THE IMPACT OF
VISION ON
LEARNING
By: Megan Thistle, PUCO Class of 2017
SURVEY TIME!
Purpose
■ To help share knowledge with teachers to
increase awareness of vision and how it can
affect their students in the classroom
Vision: an introduction
■ Vision has been long connected to your ability to read, but also a
child’s ability to perform in school.
■ Vision screenings have been performed in schools for many years
– Since the 1920s!
■ Vision screenings are good at catching some vision problems, but not
all of them
■ Binocular vision can affect a child’s reading ability
If a child has a reading problem, check their
vision!
The Human Eye
Visual Acuity
■ Sharpness of vision, uses your central vision
■ For example, 20/20 means you can see letters of a certain
size at 20 feet.
■ Whereas, 20/100 means someone can see a letter at 20
feet that most people can see at 100 feet.
– So you need a bigger letter!
Normal Development
■ Acuity changes with age!
– Expect 20/30 best acuity in a 3 year old without
refractive error (need for glasses)
– Expect 20/20 by age 4-5 years without refractive error.
Refractive Error
■ Myopia
– Near-sightedness
– Minus powered lenses
■ Hyperopia
– Far-sightedness
– Plus powered lenses
– Sometimes hard to catch at
screenings
■ Astigmatism
– Different meridians of the eye have
different powers
Normal Development
■ When we are born, we all have a bit of a refractive error.
■ Over time, our eye stabilizes and most people do not have a
significant refractive error, and do not need glasses
– This is called emmetropization
– This is usually done by 3-5 years old
■ If a child still have a refractive error after this age, it should
be corrected with glasses
■ Myopia increases between the ages of 6 and 15 years as
school work increases
– They have more nearpoint visual demands, which
causes the eye to grow and change
Vision is more than 20/20
■ Just because you can see well in the distance does not mean you can
see well up close!
■ Just because you can see well up close does not mean you can use
your eyes well together!
■ Screenings are great at checking for VA or 20/20 vision, but not eye
teaming skills
■ If you suspect a vision problem, recommend a comprehensive vision
exam with a PEDIATRIC OPTOMETRIST!
Visual Skills
■ Amblyopia
– Permanent reduced vision that is not
correctable
■ Strabismus
– ‘Eye-turn’
– Can cause Amblyopia
■ Stereopsis
– The ability to see float or depth
Normal Development
■ Eyes should be 100% aligned by 3-4 months!
– Before this, infants can have a hard time controlling
both their eyes at the same time. You may fleetingly see
one eye wander in or out while the other eye stays
straight.
Visual Skills
■ Accommodation
– Focusing ability
– Near vs Far requires different
focusing
■ Binocular Vision
– Team teaming skills
– Convergence and Divergence
Eye movements
■ Our eyes have to move together to be able to work at their best
■ To read, we need to be able to make small eye movements accurately
over the text we are reading
– Saccades and fixation
■ If we can’t do this, reading can be really difficult
Normal Development
■ The ability to maintain accurate fixation on a new target
improves dramatically in the first few months.
■ When a novel stimulus is introduced into the periphery, 1 to 2
month-old infants approach the target with a series of small
saccades rather than with a single large saccade (they are not
super accurate)
■ By 6-8 months, infants are capable of making a large single
saccade to redirect gaze to a novel target
■ By 4 months, infants show much more accurate pursuits and
rely much less on saccades.
■ Young children will use head movement to supplement both
saccades and pursuits
■ By age 6, the child entering school should be able to perform
pursuits and saccades with little or no head movement.
Potential binocular vision problems
■ CI
■ CE
■ DI
■ DE
These problems can occur in
children and adults! They may
be more noticeable in children
however, because they can
negatively affect their
schoolwork!
http://www.drgallaway.com/vision-and-learning/eye-teaming-focusing-and-tracking/
Adaptations?
■ Avoidance Behavior
– Child is ‘unmotivated,
distractible, or lazy’
– Short attention span
– Disruptive behavior
problems
■ Physical Adaptations
– Very close reading
distance
– Head movements while
reading
– Closing or covering one
eye while reading
■ Symptoms
– Eyestrain
– Headache
– Child doesn’t feel well
– Squinting
How common are these problems?
■ Vision anomalies occur in 10-15% of school children. Known to be
severe enough to decrease academic performance in these children
■ After refractive error, binocular vision and accommodative disorders
were the most common disorders
■ These conditions are 9.7 times more likely than ocular disease in
young children and 8.5 times more likely in children age 6-18 years
What do teachers know?
■ Michigan Elementary and Middle School Teachers
– All teachers are aware of the connection between vision and academic
performance
– Most do not know where to refer their students if they do suspect a
vision problem
■ Kansas and Oklahoma school teachers
– Unaware of potential consequences of visual dysfunction on reading
and learning
– Teachers often can note when students struggle with phonetic skills
and inattention
■ 38% of teachers said they had received no information regarding proper
visual skills during their entire college career
But, does Vision really affect Reading?
Correlation Studies
■ Duesk et al
– Those that struggle with reading and writing compared to an age
matched control group. All had normal IQ
– The struggling reading/writing group had a significantly higher
proportion of visual function anomalies than the control group
■ Poorer distance VA, an exophoric deviation at near, lower
amplitude of accommodation, reduced accommodative facility,
reduced vergence facility, reduced NPC , lower AC/A and
slower reading speed
■ Grisham et al
– Poor high school readers had several weak or inadequate visual
skills
Does Vision really affect Learning?
Treatment Studies
■ CITT study
– Office and home treatment of CI leads to decreased symptoms in
children doing near work
■ Borsting
– Successful treatment of CI lead to improved academic behaviors in
children as reported by parents
– Students were less distracted and were able to focus their attention on
details and parents were less likely to worry about their child completing
their homework.
