Reading and learning-related vision problems

VISION AND LEARNING OR READING PROBLEMS

Vision is our most important sensory modality: 80% of what we learn is achieved through our visual system. However, we easily underestimate this important information system (the visual system).

In many instances, children who manifest visual problems or whose visual abilities are not well integrated will have difficulties to perform properly in school.

Unfortunately, many still believe that a child who has “good vision” (a visual acuity of 20/20 or 100% at far) should be performing well in school and that learning or reading difficulties are then not related to their vision…

To really understand what we, optometrists specialized in visual training, mean by the word “vision”, we will discuss once again, briefly, the three prinicpal components of vision:

THE OPTICAL COMPONENT

This component determines if the child can see clearly at far: he may be nearsighted (myopia), farsighted (hyperopia) or have astigmatism. But “seeing clear” is not the whole aspect of vision. By experience, we know that 95% of children who have learning or reading disabilities can see clearly at far. Near vision is thus more important than far vision and has to be assessed.

Amongst the problems we find in this component are: child reads or writes very close, vision can be blurred in books, child cannot sustain proper concentration or attention, he does not understand easily what he reads. Reading glasses (for the brain) can help children decode or perform better and sustain focus longer while reading.

THE FUNCTIONAL COMPONENT

Another aspect of vision is how the eyes function together. Here, we must assess how well the focusing mechanism of the eyes can perform, how the eyes are aligned (visual-motor coordination), and if eye tracking (eye movements) is easy, smooth, precise. Needless to say that adequate eye movements are essential to good reading! Unfortunately, this functional component is not always tested in a conventional eye examination.

Amongst the problems we find here are: the child cannot focus on what he reads or writes more than a few minutes (homework takes forever), the child tires easily when reading because of the muscular effort required, and eye movements are jerky, imprecise and head movements are most often used (instead of eyes).

Children with learning disabilities often have trouble following an object with their eyes and move their eyes from one place to another. Instead of precise movements, their eyes show jerking movements with lots of delays. This visual problem causes activities such as playing ball, make a straight line or read a line of text become very difficult.

• (Jean Ayres, Sensory Integration and the child)

THE PERCEPTUAL COMPONENT

The perceptual abilities of the child are the refinement and the end-product  of all visual abilities: perceptual-motor abilities are related more directly to the ability to decode  visual information.

Amongst the perceptual abilities we must assess are: form perception (can child recognize basic forms?), eye-hand reproduction (can child reproduce with hands what eyes see?), eye-hand coordination (are eyes and hand matched to perform adequately?), visual memory, auditive memory, etc.

Amongst the perceptual problems we can find are: form perception is weak, eye-hand coordination is difficult, visual and/or auditive memory is low, fine motor control of the hand is inefficient.

All these visual and perceptual abilities are of great importance: they help make the child succeed in school. We must remember that for children, the most difficult task in life is to learn to read and write. A complete visual-perceptual examination is thus required to be able to analyse how the child performs visually and perceptually.

WHAT CAN BE DONE ABOUT IT?

This is the next evident question. As we said, sometimes reading glasses are required to help the child cope with the visual stress of reading and writing.

But most of the time vision training will also be needed. Vision training consists of a programmed series of activities to enhance visual and perceptual abilities. Visual training thus consists of gross motor activities, fine motor activities, visual motor activities and perceptual activities.

SYMPTOMS CHECKLIST

Here is a list of different symptoms whose parents are constantly sharing with us in a consultation. I distinguished visual symptoms from symptoms related to reading and writing.

