Articles Written for yorKids

The 20/20 Myth

The 20/20 designation of how clearly you see is simply a measure of how small a letter you can see from 20 feet away. The chart we use to measure this was devised by Herman Snellen in the mid 1800's, and is commonly called the Snellen chart. Most people think that if you can read this small row of letters and thus are deemed to have 20/20 vision, that you have perfect vision. This is not true. The measure of visual acuity is only one aspect of how well we see. There are, in fact, many other aspects of vision to consider such as peripheral vision, depth perception, coordination of the eyes, eye-hand coordination, and visual processing or perceptual skills.

In order for our brain to gather visual information from our environment, we first have to be able to move our eyes and hold them steady, adjust our focusing muscles for that distance, and aim each eye at the same location. This enables us to see clearly, keep our eyes on a target, see the three dimensional world, and judge where our target is. The visual system is also responsible for piloting us through the environment.

When your child passes the vision screening, almost always the Snellen Test, at school or the pediatrician, know that they have good distance vision clarity, but be aware that this test does not tell you about the basic visual skills, and processing of visual information. There may still be delays in the development of visual skills which make it difficult to keep their place when reading, or create strain in looking at the printed page. Likewise, the Snellen Test does not tell you about how well the brain coordinates the eyes in order to catch or hit a ball.

Scientists tell us that the information from the eye goes to at least 40 different areas of the brain, but the designation of 20/20 only tells us how well a couple of those circuits are working. Eye doctors recommend that children have a comprehensive vision exam before starting school and every year while in school, since 80% of what we learn comes in through the visual system, and their vision can change dramatically from year to year. This comprehensive exam should include testing for clarity of vision, refraction (measure for the need of glasses), eye health, and basic eye coordination skills (eye teaming, eye movements, and focusing). When there are concerns about catching a ball or handwriting, eye hand coordination can be tested. If there are concerns about learning, visual perceptual skills such as visual memory, visualization, and reversals, can be tested.

So when your child passes the school vision screening with or without glasses, remember that this only tells you about their eye sight at distance. Annual visits to the eye doctor are still recommended to ensure that visual skills are developing properly, so that learning can occur unhindered by weak or delayed visual skills.

Vision and Learning

Eighty percent of what we learn comes into our brain through the visual system.  So the better our visual system functions, the better we will learn.  "When vision is working well it leads and guides in all we do, when not, it interferes."  John Streff, O.D.
We all know that if someone is not seeing clearly, it will interfere with how well they perform in school.  That is why there are vision screenings in schools, and why parents take their children for eye exams when they struggle in school.  Often times, children will pass the school or pediatrician screening of eyesight, and parents will be lead to believe that their child's vision is perfect, but there is far more than just 20/20 eyesight to consider.
Children also need to have good coordination of their eyes, visual processing/perception, and visually guided movement (eye-hand coordination) in order to perform in the academic world.  When the brain is not coordinating the eyes properly, there is a lack of visual efficiency.  This can show up in how well the eyes move, how well they work together as a team, and how well they focus.  Most parents and teacher are aware of tracking problems, where the brain is not coordinating the movements of the eyes, causing difficulty with smoothly reading across rows of print.  
Children with eye movement coordination difficulties often:
    -lose their place with reading 
    -skip words or rows of print 
    -skip problems on a math page
    -make "careless mistakes"
    -confuse similar looking words
    -guess at words from the first few letters
    -miss endings of words
    -skip punctuation
    -read in a choppy, word-by-word fashion
Children with eye teaming coordination difficulties often experience:
-fatigue, or tired eyes with reading
-headaches while reading or just after reading
-blurred vision after reading
-difficulty sustaining near work
-avoidance of near work
-double vision
-print running together
-working too close to the page
-turning head as though only using one eye
-closing or covering an eye when reading
-decreased performance after just a short amount of near work
    -dizziness or nausea with near work
Children with focusing (accommodative) difficulties often experience:
-blurred near vision
-blurred vision when shifting near-far as when copying from the board
-eye aches
Difficulties in visual processing or visual perception present with a whole new set of concerns impacting academic performance.  These skills represent how well we utilize visual information once it gets into the brain, including sorting, processing, organizing, manipulating, and storing visual information.  Areas of visual processing include visual discrimination, directionality (letter/number reversals), visual memory, visual spatial relations, figure-ground perception, visual closure, and visualization.
Children with visual processing/perceptual difficulties often experience:
-letter or number reversals or transpositions
-challenges in spelling
-difficulty retaining sight words
-confusion of similar looking words
-trouble retaining math facts
-difficulty learning the alphabet
-reading comprehension issues
-difficulty grasping new concepts
-trouble following multiple step directions
-difficulty planning, organizing thoughts for writing, and organization in general
The final piece of visual processing has its own category, and that is integrating vision with movement.  There are both fine visual motor and gross visual motor considerations.  Vision guides fine motor skills in handwriting/penmanship, and handling tools (including utensils).  Vision also guides gross motor skills in piloting our bodies thru space, and in sports involving the eye-hand coordination required to catch, and hit a ball.
Children with fine visual motor difficulties often:
-have sloppy handwriting
-laborious handwriting
-hate writing
-write the shortest sentences possible
-dislike arts and crafts
EVERY child and adult that struggles academically, or simply is not performing up to their potential should have a Behavioral Vision evaluation to determine if there is a functional vision deficit hindering their performance.  In addition to testing clarity of vision, eye health, and the need for glasses, this examination should include testing for eye coordination, focusing, visual processing, and visual motor coordination.
The good news is that these are all learned skills.  So if our visual skills are deficient, we can work to develop them.  At home, simple exercises such as mazes, dot to dots, word searches, hidden pictures, marbles, pick-up sticks, and ball play all help develop visual skills.  For more serious visual skill deficits, a vision therapy program may be necessary to develop these visual skills in a sequential, individualized treatment program involving lenses, prisms, and more sophisticated in-office techniques.
The bottom line is that the better your visual skills are, the better you will perform most of your tasks, whether you are reading, writing, figuring math word problems, or playing baseball.  More ideas of how you can improve visual skills at home will be shared in future issues of YorKids.