– Better self-esteem!
What do we suggest if you suspect a
vision problem?
■ Suggest to parents to get a comprehensive vision
exam by a pediatric optometrist for their child!
Treatment
■ When a child is tested with a pediatric optometrist and there are
vision anomalies detected, vision therapy is often the choice for
treatment
■ Vision therapy, is a series of vision and eye exercises that strengthen
the visual system of the patient
Does Vision Therapy work?
■ Many anecdotal reports of successful vision therapy
■ Previously discussed CITT studies
■ Atzmon et al
– Compared vision therapy treatment to conventional reading
treatment
– Found that both groups showed equal and statistically significant
improvement in reading performance on all tests used in the
study
■ Better technical reading skills, improved comprehension,
improved perceptual skills
Atzmon et al, continued
■ The really cool part?
– Not only did VT produce the same reading performance
improvement as traditional reading tutoring, but the VT group was
the only group that had a decrease in symptoms while reading!
– The reading tutoring group had either the same amount of
symptoms, or more symptoms of reading strain
■ Symptoms include: double vision, blurry vision, eye ache,
burning, losing place while reading, repeating a line, skipping
a line, headaches
– Treatment was 2-3 months (35-40 individual sessions)
View of Vision Therapy
■ Studies show that parents and children are overall very satisfied with
vision therapy
■ Visual skills are shown to improved with tests results
■ Parents report better performance on school activities
■ They also report increased self esteem in their children
Disclaimer!
■ We all know that reading struggles and learning problems are a
multifactorial problem!
■ Getting a vision exam and getting lenses or going through vision
therapy is not a fix-all
■ But! Vision should be addressed because:
– Getting vision anomalies addressed and treated is one less thing
that the student has to worry about
– By putting in less effort to get their eyes to work, they can focus
more energy and attention on other aspects of their other
therapies!
■ Collaboration!
Can YOU catch vision problems?
■ A short teacher in-service can go a long way!
■ Krumholtz, 2004
– “Educating the educators: increasing grade-school teachers’
ability to detect vision problems”
– Gave teachers a 40 minute lecture and brochures
– Ask for teacher observations 2 years later
– Results
■ Slightly increased in accuracy of detecting functional vision
problems
■ Dramatic increase in number of comments made by teachers
■ Accuracy of comments also increased as well as their depth
Catch them early!
■ You are in the best position to do so!
■ You get to see the children in your classroom every day and see their
behaviors!
■ Early detection and treatment, especially of amblyopia and
strabismus, give the best results
– Try to catch them before age 8!
Signs and Symptoms
Symptom Checklist
■ Drowsiness in class
■ Light sensitivity
■ Fatigue
■ Poor comprehension
■ Blur
■ Loss of place when reading
■ Headaches
■ Omitting or substituting words
■ Intermittent Double Vision
■ Poor chalkboard-to-desk copying
■ Eye Strain
■ Failure to complete work on time
■ Rubbing of eyes
■ Gradually decreasing grades
■ Tearing
Helpful Websites
■ Information about Vision Therapy
– http://alderwoodvisiontherapy.com/
– http://www.visiontherapy.org/
– http://www.allaboutvision.com/parents/vision_therapy.htm
– http://childrensvisionwichita.com/vision---learning.html
■ Parents Active for Vision Education
– www.pavevision.org
■ Optometric Extension Program Foundation
– www.oepf.org
■ College of Optometrists in Vision Development
– www.covd.org
■ Great Website for Parents
– http://www.seeingsmarter.com/
■ Statement from COVD on dyslexia
– http://www.covd.org/default.asp?page=Dyslexia
Resources
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State University Michigan College of Optometry, Big Rapids, MI.
Atkinson, J., Braddick, O., Bobier, B., Anker, S., Ehrlich, D. King, J., … Moore, A. (1996). Two infant vision screening programmes:
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Atzmon, D., Nemet, P., Ishay, A., Karni, E. (1992). Randomized prospective masked and matched comparative study of orthoptic
treatment versus conventional reading tutoring for reading disabilities in 62 children. Binocular Vision and Eye Muscle Surgery
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Press, Berkeley, California.
Borsting, E., Mitchell, G.L., Kulp, M.T., Scheiman, M., Amster, D.M., Cotter, S.,....CITT Study Group. (2012). Improvement in
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Ciner, E.B. (1990). Management of refractive error in infants, toddlers and preschool children. Problems in optometry, 2(3), 394418.
Creswell, J.H. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th Ed). Los Angeles, CA: SAGE
Publications.
Dusek, W., Pierscionek, B.K., McClelland, J.F. (2010). A survey of visual function in an Austrian population of school-aged children
with reading and writing difficulties. BMC Ophthalmology, 10(16), 1-10.
Jones, D., Stilley, J., Bither, M., Rounds, R. (2005). Elementary school teachers’ perspectives of factors associated with reading
disability. Journal of Behavioral Optometry, 16(1), 11-16.
Krumholtz, I. (2004). Educating the educators: increasing grade-school teachers’ ability to detect vision problems.Optometry:
Journal of the American Optometric Association., 75 (1), 445-451.
Lane, K.A., Maples, W.C. (1995). Parents’ satisfaction with vision therapy. Journal of Behavioral Optometry, 6(6), 151-153.
Peters, H.B. (1984). The Orinda Study. The American Journal of Optometry and Physiological Optics, 61(6), 361-363.
Scheiman, M., Gallaway, M., Coulter, R., Reinstein, F., Ciner, E., Herzberg, C., Parisi, M. (1996). Prevalence of vision and ocular
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