Monthly Archives: August 2014

skipping letters when reading

Skipping Letters When Writing and Reading

The Visual Learning Center offers
developmental optometry & vision
in Olney, MD near Silver Spring.

Is your child skipping letters when writing or skipping letters when reading? Perhaps they are even skipping words or entire lines of text. This is a common symptom for patients who come into our office, and it may indicate a vision disorder or deficiency, even if the child has 20/20 eyesight.

To learn more how vision can affect learning, download our free guide here and watch our pre-recorded webinar here.

When a child skips letters or words, parents and teachers often initially blame carelessness. They encourage the child to try harder and to concentrate and mistakenly believe the child is simply distracted. At first, adults tend to attribute skipping letters, words, and lines to too much screen time, lack of interest, or laziness.

But when they observe over time that the child is trying yet still struggling to read or write, skipping words and letters may seem to be a sign of impatience or sheer frustration.

However, children with eye tracking problems– an oculomotor dysfunction–may actually be experiencing difficulty with eye muscle coordination.

A child with an eye tracking problem strains to accurately and efficiently control eye movements. Oculomotor dysfunction causes their eyes to jump erratically, rather than move along a line of text smoothly. The irregular eye movement may be subtle enough not to detect by observation. But even slight eye movement deviations can make it challenging to read and write without skipping text.

Without the eye muscles functioning in a normal healthy way, you may notice your child losing their place while reading or copying from the board, rereading words or lines, or using a finger, pencil or some other tool in an attempt to maintain his place while reading or writing.

Eye tracking is a complex function that involves both muscles and many different areas of the brain. When someone with a healthy visual system reads or writes, eye tracking movements are not smooth as they scan along the text from left to right.

Normal oculomotor movements occur as a series of “jumps” and “fixations” on certain points across the text. Readers take in either a whole word or part of a word with each these pauses and fixations. Next, they process the word through the visual system. And then their eyes fixate on the next set of text, just long enough to see and process it.

All of this has to happen in a healthy manner without disruption or dysfunction. If your child is struggling with oculomotor weakness, reading is challenging and requires strained effort, especially as the paragraphs and reading or assignments grow longer.

If oculomotor dysfunction causes a child to continues to skipping letters, words or lines by third or fourth grade, they will likely fall below expected grade level performance. Fortunately, if your child is diagnosed with an oculomotor problem, vision therapy can treat and even cure the deficiency.

See our vision therapy success stories.

Only a functional vision exam by an optometrist who specializes in developmental vision care can diagnose or rule out a learning-related vision problem.

To schedule a comprehensive vision exam and access vision therapy in Olney, MD near SIlver Spring, contact Dr. Philip Nicholson’s Visual Learning Center.

Register for an upcoming webinar here.

Does Your Child Need to see a Developmental Optometrist or is a Routine Eye Exam Good Enough?


Dr. Philip Nicholson’s Visual Learning Center
provides developmental optometry and vision
therapy in Olney, Maryland near Silver Spring.

Has your child been screened for vision problems that may interfere with learning? Typical eye exams only test for clarity and sharpness of eyesight at a distance. However, most parents and teachers are not aware that many children with common vision disorders and visual processing deficiencies need to be assessed by a developmental optometrist who specializes in functional vision care.

Most states around the U.S. have some regulations requiring access to vision screening for children, typically through schools. The state of Maryland requires each county school board to provide vision screenings to all students entering first grade and again when entering eighth or ninth grade. These requirements are in place to prevent students with poor eyesight from falling through the cracks.

By getting annual exams with your family eye doctor, you likely believe your child is being tested for common problems and that you’re ensuring the best care for their child. Annual exams are important–if a child doesn’t have 20/20 eyesight, corrective lenses can make a world of difference. But 20/20 eyesight isn’t enough.

For children to be able to learn effectively and perform at their best, they must have a fully functional and healthy visual system. They must be able to coordinate their eye movements effectively and efficiently, and they must be able to process information quickly through their visual system.

Unfortunately, routine eye exams do not screen for learning-related vision problems. Your family eye doctor is most likely not trained in developmental optometry or functional vision care and vision therapy.

Even if your child has 20/20 eyesight, you may notice some of the following problems that could be attributed to a vision disorder or deficiency:

  • Skipping words, letters or lines while reading or writing
  • Reversing or substituting letters or numbers
  • Performing below grade level or below average on standardized tests
  • Poor handwriting
  • Difficulty copying from the board
  • Attention problems similar to ADHD
  • Complaining of headaches, eye aches, or tiredness while reading
  • Clumsiness, awkwardness, and poor coordination

Many children diagnosed with developmental delays, learning disabilities, dyslexia, or attention deficit disorder and behavior problems, actually have treatable vision problems that can be improved or cured with vision therapy.

