With children’s vision, we typically think pass-or-fail on school or pediatric screenings. What most people are not aware of is that these screenings typically only assess acuity or eyesight at distance, a gross defect in refractive error, or a need for strong glasses. Unfortunately, when parents receive the “pass” finding, they make an assumption that their children’s eyes are healthy and not interfering with learning. Aside from good distance eyesight, there are many visual skills that are necessary in order to perform well in the classroom and on the playground.

Vision is a complex process that is integrated with various other systems throughout the brain. It is connected to speech and language areas, and movement and proprioceptive centers; it directs how we move and communicate in the world. If the eyes are not working properly, many different aspects of a child’s life are affected, particularly learning, reading, writing and sports performance.

Some of the visual skills needed for learning include seeing clearly at all distances (not just far away), keeping targets clear and shifting focus quickly for different locations. In addition to clear vision, we must be able to aim the eyes together and coordinate them as a team to be able to point where they need to look. We need to also keep them aimed at a given target so we have clear and single binocular vision. Only when the two eyes work in tandem do we have stereoscopic depth perception.

Particularly for such tasks as reading and writing, it is crucial for the eyes to remain converged or pointed accurately. The eyes must be aimed up close and both eyes must remain focused to keep the print and paper clear and single. In order to read efficiently, the eyes must scan or track across the page smoothly and accurately while maintaining clear, single binocular vision.

All of these basic visual skills, including focusing, eye teaming and tracking, are required in order to succeed in school. These skills develop over time and become efficient at particular ages. It takes time for those eye-brain connections to be made. Sometimes, the demands on the child are much greater than his/her visual readiness. For example, smooth and efficient tracking skills are not established until seven or eight years of age, with boys developing slightly later than girls. Yet our children are being asked to read at earlier ages. If the child does not have these basic skills in place when they begin reading and writing, they may struggle with early reading, have difficulty with writing and fall behind in school. Specifically, they may lose their place, re-read, skip words, reverse words and/or have poor reading comprehension. If they have difficulty focusing, they may find that words or letters go in and out of focus; it may take longer for them to shift their focus between near and far, such as when they are asked to copy notes from the blackboard. Some children see double and learn to ignore the image from one or the other eye or turn their head to block the double vision when reading. They just assume everyone else sees like they do and may not realize that blurred or double vision is not normal.

In addition to the basic skills, there are many higher level visual skills that develop over time and may not be fully developed until 10 to 12 years. These include visual motor integration (eye-hand coordination), eye-body coordination, auditory visual integration (visualizing what is heard or read), and visual perceptual or processing skills (making sense of and interpreting what is seen). Such skills are necessary for learning to hold a pencil properly, following the pencil across the page, riding a bike, identifying sight words, following directions, understanding right and left, following multiple step directions and organizational abilities.
When a child has difficulty with visual integrative or visual processing skills, they may struggle with many areas, including academics and sports performance. They may be behind in reading level, write crookedly, have difficulty with spelling, miss out on teacher instructions and struggle with homework. They may be clumsy, uncoordinated or poor at team or ball sports, and misread social cues. This may lead to poor self- esteem or confidence in their abilities.

Many children with learning disabilities, or attention deficit and autism spectrum disorders have delayed or inadequate visual skills. The learning challenges, inattention, poor eye contact and social difficulties may not be just due to those disorders; they may also be a reflection of poor visual skills, such as tracking, focusing, eye coordination, vision integration or processing.

Luckily, there are ways to identify and treat vision problems hindering learning and performance in all areas of life. Behavioral or integrative optometrists are doctors of optometry that specialize in determining the visual abilities of the child and whether or not they are developmentally appropriate for their grade and school demands. They do multiple tests to determine eye movement, eyesight for different tasks, eye teaming, coordination and overall vision processing. The doctor can also determine the eye health and whether or not the child needs prescription glasses. Sometimes glasses are prescribed to help develop skills or reduce visual stress. Typically, these performance therapeutic glasses are only used for specific tasks such as reading, writing or computer use. Another highly effective treatment option is vision therapy.

Vision therapy entails a program of vision activities that will build and develop the child’s visual skills, and enhance the eye-brain connection. Therapy can be done in the office, typically on a weekly basis with a supportive home program, as well as guided home exercises and/or computer-based training. The child is re-evaluated after every 10 or so weekly sessions to individualize and build on the therapy program. Those that have completed vision therapy report improved speed and comprehension in reading, better math skills, improved spelling and a decrease in “homework wars”. An added bonus is better performance on the field and enhanced self-confidence.

Randy Schulman, MS, OD, FCOVD, is a behavioral developmental optometrist with EyeCare Associates, PC, which has locations in Norwalk, Southport and Trumbull. Connect at CTEyecareAssociates.com. See ad, page 19.