Simple Exercises to Get Your Child's Eye in Shape for Going Back to School

As we begin to think about our children going back to school, we can have them do some simple exercises to get their eyes back in shape for the rigors of all the near work involved in their academic pursuits.  Our eyes were not designed to spend extended periods of time looking up close at the flat world of papers, books, and electronic device screens.  They were designed to function in the three dimensional world with all of its clues to depth, which aid the eyes in knowing where to aim.  The combination of sustained near work, and decreased time spent playing outside, increases the risk of numerous visual system dysfunctions including myopia (nearsightedness), especially in younger children.
Here are a few exercises to strengthen your child's visual system so it is more prepared to handle the stress of concentrated near work.  The first exercise, Four Corner Fixations, is designed to strengthen, and limber the eye muscles.  Have your child sit 6 to 8 feet from a wall, and move their eyes from corner to corner in a clockwise fashion, stopping in each of the four corners for three seconds.  Repeat this for a total of five rounds, and then go counterclockwise for another five rounds.
The second exercise, Focus Shift, is designed to build strength, and flexibility in the focusing muscles.  Have your child cover their left eye with their left hand, and hold a pencil 6 inches in front of their right eye.  Ask them to shift their focus from the print on the pencil to a picture or calendar on the wall across the room.  Do this 10 times, and then repeat with their other eye.  This will help them sustain clarity with near work, and shifting from the board to their paper.
The third exercise, Near-Far Rock, is aimed at strengthening how well the eyes work together as a team.  Have your child hold a pencil 6 to 8 inches from their nose, and shift their eyes from the pencil to a target across the room, or out the window, holding fixation on each target for 3 seconds.  Repeat this 20 times.
The fourth exercise, Letter Fixations, works on the eye movements we use with reading, and writing.  Have your child pick a book appropriate for their reading level, and just say the first, and last letter on each row for a page or two.  Strive for accuracy first, flow second, and finally ask for speed.
The fifth exercise, ABC Search, is one that can be done with the whole family (except the driver)  working together.  While riding in the car, or going for a walk, start by looking for an item that begins with the letter "a", such as an apple. Then find something which begins with the letter 'b", and so on thru the entire alphabet.  When you have finished, you can add a memory component to this game by seeing if you, as a family, can name all of the items you found in order.
These exercise are good for anyone, but the over 40 crowd may find the focusing exercise too taxing or even impossible.  If any of these exercises cause a headache, or eye straining that lasts for more than a few minutes, stop the exercise.  This may indicate that there is a weakness that should be evaluated by an eye care professional.
By doing eye exercises, or vision therapy, we know we can improve our visual functioning and efficiency, which will benefit our reading and writing.
Arts and Crafts: A Great Way to Develop Visual Skills

