Reading, Eye Problems, and Education

When student eyes aren’t ready to read:

  • 25% of all students cannot read due to vision skills deficits. ~ National PTA, 1999
  • 66% of illiterate adults cannot read due to vision skills deficits. ~ National Center on Adult Literacy
  • 70% of juvenile delinquents cannot read due to vision skills deficits. ~ CA Youth Authority, 1989
  • 90% of prison inmates cannot read due to vision skills deficits. ~ Folsom Prison Study
  • Poor “basic skills” cost businesses sixty billion per year. ~ National Institute for Literacy

Vision is More Than 20/20

Parents and educators often incorrectly assume that if a child passes a school vision screening, then there is no vision problem. However, school vision screenings often only test for visual acuity. In reality, the vision skills needed for successful reading and learning are much more complex. A child who can see 20/20 can still have a vision problem.

Vision is a complex process that involves several visual skills, and more than 65% of all the pathways to the brain. One in four children have undiagnosed eye problems which can interfere with learning and lead to academic and/or behavioral problems. However, it is important to know that these children frequently do not report symptoms because they think everyone sees the same way they do.

Often a child with a vision-based learning problem has excellent verbal skills, causing parents and educators to think the child must be lazy, have ADD/ADHD, or is learning disabled. The possible misdiagnosis can be due to similar symptoms, but the causes are not the same.

  • 25% of students in grades K-6 have visual problems that are serious enough to impede learning.” - American Public Health Association
  • “When vision problems go undetected, children almost invariably have trouble reading and doing their schoolwork. They often display fatigue, fidgeting, and frustrations in the classroom—traits that can lead to a misdiagnosis of dyslexia or other learning disabilities.” - American Optometric Association
  • “It is estimated that 80% of children with a learning disability have an undiagnosed vision problem.” - Vision Council of America
  • “Early diagnosis and treatment of children’s vision problems is a necessary component to school readiness and academic learning; and that vision screening is not a substitute for a complete eye and vision evaluation by an eye doctor. Comprehensive eye and vision examinations … are important for all children first entering school and regularly throughout their school-aged years to ensure healthy eyes and adequate visual skills essential for successful academic achievement.” - National PTA Policy Statement 2005, Elements of Comprehensive Health Programs
  • “Early testing for vision problems is key to preventing learning disabilities or, in some cases, significant visual impairment in children.” - Ned Calonge, MD, MPH, Task Force Chairman, Chief Medical Officer and State Epidemiologist at the Colorado Department of Public Health and Environment.
  • “A three year study of 540 children found that those children who had visual perceptual and eye movement difficulties did poorly on standardized tests.” - Dr. Lynn Hellerstein, FAAO, FCOVD, Developmental Optometrist and Past President of COVD.

Eye Problems Checklist for Educators, Parents, and Students

20/20 eyesight determines how well we can see to drive or to see a blackboard. It tells us if we can see a newspaper or a computer screen. But there are many things 20/20 eyesight will never tell us.

It will never tell us if your child:

  • sees clearly all day long
  • can focus back and forth to the whiteboard and book
  • sees single rather than double
  • can read without getting a headache
  • can follow words on a page without losing his place
  • can read without wanting to fall asleep
  • has healthy eyes

Do you think that these things would be important to a student or anyone for that matter? Of course they are! When children do not move their eyes properly across the page, they lose their place, get discouraged and give up.

The following checklist of visual symptoms will help you understand how your child performs visually in his daily activities.

Reading

  • Fatigue with reading or comprehension drops with time
  • Confusion with similar words or letters
  • Omits words
  • Short attention span while reading
  • Difficulty keeping place while reading
  • Holds head too close to book
  • Slow reading or word-by-word reading
  • Skips or rereads lines
  • Uses finger or marker as a pointer
  • Avoids reading

  • Says the words aloud or lip reads
  • Difficulty remembering what has been read
  • Reverses words or letters
  • Difficulty remembering newly learned words
  • Poor sitting posture and position while reading
  • Excessive head turning while reading
  • Frowning, excessive blinking, scowling, squinting, or other facial distortions while reading
  • Rubs eyes during or after reading
  • Tilts head to one side
  • Turns head so as to use one eye only
  • Closes or covers one eye

