Welcome to the world of children's vision!

Much of learning is associated with visual cues, so children with vision-related problems may find it difficult to keep up with their peers in an academic setting. In order to assess the relationship between success in an academic setting and vision-related problems, we compared the prevalence of vision-related problems between children with Individualized Education Programs (IEPs) to population-based samples from the literature.

An IEP is a written statement that includes a child’s present levels of academic achievement and functional performance, measurable academic and functional goals, alternate assessments aligned to alternate achievement standards (if necessary), and a description of necessary special education services, supplementary aids, and accommodations. An IEP is written by a team of professionals that may include school psychologists, teachers, school nurses, speech and language teachers, and medical specialists in order to set measurable goals and establish a guide for the child’s special learning needs.

Eye care professionals completed a visual examination on children with an IEP. The prevalence of a variety of conditions exhibited by children with IEPs was compared to prevalence rates reported in the literature.

Data were analyzed for 255 children reported to have an IEP. The average age of the children was 9.6 years.

Higher prevalence rates were reported for IEP patients than for samples from the literature for myopia (9 of 13 studies), hyperopia (10 of 13 studies), astigmatism (6 of 9 studies), anisometropia (myopia oy hyperopia different in each eye) (3 of 4 studies), and strabismus (6 of 6 studies). The entering distance visual acuity of IEP patients was 20/40 or worse for 23.7% of them, but 7.2% of eyes still had a visual acuity worse than 20/40 after correcting their problem. Of the children who required some form of treatment, 124 (69.3%) had better than 20/40 entrance visual acuity in both eyes.

Many of these vision problems would solely be undetected by vision screenings based on distance visual acuity, illustrating the need for comprehensive vision examinations for children who are struggling academically.

(1)   Walline JJ, Johnson Carder ED. Vision Problems of Children with Individualized Education Programs Journal of Behavioral Optometry. Volume 23/2012/Number 4.

It has been estimated that 80% of learning is obtained through vision. Although there is no scientific evidence for this statement, few disagree with the assertion. Scientists have found significantly lower achievement test scores, as well as reduced letter and word recognition, receptive vocabulary, emergent orthography, and verbal and performance intelligence quotients among children with uncorrected hyperopia. Furthermore, children with learning disabilities exhibit a greater prevalence of vision-related problems than the entire population. Certain vision problems that may affect learning, but not all, are related to refractive problems (hyperopia, astigmatism and less with myopia), so vision examinations may provide helpful information in the management of children with learning disabilities.

Source: VisionHelp Blog – Dr Fortenbacher, OD FCOVD:


But, what if a child with an IEP also has a vision problem? Wouldn’t that pose a risk to the child responding effectively to their IEP?   To attempt to answer this question, 3 states in the US (Illinois, Kentucky and Missouri) have mandatory eye examinations for children before Kindergarten. Only Arkansas, North Carolina, Oklahoma and Massachusetts require examinations for children who fail a school vision screening. And only Ohio and Massachusetts require examinations for children with learning difficulties. Sixteen states do not even require vision screenings for children.  Regardless of the state laws, when an eye examination has not been performed by a qualified eye doctor, the school will typically provide a vision screening to determine that vision is functioning “normally”. However, here is where problems begin to surface. Vision screenings are predominantly an eye sight test. That is, if the child’s visual acuity (eye sight) is better than 20/40 they pass the vision screening!

Even more critical to the question of the validity of a school vision screening was another startling conclusion of the team which found that out of the 179 that required treatment, 124 (69%) of the children with IEPs would have passed the school vision screening test. That is to say, nearly 70% of those children with an IEP were identified with treatable vision problems and yet would pass the vision screening because their vision problem did not affect their distant eye sight!

If you are a teacher, insist that any child who has an IEP be seen by an eye doctor who will provide a thorough vision evaluation and provide you with feedback about the results.

If you are a parent, whose child struggles in reading and learning and/or has an IEP, it is imperative that you seek help by a doctor who is thorough, enjoys working with children and either provides office-based vision therapy or will refer you to a qualified doctor who provides office-base optometric vision therapy.



An IEP is a written plan. It is a working document that describes the strengths and needs of an individual exceptional pupil, the special education program and services established to meet that student’s needs, and how the program and services will be delivered. It also describes the student’s progress.

An IEP should be based on a thorough assessment of the student’s strengths, interests, and needs. It should identify specific goals and expectations for the student, and should explain how the special education program will help the student achieve the goals and expectations set out in the plan. The special education program and services the IEP describes should be modified as necessary by the results of continuous assessment and evaluation.

A student’s IEP should be developed, implemented, and monitored in a collaborative manner. The educational growth of a student is best accomplished through the mutual efforts of, and close communication among, the student, the student’s parent, the school, the community, and other professionals involved with the student. The IEP provides an opportunity for all those involved with the student to work together to provide a program that will foster student achievement and success.

In summary, an IEP is…

  • a summary of the student’s strengths, interests, and needs and of the expectations for a student’s learning during a school year that differ from the expectations defined in the appropriate grade level of the Ontario curriculum;
  • a written plan of action prepared for a student who requires modifications of the regular school program or accommodations;
  • a tool to help teachers monitor and communicate the student’s growth;
  • a plan developed, implemented, and monitored by school staff;
  • a flexible, working document that can be adjusted as necessary;
  • an accountability tool for the student, his or her parents, and everyone who has responsibilities under the plan for helping the student meet his or her goals and expectations;
  • an ongoing record that ensures continuity in programming;
  • a document to be used in conjunction with the provincial report card.

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