For some families, getting their child to read for 15 to 30 minutes a night can be a real struggle, if not an all-out battle. Some children have no problem identifying words on a flashcard but struggle to read a line of print on the page. Other children start to have difficulties when they attempt to transition into chapter books with smaller print. They are able to decode at a high level but continue to prefer graphic novels, larger print and/or books that are broken-up with pictures. Other children may do what is required but not one minute more. They may complain about their reading speed, lose their place or have to re-read information to comprehend.
All of these examples of avoidance of reading are unfortunate because studies show that the amount of time spent reading plays a large role in future academic success (Allington, 2014; Cunningham & Stanovich, 1998; Krashen, 2004 and 2011). What parents and teachers do not realize is that there is often an underlying cause behind why these children avoid reading, and that cause is related to their visual system. It might surprise you to know Learning-Related Vision Problems affect 1 out of 4 children. Even more surprising, is that many of these Learning-Related Vision Problems have nothing to do with the ability to see 20/20 on an eye chart.
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In most cases, distance vision has very little to do with reading performance and the desire to want to read. In fact, avid readers tend to have more difficulty with their distance vision (nearsightedness) then the general population. Below, I’ll outline the most common visual conditions that contribute to reading avoidance.
Common causes of Learning-Related Vision Problems:
1. Uncorrected Farsightedness or Astigmatism
Refractive error generally refers to the lenses required to provide a clear image on the back of the eye. Nearsightedness (myopia), farsightedness (hyperopia) and astigmatism are all types of refractive error.
Nearsightedness is most often associated with decreased eyesight at distance and as mentioned above, may not interfere much with reading.
Farsightedness can require the focusing system in the eyes to work harder to clear words up close, but if severe enough, it can also interfere with distance vision. It is normal for infants and young children to be farsighted and then as the visual system develops, the amount of farsightedness decreases through a process called emmetropization.
Uncorrected astigmatism, if significant, can interfere with both distance and near eyesight and can also create increased visual strain to see 20/20.
Both uncorrected moderate to severe farsightedness and astigmatism have been associated with decreased pre-literacy skills in preschoolers and overall lower reading performance in older children. This makes sense because both of these conditions can cause the eyes to have to work harder to see print at near. Because children with uncorrected farsightedness and astigmatism often can pass traditional vision screenings, the American Optometric Association recommends that children receive a comprehensive vision evaluation between the ages of 6 months to 1 year (InfantSEE), between ages 2 or 3, before entering kindergarten and annually while in school.
2. Eye Focusing Skills (Accommodative Dysfunction)
When we look far away, the focusing muscles in each eye relax, when we look up-close, they constrict. The accurate and efficient use of these muscles allows us to focus on near-print for a sustained period of time and easily switch our focus from near to far and back again. This ability develops early in life and for most children, focusing should be easy and automatic.
It is at around age forty, when the lens inside the eye becomes stiffer and harder to move, that most people begin to have difficulty with blurry vision at near. Interestingly, while adults with age-related focusing problems tend to move the reading material farther away, children with focusing problems may move the book closer or turn their head to focus with only one eye.
Inefficient focusing skills can cause blurred vision at distance or near, visual fatigue, headaches, trouble copying from the board, reduced reading comprehension and of course, avoidance of detailed near tasks such as reading.
3. Eye Tracking Skills (Dysfunctions of Saccades)
Saccadic eye movements are the ability to move our eyes between stationary objects, such as accurately moving the eyes along a line of print when reading. Inaccurate eye movement skills can cause loss of place when reading, skipping over words/lines, poor reading fluency and “careless” errors in reading and school work. All of these symptoms will make reading slower and reduce comprehension. This is especially true for smaller print and chapter books, where eye movements need to be more precise.
4. Eye Teaming Skills (Convergence)
Eye teaming refers to the ability of the eyes to work together as an efficient, coordinated team to create a clear and single picture when looking near or far. There are different types eye teaming difficulties including convergence dysfunctions, strabismus (eye alignment/eye turn) and suppression of binocular vision also known as amblyopia.
Convergence insufficiency is by far the most common vision condition that affects reading. This type of eye teaming problem cannot readily be detected by an untrained observer; however, it can significantly interfere with the ability to efficiently process visual information, especially at near when reading and writing. Convergence insufficiency can cause numerous symptoms and adaptations including eyestrain, headaches and blurred, overlapping or double vision. It can make words run together when reading or appear to move on the page.
Some children will try to compensate by covering or closing one eye. They may also tilt their head or lay their head down on the desk. Fatigue can play a big role in performance, the more tired the child or the longer they have to sit and read or write, the more difficult it is for their visual system to compensate. When the visual system has to work harder to complete a task, it leads to difficulty sustaining attention on reading and reduces the ability to comprehend what is read.
Finding the Correct Treatment
Glasses are usually necessary to help children with farsightedness or astigmatism. Children with eye teaming, focusing and tracking problems often require Optometric Vision Therapy to develop these visual skills.
Optometric Vision Therapy teaches the child how to coordinate their eyes allowing for a more efficient visual process. In addition, vision therapy can improve other visual processing skills important for reading and learning such as: visual discrimination skills for picking out details, visual memory for quick recognition of words and spelling, and visual-motor skills for writing and eye-hand coordination.
In-office vision therapy that is supervised by a trained Optometrist has a very high success rate. The National Institute of Health found (Randomized clinical trial of treatments for symptomatic convergence insufficiency in children) that in-office vision therapy is by far the most effective treatment for Convergence Insufficiency.
A related study, Improvement in Academic Behaviors Following Successful Treatment of Convergence Insufficiency, showed that academic behaviors and attention showed significant improvement in children treated for convergence insufficiency and ADHD.
Don’t just take our word for it…. See what our patients have to say!
“During 1st grade Heidi’s teacher started to notice a few things. As the school year ended her teacher suggested we contact New Horizons for a second opinion. At this point Heidi was having trouble with b’s and d’s, left and right, and while reading would sound words out including letters from the words around the word she was sounding out. Heidi also complained of headaches and eye soreness.
Coming to New Horizons made a huge difference in Heidi’s reading and other school work! She worked with Beth on strengthening her eye muscles to be able to focus far and near. Beth also worked with Heidi on her left/right, making it visual, physical and mental. I really liked how the therapy was total body- knowing the parts all need to work together.
Heidi progressed on schedule and never complained about our weekly visits.”
-Amanda, mother of Heidi, age 7
About Dr. Valerie Frazer
Dr. Frazer is a board-certified Fellow of the College of Optometrists in Vision Development and specializes in vision therapy. She has over 15 years of experience with diagnosing and treating both children and adults with Learning-Related Vision Problems, binocular vision problems, strabismus (eye turn) and amblyopia (lazy eye). She also treats visual skill dysfunctions commonly seen in individuals with autism, other developmental disabilities and brain injury. Dr. Frazer owns New Horizons Vision Therapy Center and has two locations serving both the Madison, WI and Lake Country areas.
Call us 608-849-4040 or email at firstname.lastname@example.org for more information.