Vision & Reading

http://www.children-special-needs.org/vision_therapy/esophoria_reading.html

The following are excerpts from an article on Vision, Learning and Nutrition
by Donald J. Getz, OD, FCOVD, FAAO

This article by an eye doctor discusses children's problems with reading, learning, and behavior caused by convergence insufficiency, eye tracking problems, esophoria, exophoria, and other visual problems.

Vision and Eyesight

Eyesight is simply the ability to see something clearly, the so-called 20/20 eyesight (as measured in a standard eye examination with a Snellen chart). Vision goes beyond eyesight and can best be defined as the understanding of what is seen. Vision involves the ability to take incoming visual information, process that information and obtain meaning from it.

Two general statements can be made about vision. First, vision is learned. A child learns to see just like he learns to walk and talk. When learning to walk and talk, he has the added opportunity of imitating his parents and siblings. In addition, parents can observe their children to determine if walking and talking are developing properly. Vision development, however, generally proceeds without much concerned awareness on the part of parents. Because of these differences in development, no two people see exactly alike.

Vision Is Learned

Vision is learned; therefore vision is trainable. If a child does not possess the necessary visual skills, he can be taught to possess them through the proper Vision Therapy techniques.

Adequate Vision Is Critical to Learning

Since something like 75% to 90% of all a child learns comes to him via the visual pathways, it stands to reason that if there is any interference in those pathways, a child will not develop to his maximum potential.

Vision

The Visual Skills Needed for Academic Success

Visual Acuity: There are many visual skills which are important for academic success. One of the least important skills is termed visual acuity (clarity, sharpness). This is the so-called 20/20, 20/400, etc., eyesight. All that is meant by the notation 20/20 is that a person is capable of seeing clearly at a distance of twenty feet. Unfortunately, how well a child sees at twenty feet has little to do with how his vision functions at the reading and learning distance -- aproximately eleven to sixteen inches from the face. In fact, it is my opinion that the Snellen eye chart test which measures visual acuity actually does more harm than good. It gives both parents and teachers a false sense of security that vision is normal. There are many other important visual skills that might not be developed even though visual acuity at distance is normal.

Binocular Coordination: One of the more important visual skills is the ability to coordinate the two eyes together. A child is born with two eyes, but he must learn to team them together. Some children learn to do this properly while others do not. For example, some children develop a problem known as exophoria, which is a tendency for the eyes to deviate in an outward direction. This is not the same as a condition known as exotropia where the eye actually can be seen to be in an outward position.

Adequate Convergence: During the act of reading, the demand is for the two eyes to turn inward so that they are aimed at the reading task. If the eyes have a tendency to deviate outward, the child must use excess effort and energy to maintain fixation on the reading task. Most studies have shown that the greater the amount of effort involved in reading, the lower will be the comprehension and the lower will be the performance. When reading, the eyes do not move smoothly over a line of print. Rather, they make a series of fixations looking from word to word. When an exophoria exists, each time fixation is broken and moved to the next word, the eyes will tend to deviate outwards and they must be brought back in to regain fixation. Human nature being what it is, the child generally has an avoidance reaction to the reading task. This is compounded by the fact that anything the child doesn't do well, he would rather not do. This is the child who looks out the window rather than paying visual attention. He is commonly given labels. He is often accused of having a short attention span and not trying. He is told that he would do better if he tried harder, but he has tried harder to no avail. He is often labeled as having dyslexia, minimal brain dysfunction, learning disability, etc. Commonly, he loses his place while reading and/or uses his finger or a marker to maintain his place. While making the eye movements during the act of reading, he might not land on the next word, but rather land a few words further on. Consequently, he commonly omits small words or confuses small words. Often, he just adds a word or two to make the sentence make sense. If the two eyes are pointing at the same point in space, a person will see the fixated object as being single. Double vision or overlapping vision (Figure #3) results if the two eyes are not exactly pointing at the same point. Don't expect a child to tell you that his vision isn't clear. He has no yardstick of comparison to inform him that his vision differs from the vision of anyone else.

Figure 3

Astigmatism, Eye-Hand Coordination, Visual-Motor Problems and more: I have maintained for many years that I could walk into a classroom and pick out those children with coordination type visual problems. They get into distorted postures in an attempt to get one eye out of the act. They often put their head down on their arm, cover one eye with their palm or rotate their head so that the bridge of their nose interferes with the vision from one eye.

