Signs of Vision Problems in Grade School

Sometimes it is hard to know if a kid is “just being a kid” or is their behaviors are an undiagnosed vision problem that is impacting learning. We see the full spectrum in our clinic: kids who pretend to have a vision problem so they can get glasses like their best friend, kids who can barely see the board but say nothing is wrong, and kids who are begging their parents to bring them in for an eye exam because things are blurry and uncomfortable at school.  So what can parents and teachers look for in kids that suggests an underlying vision problem rather than too much sugar, too many thoughts of summer, or disinterest in learning?

Squinting to see the board
Squinting is one of the most common signs of blurry vision. Vision screenings and basic eye examinations can detect uncorrected near-sightedness, which causes blurry distance vision, but often miss vision conditions that cause variable vision. Did you know that far-sightedness (which is far more common in children than near-sightedness) can put strain on a child's visual system? When the child is fatigued this strain becomes too much for their visual system to overcome and their vision becomes blurry. These children may be able to read the few letters on the eye chart to pass a screening, but the sustained visual demands of the school day caused blurred vision later in the day.

Words come in and out of focus on the page
Accommodation, or eye focusing, is the skill that we use to maintain clarity when reading or performing other near activities. When an individual's eye focusing system is not functioning properly it affects the clarity of print. Kids with accommodative dysfunction will often experience variable vision throughout the day. These children will also have impaired reading fluency as they have to stop and wait for their vision to become clear again before resuming their reading. A residency-trained pediatric optometrist can detect accommodative dysfunction during a developmental eye examination. Be sure to ask if your child's doctor is residency-trained in pediatrics or binocular vision before scheduling an appointment. Also ask if your child's doctor will be performing a developmental eye examination that evaluates how your child uses their eyes; not just visual acuity, prescription, and eye health. Accommodative dysfunction is easily treated by optometrists with residency-training in binocular vision and vision therapy.

Covers or closes one eye when reading
Kids are experts at figuring things out, including their eyes. Many kids discover that closing one eye to read makes it easier. Other kids will lean on one arm so that they can use a hand to cover their eye (this may not be a conscious action). Improved comfort or reading fluency when one eye is blocked/closed is a sign of eye teaming difficulty, also called binocular vision dysfunction. Kids with binocular vision dysfunction will often cover an eye to eliminate the need to use both eyes in a coordinated manner. When both eyes are open, these kids will experience headaches, eyestrain, discomfort, and fatigue during near activities. Binocular vision dysfunction can also cause one to lose their place when reading, re-read the same line multiple times, or dedicate so much energy to getting through the text that they have no clue what they have just read. Believe it or not, these individuals can also see text move, float, or swim on the page. Binocular vision dysfunction is easily treated by optometrists with residency-training in binocular vision and vision therapy.

Using a finger or line guide to read
In order to be an efficient reader the eyes must move efficiently. When the eyes have difficulty tracking, reading fluency is impacted. Re-reading lines and skipping lines are very common for kids who have tracking difficulties. In order to keep their place, these kids will often use their finger as a guide or use a book mark to underline the text they are reading. While these crutches allow the student to skip fewer lines, they ultimately will become a barrier. We are able to read much faster and with much more enjoyment when our eyes glide across the text and our finger is not in the way. Oculomotor dysfunction (eye tracking difficulties) is easily treated by optometrists with residency-training in binocular vision and vision therapy.

Avoidance of reading
None of us like to do things we are not good at. When a student fails to see success in reading they often will begin avoidance behaviors to get out of reading. It is better to be the class clown and sit in the principal's office than see words coming in and out of focus, floating on the page, and struggling to read aloud in front of your peers. Many schools place an emphasis on reading speed. Whether you name the reading groups after animals, colors, or any other category, kids are smart enough to know it is better to be in the cheetah group than the turtle group. We have many parents who say the same thing, “my kid is a smart, just not a good reader”. It is important to diagnose and treat vision conditions that impact learning before students give up on themselves and start saying “I hate school”, “I am dumb”, or “I am never going to be a good reader”.

If a vision problem is suspected, we recommend a comprehensive examination with a residency-trained pediatric optometrist. A residency-trained pediatric optometrist is able to determine if the above behaviors are related to a vision problem and then develop a treatment plan for your child. For many vision conditions in young children, early intervention is a key to success. Through the use of glasses and/or vision therapy, a residency-trained optometrist can fix the problem before it affects school performance.