Most classroom learning occurs through our eyesight. Our visual system is one of the largest driving factors in a successful education. It is estimated that 10% of schoolaged children have undiagnosed visual problems and are likely suffering academically as a result. Of course, not all learning problems are related to eyesight, but many are, so analysis of the visual system is an important step in determining the source of any learning disabilities.

Conditions such as dyslexia, attention-deficit/hyperactivity disorder (ADHD), and other learning disabilities are often elusive diagnoses since each child will manifest their symptoms differently. A thorough visual system analysis is critical to fully understanding the underlying problems. Your eye care provider will communicate with other health-care providers, such as the child’s pediatrician, psychologist, and school nurse, to accurately combine all findings to better arrive at an accurate diagnosis. In many cases, the visual system does not play a role in the learning disability, but this should be determined after an examination.

Refractive conditions of the eyes, particularly farsightedness and astigmatism, can make near visual tasks very difficult for sustained periods of time. These visual conditions may allow the individual’s eyesight to test well at a distance or even at near for short periods of time. A condition called “latent hyperopia” is particularly insidious to proper functioning of the visual system, since it can be an intermittent problem. Latent hyperopia is farsightedness that is partially compensated for by the eye muscles working overtime. It is only diagnosed with the use of prescription eyedrops, which temporarily prevent the visual system from over-compensating. This problem is simply resolved with the proper eyeglass prescription, and often dramatic improvements in academic performance result. Other types of refractive errors may also be the source of the problem, and they can be diagnosed during a vision examination.

Ocular functioning, such as eye tracking and improper eye movements, may be the cause of academic problems, even if there is no need for prescription eyeglasses or contact lenses. Many children with academic problems related to vision may have 20/20 sight on screening tests at school and in pediatrician’s offices and appear to have “normal” eyes. This is one further reason that a comprehensive examination by an eye doctor is important starting at six months of age.

The six eye muscles around each eye are controlled by a complex set of different nerves and neurological processes. If the eye muscles are unable to direct the eyes to the proper place, even a 20/20 eye won’t function properly. Eye muscle balance and strength will be assessed as part of a comprehensive vision examination. One of the most common visual disorders that results in difficulty reading is convergence insufficiency.

For proper binocular functioning of the visual system, the eyes should line up straight ahead when looking at any object further than six feet away. In reality, each of our eyes (in a relaxed state) has a slight tendency to point in slightly different directions. These “phorias” (tendencies of the eyes to not line up together) are compensated for pretty easily by the nervous system, but excessive phorias are more difficult or impossible for our visual system to adjust for. Phorias are rarely visible to the naked eye, but phoria testing in an eye doctor’s office is quite accurate. Problematic phorias can often be managed through the use of prisms ground into eyeglass lenses or by vision therapy.

Copyright- The Big Book of Family Eye Care  Dr.  Joseph DiGirolamo

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