Esophoria: Another eye coordination problem is termed esophoria, which is a tendency for the eyes to turn inwards. The educational implication of this particular problem is that a child with esophoria sees things smaller than what they actually are. In order to see an object properly, it is necessary to make the object larger. The only means at the disposal of the child to make it larger is to bring it closer. Eventually, the child is observed with his head buried in a book and still not achieving.

Reading Skills and Binocular Visual Skills

One of the tests used in optometric offices is to have the child read words while looking into an instrument called a Telebinocular. The performance is compared between reading with either eye alone and with both eyes together. The difference in performance is often quite dramatic if there is an eye teaming problem. One eye performance might be quite satisfactory, but reading with both eyes together will be slower and many more errors will be made.

Other Visual Skills

Directionality: Directionality is another visual skill important for academic success. One test for this skill is illustrated in Figure #5. Look at Figure #5 and determine what you see. If the visual reflex is from left to right, a duck will be seen. However, if the visual reflex is from right to left, a rabbit will be seen. This is just one test out of a series to determine the directionality of the visual reflex.

Figure 5

It is just a convention of our culture that the English language proceeds in a left to right direction. Other languages proceed in a right to left direction and still others have a vertical orientation. Many people feel that it would make more sense if the language proceeded as illustrated in Figure #6. If a child does not visually proceed from left to right, through Vision Therapy he can be taught to develop this skill just like he can be taught to team his eyes together.

Figure 6

Form Perception: Form perception is another important visual skill for academic achievement. This can best be illustrated by referring to Figure #7. The child is shown these forms one at a time and he is simply asked to copy them. It is amazing to see some of the distortions that a child will make in attempting to copy these forms. If a child can't perceive and copy these simple geometric forms, it is unreasonable to assume that he will be able to perceive the wiggly lines which make up letters which in turn make up words, which in turn make up sentences which stand for abstract ideas. We see children often who can't tell the difference between a square and a rectangle or a circle and an oval. This is also a skill which can be improved through Vision Therapy.

Figure 7

Attention Span/Span of Perception: The Span of Perception is also related to success in school. Many children see just one word at a time with each eye fixation. Reading speed can be improved by learning to see two, three, or more words with each eye fixation. This could be compared to reading through a straw. This is illustrated in Figure #8. It is easy to see the difference in reading for meaning when the span of perception is wide.

Figure 8

Visualization: The ultimate visual skill is visualization. This is similar to being able to see things in the mind's eye. There are authorities that state that the ability to visualize is very closely allied to the ability to think. In other words, thinking is related to the ability to abstract from specifics and the ability to visualize is deeply involved in this process. Visualization is also a trainable skill.

There are many other visual skills that time and space do not permit me to mention. However, it is hoped that the reader will realize from the above discussion that there is a lot more to vision than just 20/20.

Nutrition and Vision

When I see a child with a learning problem, I feel very strongly that there usually is more than just a single cause. For example, when I find a visual problem, if I probe a bit further, a nutritional problem will be found as well. Children often walk into the office eating a candy bar or sipping on a cola or other soft drink. When they are asked what they had for breakfast, the response usually falls in the frosted, sugary flake category or the answer is that they had no breakfast at all.

When I am asked which nutrients are important for optimum visual functioning, I respond that the same nutrients essential for the rest of the body are the ones needed for vision. This is because vision does not operate independently of the rest of the body.

In all cases, a diet of high quality, nutrition-rich, unprocessed foods is important if we are going to be successful in Vision Therapy. Vision therapy involves a learning process and, as with any learning process, learning will be maximized if a healthy body and a healthy mind are brought to the learning task.

Reprinted with permission from The Journal of Applied Nutrition Volume 28, Winter, 1976

This complete article may be purchased by writing to College of Optometrists in Vision Development, 243 N. Lindbergh Blvd., Ste. 310, St. Louis, MO 63141-7851 and requesting the article: Getz, Donald J., O.D., "Vision and Perception Therapy," 1973.

Bibliography

Feingold, Ben F., M.D., Why Your Child Is Hyperactive, Random House, New York, 1975.

Lane, Benjamin. O.D., "Myopia," 1976. College of Optometrists in Vision Development

Ludlam, William, O.D., "Visual Evoked Response," 1974. College of Optometrists in Vision Development

McDonald, Lawrence W., O.D., "Visual Training," 1962-1963. Optometric Extension Program

Ott, John. Sc.D., Health and Light, The Effects of Natural and Artificial Light on Man and Other Living Things, Devin-Adair Co., 1973.

