Understanding Learning-Related Vision Problems in Children

At the Neuro-Visual Performance Institute (NVPI), we know that every parent wants their child to excel academically and socially. However, hidden challenges such as learning-related vision problems can significantly hinder a child’s ability to thrive. These challenges often extend far beyond simple clarity of sight, involving how the eyes coordinate and how the brain interprets visual information.

This guide is designed to help you understand learning-related vision issues, recognize the signs, and explore how our specialized services can support your child’s learning journey.

How Vision Problems Impact Learning

Unlike standard eye exams that focus primarily on clarity, developmental vision evaluations assess the complex interaction between the eyes, brain, and body. Research highlights that learning-related vision problems are surprisingly common and can greatly affect academic performance.

For instance, studies from Harvard Medical School and Boston Children’s Hospital reveal that 79% of children with reading challenges face specific vision issues, such as difficulty with eye teaming (binocular vision), tracking (oculomotor function), or focusing (accommodation). In contrast, only 33% of proficient readers exhibit these issues. These challenges can make reading and learning an overwhelming experience for children.

At NVPI, Dr. Rick Graebe FCOVD specializes in identifying and addressing these often-overlooked vision issues. Our advanced assessments go beyond routine eye checks to pinpoint and treat the underlying causes of learning-related vision difficulties.

Why Early Intervention Matters

An article published in February 2019, titled “Self-Reported Visual Symptoms in Children with Developmental Dyslexia,” underscores the importance of early and comprehensive vision evaluations. The researchers advocate for testing key sensorimotor functions, including eye teaming, tracking, and focusing, to address high-prevalence visual symptoms in children with developmental dyslexia. This aligns with our approach at NVPI, where we emphasize thorough evaluations tailored to each child’s unique needs.

By addressing these vision challenges early, children can build the skills necessary to excel academically, boost their confidence, and achieve their full potential.

How NVPI Can Help Your Child

If your child struggles with reading or other learning activities, it may be time to consider a developmental vision evaluation. At NVPI, with convenient locations in Versailles serving the greater Lexington area and Somerset, we offer specialized exams to identify and treat learning-related vision problems. These evaluations go beyond standard prescriptions to determine how your child’s visual system is functioning and whether it is impacting their academic success.

Dr. Rick Graebe FCOVD, a specialist in pediatric and developmental optometry, has helped countless children across Central and Southern Kentucky overcome vision challenges that impact learning. With over 35 years of experience, our practice is dedicated to enhancing the visual skills that drive success in school and life.

Understanding Learning-Related Vision Problems: What Are They?

Learning-related vision problems are deficits in visual efficiency and visual information processing that can interfere with a child’s academic performance. These issues go beyond clarity of sight and include:

• Visual Efficiency Problems: Difficulties with eye focusing (accommodation), eye teaming (vergence), and eye movement control (ocular motility).
• Visual Information Processing Problems: Challenges in interpreting and organizing visual information, such as visual-spatial orientation, visual analysis, and visual-motor integration.

Types of Vision Problems

1. Visual Efficiency Problems
   • Refractive Errors: Nearsightedness, farsightedness, and astigmatism.
   • Accommodation Dysfunctions: Difficulty focusing on near or distant objects.
   • Vergence Dysfunctions: Problems with eye alignment and teaming, such as convergence insufficiency.
   • Ocular Motility Disorders: Issues with eye movements, affecting tracking and scanning abilities.
2. Visual Information Processing Problems
   • Visual-Spatial Orientation: Difficulty understanding spatial relationships.
   • Visual Analysis Skills: Trouble recognizing and interpreting visual information.
   • Visual-Motor Integration: Challenges in coordinating visual input with motor output (e.g., handwriting).
   • Auditory-Visual Integration: Difficulty integrating auditory and visual information.

How Vision Problems Affect Learning

Impact on Academic Performance

Visual skills are fundamental to learning. When these skills are compromised, it can lead to:

• Reduced Reading Comprehension: Blurred or double vision can make text difficult to read, affecting comprehension.
• Slow Reading Rate: Difficulty tracking lines of text slows down reading speed.
• Poor Handwriting: Visual-motor integration issues can result in messy or illegible handwriting.
• Difficulty with Math Concepts: Visual-spatial problems can make understanding mathematical relationships challenging.

