There are signs that a child may be having vision problems.

• A child having difficulty with reading and writing even though they are receiving tutoring to improve these subjects.
• Poor handwriting and letter reversals can be a sign of binocular vision problems.
• Frequent headaches and eye rubbing or tearing while reading or doing near vision tasks.
• A child that is doing well in most subjects but struggles and dislikes reading tasks.
• A child that fidgets, turns their head or closes one eye during reading. They may also hold the pages close to their face or particularly far away while reading.
• Motion sensitivity or disliking movement (like rollercoasters), difficulty learning to ride a bike.
• Difficulty catching a ball.
• Child diagnosed with ADHD that does not respond to medication.

All eye exams are not created equal

In order to identify and properly diagnose an eye movement problem, the child will need a binocular vision exam. In this exam, the eye doctor will perform assessments like the near point of convergence and a measured cover test. Parents may have to ask if the office performs this service.

A complete eye exam will also include a cycloplegic dilation and refraction. This procedure will allow the doctor to get the most accurate prescription possible and thoroughly examine the health of the back of the eye. It is a necessary part of the complete eye exam.

When should my child get their eyes checked?

Most eye doctors agree that the first eye exam should be between 6 months and one year. The Infantsee Program provides this exam at no charge with providers listed on the linked website. The next exam is at 3 years old, then annually from 6-18 years old as vision changes as the child grows.

Get to the Eye Doctor

The visual system is very important in development and academic success. Every child should get a complete binocular vision exam to make sure they are reaching their full potential.

ARE YOU A SCHOOL OCCUPATIONAL THERAPIST? 

School Occupational Therapy practitioners can screen and remediate many different undiagnosed vision issues. It’s important to receive training so you feel competent.

Sign up for Eyes First:The Complete Vision
Course for School-based Occupational Therapy Practitioners, an AOTA-approved online training for school occupational therapy assistants and therapists.

Did you know that the eye exam that the school gives just looks to see if the child may need glasses?  There are actually WAY more problems that a child can have that would interfere with their progress in school.

There are different kinds of eye care professionals and different models of treatment. Some doctors may only check the health of the eye and if the child needs glasses. Others also check eye movement and if the eyes work together.

Visual Efficiency NEEDS TO BE ASSESSED

Binocular Vision Disorders  – when a child’s two eyes aren’t working together as a team.  This may include strabismus, convergence and divergence.  Binocular vision issues are more common in children with learning disabilities and developmental delays.

Ocular Motor (Eye Movement) Disorders – Eye movements include pursuits, saccades, and fixation.

• Pursuits – The reflex to follow a moving visual stimulus
• Saccades – A single eye movement from one thing to another, such as words in a sentence.
• Fixation – The ability to keep the eyes focused on a stationary object.

Accommodative Disorders are also called Focusing Disorders. Children who struggle with looking from near to far and back again are among 5 to 6 percent of the general pediatric population (Scheiman, 2104).

Think of how many children have trouble copying from the board.  That could be due to Accommodation.

Many children struggle with reading. Despite tutoring, they don’t make progress.  That could be a problem with the near vision system.

A child who tends to avoid sports and doesn’t want to play catch may struggle with convergence and can’t see the ball as it’s coming toward them, or they may see double.

The Traditional Exam doesn’t assess these areas.

Sign up for Eyes First: The Complete Vision Course for School-based Occupational Therapy Practitioners, an AOTA-approved online training for school occupational therapy assistants and therapists.

Related Reading

There are different kinds of eye care professionals and different models of treatment. Some doctors may only check the health of the eye and if the child needs glasses. Others also check eye movement and if the eyes work together.

Max was in the third grade. He was diagnosed with ADHD, but his meds just weren’t working.

“He’s in reading extra help and math extra help—but they’re not helping!?” 

Mom’s mood changed from angry to confused to sad.

“He’s starting to hate school. I don’t know what to do!” 

Unfortunately, this is pretty common for children with undiagnosed vision deficits. The parents get them glasses so they think they’ve crossed vision problems off the list.

But it’s just not true.

The most common vision problem (besides needing glasses) that school Occupational Therapy practitioners encounter is binocular vision deficits.

But there are a huge number of vision problems that may be impacting a child’s schoolwork. It’s really important that children have a complete eye exam. Not just finding out if they need glasses.

Understanding Visual Efficiency with Children

Binocular Vision Disorders – when a child’s two eyes aren’t working together as a team.  This may include strabismus, convergence and divergence.  Binocular vision issues are more common in children with learning disabilities, and developmental delays.

Ocular Motor (Eye Movement) Disorders – Eye movements include pursuits, saccades, and fixation.

• Pursuits – The reflex to follow a moving visual stimulus
• Saccades – A single eye movement from one thing to another, such as words in a sentence.
• Fixation – The ability to keep the eyes focused on a stationary object.

Accommodative Disorders are also called Focusing Disorders. Children who struggle with looking from near to far and back again are among 5 to 6 percent of the general pediatric population (Scheiman, 2104).

Sometimes It’s Not ADHD. It’s Vision.

Very often, children with vision difficulties display behaviors such as:

• avoiding work
• taking much longer to complete reading and writing assignments
• complaining of headaches
• difficulty focusing and paying attention

These are also common symptoms of Attention Deficit Disorder. So it’s sometimes hard to tell what exactly is going on with that student.

WHAT IS A COMPLETE EYE EXAM?

There are two models of vision:

The One Component Model of Vision:

• Checks the health of the eye and if the child needs glasses

An annual eye exam done by an Optometrist may not include all three of these components.  It depends on the doctor’s training.  It can be difficult to find an optometrist who will do an exam that looks for more than just glasses.  But for some children, it makes all the difference in the world.

After all, it’s awfully hard to learn if you can’t see what you’re looking at. 

Max’s mom listened to me explain the different types of eye problems that a complete eye exam would rule out.  “I had no idea that my doctor may not have looked at that!”

She laughed ruefully. “Half of me is mad… and the other half is hopeful!”

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