Skeffington, A.M., O.D., Continuous writings, Optometric Extension Program

---

To locate an eye doctor who provides comprehensive pediatric vision examinations and treatment, including Vision Therapy, request a referral through our Referral Directory: Find a Pediatric Eye Doctor.

How Inefficient Visual Processing Can Affect a Student's School Performance

 

From The Vision Therapy Center

 

 

 

Published on Feb 21, 2013

 

Dr. Kellye Knueppel of The Vision Therapy Center discusses how vision problems affect each academic subject, including reading, composition, math and handwriting.

 

 

81 Vision-Friendly Gifts for Kids

Discovering Vision Therapy Blog

Posted on Tue, Nov 13, 2012 @ 03:00 PM


It’s back! Our 2012 Vision-Friendly Holiday Gift List. The list includes 81 toys and games that promote visual skills such as hand-eye coordination, visualization, and space perception.

You’ll note a distinctive lack of hand-held video devices and home gaming systems, which can increase the risk of computer eye-strain. It’s our hopes that we can provide alternatives to the electronics with activities that can enhance a child’s visual skills.

“These toys can improve hand-eye coordination, depth perception, visualization, fine motors skills and other visual skills,” said Dr. Kellye Knueppel, developmental optometrist and owner of The Vision Therapy Center.

It’s our hopes that these gifts will be a fun alternative to video games. By spending excessive amounts of time on hand-held video devices and home gaming systems, there is a potential for worsening vision problems such as focusing issues, poor eye teaming and even nearsightedness.

In particular, we want people who have a child with an existing functional vision problem to gift wisely this holiday season. “If you have an existing vision problem, too much time playing hand-held video games will likely make the condition worse and will not be helpful,” said Dr. Knueppel.

The 2012 Vision-Friendly Gift List is arranged by visual skill and includes ideas for pre-schoolers through adults.

Remember that learning and enjoyment is usually best when the child can accomplish the activity relatively easily about 80-90% of the time, and is therefore challenged 10-20% of the time. Choose toys based on developmental age rather than actual age, and consider playing without being competitive.

Building toys – Develop eye-hand coordination and visualization/imagination.

1. Building Blocks


2. Legos/Duplos


3. Lincoln Logs


4. Tinker Toys

5. Erector Set

Fine motor skill toys – Develop fine motor skills including visual skills and manual eye-hand coordination.

6. Light Bright 


7. Pegboard and Pegs


8. Coloring Books and Crayons


9. Dot-to-Dot Activity Books


10. Finger Paints


11. Playdough/Silly Putty/Modeling Clay


12. Chalkboard (24” x 36”)/Easel


13. Bead Stringing


14. Sewing Cards (craft)


15. Paint or Color By Numbers


16. Sand Art


17. Stencils


18. Bead Craft Kits


19. Models (car, airplane, ships, etc.)

20. Jacks

Space perception toys – Develop depth perception and eye-hand coordination.


Within arm’s length:

20. Jumpin’ Monkeys

21. Flippin’ Frogs

22. Ants in the Pants


23. Fishin’ Around


24. Operation


25. Pick-up Sticks


26. KerPlunk


27. Jenga

28. Don’t Break the Ice

29. Marbles

Beyond arm’s length:

30. Oball (good for kids who aren’t very good at catching)


31. Ball (any kind!)


32. Pitchback


33. Toss Across (tic-tac-toe)


34. Ring Toss


35. Nerf Basketball


36. Dart Games (velcro)


37. Ping Pong

38. Cuponk

39. Elefun

Visual thinking toys and games - Develop visual thinking including visualization, visual memory, form perception, pattern recognition, sequencing and eye tracking skills. These skills are important basics for academics including mathematics, reading and spelling.



40. Color Blocks and 1” Cubes


41. Parquetry Blocks


42. Attribute Blocks


43. Make N Break Game


44. Jigsaw Puzzles


45. Rory’s Story Cubes


46. Card Games (Old Maid, Go Fish, etc.)


47. Dominoes

48. ThinkFun Bug Trails


49. Checkers


50. Chinese Checkers


51. Perplexus


52. Qwirkle


53. Battleship


54. Labyrinth


55. Blokus


56. Connect Four


57. Rush Hour/Rush Hour Jr.

58. Regatta


59. Perfection


60. Tactilo


61. Bingo


62. Memory Games


63. Chicken Cha-Cha-Cha


64. Simon Flash


65. Bop It


66. Hyperdash

67. Blink  

68. Set

69. Loopz

70. Racko

71. Sort it Out

72. Tangrams/Tangoes

73. Mancala

74. Q-bitz

Balance and Coordination toys and games – Develop large motor skills.

