Monthly Archives: August 2014

My child has “20/20” eyesight but still has trouble copying off the board at school. What could cause that?

You probably remember struggling from time to time to see the blackboard in school when you were a child. Maybe you sat in the back of the classroom, behind the tall kid, or someone with big hair sat in front of you. Perhaps you needed your first pair of glasses before you could easily make out the letters and numbers on the board without squinting.

If you remember those brief periods of frustration, you understand how some children with certain vision problems feel throughout the day while struggling to copy from the board, even with 20/20 eyesight.

Modern classrooms include whiteboards, ActivBoards, and Promethean Boards. Students spend a lot of time looking at boards, and then back at their desks, during a school day. If a child has a vision problem, it may be difficult for the child to copy off the board and follow the lesson.

A child may have “20/20” clear eyesight but may also lack the ability to refocus from near to far and from far to near. As the child looks down at his paper to read or write, he may see clearly. After he is looking at the board for some time, he can see clearly too. However, looking up and down, back and forth, from the board to the paper might be where the difficulty comes into play.

The focus mechanism in the child’s eyes might be weak, slowing down the adjustment period as he looks from one point of site to the other. In functional optometry, focusing is called “accommodation.” A full functional vision exam tests “accommodative facility,” which is the ability to sustain clear vision and to shift focus.

Weak accomodative facility (focusing) is not detected during most normal vision screenings.

Another vision problem that would make it difficult for your child to copy from the board at school is poor eye teaming. Eye teaming, known in functional optometry as “binocular vision skills,” refers to the ability for the two eyes to work together as a team. If both eyes are not moving at the same time in the same direction, a child will struggle to look up at the board, down at her paper, and back again without experiencing visual fatigue and tiring quickly.

Your child could also have poor eye movements, such as tracking and pursuits. Tracking eye movement skills help the child “locate” the words on the board and then locate the space on the paper where they are to place their print. A child with poor tracking skills loses her place often, and getting lost frequently is frustrating and tiring.

Poor teaming and tracking skills are not detected during most normal vision screenings.

If your child has been complaining that he is having trouble copying from the board, or your child’s teacher complains that he is not copying down the lessons or assignments as instructed, a vision problem could be to blame.

Even if a school vision screening or visit to your family vision care clinic indicated that your child has 20/20 eyesight, problems with focus, eye teaming, or eye tracking might be interfering with his or her ability to copy from the board and learn efficiently alongside his classmates.

Find an optometrist in your area who specializes in developmental or functional vision care. If you live near Olney or Silver Spring, Maryland, schedule an appointment with Dr. Nicholson’s Visual Learning Center for a full visual analysis.

The good news is intensive vision therapy can improve eye teaming, eye tracking, and focusing skills. Within the next few months, your child could experience significant improvement, and copying from the board can become easier.

What is Visual Processing Therapy?

Unless we have complete vision impairment, we all take information in from our environment through our eyes. However, it is the brain, not the eyes, that processes this visual information. We cannot make sense of what we see with our eyes without the accompanying healthy functioning of the brain and healthy communication between the eyes and brain. Normal visual processing requires a complex system of neurological activity to be developed and functioning properly.

Many children lack good visual processing skills. Because of a delay in development or disorder, their vision system has trouble computing visual input. They can’t make sense of what they see as easily as their peers who have a properly functioning vision system. Consequently, their performance of everyday tasks such as reading, memorizing, and studying tends to be slower than normal and their abilities in these areas can fall below average.

Effective visual processing therapy involves intense one-on-one vision training programs that develop skills vital for fast and efficient learning.

At the Visual Learning Center in Olney, MD, our visual processing therapy program specifically works on areas of processing speed and accuracy, selective concentration, visual memory, letter reversals, visual-motor integration and speed, and visualization.

Visual processing speed and accuracy involves reading words, sentences, and numbers quickly and accurately. Because students with visual processing problems tend to work slowly, vision therapy includes procedures designed to increase the speed with which they are able to process information, with greater precision.

Selective concentration requires a child to stay on a visual task, even with distractions present. During visual processing therapy, the child practices tasks repeatedly while also enduring distractions. This practice trains the visual processing system to improve and become more focused.

Visual memory refers to the ability to accurately remember what is only seen for a short period of time. In visual therapy, children complete activities created to enhance their memory so they can recall the visual information they take in more readily.

When children struggle with letter reversals, they confuse similarly shaped letters such as b, d, p and q. If this is a problem for your child, visual processing therapy will help them better recognize and correctly write the letters they have been reversing.

Another difficulty children with visual processing problems sometimes face is trouble with visual-motor integration and speed. In other words, their eye-hand coordination may be delayed or awkward. Through vision therapy, children’s visual-motor integration can improve significantly, which can improve confidence and performance in sports, physical activities, handwriting and social interaction.

Healthy visual processing also requires the ability to visualize. Visualization is the process of creating a mental picture in the mind that is used to solve a problem. Learning and school performance often requires problem solving, so vision therapy works to improve a child’s ability to visualize.

Visual processing skills are required for learning and functioning normally in everyday life. If your child has problems with visual processing, school, athletics, and even social interaction can be difficult. An intense visual processing therapy program can result in remarkable improvement in the areas of processing speed and accuracy, selective concentration, visual memory, letter reversals, visual-motor integration and speed, or visualization in a relatively short period of time.

Philip Nicholson, O.D.

