Last week I witnessed the astonished look on a father’s face when his 7 year old little girl (we’ll call Jenny) struggled with some routine chair-side vision tests. His surprise was not during the measurement of her ability to read the eye chart. She read the 20/20 line of letters like a pro. But, when I asked Jenny to visually look at and follow a moving bead on a stick, Jenny responded as if she couldn’t or wouldn’t do it. Observing his daughter’s seeming lack of compliance, Dad began to go into a coaching mode. “Jenny, look at the bead!” , he repeated as I moved it very slowly in front of her face. Then in almost a sense of exasperation he said, “Come on, Jenny, you have to do your best for the doctor”, as if this was a routine personal frustration he had for his 7 year old daughter. Jenny’s face just grimaced as if this was almost a painful process.
So I stopped the visual tracking test and gave Jenny a break. Then I asked her to put on some red/green anaglyph glasses. Sometimes kids call them the 3-D glasses. I asked her to look at a penlight that I positioned about 3 feet in front of her face. Then I brought the light in toward her nose and asked her to tell me when she saw it go double. Jenny reported double at about 14 inches. I repeated the test 2 more times and she consistently reported the light separating into 2 lights further and further away from her face. When her Dad saw this, he thought Jenny was simply “playing around” and said, “Jenny, this is important, you have to try harder!” So, I removed the red/green glasses from Jenny and asked Dad to put them on. I did the same test on him, except he saw the light remain single up to about 2-3 inches from his nose. Now he was starting to get it!
Jenny’s parents situation is not unusual because every family has their own unique side to the story when unaddressed vision problems cause reading and learning problems. It usually begins with a child who is bright and yet struggles in school. In this case their almost 8 yr old daughter, Jenny was having a difficult time reading. She even had extra tutorial support and attention at school. But, her parents were prepared to retain her in the first grade, even though her teachers said Jenny was capable of “just barely” reading 2nd grade material and suggested that she be promoted to 2nd grade. However, while Jenny could read single words at a time, what she struggled with was reading them in a sentence, losing her place and slow to do her work. Her parents felt a bit remorseful of having to make a decision to retain her in 1st grade because Jenny was good in math and was mature enough to handle the transition to 2nd grade. But, because of the reading discrepancy Jenny’s parents thought they should retain her in 1st grade, while on the other hand they were worried that she would get bored and grow to dislike school and feel the emotional sense of failing when her peers were moving forward. They were visibly torn!
Fortunately for Jenny, one of the teachers helping to tutor her, spotted some of the hallmark signs of a visual tracking problem and made the referral to our office. At first, Jenny’s dad was convinced that his daughter couldn’t have a vision problem because she had passed the school eye sight test and the pediatricians vision screening. But, he and his wife wanted to make sure so they made the appointment.
What did I find? Yes, little Jenny had normal eyes, good eye sight (20/20) and no need for corrective lenses. But, she had severe delays in her Oculomotor (visual tracking)abilities causing her to lose her place when reading, a binocular vision dysfunction (Convergence Insufficiency) causing her to experience intermittent double vision and fatigue when reading and Accommodative (eye focusing) Dysfunction that resulted in loss of visual attention for reading.
I met with Jenny’s parents outlined a treatment plan of twice a week office-based optometric vision therapy and within 4-5 months I expect Jenny will be visually fully functional and able to apply herself in the classroom. Jenny got started last week in treatment, and because we were able to clearly identify a discernible visual problem that can be completely remediated with the proper evidenced-based treatment in a relatively short period of time, Jenny’s parents decided to place her forward into 2nd grade.
If you are like so many who are searching for answers, this story about Jenny helps to give some insight. However, it is probably safe to say that you have questions about how a child, possibly your own child can pass the school or pediatrician vision screening, reportably have normal sight (20/20) and yet have vision problems that cause significant problems in school, such as reading!? Yes, while Dr. Press and I have written about this extensively on the VisionHelp Blog, sometimes it’s better to hear about it from a parent who has been through it before.
With that thought in mind, here is a video of a mother, Michelle, whose son Dimitre had his crossed-eye surgically aligned, did occlusion therapy and had 20/20 visual acuity, but still had serious vision problems that blocked his abilities to read, learn, ride his bike and even make friends. Take a look and see if this helps explain why 20/20 sight is simply not good enough to define vision readiness for reading and learning in the classroom…
For more Facts about vision problems that affect reading and learning, here are some helpful sources:
To find a doctor nearest you go to www.covd.org and click on the Doctor Locator.
Dan L. Fortenbacher, O.D., FCOVD