Behavioral and Emotional Effects

• Attention and Concentration Issues: Visual discomfort can make it hard to focus on tasks.
• Task Avoidance: Children may avoid reading or homework due to visual strain.
• Low Frustration Tolerance: Persistent difficulties can lead to frustration and decreased motivation.
• Impulsiveness: Struggling to process visual information can result in impulsive responses.

Associated Conditions

• ADHD: Attention Deficit Hyperactivity Disorder often co-occurs with learning-related vision problems.
• Dyslexia: A specific reading disability involving difficulties with word recognition and decoding.

Both ADHD and Dyslexic children have a higher likelihood of having developmental vision deficiencies. Furthermore the symptoms are often the same as those of a vision issue, making a developmental eye exam extremely important for these kids. 

Signs and Symptoms to Watch For

Early identification of vision problems can make a significant difference in your child’s learning journey. Here are some signs to look out for:

Visual Information Processing Symptoms

• Letter and Number Reversals: Confusing ‘b’ and ‘d’ or ‘6’ and ‘9’.
• Poor Reading Comprehension: Difficulty understanding or remembering what was read.
• Trouble with Spelling: Inconsistent or phonetic spelling errors.
• Difficulty with Math: Problems understanding spatial concepts or aligning numbers.
• Poor Handwriting: Messy, uneven spacing, or inconsistent letter sizes.

When to Seek Help

• Consistent Struggles: Ongoing difficulties in school despite effort.
• Teacher Concerns: Feedback from educators about attention or academic issues.
• Family History: Relatives with vision problems or learning disabilities.

Diagnosis: What to Expect

A developmental eye examination by a pediatric optometrist is crucial for diagnosing learning-related vision problems.

Components of the Examination

1. Visual Acuity Testing
   • Measures clarity of vision at different distances.
   • Identifies refractive errors needing correction.
2. Refraction
   • Determines the exact prescription for glasses or contact lenses.
3. Ocular Motility Testing
   • Assesses eye movement control.
   • Checks for tracking and fixation stability.
4. Accommodation and Vergence Testing
   • Evaluates focusing abilities and eye teaming.
   • Identifies problems like convergence insufficiency.
5. Visual Information Processing Assessment
   • Tests skills like visual memory, spatial orientation, visual-motor integration, and rapid naming.
   • Uses standardized tests to compare performance with age norms.

Reading Disabilities and Dyslexia

Understanding Dyslexia

• Dyslexia is a specific learning disability characterized by difficulties with accurate and/or fluent word recognition and by poor spelling abilities.
• It often stems from deficits in phonological processing.

Visual Components of Dyslexia

• While dyslexia is primarily language-based, visual deficits can exacerbate symptoms.
• Visual-Spatial Orientation Problems
  • Difficulty distinguishing similar letters (e.g., ‘b’ vs. ‘d’).
• Visual-Motor Integration Issues
  • Challenges in writing letters correctly and legibly.
• Visual Attention Deficits
  • Struggling to focus on specific words or letters.

Assessment for Dyslexia

• Phonological Awareness Tests
  • Assess the ability to manipulate sounds in words.
• Reading and Spelling Evaluations
  • Identify patterns in errors and difficulties.
• Visual Processing Tests
  • Determine if visual deficits are contributing to reading challenges.

Importance of a Multidisciplinary Approach

• Effective management often requires input from:
  • Pediatric Optometrists: Address visual efficiency and processing issues.
  • Educators: Implement appropriate teaching strategies.
  • Speech-Language Pathologists: Work on language processing skills.
  • Psychologists: Provide cognitive assessments and support.

Treatment of Vision-Related Learning Problems in Children

Even 20/20 Vision Isn’t the Whole Story

You might think that because your child has perfect “20/20” eyesight, vision problems aren’t affecting their learning. However, vision is much more than just the ability to see clearly at a distance. Even children who can read the eye chart flawlessly may still struggle with visual skills essential for learning.

