80% or more of classroom learning occurs through the visual system. The teacher shows the students new skills to master, students look at worksheets to reinforce what they are learning and they use their eyes to read books on all of the subjects of the day. Regardless of your academic environment, learning is a visually rigorous task. With so much riding on your child's visual system, it is important to have it properly evaluated for school readiness.
Vision is much more than 20/20. Vision screenings at the pediatrician's office or through school are not designed to catch the types of vision problems that add up to 1 in 4 children being effected by a vision problem impacting learning. Screenings are meant to catch gross abnormalities, not thoroughly test a child's visual abilities. We see patients every day who have passed every vision screening with flying colors, yet they have a vision condition that gets in the way of their learning. Unfortunately, we also see children who have been to a general eye doctor who has told the parents 'everything is fine, your child sees 20/20'. Non-pediatric eye examinations often miss pediatric vision conditions that impact learning. This is why it is so important that children be seen by a pediatric eye doctor. A residency-trained pediatric optometrist performs the types of testing necessary to diagnose vision problems that affect learning. After all, you can only diagnose a condition if you test for it.
The relationship between vision and learning is more complex than you may imagine. On the surface it makes total sense. If a child cannot see, they will have a hard time learning. What makes this topic more complex is the fact that many children can see 20/20 even if they have vision conditions that negatively impact learning. This means that relying exclusively on the 20/20 eye chart can be extremely misleading. Would seeing double make it more difficult to learn? What if words moved on the page or came in and out of focus? What if your eyes could not keep their place on the page?
Even with the obvious importance of vision in the learning process, there are still doctors who claim that vision has nothing to do with learning. Generations of personal experiences speak to the importance of vision in the learning process (and the power of treating these vision conditions to remove barriers to success). While personal experiences may be inspirational to parents looking to help their children, research can be more powerful to shift the mindset of why vision is so important to school readiness. Fortunately, more and more research emerges every day that shows the importance of vision in the learning process.
This year, researchers at the University of Arizona, Tucson released a study indicating how uncorrected astigmatism can impact reading fluency. Astigmatism is a refractive error that occurs when the eye is not completely spherical, but more oblong. This refractive error impacts vision at all distances. People are more familiar with the terms nearsighted (myopia) and farsighted (hyperopia). Astigmatism is a third type of refractive error that suffers from not having an easy to remember name. Generally astigmatism causes a decrease in vision, inhibits letter/word recognition, depth perception, and decreases contrast sensitivity. The research team found that children with uncorrected astigmatism had poorer reading fluency and that reading fluency improved with spectacle correction. This is especially important because many children, even with moderate astigmatism, can sneak past vision screenings. Even better for parents, they can take advantage of insurance benefits and fix this problem with a pair of glasses or contacts (a pretty inexpensive fix for years of poor reading fluency).
Another research group, Vision in Preschoolers, conducted a study examining the effect of uncorrected hyperopia (farsightedness) and literacy. They found that children with uncorrected hyperopia had difficulty identifying letters and words, decreased binocular vision, difficulty learning sounds associated with letters, and intermittent blurred vision. Hyperopia requires the eyes to work and flex their muscles regardless of what they are looking at to see clearly. Looking at near objects requires a greater work demand on the eyes and can cause increased strain, headaches, and fatigue. Vision screenings are notoriously bad at catching hyperopia. This makes this condition under diagnosed and under treated. Just like astigmatism, hyperopia is easily corrected with a pair of glasses or contact lenses from your child's pediatric eye doctor.
Beyond correcting a simple prescription, researchers are also investigating the impacts of binocular vision dysfunction (eye teaming deficits) on reading. This research is especially important because children with no prescription (or one who is wearing glasses to correct their prescription) can still have difficulties with eye teaming, eye focusing or eye tracking. These vision conditions are going to be missed on a vision screening (and by many non-pediatric eye doctors) and present a barrier to learning for a child who sees 20/20. Correcting a prescription with glasses may be the first step in helping your child be school ready, but treating their binocular vision dysfunction may be the next.
So as you get ready for fall, be sure to schedule a comprehensive eye examination with your pediatric eye doctor. Do not leave your child's vision or their academic success to chance with a vision screening or eye exam with a non-pediatric eye doctor. Missing a childhood vision problem could mean difficulties seeing, but it could also mean poor reading fluency and visual barriers to learning.