75. Hoppity Hop


76. Jump Ropes


77. Sit and Spin


78. Slip ’n Slide


79. Trampoline


80. Stilts


81. Twister

Finding an Eye Doctor to Assess and Treat Vision Issues Impacting School Success

Optometrists Network:  Find doctors by state and learn about some common, virtually unknown to educators, vision difficulties.

http://www.optometrists.org/optometrists_pub.html

Vital Connections Between Vision and Learning

http://info.thevisiontherapycenter.com/download-your-free-vision-and-learning-guide/?utm_campaign=Vision-and-Learning-Guide-Download&utm_source=TVTC%20Blog

Vision Therapy Center, Inc.


 

Teacher/Parent Vision and Learning Guide

www.thevisiontherapycenter.com

The information in this guide was created for teachers and parents. It provides background information on the vital connections between vision and learning.

You’ll find the following information:

• Vision and Learning Overview

• What are some of the vision skills that affect learning?

• Impact on Subjects

• What does the work of someone with vision problems look like?

• Stress Points

• Take the Vision Quiz

• Vision Therapy

• Studies

• Success Stories

• Modifications for the Classroom

• The Vision Therapy Center Contact

Vision and Learning Overview

Good vision requires your eyesight, visual pathways, and brain to all work together. When they don’t, even a person with 20/20 eyesight can experience difficulty reading, writing and processing information, as 80% of all information comes to a child through their vision.

Most people think that if a person’s visual acuity is 20/20 their vision is ‘normal’ or ‘perfect’. That’s not the case.

Visual acuity is a measure of the clarity of a person’s vision and is tested by having a patient read a line of letters on an eye chart. This test does not require the same amount and types of eye movements that reading does, so it cannot be used to determine whether a child has the visual skills necessary to read.

While clear vision is important, it is only one of many visual skills required to be able to read and learn.

·         75-90% of classroom learning comes through the visual system.

·         80% of children who are reading disabled, including dyslexics, have vision problems that can be solved.

·         25% of ALL children have a vision problem significant enough to affect their performance in school.

·         95% of first grade nonreaders had significant vision problems. They had nearly 2.5 times more visual problems than first grade high achievers.

·         In one study, 70% of juvenile delinquents had a vision problem.

·         In one California funded study, recidivism (repeat offenders) reduced from 45% to 16% when wards received on-site optometric vision therapy.

·         When a group of illiterate adults were vision screened, there was a 74% failure rate.

·         School vision screenings, such as a Snellen eyechart, detect only 20-30% of vision problems in schools.

·         Only 13 percent of mothers with children younger than 2 years of age have taken their baby for a functional well-care eye exam. Yet 1 out 10 children are at risk for having an undiagnosed vision problem.

Source: Visionandlearning.orgwww.thevisiontherapycenter.com

What are some of the skills that affect learning?

Convergence

When reading, the eyes should aim inward at the same spot in order to fixate on print. If the eyes aim at a spot in front of or behind the print, extra energy and effort is required to maintain fixation and double or overlapping vision may occur. An example is shown to the left.

Directionality

Directionality is important in understanding how similar shapes can have different meanings when they are in different orientations. To the left is an example of some letters that are commonly reversed by children with poor directionality. The letters are the exact same shape, but are called a different name depending on their orientation. This can be a difficult concept because if another object, such as a chair, is turned on its side or upside-down it is still called a chair.

Form Perception

Below is an example of an item from a visual perceptual skills test. In this particular test the child is asked to identify which form among the choices at the bottom matches the form on top. Other visual perceptual skills tests assess the child’s ability to identify a form from memory, identify which form is oriented in a different direction, identify a form that has a different size or orientation, identify a sequence of forms from memory, identify a figure hidden in ground and identify an incomplete form as if it were complete.

b d p q

Span of Recognition

Children who can read at accelerated speeds often have a good span of recognition, allowing them to recognize and process several words at one time. Children lacking this skill may only be able to see one word or letter at a time. In order to see what this would be like, try reading a sentence or paragraph while looking through a straw.

