Resources for Teachers (AOA)

Teachers know that good vision is essential for children being fit, healthy and ready to learn.¹ Unfortunately, two in five children have vision conditions that affect learning.²

According the the American Optometric Association'S (AOA) Health Policy Institute, "In the U.S. one in every four children has a vision disorder that requires diagnosis and treatment by an eye doctor, yet 93% of children during the critical developmental years before starting school never see an eye doctor for diagnosis and treatment. This situation exists because of a singular overreliance on so-called “vision screening” to identify children requiring eye examination from an eye doctor."⁴

For this reason, the AOA recommends that all children have a comprehensive eye exam by an eye doctor, as opposed to a vision screening, before beginning first grade. Children beyond first grade who have not yet had an eye exam by an eye doctor should be referred for an eye exam regardless of vision screening status.

Undiagnosed and untreated vision disorders increase the potential for misdiagnosis of special needs and Attention Deficit Hyperactivity Disorder (ADHD), placing unnecessary stress on families and classrooms.⁵

Vision disorders are often "silent," with no outward symptoms. Parents are unaware that their child needs an eye exam. Left untreated, vision conditions may cause irreparable harm.

Fortunately, the U.S. Congress and federal agency officials have made children's vision care a true national health care priority. Now, under federal law and regulations, pediatric eye health is recognized as essential medical care. Millions of previously uninsured children now have insurance coverage for annual eye exams and follow-up care.⁶ As the starting point for primary prevention, children's eye exams can help assure children a lifetime of vision health and learning.

Schools and teachers can also help by moving away from relying on vision screenings to assuring all children receive eye examinations from an eye doctor.

A look at reading and vision 

Getting at the root of reading problems

When children have trouble reading, parents and teachers need to investigate many possible causes. That's because reading difficulty usually stems from a combination of problems, rather than just one. 

One potential problem that is sometimes overlooked is the child's vision. This may happen because the child appears to be able to see, does not complain about his or her eyes or has passed a school vision screening. 

Reading requires the integration of a number of vision skills: visual acuity, visual fixation, accommodation, binocular fusion, saccades, convergence, field of vision, and form perception. The typical school eye chart test only evaluates the visual acuity far away. And parents, teachers or children often don't notice the symptoms of reading-related vision problems. 

A comprehensive optometric examination, however, covers all of these vision skills. Any child who is having trouble reading should have a comprehensive eye exam. Following are the vision skills that a doctor of optometry will evaluate during the exam: 

• Visual acuity is the ability to see objects clearly. The typical eye chart is designed to be seen at about 20 feet and measures how well or poorly the child sees at that distance. 
• Visual fixation is the ability to aim the eyes accurately. Static fixation is the ability to focus on a stationary object when reading a word or working a math problem. Saccadic fixation is the ability to move the eyes quickly and accurately across a page to read a line of print. Pursuit fixatio n is the ability to follow a moving object with the eyes. These complex operations require split-second timing for the brain to process the information received and to track the path of the moving object. 
• Accommodation is the ability to adjust the focus of the eyes as the distance between the individual and the object changes. Children frequently use this vision skill in the classroom as they shift their attention (and focus) between their books and the chalkboard for sustained periods of time. Being able to maintains focus at near distances is important for reading, writing and taking tests. 
• Binocular fusion refers to the brain's ability to gather information received from each eye separately and form a single, unified image. If a child's eyes are not precisely aligned, he or she may experience blurred or double vision, discomfort, confusion or avoidance. If that occurs, the brain often subconsciously suppresses the vision in one eye to avoid confusion. That eye may then develop poorer visual acuity (amblyopia or lazy eye).
• Saccades are rapid eye movements in which the eyes move together from one location to another, such as when looking from one word or group of words to the next when reading. 
• Convergence is the ability to turn the two eyes toward each other to maintain single vision when looking at a close object. Children depend on this vision skill for school desk work. 
• Field of vision is when the wide area over which vision is possible. It is important that a child be aware of objects in the periphery (left and right sides and up and down) as well as in the center of the field of vision. Near central (or para-central) vision is important for reading ability. 
• Form perception is the total process responsible for the reception and understanding of what is seen. Form perception is the ability to organize and recognize visual images as specific shapes. The shapes the child encounters, such as letters and numbers, are remembered, defined and recalled when he or she begins developing reading skills. 

