There’s more to vision than just needing glasses.

“But he already has glasses!”  Even though we were separated by the phone, I could tell the mom thought I was crazy. Her son wears glasses every day, and here I just recommended that she take him for a vision exam.

“But there’s more to vision than just needing glasses” I explained. “He needs a COMPLETE vision exam, so we can see what’s going on.”

Now the mom’s voice was exasperated.  “What are you saying? The doctor did an incomplete exam?” 

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.


There are two models of vision:

The One Component Model of Vision:

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

The second called the Three Component Model of Vision:

  • Checks the health of the eye and if the child needs glasses
  • Visual Information processing skills (aka visual perception)
  • Checks the child’s visual efficiency
        • Accommodation
        • Binocular Vision
        • Eye Movements

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!”

I knew what she meant. Of course, she didn’t WANT Max to have a vision deficit besides needing glasses. But on the other handwhat if there’s been a hidden problem all along?

It’s time to UNCOVER those hidden vision problems!


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

Sign up for Vision 101 for School Occupational Therapy Practitioners, an AOTA approved online training for school occupational therapy assistants and therapists.

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