THE IMPACT OF VISION ON LEARNING By: Megan Thistle, PUCO Class of 2017

SURVEY TIME!

Purpose ■To help share knowledge with teachers to increase awareness of vision and how it can affect their students in the classroom

Vision: an introduction ■Vision has been long connected to your ability to read, but also a child’s ability to perform in school. ■Vision screenings have been performed in schools for many years –Since the 1920s! ■Vision screenings are good at catching some vision problems, but not all of them ■Binocular vision can affect a child’s reading ability

If a child has a reading problem, check their vision!

The Human Eye

Visual Acuity ■Sharpness of vision, uses your central vision ■For example, 20/20 means you can see letters of a certain size at 20 feet. ■Whereas, 20/100 means someone can see a letter at 20 feet that most people can see at 100 feet. –So you need a bigger letter!

Normal Development ■Acuity changes with age! –Expect 20/30 best acuity in a 3 year old without refractive error (need for glasses) –Expect 20/20 by age 4-5 years without refractive error.

Refractive Error ■Myopia –Near-sightedness –Minus powered lenses ■Hyperopia –Far-sightedness –Plus powered lenses –Sometimes hard to catch at screenings ■Astigmatism –Different meridians of the eye have different powers

Normal Development ■When we are born, we all have a bit of a refractive error. ■Over time, our eye stabilizes and most people do not have a significant refractive error, and do not need glasses –This is called emmetropization –This is usually done by 3-5 years old ■If a child still have a refractive error after this age, it should be corrected with glasses ■Myopia increases between the ages of 6 and 15 years as school work increases –They have more nearpoint visual demands, which causes the eye to grow and change

Vision is more than 20/20 ■Just because you can see well in the distance does not mean you can see well up close! ■Just because you can see well up close does not mean you can use your eyes well together! ■Screenings are great at checking for VA or 20/20 vision, but not eye teaming skills ■If you suspect a vision problem, recommend a comprehensive vision exam with a PEDIATRIC OPTOMETRIST!

Visual Skills ■Amblyopia –Permanent reduced vision that is not correctable ■ Strabismus –‘Eye-turn’ –Can cause Amblyopia ■Stereopsis –The ability to see float or depth

Normal Development ■Eyes should be 100% aligned by 3-4 months! –Before this, infants can have a hard time controlling both their eyes at the same time. You may fleetingly see one eye wander in or out while the other eye stays straight.

Visual Skills ■Accommodation –Focusing ability –Near vs Far requires different focusing ■Binocular Vision –Team teaming skills –Convergence and Divergence

Eye movements ■Our eyes have to move together to be able to work at their best ■To read, we need to be able to make small eye movements accurately over the text we are reading –Saccades and fixation ■If we can’t do this, reading can be really difficult

Normal Development ■The ability to maintain accurate fixation on a new target improves dramatically in the first few months. ■When a novel stimulus is introduced into the periphery, 1 to 2 month-old infants approach the target with a series of small saccades rather than with a single large saccade (they are not super accurate) ■By 6-8 months, infants are capable of making a large single saccade to redirect gaze to a novel target ■By 4 months, infants show much more accurate pursuits and rely much less on saccades. ■Young children will use head movement to supplement both saccades and pursuits ■By age 6, the child entering school should be able to perform pursuits and saccades with little or no head movement.

Potential binocular vision problems ■CI ■CE ■DI ■DE These problems can occur in children and adults! They may be more noticeable in children however, because they can negatively affect their schoolwork!

Adaptations? ■Avoidance Behavior –Child is ‘unmotivated, distractible, or lazy’ –Short attention span –Disruptive behavior problems ■Physical Adaptations –Very close reading distance –Head movements while reading –Closing or covering one eye while reading ■Symptoms –Eyestrain –Headache –Child doesn’t feel well –Squinting

How common are these problems? ■Vision anomalies occur in 10-15% of school children. Known to be severe enough to decrease academic performance in these children ■After refractive error, binocular vision and accommodative disorders were the most common disorders ■These conditions are 9.7 times more likely than ocular disease in young children and 8.5 times more likely in children age 6-18 years

What do teachers know? ■Michigan Elementary and Middle School Teachers –All teachers are aware of the connection between vision and academic performance –Most do not know where to refer their students if they do suspect a vision problem ■Kansas and Oklahoma school teachers –Unaware of potential consequences of visual dysfunction on reading and learning –Teachers often can note when students struggle with phonetic skills and inattention ■38% of teachers said they had received no information regarding proper visual skills during their entire college career

But, does Vision really affect Reading? Correlation Studies ■Duesk et al –Those that struggle with reading and writing compared to an age matched control group. All had normal IQ –The struggling reading/writing group had a significantly higher proportion of visual function anomalies than the control group ■Poorer distance VA, an exophoric deviation at near, lower amplitude of accommodation, reduced accommodative facility, reduced vergence facility, reduced NPC, lower AC/A and slower reading speed ■Grisham et al –Poor high school readers had several weak or inadequate visual skills

Does Vision really affect Learning? Treatment Studies ■ CITT study –Office and home treatment of CI leads to decreased symptoms in children doing near work ■Borsting –Successful treatment of CI lead to improved academic behaviors in children as reported by parents –Students were less distracted and were able to focus their attention on details and parents were less likely to worry about their child completing their homework. –Better self-esteem!

What do we suggest if you suspect a vision problem? ■Suggest to parents to get a comprehensive vision exam by a pediatric optometrist for their child!

