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Expert Answers to Ten Common Questions About Vision and Learning

Dr. Pamela Lowe - Optometrist and AOA's Vision and Learning Specialist


Updated September 01, 2010

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

To get answers to ten commonly-asked questions about children's vision and learning, I interviewed Dr. Pamela Lowe, an optometrist and the American Optometric Association’s vision & learning specialist. She addresses concerns about the importance of detecting childhood vision problems, and how important healthy vision is for excelling in school.

Q: How important is good vision to school-aged children?

A: Since experts agree that 80% of what children learn is processed through the visual system, good vision is critical for the school-aged child’s academic success. The ability to see clearly, along with the eyes maintaining adequate tracking skills to allow for comfortable reading at distance and near, is an essential tool for every student.

Q: What is the teacher's role in detecting a child's vision problems?

A: Our nation’s teachers are with our children hands-on in the classroom day after day; they have a front row seat to observe warning signs of potential visual problems that may otherwise go undiagnosed. Teachers can alert parents to some of these warning signs like noticing a student squinting, losing their place while reading, rubbing the eyes, tilting or turning the head, headaches during the day and avoidance of visual tasks. If the student is struggling academically or acting out inappropriately in the classroom, teachers can alert parents that a potential vision problem needs to be ruled out.

Q: Do you feel that a vision problem could actually cause ADD/ADHD?

A: We do know that more than 60% of children diagnosed with behavioral disorders like ADD/ADHD have some type of visual impairment, and we do know that sometimes a child will be labelled with a behavioral disorder when they simply have an undetected visual disorder. Just think, if a child has a visual impairment that precludes them from seeing well enough to perform normal classroom skills comfortably, that child will have a natural tendency to "act out" or distract other students to occupy their time. The vision problem doesn’t actually cause the medical condition of ADD/ADHD, but it can cause the child to exhibit poor behavior that unfortunately can lead to an erroneous diagnosis of a behavioral disorder.

Q: Should an eye exam be a requirement for entrance into public schools?

A: Comprehensive eye exams are the only sure way to ensure a child’s eyes are adequate enough to perform all their classroom visual functions. Some schools have vision screenings in place to try to detect children with visual problems, but unfortunately, a screening only scratches the surface of what a comprehensive eye exam can detect. Vision screenings are not diagnostic and basically assess a child’s ability to see letters clearly.

In a comprehensive eye examination, the testing will determine not only if a child sees clearly or is in need of glasses, but also checks eye teaming skills or binocular vision to make sure the child has adequate depth perception and tracking capabilities, while also checking the health of every structure of the eye. Screenings just miss the boat in detecting subtle vision disorders that can easily be undiagnosed, and screenings do not in any way assess the health of the eyes.

I am proud to say that I practice in Illinois, which is one of three states in the nation (Missouri and Kentucky are the others) that requires a comprehensive eye examination before entering school full-time. The teachers in our state were instrumental in crafting and passing this legislation because they realized the critical, direct correlation between learning and vision. Just today I performed a mandatory eye examination on a 5-year-old entering kindergarten (who had no complaints) and was able to diagnose and treat a significant visual need that would have otherwise gone undetected because the child "saw clearly!"

Q: What are some signs or symptoms of a child with learning difficulties?

A: Most children with learning difficulties will avoid or perform poorly with anything to do with the learning process. They tend to display hyperactivity or become inattentive, and they get frustrated with most academic tasks. So, acting out or being disruptive in the classroom is a warning sign, along with poor academic performance with reading, writing, mathematics, comprehension and reasoning abilities. In general, children who suffer from learning disorders perceive the world very differently than the average student.

Q: How do perceptual skills fit into the lives of children with vision problems?

A: Again, since more than 60% of children with a learning disability (LD) have an associated visual disorder, and how a child views their world is key to the learning process, perception and perceptual skills are directly linked to those with learning disabilities and/or children with vision problems. Testing a high risk student's perception is essential in making an adequate diagnosis of LD or behavioral visual disorders.

Q: Are there special tests that can be performed to measure perceptual skills?

A: There are doctors of optometry called behavioral optometrists who test specifically for the more subtle perceptual disorders like visual memory, visual closure and visual tracking. The testing is very specialized and is great at picking up perceptual issues that would otherwise go undetected.

Q: Who should conduct tests to measure perceptual skills in children?

A: These tests need to be performed by a doctor of optometry or ophthalmology that is well trained in behavioral disorders and has access to all the proper equipment to adequately diagnose these more subtle visual conditions.

Q: What should parents do if they have a child who may have a learning disorder?

A: As we discussed previously, more than 60% of learning-disabled children also suffer from a visual disorder, so a comprehensive eye exam, along with behavioral testing when deemed appropriate, is a must with these students.

Q: Do you feel that vision problems are connected to dyslexia?

A: Vision is a learned skill. From the time we first open our eyes, especially in the first year of life, the visual system dramatically changes and evolves. Vision problems can certainly contribute to how a child perceives their world but do not necessarily cause other disorders, like dyslexia.

Dyslexia is a learning disorder that occurs in the brain and causes children to be poor readers and spellers. A child with dyslexia can certainly have a visual disorder that complicates their condition, but the vision disorder is not the causative factor.

Pamela Lowe, OD, FAAO

Pamela Lowe, OD, FAAO is currently Director/President of Professional Eye Care Center, Incorporated, a private practice she founded in 1992 on Chicago’s Northwest Side. She received her Bachelor of Science degree from Loyola University of Chicago in 1984 and graduated with honors from the Illinois College of Optometry in 1988. The college named her the Alumnus of the Year in 2002. Dr. Lowe is active in organized optometry and is Past President of the Illinois Optometric Association. Dr. Lowe was awarded Illinois’s Young Optometrist of the Year in 1995. She has been a long time member of the American Optometric Association and is a Fellow with the American Academy of Optometry. Dr. Lowe stays active on the education side of her profession by serving as an Adjunct Clinical Preceptor for the Illinois College of Optometry’s Private Practice Clerkship Course. She has lectured on many topics including retinal disease, cataract extraction, laser vision correction and currently travels throughout the country speaking on advanced techniques for retinal evaluation and silicone hydrogel contact lenses. She has had the distinction of serving as a Clinical Examiner for the National Board of Optometry since 1992.
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