Q&A: Why did the other eye doctor we took our child to say he didn’t see anything wrong with his eyes?

Parents often contact us at the Visual Learning Center confused, wondering how their child could possibly have a vision problem when their family eye doctor did not indicate that anything was wrong with the child’s eyes.

We understand that, as a parent, you only want the best for your child and you rely on professionals to detect problems and advise you on the best course of action to care for your child.

Sometimes families express frustration with their eye doctor, wondering how the visual processing problem that — as it turns out — is causing so much disruption in their child’s ability to learn, could have been missed. They question whether earlier intervention and vision therapy at a younger age could have set the child up for better success at school.

The simple answer is that the particular eye doctor who examined your child is probably not a developmental optometrist. Though he or she is an O.D., just like I am, that doctor has not been trained in developmental diagnosis and vision therapy.

Routine eye or vision exams check the health of the eyes and the need for glasses. Eye doctors that specialize in surgery or disease treatment will likely not be able to diagnose functional problems, related to learning. This is simply not their area of expertise.

If you are a parent who suspects that your child might be struggling with a learning-related vision problem, have a conversation with your eye doctor to make sure your provider will look beyond ‘20/20 vision.’ If your eye doctor does not test using specific methods, vision-related learning problems will not be diagnosed and your child may continue to have functional vision problems.

Here is a helpful list of questions to ask your eye doctor:

  • Do you test for and correct accommodation (focusing) facility with +2 and –2 diopter flippers? Do you test for and correct lateral vergence facility (lateral eye alignment and speed) using prism flippers with 3 diopters base in and 12 diopters base out?
  • Do you test for and correct vertical vergence ranges (vertical eye alignment) using single prisms base up and down?
  • Do you test for and correct eye movement while the child is reading or answering questions that require comprehension? (using Visigraph infrared monitoring devices or similar equipment)? Eye movement analysis while simply following a moving target is not an accurate measurement of eye movement skills used while reading as this measures pursuit movements and not saccadic movements used while reading.
  • Do you test for visual perceptual or visual processing skills like visual discrimination, visualization or visual memory?

Feel free to print this off and take it with you to your appointment.

And if your family lives in the Olney, MD or Silver Spring, MD area, and you are interested in having your child tested for vision problems that may be interfering with their learning, contact our office and schedule an appointment to determine if your child might significantly benefit from treatment of learning related vision problems.

Philip Nicholson, O.D.

eye with earth reflection

How are “Visual Skills” related to learning?

Discovering that your child is struggling to learn, not because of a learning disability or lack of classroom skills, but instead a problem with their “visual skills” can be confusing for parents.

If a school screening or an eye doctor’s exam indicates that your child has no trouble with her eyesight, it can be even more confusing. You might ask yourself, “If my child can see just fine, how can there be something wrong with her vision?”

You might wonder how a child with 20/20 eyesight can also have a vision problem that is so significant that her learning is delayed or disrupted.

Most people think that vision is the same as sight. So if that’s what you thought too, you’re not alone.

However, sight simply provides the input for a child’s learning, while vision represents a complex system. When a child’s vision system is working efficiently, that child can process, understand, and relate new information to knowledge he or she already has.

On the other hand, when a child’s visual system is not working as it should, visual skills deficiencies can contribute to learning problems. If children experience a lag in their ability to recognize what they see, and relate it to what they already know, and then use this information as a basis for future understanding, the learning process can become frustrating.

For the learning process to work as it should, your child must first be able to see, then use what he sees to understand. The ability to see letters on a chart for an eye exam is not enough — 20/20 vision is not enough.

What developmental optometrists know is that there is a very important relationship between vision and the brain. The two work together so closely that vision and intelligence and understanding are almost synonymous

Sound complicated? It is. But the good news is, many children with low visual skills are often quite bright, or they may have little enduring learning problems with proper vision therapy. Also known as vision training, vision therapy can improve visual skills significantly and quickly.

A child’s ability to perform visual tasks (such as reading and studying) depends on the ability to synchronize thinking and seeing. The processes of thinking and seeing work together to give a perceptual and conceptual understanding of the material. The full spectrum of seeing and thinking needs to run smoothly for a child to gain meaning from what is taught.

Vision therapy exercises improve the integration of seeing and thinking.

Visual skills such as focusing, following moving objects, aiming, turning the eyes together as a team, visual processing and other abilities can be inefficient or poorly integrated, which can put great strain on a child.

Vision training allows a child to practice and strengthen vision skills, lessening the strain and effort they will have to put forth.

Experts have found that when anyone’s attention is spread between a number of tasks, it reduces the efficiency of the tasks. Think of the last time you tried to do two things at once. Was it easy? Did you do both as well as you wanted to? Or did one (or both) tasks suffer

When a child’s attention and efforts are spread between trying to make the visual system work physically and understanding the material, attempting to learn anything new that requires visual skills can be discouraging. A child who does not have deficiencies in visual processing can simply focus on understanding the material, without the interference of trying to get their system to function as it should.

Vision therapy serves to help children strengthen the link between vision and intelligence. Once visual skills are improved through vision therapy, it frees up energy and focus for actual learning. The less stressed mind is freed to focus on the task at hand.

Vision therapy in Olney, MD, and convenient to Silver Spring, MD, is provided by Dr. Philip Nicholson, O.D. and his staff at the Visual Learning Center. Call 301-570-4611 for a comprehensive assessment and to see if your child might significantly benefit from vision training.