Visual symptoms:

• Headaches
• Blurred vision
• Double vision
• Eyes get tired easily
• Reads quite or very close
• Writes very close to paper
• Turns head when reading/writing
• Bad posture while reading or writing
• Closes or blocks one eye while reading
• Eyes are often red, itchy, burning
• Eyes blink a lot
• Rubs eyes often
• Eyes blink very often
• Complains about his (her) eyes often

Symptoms related to learning/reading/writing

•  Loses his (her) place when reading
• Must read a few times to understand
• Does not understand easily what is read
• Follows text with a finger
• Mixes up letters or numbers
•  Follows text with head
• Reverses letters or numbers
• Must read aloud to understand reading
• Reads very slowly
• Lack of concentration, attention
• Takes lot of time to do homework
• Daydreams a lot

Other behavioral symptoms

•  Is quite hyperactive
•  Is rather clumsy, trips over things often
•  Is always dropping things
•  Problems regarding gross motor skills
•  Problems regarding fine motor skills

VISUAL-MOTOR-PERCEPTUAL EXAMINATION

The visual-perceptual tests for children who manifest learning/reading problems will generally be done in two separate visits at our clinic:

First, a general visual examination will be done to analyze following factors:

• a complete case history;
• visual acuity at far and at near;
• refractive examination (near-sightedness, far-sightedness, astigmatism)
• eye coordination;
• focus mechanism
• reading and/or writing distance;
• eye movements/eye tracking;
• visual performance test;
• depth perception (stereoscopic vision).

At the same visit, or sometimes at the next, perceptual abilities will be evaluated:

• body awareness;
• laterality;
• directionality;
• fine motor skills;
• eye-hand coordination;
• eye-hand reproduction;
• visual comparison;
• visual memory;
• auditive memory;
• form perception;
• writing abilities;
• space organization;
• visualization;
• visual attention

Following the complete visual-perceptual examination, a complete report will be prepared for parents and for the school individual who has referred the child to our clinic.

Posture and Vision (2)

Slant desk or slant board with a 20 degree angle

Ideal work surface (http://www.visualedgesb.com/)

 Many years after Harmon’s studies, Drs Pierce and Greenspan have also studied the relationship between posture and vision. Once again, they have shown that there is an integral working relationship between posture, work distance and work surface.  Their research has proven that learning performance improves when the proper conditions are established for near-point visual activities such as reading and writing.

Their studies show when work is presented on a sloped work surface, with an angle at between 20 and 23 degrees, sitting no closer than fist to elbow length from the work surface, the worker experiences a reduced heart rate, neck, muscle and overall body tension as well as a more regular and deeper breathing pattern. A slanted surface compels your body to sit in a more upright posture

• Dr. John Pierce Rev Optometry 1977; 114:48-63
• Dr. Steven Greenspan; Optometry Weekly 1971; 62(33): 754-757, Optometry Weekly 1971; 62(34): 776-780

Source: http://www.visualedgesb.com/

A century ago, classroom designers and teachers understood the importance of proper ergonomics in the classroom and the use of slanted desks in a learning environment. It is amazing how something so simple in concept, is so effective in application and can have such huge benefits. It begs the question: why were slanted desks taken out of the classroom in the first place?  The simple answer is most likely the right one: it was more cost effective. Since flat desks were introduced to the classroom, reading scores have dropped considerably.  European schools are now reintroducing slanted desks in their school classrooms and we too should rethink the ergonomics of learning.

Finally, Sampedro et al. observed the characteristics of the spontaneous reflex reading distance (RRD) in 351 children in two stages, first in reading then writing, and comparing their RRD with the Harmon distance in the same environmental conditions. The results show that 72, 08% of the population analyzed (65% while reading and 53% while writing) had a normal RRD. Also, 50, 96% of people who had too short a RRD were myopic, 38, 46% were emmetropic and 10.58% were hyperopic. Conclusions: the shorter the RRD, the more mental effort is required in near vision; the situation creates more visual stress. So in this study, one third of the children were standing too near their work plan and the RRD was shorter in writing than in reading. More myopic individuals had a tendency to read closer than they should.

•  Gené Sampedro, Andrés; Montalt, Juan C.; Alemany, Antonio L. Estudio del reflejo visuopostural. Gaceta Óptica, 1997 JUL-AGO; (307)