Vision Problems In Grade School

The topic of vision and learning comes up on a daily basis. Parents, teachers, therapists, and even students are always asking if vision could be the cause of academic struggles.

Considering that 80% or more of classroom learning occurs through the visual system, it is quite possible that academic struggles are due to a vision problem. During this blog we will discuss vision problems that can affect academic performance and clarify the differences between vision-related learning difficulties and non-visual learning difficulties.

When I say the word “vision” many people think of the magic numbers 20/20. While 20/20 vision is something that we should value in our students, it is only the tip of the iceberg when discussing the visual process. 20/20 tells you that the student is able to see a certain size of letter at a certain distance. What it does not tell you is how much effort it takes to see that letter, how stable the vision is throughout the day, or how well the eyes function at near (where all desk work takes place).

Unfortunately school screenings only measure distance visual acuity (clarity of vision at distance). It has been shown that vision screenings miss up to 66% of vision problems, and included in those numbers is nearly every vision problem that affects performance at near. While screenings do a fairly good job of assessing the “tip of the iceberg”, they leave many causes of vision-related learning difficulties lingering beneath the surface and undetected.

Below are listed 10 of the most common vision conditions affecting our students:

Myopia (Nearsightedness)
Nearsightedness has the primary effect of creating distance blur. This is the only condition on the list that is effectively detected on a school screening. Students with moderate to high nearsightedness in both eyes will be unable to read the eye chart at distance. Unfortunately the condition that is best detected with school screenings has the least impact on near work. You can think of nearsightedness as parents wearing their readers full time. These students do quite well with deskwork at school and will often look off of other students’ notes when copying from the board. Nearsightedness is easily corrected with a pair of glasses or contacts.

Hyperopia (Farsightedness)
Farsightedness is often simplified as the opposite of nearsightedness, and thus creating near blur. A better understanding of farsightedness is that it creates a demand on the visual system that must be overcome to see clearly. This demand is higher at near than far, so typically symptoms first appear at near. If the amount of farsightedness increases to an amount that the student is no longer able to compensate for it creates blurry vision at near, distance, or both. Just like any demand in life, the student’s ability to compensate for their farsightedness will change throughout the day and week. For this reason the student can see clearly during a morning screening, but unable to see clearly at the end of a six to eight hour day (making homework a constant struggle). Farsightedness is easily corrected with a pair of glasses or contacts.

Astigmatism
Astigmatism is the third type of refractive error (nearsightedness and farsightedness being the other two). Astigmatism is a condition that results when the eye is not perfectly round. Astigmatism causes images to be focused at two different points in the eye and results in blurry vision at all distances, a doubling or “ghosting” of images, and can even cause eyestrain and other visual symptoms. Astigmatism is easily corrected with a pair of glasses or contacts.

Amblyopia
Amblyopia is a condition wherein vision is reduced in an otherwise healthy eye. Vision can be reduced in one eye or both, and occurs as the result of uncorrected refractive error and certain types of strabismus (eye turn). Treatment of amblyopia should be performed by an eye doctor with residency training in pediatrics (such as Dr. Jill Kronberg) or binocular vision (such as Dr. Ryan Johnson). Treatment can consist of glasses, contacts, patching, and binocular therapy. The goal of amblyopia therapy is to restore vision in the amblyopic eye and improve binocular vision functioning (eye teaming abilities).

Strabismus
Strabismus, or eye turn, is a condition that occurs when a person is unable to use their two eyes as a team at all times. The eye can either turn in, out, up or down. The eye turn can be present at all times, intermittently, or only be present at certain distances. The eye turn can be very large and easily visible to parents, teachers, and friends, but it can also be smaller in magnitude and very difficult to see with the untrained eye. Many people assume that the only way to “fix” an eye turn is with surgery. Strabismus surgery can be thought of as a “cosmetic fix” as the goal is to reduce the size of the eye turn so that it is not visible. The cosmetic fix does not always provide a functional fix to the eye turn, meaning that the patients may still have difficulties with eye teaming. This results in double vision or suppression (the brain ignores the signal from one eye). Without a functional fix the patient is likely to experience the same struggles as before the surgery. We recommend a Binocular Vision Evaluation with Dr. Johnson to determine the best course of treatment. Our treatment protocols are designed to provide both cosmetic and functional improvements.