Beyond Visual Acuity

Visual acuity refers to the sharpness of vision at a distance, such as reading letters on a wall chart. While important, it’s just one aspect of comprehensive vision health. Other critical visual functions can significantly impact your child’s educational performance, even if they have perfect distance vision.

Key Visual Skills Related to Learning

Consider the following essential visual skills that play a crucial role in your child’s ability to learn effectively:

1. Eye Movement Skills (Ocular Motility)

• What It Is: The ability of the eyes to move smoothly and accurately across a line of text.
• Why It Matters: Efficient eye movements are essential for reading. If your child’s eyes skip or jump unpredictably, they may lose their place or have difficulty comprehending what they’re reading.

2. Eye Focusing Abilities (Accommodation)

• What It Is: The capacity to quickly and accurately maintain clear vision as the distance from objects changes.
• Why It Matters: In a classroom, children often need to shift focus from the chalkboard (far) to their desk (near) and back again. Difficulty with this skill can lead to blurred vision and eye strain.

3. Eye Teaming Skills (Binocular Fusion)

• What It Is: The ability of both eyes to work together in a coordinated manner.
• Why It Matters: Proper eye alignment is necessary for depth perception and reading. Issues like convergence insufficiency, where the eyes don’t work together at near distances, can cause double vision and headaches.

4. Binocular Vision Skills

• What It Is: The blending of images from both eyes into a single, three-dimensional image.
• Why It Matters: This skill is crucial for understanding spatial relationships and for activities that require depth perception, such as reading maps or participating in sports.

5. Visual Perceptual Skills

• What It Is: The ability to interpret and understand visual information.
• Why It Matters: This includes recognizing letters and numbers, understanding symbols, and making connections with previously learned material. Deficits can affect reading comprehension and math skills.

6. Visual-Motor Integration

• What It Is: The coordination of visual information with body movements.
• Why It Matters: Essential for tasks like writing and drawing, as well as for sports. Poor eye-hand coordination can lead to messy handwriting and difficulty copying information from the board.

How Vision Problems Affect Learning

Undetected vision problems are common and can significantly hinder a child’s academic performance. In some cases, children with vision issues may be misdiagnosed with behavioral problems or conditions like ADHD/ADD because they exhibit similar symptoms, such as inattention or hyperactivity.

Possible Consequences of Untreated Vision Problems

• Academic Struggles: Difficulty reading, writing, and concentrating can lead to poor grades.
• Behavioral Issues: Frustration from vision problems may result in acting out or withdrawing.
• Misdiagnosis: Vision problems might be mistaken for learning disabilities or attention disorders.
• Social Challenges: Children may avoid activities they find difficult, impacting social interactions.

Prevalence of Vision-Related Learning Problems

• Convergence Insufficiency: Studies indicate that approximately 13% of children aged 9 to 13 suffer from moderate to severe convergence insufficiency. This condition affects the eyes’ ability to work together at close range and is crucial for reading.
• Learning-Related Vision Problems: Research shows that one in four school-age children has at least one learning-related vision problem.

Signs and Symptoms to Watch For

Identifying vision-related learning problems early can make a significant difference in your child’s educational experience. Be attentive to the following signs:

Common Symptoms

• Double Vision: Particularly during or after reading.
• Blurred Vision: Especially after prolonged near work.
• Eye Strain or Frequent Headaches: Often associated with visual tasks.
• Poor Handwriting: Messy or illegible writing that may indicate visual-motor integration issues.
• Word and Letter Reversals: Mixing up ‘b’ and ‘d’ or ‘p’ and ‘q’.
• Easily Distracted During Reading: Difficulty maintaining focus on visual tasks.
• Poor Reading Comprehension: Struggling to understand or remember what was read.
• Avoidance of Reading: Reluctance to engage in reading or other close work.
• Hyperactivity or Restlessness in Class: May stem from discomfort during visual tasks.
• Overall Poor School Performance: Despite effort, grades do not reflect the child’s potential.

Signs and Symptoms of Learning-Related Vision Problems

Children May Be Unaware of Their Vision Issues

It’s important to recognize that children with vision problems are often unaware of their condition. They may assume that everyone sees the world as they do, making it crucial for parents and educators to be vigilant in observing signs that might indicate a vision-related issue affecting learning.

