Vision Therapy and Learning

The learning problems we see in our Vancouver vision therapy clinic

We see many patients every year who are struggling in school and having difficulty reading. They are often suspected of having ADHD or a learning disability. In reality, they had a treatable vision problem that was interfereing with learning. The problem went undetected because cursory school vision screenings don't investigate possible problems with eye movement, eye teaming, eye scanning or visual information processing. School vision screenings are merely a rudemantary test of visual acuity, which is only one of several visual skills required by humans in today's complex society. After vision therapy, many patients, parents and teachers report an improvement in school performance, a greater willingness and even enjoyment with reading.

It is imporant to be clear that sometimes a patient will actually have ADHD or dyslexia. But before that diagnosis is accepted, along with all the implications and special programs that go along with it, the patient should be brought in to see us for a comprehensive evaluation of all his or her entire visual system to ensure that the vision is not the real culprit.

"Learning" problems are often vision problems

If children are struggling with reading they should be taken to see a developmental optometrist who will evaluate the child to determine if the "learning" problem is in fact a visual problem. Note that some learning problems are cause by bona fide learning disabilities that are not connected to the visual system. The latter likely cannot be treated with vision therapy. It is important to rule out vision as an obstacle to learning.

A large amount of scientific evidence supports the connection between vision and learning. Many of the relevant studies are discussed below. In addition, the American Academy of Optometry released a position paper on the care of the struggling student in August 2013, which summarizes the latest science in easy to understand language.

It is essential that a child’s visual system function properly because two-thirds of all information we receive is visual and 80% of all classroom learning comes through our visual system.  Optometric vision therapy improves vision function and rehabilitates deficiencies and dysfunctions related to visual performance and this in turn improves learning ability.

A student’s visual skills are employed to perform tasks such as reading and using a computer. According to the American Optometric Association, vision disorders affect one in every four school-age children.

While many of these patients have refractive errors that can be treated with compensatory lenses, some have additional problems in the functioning of the visual system that are best treated by optometric vision therapy.

Most students on individual learning plans have a binocular vision disorder that can be treated with vision therapy

A study published in January 2018 in the Journal of Optometry, titled "Efficacy of vision therapy in children with learning disability and associated binocular vision anomalies", looked at a popultion of children with specific learning disorders. The researchers found that 62.8% had binocular vision abnormalities. Of those students, 78% had non-strabismic abnormalities and 68% had accommodative infacility and 25% had convergence insufficiency. After a course of vision therapy to address these abnormalities, clinical measures showed significant improvement. The authors concluded that children with specific learning disorders have a high frequency of binocular vision disorders and vision therapy plays a significant role in improving binocular vision problems.

A recent study entitled Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls published in the May 2012 issue of the journal Graefes Archives of Clinical Experimental Ophthalmology adds to the evidence of the connection between eye and vision problems and learning.

The researchers were struck by the fact that in Ontario, Canada, approximately one in ten students aged 6 to 16 in Ontario have an individual education plan (IEP) in place due to academic challenges because of various learning disabilities.  Many of those learning problems were specific to reading. They wanted to investigate the relationship between reading vision problems and binocular vision problems. To do this, the researchers measured the visual acuity and eye movement measurements of students that had an IEP and compared those results with students in a regular education program.

The researchers found that the IEP group had significantly greater hyperopia, compared to the control group on cycloplegic examination. Vergence facility was significantly correlated to (i) reading speed, (ii) number of eye movements made when reading, and (iii) a standardized symptom scoring system. Vergence facility was also significantly reduced in the IEP group versus controls. Significant differences in several other binocular vision related scores were also found.

Here is the study's conclusion:

This research indicates there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination (including cycloplegia), in addition to a comprehensive binocular vision evaluation.