Writing and Other Desk Tasks

  • Holds head too close to desk when writing
  • Gross postural defects, such as leaning head to one side, leaning head on arm, or moving head as he reads.
  • Restlessness while working at desk
  • Difficulty copying from whiteboard or book
  • Squints or blinks looking up at chalkboard
  • Tilts head to one side
  • Turns head so as to use one eye only
  • Omits or repeats letters, words, or phrases
  • Poor eye-hand coordination including poor writing
  • Writes neatly but too slowly
  • Reversals persisting in grade 2 or beyond
  • Weight on the writing arm
  • Does not use other hand to hold paper
  • Immature pencil grip
  • Poor finger movement in writing
  • Draws with short sketchy lines
  • Turns paper to draw lines in different directions

Body Posture and Space Awareness

  • Unusual awkwardness
  • Frequent tripping or stumbling
  • Body rigidity while looking at distant objects
  • Thrusts head forward or backward while looking at distant objects
  • Confuses right and left directions

Appearance of Eyes

  • Crossed eyes-turning in or out
  • Watering or bloodshot eyes
  • Red-rimmed, crusted or swollen lids
  • Frequent sties

General Behavior

  • MELTDOWN at homework time
  • Short attention span or avoiding task when doing near work, such as reading and writing
  • Dislike for tasks requiring sustained visual concentration
  • Nervousness, irritability, or restlessness after maintaining visual concentration
  • Inattentiveness, daydreaming
  • Unusual fatigue after completing a vision task
  • Frequent signs of frustration
  • Tension during close work
  • Avoids close work

Questions for Children

  • Does your vision get blurry at any time?
  • Can you make it clear?
  • Do you ever see objects double?
  • Do you have headaches, dizziness, or feel sick to your stomach when you use your eyes, or do you get carsick?
  • Do letters and lines “run together” or words “jump”?
  • Do your eyes get tired after reading for a few minutes?
  • Do your eyes ever feel hot or itch?
  • Does light bother your eyes?
  • Do you know where to catch a pop-up fly ball, how far to throw a ball, where the ball is going to be?

CLASSROOM / HOME VISION SKILL IMPROVEMENT EXERCISES

Equipment: Time Commitment: 5-8 minutes daily / 8-12 weeks

  • Pencils or pens
  • Stopwatch
  • Time Chart
  • TEXT in large font
  • Large Notebook / Slant Board

Child’s eyes should move smoothly and in sync. To screen for possible eye teaming / tracking issues:

  1. Have child sit up straight with head and eyes focused forward. Without moving head, have child’s eyes follow a point (eraser on top of pencil is a good one / at Harmon distance – length from elbow to hand) as you slowly move the pencil horizontally, then vertically, diagonally and in a circle slightly wider than the child’s face. To check periphery vision, gradually increase size of circle, inquiring often if child can still see the point.

    2. Child’s eyes should move smoothly and in sync. Note excessive blinking, watery eyes, head tilting, and/or eyes darting from point.

  2. Hold pencil directly in front of child’s face at Harmon distance (length from elbow to middle knuckle) and instruct child just to stare at the fixed point. (Ages 6-8, hold for about 10 seconds; 8-10 years / 15 seconds; 10 to 12 / 20 seconds).

    3. Note excessively blinking, watery eyes, head tilting, and/or eyes darting from point

  3. Slowly bring point (eraser) towards child nose, watching to see if both eyes converge / cross when point reaches nose.

Note excessive blinking, watery eyes, head tilting, uneven eye movement, and/or eyes darting from point.

This screen is also an effective vision exercise tool that can be done with parent and child and/or depending on maturity, the child on his own.

To improve eye “teaming”, tracking, provide opportunities for both eyes to focus together on a moving point:

Print text in 16 point font. Have child circle the vowels, then consonants, then blends (“ing” “ed” “sh” “ch”, etc.) Write between words by going above, then underneath words, losing points if pencil touches any letter.

As vision skills improve, decrease size of font and “white space” between lines.

To increase peripheral vision:

Have child practice “thumb circles,” by extending hand out and horizontal with body, with thumb up, visually following in a circular pattern keeping face forward, only using eyes to follow thumb.

To improve visual tracking / fluency:

Extend hand at nose level, then direct child to look at “pinky”, “pointy”, middle, ring, thumb finger, in random order.

To improve focus shift / near to far focus:

“SPY HOLE” – with thumb and index finger, alternate between viewing with both eyes / one eye at a time, focus for 10 seconds on far spot on wall, then transfer to near point for 10 seconds.