Common Physical Signs and Symptoms

These are some of the more noticeable signs that may suggest your child is experiencing vision problems:

• Squinting: May indicate difficulty focusing or seeing clearly.
• Excessive Blinking: Could be a response to blurred vision or eye strain.
• Excessive Eye Rubbing: Often a sign of eye fatigue or discomfort.
• Tearing, Red, Itchy, or Burning Eyes: May suggest eye irritation or strain.
• Holding Objects Close to the Eyes: Indicates potential nearsightedness.
• Headaches or Eye Strain: Especially after reading or close work.
• Blurry Vision or Double Vision: Difficulty focusing at certain distances.
• Eye Turn (Strabismus): One eye may turn in, out, up, or down.
• Turning or Tilting the Head: Could compensate for double vision or misalignment.
• Covering or Closing One Eye: May help the child see better if eyes aren’t working together.

Behavioral Signs and Symptoms

Vision problems can also manifest in behaviors that might not immediately seem related to eyesight:

• Avoidance of Near Work: Dislikes activities like reading or playing with small objects (e.g., Lego).
• Short Attention Span: Particularly during tasks that require visual concentration.
• Daydreaming During Work Time: May appear disengaged due to visual discomfort.
• Skipping Words, Letters, or Lines: Difficulty tracking text when reading or copying.
• Using a Finger or Moving the Head to Track While Reading: Compensating for tracking difficulties.
• Trouble Remembering What Was Read: Poor comprehension due to visual processing issues.
• Delayed Learning of the Alphabet: Difficulty recognizing and remembering letters.
• Persistent Letter, Number, or Word Reversals: Common in writing and reading.
• Problems with Laterality: Confusion between left and right directions.
• Not Completing Assignments on Time: Visual tasks may take longer due to difficulties.
• Difficulty with Geometric Shapes: Challenges in visual-spatial processing.
• Poor Hand-Eye Coordination: Affects writing, drawing, and sports activities.
• Behavior Problems: Frustration from vision issues may lead to acting out.

Academic and Learning-Related Signs

These symptoms are often observed in a school setting and can impact academic performance:

• Struggles in Reading: Slow reading pace, frequent errors, or avoidance.
• Homework Is a Battle: Resistance to starting or completing assignments.
• Poor Attention and Concentration: Easily distracted during visual tasks.
• Letter Reversals: Writing ‘b’ instead of ‘d’, ‘p’ instead of ‘q’, etc.
• Poor Handwriting: Messy or illegible writing due to visual-motor integration issues.
• Headaches with Reading: May complain of discomfort after sustained reading.
• Words Overlap or Go Double: Indicative of binocular vision problems.
• Losing Place When Reading: Difficulty tracking lines of text.
• Blurriness When Reading: Especially after prolonged near work.
• Motion Sickness: Discomfort during movement, possibly linked to visual-vestibular integration.
• Difficulty Riding a Bike: Challenges with balance and spatial orientation.
• Difficulty Planning: Trouble organizing tasks or following sequences.
• Trouble with Math: Issues understanding spatial relationships and aligning numbers.

Detailed Symptoms and Possible Vision Problems

Understanding the specific symptoms can help identify the underlying vision issues:

1. Blurred Vision, Frequent Eye Rubbing, Squinting

• Possible Vision Problems:
  • Nearsightedness (Myopia): Difficulty seeing distant objects clearly.
  • Farsightedness (Hyperopia): Difficulty focusing on close objects.
  • Astigmatism: Distorted or blurred vision at any distance due to an irregularly shaped cornea.

2. Closing or Covering One Eye, Occasional Double Vision

• Possible Vision Problems:
  • Eye Coordination Problems: Inability to coordinate both eyes effectively (binocular dysfunctions).
  • Strabismus: Misalignment of the eyes causing them to point in different directions.
  • Amblyopia (Lazy Eye): Reduced vision in one eye due to poor development of normal sight during early childhood.

3. Holding Reading Material Very Close, Complaints of Blurred Vision

• Possible Vision Problems:
  • Accommodation Issues: Difficulty maintaining clear focus on close objects or when shifting focus between distances.
  • Convergence Insufficiency: Eyes do not work together when looking at near objects, causing double or blurred vision.