Similar results have been obtained in numerous studies on vision and learning and the positive impact of vision therapy on those with vision related learning problems. For example, a 2010 study published in the journal BMC Ophthalmology found that children with reading difficulties were more likely to have a wide range of visual problems that are effectively treated with vision therapy, such as poorer distance visual acuity, an binocular vision dysfunctions that are effectively treated with vision therapy such as

The study confirmed the importance of a full assessment of binocular visual status in order to detect and remedy these deficits in order to prevent visual problems continuing to impact upon educational development.

Vision, learning, reading and vision therapy

According to the College of Optometrists in Vision Development, "the importance of good vision to reading and learning has been the subject of considerable study. Numerous clinical and research studies have shown that good visual abilities are beneficial to learning to read and to read with understanding. Children with normal eyesight (20/20) can have visual problems which affect how their eyes focus, team together, or move along a line of print when reading."

The College of Optometrists has complies a research summary for those interested in learning more about the science behind vision and learning and the positive impact that vision therapy can have on learning and reading, when deficiencies are caused by vision related dysfunctions. Click here for the research summary on vision, reading and learning.

Vision and reading

Reading is a prime example of a complex visual task that can be impaired by treatable eye movement disorders, especially binocular vision dysfunctions (in which the eyes do not work together properly). 

The simple activity of reading requires an individual to use visual abilities such as distance and near acuity, accommodation (eye focusing), binocularity (eye coordination/eye teaming), ocular-motor skills (eye movement), peripheral vision and visual perceptual skills such as figure-ground, form consistency, spatial relations, visual closure, visual discrimination, visual memory and visualization. A deficiency in any one of these areas will cause a child to fall behind. Fortunately, Vision Therapy has proven effective at treating such deficiencies.

According to pediatrician and member of the parent advisory committee of the National Center for Learning Disabilities, Dr. Debra Walhof M.D.:

It is important to remember that normal sight may not necessarily be synonymous with normal vision...That being said, if there is a vision problem, it could be preventing the best tutoring and learning methods from working. Now that certainly doesn't mean every dyslexic child needs vision therapy, however in my opinion, skills such as focusing, tracking and others are essential foundational tools for reading. In general, if your child has trouble with reading or learning to read, getting a vision evaluation to assess these skills from a qualified Developmental Optometrist would be a smart move.

Vision therapy and reading

Studies continue to support the positive effect that vision therapy and vision training have on reading. A recent study published in the May 2014 issue of the journal Clinical Pediatrics found that elementary school students who received vision therapy for saccades (saccades are the rapid eye movements from one word to the next that are done when reading) had significantly higher reading fluency scores after treatment, compared with a different group of students that received no therapy. The authors of the study "hypothesize that this improvement in reading fluency is a result of rigorous practice of eye movements and shifting visuospatial attention, which are vital to the act of reading."

To read more about this study on the blog of the College of Optometrists in Vision Development, click here

Convergence insufficiency, learning and vision therapy

Convergence insufficiency is one of the most common vision disorders that interferes with reading. It was recently the focus of a scientific study in the United States funded by the National Institutes of Health and the National Eye Institute - the study found that vision therapy was the best treatment for convergence insufficiency. Convergence insufficiency is a vision problem where the two eyes don't work together in unison the way they are supposed to when one is reading. The result can make reading very difficult.

It is estimated that least one out of every 20 school-age children is impacted by convergence insufficiency.  However, there are other visual abnormalities to be considered. It is estimated that over 60% of problem learners have undiagnosed vision problems contributing to their difficulties.

The good news is the majority of these vision problems can be treated with a program of optometric vision therapy. The study by the NEI found that in-office vision therapy was the best treatment for convergence insufficiency.

The five most common signs that a vision problem may be interfering with your child's ability to read and learn are:

1. Skips lines, rereads lines;

2. Poor reading comprehension;

3. Takes much longer doing homework than it should take;

4. Reverses letters like b's into d's when reading; and

5. Has a short attention span with reading and schoolwork.

Any one of these symptoms is a sign of a possible vision problem.