If a child is having difficulty reading, sometimes vision problems may be the cause. The problems may not be apparent, though, if the child does not complain about difficulty seeing or has passed their school’s vision screening. What’s required is a comprehensive optometric examination, one that addresses the many different components required for reading and comprehension. Such an exam covers the following eight vision skills:
- Visual Acuity. This is the ability to see objects clearly at a given distance. The typical eye chart measures how well or how poorly a child sees at a distance of about 20 feet.
- Visual Fixation. This is the ability to aim the eyes accurately. Static fixation allows focus on a stationary object, such as when reading a word. Saccadic fixation allows the eyes to move quickly and accurately across a page to read a line of print. These are complex processes that require split-second timing for the brain to process the information received during the fixation period.
- Accommodation. This is the ability to adjust the eyes’ focus as the distance between the person and the object changes. A prime example occurs in the classroom, where students need to shift focus back and forth between the blackboard and their reading material. Holding focus at near distances is especially important for reading and writing.
- Binocular Fusion. This is the brain’s ability to take the information it receives from each eye individually and combine the two to form a single, unified image. A child whose eyes are not precisely aligned can experience blurred or double vision, which may lead to discomfort and task avoidance. In those situations, the brain often may suppress the vision in one eye to avoid confusion over which is the proper image. That eye may then develop poorer visual acuity — what’s known as amblyopia or lazy eye. Children with amblyopia read slower than those with normal vision.
- Saccades. These are very quick eye movements, where the eyes move in unison from one point to another, such as when you shift from one word or group of words to the next when reading. The points between the saccades, at which you focus on the words, are called fixation points, and these are the only times where the brain processes the visual information on the page.
- Convergence. This is the ability to move both eyes toward each other to maintain a single integrated brain image when looking at a close object. It is critical for close work, including reading.
- Field of Vision. The field includes the entire area over which vision is possible. It includes central vision and near-central (or para-central) vision, as well as peripheral vision, the areas to the left and right and up and down from the central point, where objects can be seen but not seen clearly. Central or near-central vision is important for reading, as it is this information the brain registers and processes.
- Form Perception. This is the ability to organize and recognize visual images as specific shapes. In terms of reading, the shapes include letters and numbers, which the brain defines, remembers, and later recalls to process information on the page.
Reading problems usually have multiple causes, so any treatment should be multidisciplinary. Educators, psychologists, and optometrists need to work together to identify each child’s needs and draw up a plan for assistance. The optometrist’s input is to identify any visual problems that may interfere with reading ability and help the child, through glasses or vision training, to overcome them. Once this is accomplished, the child is then more capable of responding to special education efforts aimed at treating any other reading problem.
It’s important to understand that learning-related vision problems are not learning disabilities. The U.S. Individuals with Disabilities Education Act (IDEA) defines a specific learning disability as: “. . . a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.” IDEA also says learning disabilities do not include learning problems that are primarily due to visual, hearing, or motor disabilities.
Nevertheless, specific vision problems can contribute to learning problems, regardless of whether a child has been diagnosed as “learning disabled.” That means a child who’s having difficulty in school may have a specific learning disability, a learning-related vision problem, or both.
If you suspect your child may have a learning-related vision problem, you should look for some of the notable symptoms:
- Chronic headaches or eye strain
- Blurred or double vision, especially when reading
- Crossed eyes or eyes that appear to move independently (also known as strabismus)
- Excessive blinking or rubbing of the eyes, especially when doing close work
- Turning or tilting the head to use one eye when reading
- Closing or covering one eye when reading
- Placing the head close to the book or desk when doing close work
- Often losing place while reading, or requiring the use of a finger as a guide
- Slow reading speed or poor reading comprehension
- Omitting or repeating words while reading, or confusing similar-looking or sounding words
- Pervasive reversal of words or letters (after second grade)
- Difficulty remembering, identifying, or reproducing shapes
- Poor eye-hand coordination
If your child shows any of these symptoms, either alone or in combination, and is experiencing learning problems, he/she may have a learning-related vision problem. Seek out an optometrist who specializes both in children’s vision and in learning-related vision problems. A comprehensive evaluation should turn up valuable information.
If it turns out your child has a learning-related vision problem, treatment generally consists of a doctor-supervised program of vision therapy, and a prescription for special eyeglasses, either for full-time wear or for close work like reading.
It’s also important that, if your child receives special education and/or any other type of special services for a learning disability, you have the doctor contact your child’s teacher and any other professionals involved with the Individualized Education Plan (IEP). It is possible to combine vision therapy with remedial learning activities so that all parties can provide a coordinated effort to address your child’s learning problems.
 American Optometric Association. (2019). “A Look at Reading and Vision: Getting at the root of reading problems.” Retrieved from https://www.aoa.org/patients-and-public/resources-for-teachers/a-look-at-reading-and-vision.
 Roth, S. Moshe. (March 25–29, 2015). “Children with Lazy Eye Read Slower: Amblyopic Children Read More Slowly Than Controls Under Natural, Binocular Reading Conditions.” Presented at the 41st Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, New Orleans, Louisiana. Retrieved from https://www.newjerseyeyesite.com/2015/12/05/children-with-lazy-eye-read-slower/.
 Murphy, Rob, and Heiting, Gary. (2019). “Are learning-related vision issues holding your child back? All about Vision.” Retrieved from https://www.allaboutvision.com/parents/learning.htm.