All parents recognize how vital good vision is to their children's development and school performance. As children grow and mature, over 80% of what they learn is processed through their eyes.  However, most people have a limited understanding of what good vision means.  Good vision involves much more than just seeing clearly without glasses.  

When most parents think about vision, they think about their child's clearness of sight, or visual acuity--in other words, the sharpness of vision as measured by the eye chart.  When a child has 20/20 vision, it means that each of his eyes can see what an average person sees at a distance of 20 feet.  If a child fails the eye chart test, he can get glasses or contacts to correct his blurry vision.  But the eye chart's use is limited to only checking a child's sharpness of vision, usually measured at distance.  

The eye chart, a distance test, cannot check the important close-up visual skills that children need, especially in school.  For example, the eye chart can't check how well children team or coordinate their eyes to maintain single vision, how well they can track a line of print without losing their place, how well they can adjust focus changes from their desk to the board, or how well they can understand and make sense of what they see.  Children can have good sharpness of vision (20/20) and still have serious problems in these other areas.

Below is a demonstration on how children with eye teaming problems often see, especially when they are forced to read small print over an extended period of time. 

Do you find reading this way difficult?  Frustrating?  Did you want to quit?  Statistically, print may look this way for up to 15% of school-aged children.  These children can't control their eye movements at close ranges, and as a result they fight double vision every day, especially when reading. Still others struggle with print that blurs or jumps around. Is it any surprise these children are not doing well in school?  

If your child is struggling to read or finding it difficult to remain on task, the cause may be an undetected vision problem. According to the American Optometric Association, one out of four children have an undiagnosed vision problem that interferes with their ability to read and learn.  Many of these children are often suspected of having learning disabilities, dyslexia, or attention deficits when the real culprit is their vision.  Over 60% of children with learning disabilities have poor visual skills that are contributing to their struggles in school. 

Symptoms of Vision-Based Learning Problems:

Children with poor learning-related visual skills may struggle to read, have poor comprehension, frequently lose their place, omit or miscall words, have short attention, become easily distracted, take too long to complete assignments, frequently rub their eyes or blink excessively, have headaches, tire easily, tilt their head when reading, have poor handwriting, perform poorly in sports, develop low self-esteem, and become easily frustrated. Early detection can save years of struggling.  If your child has been labeled ADD, learning disabled, dyslexic, unmotivated or even "lazy," please call our office to learn more.  This may be the single most important thing you do for your child this year!

Vision and Attention Deficit Disorders (ADD/ADHD)

Children with undetected vision problems can exhibit symptoms similar to ADD.  Studies show that approximately 20% of school-aged children suffer with eyestrain from eye teaming or focusing deficits that make remaining on task for long periods of time difficult.  Like those with ADD, children with vision-based learning problems are highly distractible, have short attention spans, make careless errors, fail to complete assignments, and are often fidgety and off task.  However, their inability to remain on task is caused by the discomfort of using their eyes for long periods of time at close ranges, not true deficits in attention.  Unfortunately, parents and teachers are not trained to recognize the difference and these children are often misdiagnosed.   

The connection between eye teaming problems and attention deficit disorders was recently documented in medical journals. The latest research study found children diagnosed with ADHD were three times as likely to have a convergence insufficiency than children in the rest of the population.  Dr. David B. Granet, director of the Ratner Children's Eye Center of the University of California in San Diego and a nationally known pediatric ophthalmologist, explains that because this kind of eye teaming problem causes children to have difficulty keeping both eyes focused on a close target, it becomes more difficult for them to concentrate on reading, one of  the ways doctors diagnose ADHD.  As a result of his research, Dr. Granet recommends that no child be diagnosed with ADD or ADHD until their visual system has been checked because the chance of a misdiagnosis is just too great. (Strabismus, Volume 13, Number 4 / December 2005, Pages: 163 - 168).

Any child who is suspected of having ADD should have a complete eye exam by a pediatric specialist in children's vision to determine if poor visual processing is a factor in the child's behavior.  Unlike ADD which is diagnosed by a subjective checklist, objective clinical measures and tests can be run to determine for certain if the child has a learning-related vision problem which is making it difficult for him to remain on task.  