Treatment ■When a child is tested with a pediatric optometrist and there are vision anomalies detected, vision therapy is often the choice for treatment ■Vision therapy, is a series of vision and eye exercises that strengthen the visual system of the patient

Does Vision Therapy work? ■Many anecdotal reports of successful vision therapy ■Previously discussed CITT studies ■Atzmon et al –Compared vision therapy treatment to conventional reading treatment –Found that both groups showed equal and statistically significant improvement in reading performance on all tests used in the study ■Better technical reading skills, improved comprehension, improved perceptual skills

Atzmon et al, continued ■The really cool part? –Not only did VT produce the same reading performance improvement as traditional reading tutoring, but the VT group was the only group that had a decrease in symptoms while reading! –The reading tutoring group had either the same amount of symptoms, or more symptoms of reading strain ■Symptoms include: double vision, blurry vision, eye ache, burning, losing place while reading, repeating a line, skipping a line, headaches –Treatment was 2-3 months (35-40 individual sessions)

View of Vision Therapy ■Studies show that parents and children are overall very satisfied with vision therapy ■Visual skills are shown to improved with tests results ■Parents report better performance on school activities ■They also report increased self esteem in their children

Disclaimer! ■We all know that reading struggles and learning problems are a multifactorial problem! ■Getting a vision exam and getting lenses or going through vision therapy is not a fix-all ■But! Vision should be addressed because: –Getting vision anomalies addressed and treated is one less thing that the student has to worry about –By putting in less effort to get their eyes to work, they can focus more energy and attention on other aspects of their other therapies! ■Collaboration!

Can YOU catch vision problems? ■A short teacher in-service can go a long way! ■Krumholtz, 2004 –“Educating the educators: increasing grade-school teachers’ ability to detect vision problems” –Gave teachers a 40 minute lecture and brochures –Ask for teacher observations 2 years later –Results ■Slightly increased in accuracy of detecting functional vision problems ■Dramatic increase in number of comments made by teachers ■Accuracy of comments also increased as well as their depth

Catch them early! ■You are in the best position to do so! ■You get to see the children in your classroom every day and see their behaviors! ■Early detection and treatment, especially of amblyopia and strabismus, give the best results –Try to catch them before age 8!

Signs and Symptoms

Symptom Checklist ■Drowsiness in class ■Fatigue ■Blur ■Headaches ■Intermittent Double Vision ■Eye Strain ■Rubbing of eyes ■Tearing ■Light sensitivity ■Poor comprehension ■Loss of place when reading ■Omitting or substituting words ■Poor chalkboard-to-desk copying ■Failure to complete work on time ■Gradually decreasing grades

Helpful Websites ■Information about Vision Therapy – – – – ■Parents Active for Vision Education – ■Optometric Extension Program Foundation – ■College of Optometrists in Vision Development – ■Great Website for Parents – ■Statement from COVD on dyslexia –

Resources ■Abata, K., Schleef, K. (2013).Michigan teachers’ opinion on the efficacy of school vision screenings. (Unpublished Thesis) Ferris State University Michigan College of Optometry, Big Rapids, MI. ■Atkinson, J., Braddick, O., Bobier, B., Anker, S., Ehrlich, D. King, J., … Moore, A. (1996). Two infant vision screening programmes: Prediction and prevention of strabismus and amblyopia from photo- and videorefractive screening. Eye, 10(Pt 2), ■Atzmon, D., Nemet, P., Ishay, A., Karni, E. (1992). Randomized prospective masked and matched comparative study of orthoptic treatment versus conventional reading tutoring for reading disabilities in 62 children. Binocular Vision and Eye Muscle Surgery Quarterly, 8(3), ■Blum, H.L., Peters, H.B., Bettman, J.W. (1959). Vision screening for elementary schools: TheOrinda study. University of California Press, Berkeley, California. ■Borsting, E., Mitchell, G.L., Kulp, M.T., Scheiman, M., Amster, D.M., Cotter, S.,....CITT Study Group. (2012). Improvement in academic behaviors after successful treatment of convergence insufficiency. Optometry and Vision Science, 89(1), ■Ciner, E.B. (1990). Management of refractive error in infants, toddlers and preschool children. Problems in optometry, 2(3), ■Creswell, J.H. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th Ed). Los Angeles, CA: SAGE Publications. ■Dusek, W., Pierscionek, B.K., McClelland, J.F. (2010). A survey of visual function in an Austrian population of school-aged children with reading and writing difficulties. BMC Ophthalmology, 10(16), ■Jones, D., Stilley, J., Bither, M., Rounds, R. (2005). Elementary school teachers’ perspectives of factors associated with reading disability. Journal of Behavioral Optometry, 16(1), ■Krumholtz, I. (2004). Educating the educators: increasing grade-school teachers’ ability to detect vision problems.Optometry: Journal of the American Optometric Association., 75 (1), ■Lane, K.A., Maples, W.C. (1995). Parents’ satisfaction with vision therapy. Journal of Behavioral Optometry, 6(6), ■Peters, H.B. (1984). The Orinda Study. The American Journal of Optometry and Physiological Optics, 61(6), ■Scheiman, M., Gallaway, M., Coulter, R., Reinstein, F., Ciner, E., Herzberg, C., Parisi, M. (1996). Prevalence of vision and ocular disease conditions in a clinical pediatric population. Journal of the American Optometric Association, 67(4), ■Simons, K. (1996). Preschool vision screening: Rationale, methodology and outcome. Survey of Ophthalmology, 41(1), 3-30.

SURVEY TIME!