When a child is struggling with reading, a combination of problems is most often at the root of the difficulty. One factor that is often overlooked is the child’s vision. Although he or she may have 20/20 sight, there can be other complicating conditions.

To see and read requires the integration of different skills, and the typical school eye exam is unable to evaluate most of them. It is recommended a child receive a professional vision exam to evaluate the following vision skills:

• Visual acuity: The ability to see objects clearly at a distance.
• Visual fixation: The skill needed to aim eyes accurately. This includes the ability to focus on a stationary object or to read a line of print accurately, as well as the ability to follow a moving object with the eyes.
• Accommodation: The ability to focus the eyes as the distance between the individual and the object changes.
• Binocular vision: The brain’s ability to gather information received from each eye separately and form a single, unified image. A child’s eyes must be precisely aligned or blurred or double vision may result. If that occurs, the brain often subconsciously suppresses or inhibits the vision in one eye to avoid confusion. That eye may then develop poorer visual acuity (amblyopia or lazy eye).
• Convergence: The ability to turn the two eyes toward each other to look at a close object, like schoolwork on a desk.
• Field of vision: The wide area over which vision is possible. A child must be aware of objects in his or her periphery (left, right, up and down) as well as in the center of the field of vision
• Perception: The total process responsible for the understanding of what is being seen. This includes the ability to organize and recognize visual images as specific shapes.

The above vision skills will be assessed during a comprehensive eye examination with your family optemetric physician.  A lack of proficiency in some of these skills may be caused by the following eye problems

Strabismus (eye misalignment).  An eye may turn in, out, up or down and the misalignment may be worse in some eye posititions.  The eye turn may be constant or part-time.  Eye misalignment in very young children does not generally lead to double vision, although it often leads to vision loss and loss of depth perception.  The vision loss may become permanent if the problem is not treated early.  Treatments often involve glasses, vision theapy and prisms.  Sometimes, children are referred to a specialist for eye muscle surgery to fully correct the problem.

Amblyopia (lazy eye).  Amblyopia is poor vision development in one or both eyes caused by inadequate visual experience during young childhood.  It may be caused by a structural problem in the eye, a focusing problem or eye misalignment.  Whatever causes the amblyopia, the vision loss may become permanent if not treated early.  The earlier treatment is started, the more completely and easily the vision loss will resolve.  Treatment often involves addressing the underlying causes as will as patching of the better seeing eye to allow vision to develop in the eye with amblyopia.

Refractive Errors (focusing problems).  Nearsightedness, farsightedness or astigmatism may limit the ability to see clearly and require corrective lenses.

Convergence Insufficiency (inadequate near tracking).  Convergence is the type of tracking movement involved when targets approach to eyes.  The eyes must swing in toward one another to avoid doubling of vision at close distances.  Difficulty with convergence can lead to significant fatigue, headache and double vision with reading.  Sometimes problems with convergence can lead to reading avoidance and poor reading performance.  Convergence insufficiency is easily treated with vision therapy.

Accommodation Insufficiency (inadequate near focusing).  Focus for near distances (accommodation) is sometimes difficult for children.  Children may have a problem initiating or sustaining focus for near work, or they may have difficulty refocusing the eyes as required during a copying task.  The problem is easily treated with vision therapy.

Tracking Deficiency (inaccuracy of eye movements).  Poor tracking can lead to problems maintaining place while reading and can limit eye-hand-body coordination required for optimal athletic performance.  Vision therapy is used to help resolve the problem.

Visual Perceptual Disorder (visual processing problem).  Difficulty with interpreting visual symbols and organizing visual information can be one of the causes of learning disorders.  Visual perceptual problems are not caused by an eye defect, but are the result of a processing difficulty in the brain.  Specialized vision therapy can sometimes improve visual processing skills and allow improved reading