Click here for more information on the visual aspect of ADD/ADHD.

Crossed or Wandering Eyes (Strabismus) 

Vision therapy is also used to treat strabismus. Strabismus, commonly referred to as crossed or wandering eyes, occurs when one or both eyes turns in or out, up or down. The condition is caused by the brain's inability to coordinate both eyes simultaneously. The brain is the master control center of vision, and somewhere early in a child's visual development, the brain failed to develop "binocularily," or the ability to use both eyes at the same time.  The condition usually develops before a child is two but can occur as late as age six.   It is important  that strabismus receive prompt treatment.   Children do not outgrow crossed eyes, and the condition can worsen over time.  Children with strabismus may develop additional complications with amblyopia, or "lazy" eye.

Strabismus in which the misaligned eye turns in or out is divided into two categories: esotropia ("crossed" eye) means an eye turns in towards the nose, and exotropia ("wandering" eye) means an eye turns out away from the nose. In addition, the eye turn may be constant or happen only at times, such as when the child is tired; it may be the same eye which always turns, or the left and right eyes may turn alternately. The child's eye may turn  only when he is looking at objects close up, or it may turn when looking both near and far. The degree of eye turn may be so great that it is readily noticeable, or slight enough that parents may fail to recognize there's a problem.

Because the brain has not learned to align the eyes and use them together, each eye aims independently of the other.  In other words, both eyes do not point at the same place at the same time. When each eye is looking at a different place, the brain receives two different "pictures." This would normally result in double vision. However, these children's brains learn to protect themselves from seeing double by suppressing, or "turning off" the crossed eye. The brain refuses to receive the visual input from the turned eye; children with a crossed or wandering eye only see out of one eye at a time. 

Click here for more information about crossed or wandering eyes.

Lazy Eye (Amblyopia)

Vision therapy also effectively treats lazy eye. A lazy eye, technically referred to as amblyopia, means that one eye has not developed normally and always has blurred vision, even with the best glasses or contacts the eye doctor can prescribe. Amblyopia is caused when the brain favors one eye and refuses to use the other.  Simply stated, amblyopia is a dysfunction of the brain which blocks vision from one eye because it can't use the two eyes together.  Because the eye is "turned off, " clear vision does not develop in the lazy eye.  Amblyopia affects 2 to 3 percent of the population. 

Children with normal vision learned to use both eyes together in the first few months of life.  Their brains developed the ability to take the pictures coming in from both their left and right eyes and "fuse" the two pictures into a single image. This is called "binocularity," or normal two-eyed vision. 

The brains of children who have a lazy eye, however, did not learn to use their two eyes together. At an early age, these children only used one eye, and their brain "turned off" or blocked the in-coming picture from the other eye. Turning off an eye is called suppression.  Because the brain suppressed the lazy eye very early in life, normal sharpness of vision, called acuity, did not have a chance to develop.  This "use it or lose it" syndrome means that the child has lost the ability to see clearly out of the lazy eye, even with the best pair of glasses or contacts the eye doctor can prescribe. How poor the vision is in the weak eye depends in part upon how early in the child’s visual development the brain turned the eye off.

 Click here for more information about lazy eyes.

.

Vision Therapy Can Help!

Before a child can begin a vision therapy program, he or she must be seen by Dr. Price for a complete developmental vision evaluation and diagnostic workup. In addition to checking the child's eye health and sharpness of vision (visual acuity as measured by the eye chart), Dr. Price will complete a comprehensive assessment to evaluate the child's eye teaming, tracking, focusing, visual perception, and eye-hand coordination skills. 

The child's vision therapy program consists of an individualized plan of in-office treatment procedures using lenses, prisms, instrumentation, visual exercises, and occlusion meant to return the patient to normal vision. Usually home therapy is also prescribed to reinforce the new skills the patient is learning at the doctor's office.  Eye patching is often a part of the treatment program. 

The encouraging news for parents is vision therapy is very effective in restoring normal vision. If you suspect your child has a vision problem, the first step is scheduling a developmental vision evaluation with Dr. Price.  Once the problem has been identified, vision therapy can return your child's visual system to normal, usually in less than six months!