4. Excessive Head Movement When Reading, Losing Place

• Possible Vision Problems:
  • Eye Tracking Problems (Ocular Motility Dysfunction): Difficulty smoothly and accurately moving the eyes from one point to another.
  • Poor Saccadic Eye Movements: Challenges with rapid eye movements necessary for reading.

5. Mistakes Words with Similar Beginnings, Difficulty Recognizing Letters or Shapes

• Possible Vision Problems:
  • Visual Form Perception Issues: Inability to discriminate differences in size, shape, or form.
  • Visual Discrimination Problems: Difficulty noticing and comparing the features of different items.

6. Trouble Visualizing What Is Read, Poor Reading Comprehension

• Possible Vision Problems:
  • Faulty Visual Memory: Difficulty remembering and recalling visual information.
  • Visual Sequencing Issues: Challenges in remembering the order of letters, numbers, or words.

7. Sloppy Handwriting, Poor Copying Skills

• Possible Vision Problems:
  • Visual-Motor Integration Deficits: Difficulty coordinating visual information with motor output.
  • Eye-Hand Coordination Problems: Affecting writing, drawing, and other fine motor tasks.

8. Reverses Letters and Words, Trouble Learning Left and Right

• Possible Vision Problems:
  • Laterality and Directionality Difficulties: Poor development of left/right awareness.
  • Spatial Orientation Issues: Challenges understanding and remembering spatial relationships.

Vision Therapy: Personalized Solutions for Better Vision

At the Neuro-Visual Performance Institute (NVPI), we understand that vision involves much more than just seeing clearly. Vision therapy is a personalized program of targeted visual activities designed to enhance the way your eyes and brain work together. This innovative approach addresses a range of visual skills that impact everyday life, learning, and performance.

Enhancing Eye Coordination

Effective vision depends on the ability of both eyes to work together seamlessly, a skill known as binocularity. Vision therapy incorporates exercises specifically designed to strengthen eye coordination, enabling smoother and more efficient teamwork between the eyes. This improvement is essential for reading, sports, and other daily activities requiring depth perception and focus.

Improving Focusing Abilities

Whether switching focus from near to far or sustaining focus on a single task, our vision therapy programs include activities to enhance these critical skills. Improved focusing abilities reduce eye strain and make it easier to concentrate on tasks like reading, studying, and driving.

Strengthening Eye Movement Control

Smooth and accurate eye movements are vital for tracking text while reading or scanning the environment. Vision therapy provides specialized training to enhance tracking and scanning skills, helping patients follow lines of text with greater ease and precision.

Developing Visual Processing Skills

Beyond eye movements, the brain must interpret and act on visual information. Vision therapy incorporates tasks designed to improve visual processing skills such as memory, discrimination, and spatial orientation. These enhancements help patients make sense of what they see, boosting academic, professional, and athletic performance.

Components of Vision Therapy

At NVPI, vision therapy combines in-office sessions with home-based activities to create a comprehensive and effective treatment plan tailored to each patient’s needs.

In-Office Sessions

Typically held once or twice a week, these sessions are supervised by Dr. Rick Graebe FCOVD or a skilled vision therapist. During these sessions, patients engage in guided exercises designed to address their specific visual challenges and goals.

Home Support Activities

To reinforce the progress made in the clinic, patients are provided with customized home-based activities. Regular practice at home is essential to solidify the skills learned during office sessions and ensure lasting results.

Why Choose NVPI for Vision Therapy?

With over 35 years of experience, NVPI offers one of the most comprehensive vision therapy programs in Central and Southern Kentucky. Dr. Rick Graebe FCOVD, a specialist in developmental and neuro-optometry, creates individualized therapy plans for each patient. Whether you’re dealing with vision challenges related to learning, head injuries, or sports performance, our programs are designed to help you reach your full potential.

Take the first step towards better vision today. Call us at 859-879-0089 or visit https://nvpinstitute.com to learn more about our developmental eye exams and vision therapy services. Let us help you achieve lasting improvement in your visual performance.