Visual Efficiency Problems and Testing

These are problems that interfere with an individual's ability to clearly and comfortably gather information through the visual system over long periods of time. Types of efficiency problems are:

  1. Optical Problems such as
    • myopia (nearsightedness)
    • hyperopia (farsightedness)
    • astigmatism
  2. Binocular vision (eye teaming) problems
  3. Accommodative (focusing) problems
  4. Ocular motility (tracking) disorders

Effects of Visual Efficiency Problems on Learning

  • All of these conditions have the potential to interfere with the ability to concentrate and sustain at any visual task such as reading. Children with visual efficiency problems complain of eyestrain, headaches when reading, blurred vision, and occasional double vision.
  • Visual efficiency problems tend to interfere from grades 4 and older when children have already learned to read and are now reading to learn.
  • Children who have only these problems tend to perform acceptably for the first few grades.

Visual Efficiency Problems

  1. Optical Problems and Symptoms
    This refers to optical conditions which cause blurred vision at distance, near, or both distances.
    • Nearsightedness (myopia)

      This is a condition in which vision is blurred at distance but clear at near. Unless severe, myopia generally doesn't interfere with learning. If not identified early, it may interfere with motor development and cause difficulty interacting with the environment in very young children.

      Symptoms of nearsightedness include:
      • squinting
      • complaining of blurred vision far away
      • getting close to the board


    • Farsightedness (hyperopia)

      This is a condition in which the individual must use more effort to see at near. To see clearly, a person with hyperopia must contract the ciliary muscle to change the shape of the lens in the eye and regain clarity. The effort that is necessary to focus can result in eyestrain, inability to attend and concentrate, headaches, and intermittent blurred vision.

      Very high degrees of hyperopia cannot be overcome and result in blurred vision. If not corrected early, such problems can lead to amblyopia (loss of vision) and difficulty interacting with the environment.

      Symptoms of farsightedness include:
      • feeling discomfort associated with reading
      • rubbing eyes
      • watering eyes
      • complaining of blurred vision


    • Astigmatism

      This is a condition in which vision is blurred and distorted at both distance and near. Low degrees of astigmatism can be overcome by focusing the eyes. High degrees of astigmatism cannot be overcome.

      If not detected and corrected early, significant degrees of astigmatism can lead to amblyopia (loss of vision) and difficulty interacting with the environment.

      Symptoms of astigmatism include:
      • feeling discomfort associated with reading
      • rubbing eyes
      • watering eyes
      • complaining of blurred vision


    Relationship of Optical Problems to Learning

    Nearsighted children tend to be the best readers and learners in school. Their vision is clear when reading. Because they complain about not being able to see the board well, their needs are usually quickly addressed.

    Children with farsightedness and astigmatism often go undetected because they have relatively clear vision. Because of the effort needed for them to see clearly, however, they can experience eyestrain, blurred vision when reading, inability to attend and concentrate for adequate periods of time, and reduced reading comprehension.

  1. Binocular Vision or Eye Teaming Disorders

    Binocular vision, or eye teaming disorders, refer to a variety of conditions in which the eyes drift inward, outward, or upward. If such a turning occurs, it may result in the experience of double vision. To prevent this double vision from occurring, the child will use excessive effort. This muscular effort can lead to eyestrain, blurry vision, discomfort, inability to attend and concentrate, and poor reading comprehension.

    Symptoms of eye teaming problems include:
    • feeling discomfort associated with reading
    • experiencing intermittent double vision
    • closing or covering one eye
    • sensing that letters or words appear to move
    • losing their place on a page
    • seeming inattentive
    • rubbing eyes
    • watering eyes
    • complaining of blurred vision


    Relationship of Eye Teaming Problems to Learning

    The effort associated with trying to overcome eye teaming problems can lead to eyestrain, blurry vision, discomfort, inability to attend and concentrate, and poor reading comprehension.

  1. Accommodative or Focusing Problems

    Focusing problems refer to a set of conditions in which the person has difficulty focusing or relaxing the focusing system of the eyes. There are three primary types of focusing disorders.

    • focusing insufficiency: an inability to focus the eyes to see small detail at a close working distance.
    • focusing excess: a condition in which the person is unable to relax the focusing system.
    • focusing infacility: a condition in which both focusing and relaxing are difficult for the patient.

    Symptoms of focusing problems include:
    • vision blurring when looking from board to book or book to board
    • holding things very close
    • getting headaches when reading
    • feeling fatigued at end of day
    • feeling discomfort associated with reading
    • rubbing eyes
    • watering eyes
    • complaining of blurred vision

    Relationship of Focusing Problems to Learning

    Focusing disorders generally cause inattentiveness, eyestrain, and discomfort when involved in any task requiring precise vision.

  2. Ocular Motility, Tracking, or Eye Movement Disorders

    The primary type of eye movement problem that relates to school performance is called saccadic dysfunction. This refers to a condition in which the person's ability to scan along the line of print and to move his eyes from one point in space to another is inadequate.

    Symptoms of tracking problems include:
    • moving head excessively when reading
    • frequently losing their place on a page
    • skipping lines when reading
    • using finger to maintain place
    • demonstrating poor comprehension when reading
    • having a short attention span

    Relationship of Tracking Problems to Learning

    Eye movement problems can interfere with almost any school activity requiring vision. Performance will be affected because the child will be unable to consistently make accurate eye movements to look from one point in space to another. This will affect his ability to gather information and respond.

Visual Efficiency Testing

After a comprehensive eye health examination is performed we sometimes have further questions about how the eyes track, focus and work together. In order to evaluate this, we offer the Visual Efficiency testing. The following is a summary of the skills and related symptoms.

  • Eye Tracking (Oculomotor)
    This skill pemits easy shifting of the eyes along a line of print, a rapid and accurate return to the next line, and quick and accurate shifts between desk and chalkboard, or from one distance to another. Inadequate eye movement control may cause you to lose your place while reading, have difficulty copying from the blackboard, and skip or omit small words.

    Eye Focusing (Accommodation)
    This skill allows rapid and accurate shifts with instantaneous clarity from one distance to another, such as that from desk to chalkboard. It also permits you to maintain clear focus at the normal reading distance. Symptoms of a focusing problem may include blurred vision while reading, inability to clear vision at distance after reading, and fatigue or headaches while reading.

  • Eye Teaming (Binocular Vision)
    In order for you to have comfortable vision the two eyes must work together in a very precise and coordinated fashion. If this does not occur, it may result in double vision, frequent loss of place when reading, headaches or eyestrain, and inability to sustain at a visual task for any prolonged time. There are several different types of eye-teaming problems that can occur. In one form, one eye may turn in or out intermittently or even all the time. A more common form of eye-teaming problem occurs when the eyes have a tendency to turn in, out, up, or down and the ability to compensate for this tendency is inadequate.

We offer vision therapy with a Vision Therapist for all of these skills in order to improve visual efficiency and comfort. The goal is for comprehension and grades to improve as well as self-esteem.