Vision and Learning

Learning is accomplished through complex and inter-related processes. Your eyes and the visual system grow and develop from the brain, making vision a fundamental factor in thinking and learning.

There is currently much concern in the community regarding the level of literacy skills, probably because advances in information technology have increased the demands placed on people to wade through the plethora of written information presented to them each day. As such it is important that the issues regarding vision and learning are well understood by the community, schools and health professionals. In this way optometry can be of help.

Not all children with learning problems will have visual difficulties. Likewise, not all children with visual difficulties will be classified as educationally delayed. Even if an optometrist diagnoses an individual with a visually-related learning difficulty, it would not be uncommon for other factors to also contribute to that learning profile. That is, in some instances the visual problems may be primary in the development of the reading or learning difficulty, but more frequently they are contributory. (1) For this reason, optometrists work together with other professional disciplines and believe in a multidisciplinary approach to evaluating an individual’s learning difficulties.

Vision can be defined as the mental process of deriving meaning from what is seen. There are three inter-related areas of visual function.

• Visual pathway integrity including eye health, clarity of sight and refractive status;
• Visual efficiency including accommodation (focussing), binocular vision (eye teaming) and eye movement control (tracking);
• Visual information processing including spatial awareness, identification and discrimination, and integration with other senses.

We all know that development can vary immensely from child to child; it is perhaps not as well known that vision also develops!

Vision continues to develop after birth and is influenced by the visual environment and the individual’s experience. If a person’s visual system has not developed adequately, visually demanding activities may lead to inefficient or uncomfortable vision.

Good visual acuity (clarity of sight) and healthy eyes are no assurance that an individual does not have a vision problem. (See also Section 3 ii) Vision Therapy for Children and Learning Difficulties)

i) Managing Learning Related Vision Problems	TOP^

It is axiomatic in the management of learning disabilities that all physical or environmental factors likely to impair the learning process should be treated in the same way as any other aspect of health or development that will make an individual’s learning less than optimal.

The purpose of behavioural optometric intervention in the management of children and adults with learning disabilities is to eliminate any vision problem that may obstruct learning.

Educational, neuro-psychological and biological research has suggested distinct subtypes of learning difficulties. Current research indicates that some people with reading difficulties have co-existing visual and language processing deficits. For this reason, a vision examination that assesses those factors influencing learning should be included as a crucial part of the multi-disciplinary process.

Summary:

• Vision problems can and often do interfere with learning.
• People at risk for learning-related vision problems should be evaluated by an optometrist who provides diagnostic and management services in this area.
• Problems in identifying and treating people with learning-related vision problems arise if the definition of vision is limited to clarity of sight and healthy eyes.
• The goal of optometric intervention is to improve visual function and alleviate associated signs and symptoms.
• Prompt remediation of learning-related vision problems enhances the ability of children and adults to perform to their full potential.
• People with learning problems require help from many disciplines to meet the learning challenges they face. Behavioural optometric involvement constitutes one aspect of the multi-disciplinary management approach required to prepare the individual for lifelong learning.

ii) Vision, Reading and Dyslexia	TOP^

Firstly, we should define what we mean by dyslexia and reading difficulties. Dyslexia is a term that means different things to different people. The use of the term dyslexia is easily confused and sometimes used inappropriately to describe anybody who has difficulties understanding left and right, who has difficulties with reversing words and letters, or to describe any degree of reading difficulty regardless of how severe it is. Most experts would agree that true dyslexia relates to about 10% of children who exhibit a learning problem. Their difficulties are usually severe, rare, language based and the cause is obscure. Therefore appropriate professionals must make the diagnosis of dyslexia.

Behavioural optometrists do not diagnose or treat dyslexia. The role of behavioural optometric intervention is to identify and treat vision problems that affect all aspects of learning, including reading. Sometimes the signs and symptoms of these vision problems mimic those suffered by people who have dyslexia. It is essential that these vision problems are identified and treated before the final diagnosis of dyslexia is made.

Much of the way we learn, both at school and in the workplace, is by reading printed information. While learning itself is accomplished by the interaction of many different processes and skills, processing of visual information (books, newspapers, manuals, e-mail and websites, to name a few) is a major player, indeed the dominant player, in the acquisition of information.

