's struggle to read.
good news, however, is that eye teaming problems can be treated very
successfully. One type of teaming problem called convergence excess is often
corrected with reading glasses. Another teaming problem called convergence
insufficiency is usually corrected through vision therapy. Vision therapy is
a series of special eye exercises and treatment procedures prescribed by
doctors of optometry that correct problems that glasses alone can't help.
During therapy, the child learns to gain control of his or her eye muscle
coordination and builds the eye teaming skills necessary for success in
skills, or the ability to control the fine eye movements required to follow a
line of print, are especially important in reading. Children with tracking
problems will often lose their place, skip or transpose words, and have
difficulty comprehending because of their difficulty moving their eyes
Many are forced to use their fingers to follow the line because their
we read, our eyes don’t move smoothly across the line.
Instead, our eyes make a series of jumps and pauses as we read.
The small jumps between words or groups of words are called saccades.
The brief pause we make while looking at the words is called a
fixation. After a fixation, we move our eyes to the next word or group of
very precise coordination of jumps and pauses is controlled by our central and
peripheral visual systems. Our
central vision processes what we’re seeing in clear detail and defines what
we’re looking at. Our peripheral, or side vision, simultaneously locates
surrounding objects and let’s us know where to look. (These two
systems are sometimes referred to as the "Where is it?" and
"What is it?" systems.) In reading, our central vision processes the
word, while our side vision locates the following word and tells us where to
aim our eyes next. The integration of these two systems is what allows
us to efficiently move our eyes along a line of print without overshooting or
undershooting, or mistakenly aiming our eyes at lines above or below. If there
is not continuous, fluid, simultaneous integration between these two systems,
reading will be jerky, loss of place will be common, and comprehension will be
with tracking problems can't control their eye movements at close ranges. The
following is an example of how their eyes move during reading, especially as
focusing system, technically called accommodation, allows us to see clearly,
especially up close. Our eyes are designed for distance vision, so when
we look at something up close, the natural lens in our eye has to change shape
to redirect light rays on the retina for near objects. At the close
ranges required for reading, this is the visual skill needed to maintain clear
sharp images for extended periods of time. It also includes the ability to
quickly shift focus when looking from near to far, such as when looking from
our desk to the board. For children with accommodation problems, print
will become progressively blurry as they read for longer periods of time, and
their eyes will fatigue from the strain of trying to keep the print clear.
Sometimes children with focusing problems will hold their books very closely
or lay their heads down. Headaches are very common. Reading glasses are
often prescribed to help shore up inadequate focusing systems, but sometimes
therapy is need to improve a child's focusing stamina.
a child is struggling with his focusing system, print on the page will often
look like this:
ability to interpret, analyze, and give meaning to what is seen. Visual
perception skills can be broken down into the following areas:
Discrimination--the ability to
determine exact characteristics and distinctive features among similar objects
or forms. In reading, this skill helps children distinguish between similarly
spelled words, such as was/saw, then/when, on/one, or run/ran.
Memory--the ability to remember
for immediate recall the characteristics of a given object or form. This skill
helps children remember what they read and see by adequately processing
information through their short-term memory, from where it is filtered out
into the long-term memory. Children with poor visual memory may struggle with
comprehension. They often subvocalize, or softly whisper to themselves, as
they read in order to help compensate auditorily. They may have difficulty
remembering what a word looks like or fail to recognize the same word on
another page. They may also take longer copying assignments because they must
frequently review the text.
Sequential Memory--the ability
to remember forms or characters in correct order. This skill is particularly
important in spelling. Letter omissions, additions, or transpositions within
words are common for children who struggle with this skill. They often
subvocalize (whisper or talk aloud) as they write. Recognizing and remembering
patterns may also be a problem.
Spatial Relations--the ability
to distinguish differences among similar objects or forms. This skill helps
children in understanding relationships and recognizing underlying concepts.
This area is closely related to the problem solving and conceptual skills
required for higher level science and math.
Spatial Orientation helps us
with letter reversals. Many parents and educators
considered letter reversals after age seven to be a symptom of dyslexia. While
this can be true, the most common cause of reversals in older children is a
lack of visual spatial development--consistently knowing left from right,
either in relationship to their own bodies or in the world around them.
Children with poor visual processing have not developed adequate skills in
visual perception and spatial orientation, such as laterality and
directionality. Also, children who experience frequent double vision
deal with such visual confusion that their brains often misinterpret their
Form Constancy--the ability to
mentally manipulate forms and visualize the resulting outcomes. This skill
helps children distinguish differences in size, shape, and orientation.
Children with poor form-constancy may frequently reverse letters and numbers.
Closure--the ability to
visualize a complete whole when given incomplete information or a partial
picture. This skill helps children read and comprehend quickly; their eyes
don't have to individually process every letter in every word for them to
quickly recognize the word by sight. This skill can also help children
recognize inferences and predict outcomes. Children with poor visual closure
may have difficulty completing a thought. They may also confuse similar
objects or words, especially words with close beginning or endings.
Figure Ground--the ability to
perceive and locate a form or object within a busy field without getting
confused by the background or surrounding images. This skill keeps children
from getting lost in details. Children with poor figure-ground become easily
confused with too much print on the page, affecting their concentration and
attention. They may also have difficulty scanning text to locate specific
Twenty percent of
the raw visual data coming off the retina does not go back to the visual
cortex for imaging but breaks away and travels up to the brain's motor centers
to help with balance, coordination, and movement. Visual motor integration,
commonly called eye-body or eye-hand coordination, is a critical component of
vision. Think of it as a visual "follow the leader": the eyes
go first and tell the muscles where to follow.
Motor Eye-Body Coordination--the
efficient visual input to the body's relationship with its surrounding space,
commonly referred to as eye-body coordination. Good visual motor and bilateral
integration skills allow children to use their visual systems to monitor and
adjust placement of their body weight against the gravitational forces on both
sides of their body's midline, allowing for good balance and coordination.
Children with poor eye-body skills may have difficulty in such areas as
sports, learning to ride a bicycle, or general "clumsiness."
Motor Eye-Hand Coordination--the
efficient visual input into the body's fine motor system. Children with poor
eye-hand coordination may have poor handwriting and take longer to complete
written assignments. They usually become frustrated over time and lose
concentration, resulting in less time on task.
Help for Children who Struggle
is help for children who struggle to read and learn because of poor vision
optometrist who specializes in children's vision can run a complete
diagnostic workup to determine to what extent a child's visual skills are
hindering school performance and prescribe vision therapy to correct the
Vision therapy is the science of remediating inadequate visual systems
by improving function and performance. Vision
therapy is highly successful, supported by decades of research and the
testimony of countless parents and children whose lives have been changed when
dysfunctional vision systems are restored to normal. Remove a child's
stumbling block to learning, and you allow him the opportunity to succeed.
you suspect your child may be struggling because of an undiagnosed vision
problem, you may want to review the checklist
of common symptoms. The first step in helping your child is getting
good information. To
locate a qualified behavioral optometrist who provides vision therapy contact
the national certifying board of the College of Optometrists in Vision
Development at 1-888-268-3770 or visit their web site at http://www.covd.org. Also,
your family optometrist can be a good resource. Ask if he or she
provides vision therapy or if they can make a referral to a colleague who
may be interested in reading the resolution
passed by the national PTA. Because so many school-aged children are
struggling with vision-based learning problems, the Parents and Teachers
Association is calling for better school screening methods to identify at-risk