”PENCIL PUSHUPS” – Hold pencil at arms length, stare for 10 seconds, then bring pencil in half way, stare for 10 seconds. Repeat ten or more times.

Visual motor activities: “Pick UP Sticks”, Jacks, hopscotch, etc., mazes, word search, balance “bongo” board.

To increase VISUAL MEMORY:

Have child look at picture for 5 to 10 seconds. Then write or tell the objects / details they can remember / play visual “MEMORY” games.

Encourage reading and writing at “Harmon distance” – length of arm from elbow to middle knuckle.

Use a sloping work surface such as a notebook, to divert glare from overhead lights.

ONLINE Vision Activity sites: Remind your child to sit up straight, head and eyes focused forward, no head movement…….. ONLY EYES!

Additional vision skill exercises at

Posture

Proper posture for reading and writing is determined by the HARMON Distance………… the distance from the child’s elbow to his middle knuckle. If your child tends to read or write closer than his HARMON Distance, this posture may indicate eye problems.

If you observe your child leaning to one side, covering one eye as he reads or writes, or moving his head as he reads, his behavior may be compensating for his eyes not working as a team. For the brain to see print clearly, the two eyes must give the brain one picture, meaning the two eyes (binocular vision) are in sync with one another across the line of print. If one eye is slightly off, the brain receives two pictures rather than one. Print can appear blurry, “dancing on the page,” or moving in a circular motion.

By leaning to one side, or covering one eye, or moving his head as he reads, the child’s posture compensates by using only one eye (monocular vision) in order for the brain to make sense of the text.

Case Studies

Children throughout the country struggle with undetected vision problems that prevent them from reaching their full potential. In many cases, these children are labeled “dumb,” misdiagnosed as ADD/ADHD, or placed in special education resource rooms.

Learning-related vision problems can often be treated with a program of vision activities, but too many teachers and parents are not aware that 15 different vision skills are necessary to succeed in reading, writing, math, and classroom performance.

The following case studies illustrate some of the vision problems children experience and how they can be helped through the use of vision activities.

Caroline, 5th Grade

Problem: Caroline struggled with schoolwork and began to think she just wasn’t smart enough to do well in school. She complained of headaches when reading and often covered one eye. She frequently lost her place when reading and comprehended things much better when being read to by someone else.

Evaluation: An initial eye examination found that she had 20/20 visual acuity. Specialized vision testing revealed that Caroline’s eye tracking skills and focusing ability became unstable when she was reading.

Solution: She began a program of vision exercises to help her better control her eye movements and improve eye-focusing abilities.

At the conclusion of the program, Caroline’s mother reported: “Caroline has improved two grade levels in reading and math. She has not had a headache in two months and no longer suffers from frustration due to slow learning. Caroline has improved much faster than we thought possible.”

Jennifer, Age 17

Problem: Jennifer puzzled her parents and teachers. Seemingly bright, she had inordinate difficulty reading. She read very slowly and her comprehension was much better when listening.

Evaluation: A comprehensive vision examination detected a learning-related vision problem.

Solution: A program of vision exercises soon improved her reading skills. “Not only am I a faster and more accurate reader, but I can enjoy it more and read for longer periods of time,” she said. “This program has made school easier and homework time shorter. My only regret is not doing this earlier in my life so that I would be more confident and would have done better. Vision exercises makes me feel like a better person.”

Tony, Age 16

Problem: Tony started struggling with reading when he was 9 years old. His mother had taken her son for eye exams on a regular basis and had been told everything was fine, aside from the need for glasses for his nearsightedness. As a result, she had never even considered the possibility that vision was playing a role in her child’s difficulties.

Tony had been diagnosed with ADD, and was in Learning Disabilities classes in school, and was even seen by a neurologist. His mother ended up homeschooling Tony because he was so depressed about his reading problems and nothing else seemed to be working.

Evaluation: Tony had convergence insufficiency, in addition to near-far distance accommodation issues, myopia and tracking problems

Solution: “I was miserable before I started vision therapy”. Vision exercises gave me my life back,” he said. According to his mother, “Since vision exercises, he has begun to dream of a future he thought he would never have. His self-esteem has improved. He no longer thinks of himself as stupid. His vision skills have improved. He no longer sees blurred images on the page and now he is ready to go to Sylvan and catch up on all the learning he missed out on because of his visual problems. The doctor says he is ready, but more importantly, he says he is ready. This is a wonderful program that can be life-changing for a child. It was for my son.”