To learn more how vision can affect learning, download our free guide here and watch our pre-recorded webinar here.

The only way to diagnose a learning-related vision problem is with a comprehensive eye exam by a developmental optometrist who specializes in functional vision care.

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

  • How do you test for and correct accommodation facility (focusing) and lateral vergence facility (lateral eye alignment and speed), vertical vergence ranges (vertical eye alignment) ?
  • Do you test for and correct eye movement while the child is reading or answering questions that require comprehension?
  • Do you use equipment such as prisms and Visigraph infrared monitoring devices?
  • How do you test for visual perceptual or visual processing skills such as visual discrimination, visualization, and visual memory?

Here’s a handy PDF guide you can use for screening your eye doctor:


A child with a normal healthy visual system does not need to see a developmental optometrist–routine vision screenings and an annual visit to the family eye doctor will suffice.

But if a child is having trouble in school–academic, behavioral, social, or physical–you may discover that an undetected vision problem is to blame.

This vision checklist and questionnaire will help you determine if your child needs to see a developmental optometrist.

To schedule a comprehensive vision exam with a developmental optometrist in Olney, Maryland or Silver Spring, contact us at Dr. Philip Nicholson’s Visual Learning Center today.

Visual Processing Disorders Often Go Undetected in Children

Dr. Philip Nicholson’s Visual Learning Center 
provides developmental optometry and vision therapy
in Olney, MD and the surrounding Silver Spring area.

A visual processing disorder is a type of perceptual deficiency that hinders a child’s ability to make sense of information that they take in through their eyes. When a child has a visual processing disorder, they may see clearly and their eyes may function normally, but they are not able to efficiently or effectively interpret, categorize, remember, or associate meaning with the images and information in their brain.

It’s the brain, not the eyes, that associates meaning with images, symbols, text, and spatial dimensions or distance. Typical vision exams usually only test for clarity and sharpness of vision.  Even with 20/20 eyesight, there can be a weakness in visual processing that interferes with learning and other functions.

Warning signs and symptoms of visual processing disorders include:

Difficulty reading, complaints of tiredness while reading, losing place or skipping words while reading:

Visual processing disorders can cause children to mix up the order of words and letters, reverse letters, or have poor visual memory, which affects comprehension and leads to confusion and frustration.

Trouble with math or inability to make progress in math:

If a child has a visual processing disorder, you may first notice that they have trouble remembering numbers, such as their phone number or address. They may copy down the wrong numbers from the board or from an equation. They may also confuse math symbols or have difficulty distinguishing the order and meaning of symbols in an equation.

Messy handwriting, difficulty buttoning or zipping clothes, trouble cutting food or using scissors:

In these cases, the child may be experiencing a visual processing problem related to their visual-motor skills and fine motor skills, meaning they are having difficulty coordinating what they see with their associated body movements to accomplish tasks.

Types of visual processing disorders include issues with:

Visual sequencing: the ability to tell the correct order of words, symbols, or images

Visual figure-ground discrimination: the ability to distinguish a shape or text from the background in which it’s situated

Visual closure: the ability to identify an object from its parts. For example, the child might not be able to identify a cat missing a tail, a car missing wheels, or a word missing letters, which interferes with reading and spelling.

Visual discrimination: the ability to recognize the difference between similar shapes, objects, or letters, such as p and q or b and d

Visual spatial processing: the ability to tell distance or space of an object, either physically or on paper. This also affects understanding of time and narrative, which interferes with comprehension.

Visual memory: the ability to recall what they’ve seen or read, which could occur either in the short-term or long-term. This interferes with reading, comprehension, and spelling, as well as using a keyboard or calculator.

Visual-motor processing: the ability to use what you see with your eyes to coordinate movement in the rest of your body. This interferes with writing, drawing, cutting, tasks that require hand-eye coordination, and sports.

Much of what we learn and do requires efficient and effective visual processing. If there is not a problem, these visual processing skills are easily taken for granted in a normal, healthy, functioning visual system.

If a child has a visual processing disorder, however, it can cause many problems in school with learning, in social situations, and with self-esteem. A large percentage of children who have trouble in school have some sort of processing disorder, including visual processing.

The good news is, intensive vision therapy treatment can improve visual processing skills and even cure visual processing deficiencies.

If you suspect your child could have a visual processing disorder, schedule a comprehensive vision exam with a developmental optometrist who specializes in functional vision care.

For an exam to detect possible visual processing disorders and vision therapy in Onley, Maryland and Silver Spring, contact The Visual Learning Center today.

Register for an upcoming webinar here.