As school gets underway, many children may struggle in school because of undiagnosed vision problems. “Parents often confuse a school or pediatric screening with a comprehensive eye examination,” notes Dr. Randy Schulman, a functional and behavioral optometrist. “20/20 vision is only one part of seven essential visual skills that are required for reading and healthy vision.”

Most parents can detect eyes turning in or out (a condition called strabismus) but, unfortunately, many other serious conditions have no outward appearance. Those suffering silently will often avoid near work and/or display frustration while reading or doing homework. “The worst is when parents mistake a vision deficiency for laziness or unwillingness to work. These kids get punished for a problem they didn’t create, and they learn to hate reading when it should be a joyful thing” says Dr. Jason Rutherford, a behavioral and primary care optometrist for Eyecare Associates, PC, in Connecticut.

Some of the visual skills required for school include getting and keeping things clear, moving the eyes across the page, and using the eyes as a team. Optometrists specializing in developmental vision can identify problems – such as oculomotor deficiency, accommodative insufficiency and convergence insufficiency – which can be thought of as poor motor control over the eyes. Just as gross and fine motor skills need to be developed in order to have good handwriting, the eyes go through a similar process in their development. When the eye-brain connection is not developed, eye muscle control is not coordinated properly and blurred vision, double vision and visual fatigue may result.

“Often, kids don’t report seeing double or blurred print as they think that is how everyone sees,” says Schulman. “Parents and educators do not recognize the impact poor visual skills have on reading, writing, and learning.” Good visual skills are required in order to sustain focus and track words for reading and writing.

Detection of the problem is just one step. Vision therapy is recommended for most patients with vision disorders such as convergence insufficiency. A well-known National Eye Institute study, the Convergence Insufficiency Treatment Trial, found that nearly 75 percent of those who received in-office vision therapy by a trained therapist and at-home treatment reported fewer and less severe symptoms related to reading and near work.

“Not only are symptoms abated but self-esteem improves as they realize that they are smart but have a vision problem that can be fixed,” says Schulman.

Here are the visual skills needed to pass an evaluation:
• Move the eyes and look at a target
• Get and keep things clear
• Point the eyes on targets close and far
• Use the eyes as a team
• Make sense of what is seen
• Coordinate the eyes with the hand and body
• Use vision to communicate

Signs of a vision difficulty can include:
• Slow reading
• Getting close to books
• Blinking and squinting
• Poor handwriting
• Poor balance and coordination
• Poor attention and distractibility
• Fatigue and difficulty sustaining tasks
• Difficulty organizing tasks and activities

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