Sarah, Age 12

Problem: Sarah was a bright twelve-year-old who struggled to read. A neuropsychologist had evaluated her and suspected the root of her academic problems was an emotional disorder and possibly dyslexia. This diagnosis perplexed Sarah’s parents because it seemed to only partially identify Sarah’s struggles.

Evaluation: A comprehensive vision examination determined that Sarah had a significant tendency for one eye or the other to drift outward. As a result, every time she sat down to read or write, Sarah had to work very hard to keep from seeing double.

Solution: A five-month program of vision exercises resulted in significant improvement in Sarah’s visual abilities and school performance. Her eye teaming greatly improved and she was more confident and became more responsible with her schoolwork. Her mother reported that following exercises her grades improved considerably. In math, where she had found word problems very difficult, she went from a grade of “D” to an “A.” “Sarah now believes in herself, and that is the greatest gift we or her family could ever give her,” her mother said.

Jason, Age 7

Problem: At the beginning of first grade Jason tested at the fourth grade level in science and social studies, but was on a preschool level in math and reading. He also hated any activity that dealt with a ball of any sort. If a ball was thrown to him, nine times out of ten he was unable to catch it. A school psychologist assessed him to be five points above functionally retarded. He withdrew from all activities that made him feel challenged.

Evaluation: Frustrated by the school system’s inability to determine why Jason was unable to succeed, his parents sought a comprehensive vision evaluation.

Solution: Testing determined the need for vision exercises to help him learn to more effectively process visual information. Jason’s parents noticed improvements in his school performance in less than a month. “When Jason started vision exercises he could not recognize any letters of the alphabet, nor copy anything written down in front of him.

Today he can copy sentences with proper spacing and read a beginner’s book with assistance,” his parents reported. “Jason shows a noticeable improvement in self-esteem.

April 17, 2007

Dear Abby: Please help me get the word out about a common condition that severely affects children’s ability to succeed in school because it inhibits reading, spelling and concentration.

My daughter, who was obviously bright, tested at first-grade reading level in fifth grade. She had undergone all the school testing for learning disabilities, plus two days of testing at a respected university hospital. None of these tests or specialists revealed what could be wrong with her.

My child’s self-esteem suffered. Her confidence faltered; she began acting out in school. At home she was a great kid, until it came time for schoolwork. Then the battles began. She thought she was dumb. She could read for only a very short time. She often begged me to read things to her. When working on spelling and assigned to rewrite the words she missed five times, she often recopied them wrong. We thought she just wasn’t trying.

After much research on the Internet, I came across a disorder called “Convergence Insufficiency Disorder.” This visual condition is the leading cause of eyestrain. Fortunately, we had the opportunity to have her tested at the Mayo Clinic, where her condition was confirmed, and she was successfully treated with vision therapy.

It was as though a miracle had occurred. After six months of treatment, my daughter is almost at her age-appropriate reading level. Her comprehension and retention have markedly increased, and her self-esteem and attitude about reading are much better.

Children with this condition will not benefit from tutoring, special education or extra help from teachers until the condition is diagnosed and treated. My child had 20/20 vision and still had this disorder. It’s not routinely checked with eye exams, and schools don’t test for it. I suspect that many children out there are undiagnosed or misdiagnosed and going untreated. The treatment for convergence insufficiency disorder is noninvasive, effective, and much of it can be done at home. Please help me get the word out so other families won’t have to go through what we experienced.

Angie W., Minnesota

Dear Angie: I am pleased to help you get the word out to other families whose children are struggling to learn. After reading your letter, I contacted my experts at the Mayo Clinic in Rochester, Minn., and was informed that this problem, where the eyes drift too much inward (or outward) in attempting to focus, can also be present in adults.

The symptoms can include eyestrain, headaches, blurred vision, sleepiness and trouble retaining information when reading. Other symptoms associated with convergence insufficiency include a “pulling” sensation around the eyes, the rubbing or closing of one eye when reading, words seeming to “jump” or “float” across the page, needing to reread the same line of words, frequent loss of place, general inability to concentrate and short attention span.

The good news is: Vision exercises can fix the problem in most cases, some done at home and some performed in-office with a vision therapist. Prism glasses are another option; however, they are more often prescribed for adults with this disorder than for children.