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This will not be the year your child struggles in school….and here is why…COVID-19,

With the 2019-2020 school year ending early,  children were forced to participate in “school-at-home”. Many parents witnessed first-hand their child participating in the learning experience.  For some parents it was privilege to see how well their child performed. However, it was a frustration for other parents.  For these parents not knowing where to begin to seek help for their child’s problems with learning can be a daunting task.  Eighty percent of learning in a classroom involves vision.  If the visual system is ineffective, all other therapies and treatments initiated will still not allow help a child reach their full potential.  School-at-home required more, not less, near-point demand, more screen  time at the computer and TV and more independent learning than most children had ever experienced before. 

Often visual symptoms are misdiagnosed as learning disorders, dyslexia, or attention-deficit disorders.  Here are signs and symptoms of a functional vision disorder. 

  • skips words when reading
  • loses place when reading
  • poor reading comprehension
  • head tilt/closes one eye when reading
  • words “swim” on the page
  • forgetful 
  • poor handwriting 
  • reverses b/d, p/q
  • difficulty seeing the “big picture”
  • headaches 

Vision and eyesight are not the same thing.  A child who has 20/20 eyesight can still have all the symptoms listed above and school will be extremely difficult.  Eyesight is simply a measurement of visual acuity, the ability to see small print or detail.  Vision encompasses a variety of skills that enable one to track a target, see single, focus one’s gaze at varying points of interest and then to intellectually process what you have seen.  

There are different types of visual assessments.  These can  often be confusing for both parents and educators.  Here is a summary of evaluations that can be performed on a child. 

Vision screening:  Most likely performed at a pediatrician’s office, health department, a school nurse, or a charity.  Usually this screening will only measure eyesight in each eye using a distance eye chart (a child’s schoolwork is performed at near!).  This is not a substitution for a comprehensive eye exam.  Although many children’s visual issues can be detected with a screening, many parents are also given a false sense of security that their child’s vision is adequate.  According to a study by the American Foundation for Vision Awareness an eye chart alone will only identify 5% of those with vision problems.  The most common of these conditions are nearsightedness and amblyopia. 

Comprehensive examination: Performed by an eyecare physician (optometrist or ophthalmologist).  An evaluation of the visual health and eyesight.  Dilation is usually performed to determine health of ocular structures.  Glasses or contact lenses will be prescribed as needed.  The American Academy of Optometry recommends an eye exam annually. 

Functional Visual Skills and Perceptual exam:  Performed by an optometrist who has had further training in the function of the visual system.  This exam will include a comprehensive evaluation as described above and a thorough evaluation of the visual skills and visual perceptual/processing skills. These functional vision skills are essential for a child to perform in the classroom. This type exam is a must for any child that is not reaching their full potential academically, athletically, or socially.

Functional vision evaluations typically include testing in the follow areas:

Functional Skills

  • Spatial Orientation:   the foundation of all visual skills.  This skill is essential for balance and ability to move efficiently… clumsy children with poor handwriting often show problems in spatial orientation
  • Ocular Motor (Tracking):  a measurement of eye movements, crucial in efficiently moving the eye across the page when reading 
  • Binocularity (Fusing): alignment and coordination of the eyes…both eyes point at the proper place and both eyes move together
  • Accommodation (Focusing): how well the eyes can shift focus from distance to near/near to distance …it allows an image to be seen clearly and quickly wherever the eyes are pointing 

Visual Perception Testing

  • Reversals:  the ability to identify reversals…”makes “b’s” for “d’s” and “p’s” for “q’s” 
  • Visual Memory: the ability to remember what has been seen
  • Visual Memory with Output: the ability to draw/duplicate what has been seen
  • Sequential Visual Memory: the ability to remember a sequence of visual symbols
  • Visual Closure:  the ability to see the larger picture with a minimum of details
  • Figure-Ground:  the ability to see small details within busy or cluttered background
  • Spatial Relationships:  the ability to see differences in forms regardless of orientation
  • Form Constancy: the ability to see similarities in forms regardless of size or orientation
  • Auditory Visual:  the ability to match a pattern of sounds to a visual stimulus (essential for reading)
  • Visual Motor: the ability to interpret visual information and duplicate it in a written form, requiring both vision and hands working together

Reading Test

  • Reading Assessment: objective computerized reading assessment of eye movements, speed of recognition of words, reading rate, comprehension, as well as eye alignment while reading

Peripheral Vision

  • Functional Peripheral Vision: an assessment of the peripheral vision…when a person is under stress their peripheral vision shrinks and you process less

Healthy eyes are the beginning  of the visual process but how the brain gathers the information and how the brain processes this information is the essential part of an efficient visual system.

A different spectacle prescription at near-point may be all that is needed.  Visual ergonomics (lighting, desk design, proper posture) is also needed for academic success in and out of the classroom.  If difficulties in functional vision are detected a program of vision therapy to retrain or enhance the visual system may be prescribed.  

Any child who has exhibiting difficulty in academics should have a functional visual evaluation with visual perception testing.  The College of Optometrists in Vision and Development certifies doctors of optometry who have exhibited competency in the function of the visual system.  A developmental optometrist in your area can be found at

***Dr. Megan Lott is a fellow in the College of Optometrists in Vision and Development.  She was the first female to achieve this distinction in Mississippi.  Belle Vue Specialty Eye Care is the only full-time functional optometric practice in Mississippi with office locations in Hattiesburg and Jackson.

Written by Kara Martinez Bachman

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