In addition to being a fun pastime, art and crafts are a great way to develop the visual skills of visual motor coordination (eye-hand coordination), visual discrimination, visual spatial relations, and visualization.  These are critical skills necessary for performing well in school with handwriting, math concepts, reading comprehension, creative writing, and even organization.
If you would like your child to have better handwriting, you can guide their creative playtime toward activities which strengthen the pincer grasp, and eye-hand coordination.  Examples of such crafts are bead work, play dough, scissors activities, drawing, coloring, painting, string art, leather craft, loom crafts, latch hook, knitting, crocheting, and needlework.
To help build the areas of the brain used in understanding math concepts, encourage such activities as building models, making mosaics or pictures with pattern blocks, and creating or building anything where you follow illustrated directions.  My favorite art pursuit for developing this area of the brain is learning to draw something using books which show you step by step how to draw a picture starting with simple circles, ovals, and squares.  Books of this type are inexpensive, easy to find in any bookstore, available in a variety of subjects and skill levels, and provide hours of fun and entertainment.
Strengthening the skill of visualization is another benefit of spending time creating art, and crafts.  Visualization is the ability to create, and manipulate images in your mind, and is intimately involved in reading comprehension, math word problems, following multiple step directions, spelling, organizing your thoughts for writing, and organization/planning in general.  Every time you imagine what you are going to make, whether it is a simple drawing or cutting and pasting paper creations, you are practicing using your visualization.  If creativity is lacking initially, you can give your child ideas to get started.  For example, "use pattern blocks to make a flower", or "color a picture of a family going on a picnic", or "draw a picture from the book we read together last night", or "create a zoo scene with paper, scissors, and glue".
Time spent in the creative process is lacking in our society where images are thrust at us in nearly every environment.  Our free time is either organized into structured activities, or spent looking at images from electronic devices.  All we need to do is gather a few inexpensive items (paper, markers, crayons, glue, tape, blocks), and give our children the free time to get creative.  You may need to give them some ideas to get started, but children are naturally creative, and will take off on these activities.  All the while, they will be building the visual tools to help them succeed in school.
Incidentally, if you join in on the creativity with your children you can double the fun, inspire your children, guide them into pastimes which will develop better visual skills, and set up an environment, and habit of spending undemanding time with your children.
So get out the paper, scissors, glue, crayons, markers, yarn, sidewalk chalk, paint, felt, ribbon, beads and string, and stretch your imagination.
Vision Fun and Games

Puzzles, and games are great tools for developing children's visual skills, and can provide hours of fun, and entertainment.  In previous issues of YorKids, I discussed how there is so much more to vision than just seeing clearly.  There are various visual skills necessary to coordinate the eyes, to process visual information, and utilize this information to coordinate our movement.  These skills enable us to make sense of what we see, follow print across a page, catch a ball, visualize what we are reading about, and pilot our bodies thru space.  How fascinating that these visual skills are learned when children play.
Think of traditional children games; marbles, jacks, jump rope, hopscotch, pick-up sticks, checkers, mazes, dot-to-dot, kick ball, tic-tac-toe...  All of these games directly influence visual skill development by practicing eye movements, visual processing, and eye-hand coordination.  These are all skills children need to succeed in school, and reach their potential as adults.
So how can we promote these skills in our children?  We need to encourage less time on the computer, and watching TV, and more time playing.  Playing outside is one of the best ways to develop visual skills.  As we run, jump, swing, spin, and climb, we not only build motor coordination, the foundation for fine motor, and ocular motor coordination, but also practice using vision to pilot us thru space.  Interestingly, these skills of knowing where our bodies are in space are essential in order to sit still, and sustain concentration.
Eye-hand coordination, and eye-foot coordination, can be developed with ball play.  Great visual skills are learned while playing catch, Four Squares, kick ball, paddle ball, catching a ball bounced off of a wall, and dribbling a ball.  Organized sports are also good for stimulating peripheral vision, and visualization of plays, and where you need to be on the field.  Enrichment of these visual coordination skills involving timing and space will provide the foundation skills for good driving.
Fun and games which are good for fine eye-hand coordination include marbles, jacks, spinning tops, pick-up sticks, play dough, mazes, dot-to-dots, coloring, drawing, stringing beads, painting, origami, board games, crafts, and string games.  Having your children play with these activities will improve the skills necessary for handwriting.
Learning to draw, and strategy games such as checkers, chess, dominoes, backgammon, Chinese checkers, provide hours of fun, and entertainment.  These pastimes improve visual motor skills, visualization, and visual memory.  All of which are necessary for good reading comprehension, math word problems, understanding math concepts, spelling, organization of thoughts for writing, planning, and organization in general.
Puzzles of all kinds are great ways of building visual perceptual, and visual thinking skills.  Favorites include jigsaw puzzles, tangrams, Rubik's Cube, word searches, hidden pictures, picture puzzles, Sudoku, and fill-in crossword puzzles.  These build the visual perceptual skills necessary for optimum academic performance.
Video games are not my favorite way to play when considering the development of visual skills for several reasons.  While playing video games the eyes are fixed in one plane, and locked into a very small field of vision.  This strains the eyes to hold focus at one location for extended periods of time, and trains the brain to be tunnel vision.  In addition, it takes away from the time children should be playing outside, which promotes great eye movements, and the brain's awareness of great volumes of space, not to mention healthy exercise.
In our society, avoiding video games altogether is quite a challenge, so when our children do play these games limit their time, keep them on the big screens rather than the tiny hand held devices, encourage games involving movement, or ones which encourage visual thinking and processing.  
Yet another reason for children to get out there and play is that brain research is now clearly indicating the benefits of a great variety, and time spent moving and, interacting with our environment.  Our neurons are bigger, with more connections, and stronger supportive glial tissue when raised in these enriched environments.  This suggests that not only will individuals raised with this variety of activity be able to think and perform better, but also be able to withstand injury from concussion better.  

These are just a few ideas to have fun over the summer with your children, all the while honing the ever-so-important visual skills necessary to succeed in school, sports, and their pursuits as adults.