Treating reading-related vision problems

During a comprehensive eye examination, the doctor of optometry examines these vision skills and determines how well the child is using them together. If your doctor of optometry diagnoses a vision problem, he or she can prescribe glasses, vision therapy, or both. 

Vision therapy can be very effective in treating reading-related vision problems. Your doctor of optometry designs an individualized program of training procedures to help your child acquire or sharpen the vision skills necessary for reading. 

Because reading problems usually have multiple causes, treatment must often be multidisciplinary. Educators, psychologists, doctors of optometry and other professionals must work together to meet each child's needs. 

The doctor of optometry's role is to help the child overcome the vision problems interfering with the ability to read. Once this is accomplished, the child is then more capable of responding to special education efforts aimed at treating the reading problem itself. 

Free resources for teachers

Classroom Handouts

Share this handout with your students to enhance their understanding of their eyes and vision. 

1.   How Your Eyes Work 

Classroom Exercises

Please feel free to reference and repoduce any classroom exercises for your use. 

1. Day and Night 
2. Pinhole Focusing 

Activity Sheets 

In addition to the children's resources available for purches at the AOA Marketplace, we invite you to download and reproduce any of the free activity sheets for your use.

1. How the eyes work
2. Your Eye-Q test
3. Focus on seeing
4. Healthy eyes checklist
5. Eyes in action 

<sub>1. ASSOCIATION BETWEEN READING SPEED, CYCLOPLEGIC REFRACTIVE ERROR, AND OCULOMOTOR FUNCTION IN READING DISABLED CHILDREN VERSUS CONTROLS, PATRICK QUAID AND TREFFORD SIMPSON, GRAEFES ARCH CLIN OPHTHALMOLOGY (2013) 251:169-87.
2.  NATIONAL INSTITUTES OF HEALTH THE MULTI-ETHNIC PEDIATRIC EYE DISEASE AND BALTIMORE PEDIATRIC EYE DISEASE STUDIES (NEI.2011)
3.   HHS.GOV/SITES/DEFAULT/FILES/I-QUALITY-AFFORDABLE-HEALTH-CARE.PDF
4. HEALTH POLICY INSTITUTE. Vision Screening” Should Be Called “Amblyopia Screening”
5. ATTENTION DEFICIT HYPERACTIVITY DISORDER: EFFECTIVENESS OF TREATMENT IN AT-RISK PRESCHOOLERS; LONG-TERM EFFECTIVENESS IN ALL AGES; AND VARIABILITY IN PREVALENCE, DIAGNOSIS, AND TREATMENT. COMPARATIVE EFFECTIVENESS REVIEW NO. 44. AHRQ PUBLICATION NO. 12-EHC003-EF. ROCKVILLE, MD: AGENCY FOR HEALTHCARE RESEARCH AND QUALITY. OCTOBER 2011. AVAILABLE AT:  EFFECTIVEHEALTHCARE.AHRQ.GOV/REPORTS/FINAL.CFM.
6.   OBAMACAREFACTS.COM/WP-CONTENT/UPLOADS/2014/10/OBAMACAREBILL.PDF</sub>  

Author

Dr. Arthur Astorino, JR. MD Arthur Astorino, Jr., MD, is a board-certified ophthalmologist who has been practicing since 1988. He provides exceptional eye care to his patients at Astorino & Associates Eye Center in Newport Beach, California, in areas like general ophthalmology, advanced cataract care, and refractive surgery.