Visualization

Visualization is the ability to create mental images. Children who have vision problems may also have difficulty with visualization. This skill is important for success in many school subjects including spelling and math.

Tracking (Pursuits and Saccades)

Commonly referred to as ‘tracking’, maintaining fixation on a moving target (pursuits) or accurately switching fixation between two targets (saccades) are two types of eye movements that are essential for reading and learning.

An example of this is when your eyes reach the end of a line of print and have to accurately move from the end of that line to the beginning of the next line of print. Difficulty with these eye movements can cause a child to skip words or lose their place easily when reading.

Impact on Subjects

Considering 80% of the information you process comes through your visual system, it’s not surprising that a vision problem can affect a number of different subjects. Here’s a brief overview of how vision problems can manifest in various areas.

Reading

Vision problems affect reading in two significant ways:

·         When a student is learning to read, a serious vision problem could reduce their ability to know what they are looking at and impact their ability to remember numbers and letters.

·         When a student is reading to learn and has blurry or double vision, their ability to read for long periods of time and comprehend what they are reading can be severely reduced.

The ability to read and the ability to comprehend what is being read are two different things. Comprehending what is read is a visual process, and can be affected when the visual system is not working correctly. If a student sees words on the page as blurry or double, he or she has to use extra effort to keep the words single and clear and this can negatively impact comprehension.

Students with vision problems spend the majority of their time decoding words. Instead of reading fluidly and visualizing the words and the message as a whole, they focus on each specific word. This is a struggle, making it difficult to quickly process sections of text.

As a result, students will track text with their fingers. They’ll read a slower pace and will have fluency issues. Their reading will be marred by repetitions, insertions, omissions and substitutions.

These reading problems are all too often misconstrued as laziness on the part of the student. They are not. They are simply symptomatic of a vision problem. When corrected, it’s common for students to enjoy reading and no longer avoid it.

Math

If a student has difficulty seeing things as clear and single, they may have trouble seeing decimals and/or signs. An important skill in math is to organize what is being written and the student may have trouble lining things up and keeping their place if their visual skills are poor.

Laterality and directionality are also important concepts in math. If a student sees the orientation of numbers incorrectly, they will have difficulty completing the problem.

Students who lack visualization skills can often be found counting on their fingers or verbalizing sequences. Given enough time, they can generally compute an answer, but they tend to do poorly on timed tests. Awareness of numbers and what they mean as well as being able to visualize numbers and quantities, are critical to success in math and can be impacted if a child has a vision problem.

It should be noted that a child with vision problems may do well in math but be a poor reader, primarily because math doesn’t require as many precise eye movements as reading.

Spelling

Visual recall, the ability to create a visual image based on past visual experience without currently having that experience, is a visualization skill that is critical for spelling. In spelling, it is the ability to create a mental image of a word without being able to look at the word.

Writing

Writing involves both handwriting and composition skills. It is necessary for vision to lead the hand for handwriting and this can be very difficult if the student cannot see well. In fact, often you can see in the handwriting where the student stopped looking or became fatigued. Difficulty writing straight on a page is often a result of poor peripheral awareness.

There are several vision-related skills that are critical to good handwriting that may be underdeveloped in a student with vision problems. Visualization is also important in handwriting because the student needs to remember what different words look like in order to reproduce them on the page. Spatial concepts are important in handwriting to know and plan how words will go together. Good laterality and directionality are important to differentiate similarly-shaped letters in different orientations (e.g. b, d, p, q).

Visualization is also critical for writing composition because the student needs to be able to organize and re-organize the composition in his or her head.

What does the work of someone with vision problems look like?

Take a look at some of the work samples of students with vision problems:

Unequal sized print

Words moving or letters running together

Words take off and leave the page

Double print

Reversed letters

Words squished together

Words appear as splotches or streaks

Words are shaky

Stress Points

These are areas that can cause stress for students with vision problems:

• Small print

• Sustained, near point work

• Full pages of print, with blocks of text close together

• Copying from chalkboard or SMART Board to paper on desk

• Fine-motor skills

• Flickering fluorescent bulbs

• Standardized test sheets

• Random lists of spelling words

• Timed tests

• Crossword puzzles

• Reading aloud to a group without being given a warning

• Being asked to instantly identify right and left directions