Individuals with reading difficulties may experience difficulty in 'learning to read' or may have learned to read but experience difficulty in 'reading to learn'.(2, 3) Perhaps that person lacks concentration or comprehension, or is slow to complete the task, or experiences headaches or sore eyes. Perhaps a child is slower than expected to learn the letters of the alphabet or fatigues easily or has messy handwriting. Perhaps the child is performing satisfactorily academically, yet not as well as expected. All of these cases suggest a vision examination is required.

Individuals (both adults and children) with learning problems should receive a comprehensive optometric evaluation. We recommend that children undergo a visual assessment at 6 months of age, at 3.5 years of age and again in the first year of school, the third year of school, the final year of primary school and in the last year or two of high school. This covers the major times in life when the eyes change or when the visual demands on the individual changes. Once school is finished your optometrist will advise when the next assessment is due.

iii) Comprehensive Visual Examination	TOP^

A comprehensive vision evaluation includes an assessment of:

• Visual pathway integrity including eye health, visual acuity and refractive status (for example, long-sightedness, astigmatism).
• Visual efficiency including accommodation (focussing), binocular vision (eye alignment and teaming).
• Visual information processing including visual spatial skills (right/left discrimination), visual analysis skills (matching and discrimination skills), visual motor skills (required for drawing and handwriting), eye movement control skills and visual imagery skills.

Treatment strategies may include the prescription of spectacles for part time, or sometimes full time wear. Advice may be given on how to adapt the environment and alter work habits to reduce the load on the visual system. Vision therapy may be prescribed to aid visual efficiency and/or visual information processing. (4, 5) Referral to another professional may be an adjunctive or the sole outcome of the optometric evaluation.

The expected outcome of optometric intervention is an improvement in visual function with the reduction of associated signs and symptoms. (6) While optometric intervention does not directly treat learning or reading difficulties, it does address physical and developmental barriers to learning, and so renders the affected individual more amenable to educational remediation.(7, 8). The earlier the problem is addressed the better the long term results usually are.

References

1. Solan HA. Dyslexia and learning disabilities: An overview. Optometry and Vision Science, 70(5): 343-7, 1993.
2. Simons HD. An analysis of the role of vision anomalies in reading interference. Optometry and Vision Science. 70(5): 369-373, 1993.
3. Flax N. The contributions of visual problems to learning disability. J Am Optom Assoc 41: 841-5, 1970.
4. Farr J, Leibowitz H. An experimental study on the efficacy of perceptual-motor training. Am J Optom Physiol Optics. 53(9) Part 1 September 1976.
5. Cohen A. The efficacy of optometric vision therapy. A special report. J Am Optom Assoc. 59(2) 1988.
6. Scheiman MM, Rouse MW (eds): Optometric management of learning related vision problems. St Louis: CV Mosby, 1994: 127-52.
7. Seiderman AS. Optometric vision therapy- results of a demonstration project with a learning disabled population. J Am Optom Assoc 51: 489-493, 1980.
8. Halliwell JW, Solan HA. The effects of a supplemental perceptual training program on reading achievement. Exceptional Child 38: 613-2, 1972.

iv) Computerised Vision Therapy	TOP^

Developmental and behavioural optometrists use vision therapy as one of many treatments to develop or improve visual abilities.

These visual problems include:

• Focusing and convergence weakness.
• Eye movement (tracking) deficiencies.
• Problems in co-ordination of two eyes (binocular vision).
• Strabismus (turned eye, squint).
• Amblyopia (lazy eye).
• Delays in development of vision perception and visual motor abilities.

Such vision deficiencies are diagnosed as a result of standardised clinical testing procedures. When vision therapy is used as a part of the treatment plan, it is normally carried out in an optometrist's office under close supervision on a regular basis, in conjunction with programmed home therapy.

Recently a number of computer programs for vision therapy have become available. These programs offer very useful help for parents carrying out vision therapy at home, in conjunction with an optometrist. However, a computer program for vision therapy cannot provide many of the features of supervised optometric vision therapy, to help a child or adult to achieve more normal visual function and processing to reach their potential. Such computer programs should only be used as part of an overall vision therapy program. They do not work as effectively as necessary if used at home without close professional supervision.

Computerised vision therapy programs are not an effective replacement for experienced optometric diagnosis and treatment.