Convergence Insufficiency
Convergence insufficiency is a condition wherein the patient has a reduced ability to use both eyes as a team during near activities. Convergence insufficiency can result in eye fatigue, eye discomfort, headaches, and reading difficulties that result from moving words on the page and skipped lines. Research has shown that in-office vision therapy is the best treatment for convergence insufficiency and takes only a few months. Glasses, pencil pushups, home-based programs, and computer vision therapy programs are not an effective treatment option for convergence insufficiency. This is why Advanced Vision Therapy Center offers one-on-one, in-office vision therapy with a trained therapist to address a number of binocular vision conditions.

Accommodative Dysfunction
Accommodation, or eye focusing, is an essential skill in the classroom. A student with reduced accommodative abilities will experience blurred or fluctuating vision. This is most notable when shifting the eyes back and forth from distance to near (such as taking notes from the board) and during prolonged near tasks (such as reading or homework). Accommodative dysfunction responds very well to both glasses and active therapy.

Oculomotor Dysfunction
Often called “eye tracking”, oculomotor skills are critical during reading and other classroom activities. Students with oculomotor dysfunction will frequently skip lines, re-read lines, have reduced reading fluency, and frequently lose their place when copying notes from the board. Oculomotor dysfunction does not respond to glasses or contacts and does not resolve on its own. Active in-office vision therapy is very effective in remediating oculomotor dysfunction and removing it as a barrier to successful school performance.

Visual Perceptual Deficits
Visual perception describes the process of interpreting visual information within the brain. In other words once the visual information is taken in by the eyes, what does the brain do with that information? Individuals with visual perceptual deficits find it extremely difficult to make sense of visual information presented in the classroom. Typically these students will struggle with visual-spatial concepts, such as measurement, geometry, story problems, and critical thinking activities that required visualization. Advanced Vision Therapy Center successfully evaluates and treats visual perception and associated deficits.

Prolonged Visual Processing Speed
The speed with which students can take in and digest visual information is very important in the classroom setting. The group environment presents a situation where some students may fall behind or be unable to keep up with their classmates. Prolonged visual processing speed will affects school performance, sports performance, and time-dependent activities in much of life (such as driving). At Advanced Vision Therapy Center we are able to assess and improve visual processing speed.

One thing that you may have noticed from the list above is that terms like “dyslexia”, “ADD/ADHD”, and other learning disorders are not present. While these conditions do affect learning, they are not visual in nature. Dyslexia, for example, is a language-based condition and should not be evaluated by an eye care provider. Confusion occurs when people who have been diagnosed with dyslexia, ADD/ADHD, autism, fine motor difficulties, or a number of other conditions improve with the use of glasses or vision therapy. Why does this happen? Are we treating these conditions through treating vision?

Our answer is simply “no”. We do not believe that you can “cure” dyslexia, or any other non-visual condition through visual interventions. What you can do with glasses, contacts, and vision therapy is successfully treat any vision conditions that have been misinterpreted as being one of the above non-visual conditions. A child with ADD/ADHD and a child with a vision-related learning condition will behave similarly in the classroom. They can be disruptive, have a short attention span, avoid reading, etc. The difference is that one child will response well to treatment of their undiagnosed vision conditions while the other will not.

We recommend that every child have annual comprehensive eye examinations with a residency-trained doctor to identify vision conditions before they affect school performance.

Dr. Jill Kronberg received her residency training in pediatrics at the University of California Berkeley. She sees children as young as 9 months old and specializes in school-readiness exams and performs developmental eye exams for children who are non-verbal, have letter confusion, or have been diagnosed with a developmental condition.

Dr. Ryan Johnson received his residency training in binocular vision, neuro-optometry, and vision therapy at the University of California Berkeley. One of his areas of specialty is working with students who have vision-related learning difficulties. He successfully diagnoses and treats many visual conditions, including those listed above.