Screening For Routine Vision Problems (students grades 1-12):

VERA contains tests for visual acuity, farsightedness (hyperopia) and for the presence of binocular vision. The VERA visual acuity screening is more accurate since it utilizes randomly oriented "E"s which cannot be memorized or easily interpreted by squinting. The test logic is standardized and more reliable than conventional eye chart testing. The binocular vision screening tests for gross binocularity (eye teaming), stereopsis (depth) and phoria (eye alignment) to accurately determine if the student can use both eyes together, at least momentarily.

VERA 3 contains "SmartScreen" mode, where the program automatically stops the screening at the first valid referral point. "Smartscreen" reduces testing time by 15%-50% with no reduction in accuracy. VERA can be set for various visual acuity fail points and tests can be turned on or off manually if the nurse should desire either.

All students are Screened with the routine VERA 3 screening, then selected underachieving students (with normal or corrected visual acuity) in grades 2-8 can be screened with the Vision Skills Module. Students who fail the vision skills screening and who also manifest behaviors characteristic of vision difficulties (checklist provided) are considered likely to have a vision-related learning difficulty. Vision skills difficulties affect abilities in the classroom; whether reading, writing or looking from the desk to the board.

Vision-related learning problems

Most educators can recall students with learning difficulties which appeared to involve their vision even though they had passed a routine school vision screening or had been seen for a routine eye examination. These students and others like them continue to struggle academically because of undetected vision-related learning difficulties. For these children, the effort required to control focus, tracking and binocular coordination skills is a distraction from or an impediment to learning. In fact, research has shown that up to half of learning disabled students have a vision-related learning difficulty as part of their overall learning problem.

Let's take a closer look at "vision skills". The classic medical model of the eye is one of a camera, with the outer camera lens equal to the eye's cornea, the camera diaphragm equal to the eye's iris, the camera's lens equal to the eye's intraocular lens and the camera's film equal to the eye's retina. However, we don't have a single eye; we have two; therefore a much better model is a pair of binoculars.

Poor vision skills can, of course, be due to abnormal muscle structure resulting in a crossed eye, amblyopia, refractive errors or neurological dysfunction. But most children with deficient vision skills have had the neuromuscular control of their eyes affected by stress. Tension at home, pressure to perform in school, peer pressure, social development . . . all the stressful parts of growing up and into a complex society can, for some children, result in poor eye muscle coordination or poor focusing or poor eye movement skill just as the same stress can cause tension headaches, gastrointestinal distress or poor behavior in others.

As print becomes smaller and work becomes harder in successive grades, visual demands increase and a student's vision skill level may be exceeded. Students who cannot sustain changing their plane of focus may have trouble adjusting their sight from the blackboard to their desk and visa-versa. Students who cannot easily sustain control of their two eyes as a team may have headaches, poor attention span, intermittent blurred vision and/or poor retention because they are distracted by the effort necessary to keep their vision single or clear. Some students will find compensatory ways to maintain acceptable levels of school performance while others will acquire poor work habits, avoid schoolwork and/or behave poorly.

Many of these students can force themselves to see adequately well, perhaps even 20/20, for the moment their visual acuity has been tested. The result is that the student with a vision skills deficiency is often certified "visually O.K." Most vision screening formats cannot reliably identify visual skills deficiencies since they don't screen for performance over time. Consequently, most vision screening data has shown only a casual relationship to reading and learning ability.

The VERA vison skills screening rates the performance of vision skills in real time, providing a measure of the ease with which a student sustains and coordinates their vision skills. If a student has to read a book and comprehend and retain what they read, then the ongoing act of reading has to be easy enough to not be a distraction unto itself. Vision Skills screening is more relevant to reading and learning ability than other routine vision screening data.

Screening for Vision Skills Difficulties

The VERA vision skills screening helps to identify students with normal visual acuity who still have vision difficulties which can effect their schoolwork. Your routine screening program will first determine if your student has adequate visual acuity to provide reliable results on vision skills screening. If they do not, a professional eye exam is recommended before the skills screening is taken.

Each test requires the student to exercise specific vision skills over a critical time interval; usually one to two minutes. The results of this "visual performance" screening are compared to an internal age-dependent database of nearly two thousand students. The result of this comparison represents that student's relative ability to exercise their vision skills. Screening results are virtually independent of vision acuity, refractive error, intelligence and socioeconomic status.

Selecting Students for the Vision Skills Screening:

The skills screening is designed to identify students with normal visual acuity who may still have vision-related learning difficulties. These underachieving students (who have passed the routine screening or have had their visual acuity corrected to normal with glasses) should have the checklist of Indicators of Vision Performance Difficulties completed by teachers and optionally by parents. Consistent demonstration of two or more listed behaviors is considered significant; otherwise the skills screening is much less likely to be relevant.

If there is a three-way match (poor academic performance + demonstration of characteristic behaviors + failure on the VERA screening), then the student is likely to have a vision-related learning difficulty and is a candidate for school, home and professional support.

Results of The Vision Skills Screening

1. Adequate Vison Skills:

A very low likelihood that the student's vision skills are interfering with their schoolwork.

2. Questionable Vison Skills:

A low to moderate likelihood that the student's vision skills are interfering with their schoolwork.

If a student has questionable results on the vision skills screening, consider the following:

1. Optionally re-screen at a later time, since results of performance testing can vary with the subject's physical and emotional states at the time of testing.

2. Place more weight on the numbers of behaviors indicated on the behavioral checklist, teacher and parent observations, academic performance and any eye doctor's report.

3. Place more weight on observations of students as they take the screening. Vision skills difficulties are frequently accompanied by adjustments in posture and behavior during the screening. They may twist, turn, lean forward, squint, rub their eyes, turn their head or fidget nervously.

3. Inadequate Vision Skills:

A high likelihood that student's vision skills are interfering with their schoolwork.

In these cases a professional eye examination is recommended even if the student has passed the routine acuity screening to rule out any structural or neuromuscular difficulties or to advise as to the value of professional vision therapy.

Support Options:

With identified students, the process of doing schoolwork, not just the result, needs attention. Support for these students creates a more idealized learning environment and can take many forms, including the following:

Teachers: In-school instructional support:

• Providing additional time to observe and self-correct errors
• Acknowledgment of difficulty to reduce learning-related stress
• Rewarding effort that is well-directed, not just correct answers
• Increasing feedback to encourage self-correction and self-control ex: discussing answers after work is submitted, allowing re-submission with corrected answers
• Relaxation exercises to reduce tension and fatigue
• Encouraging expression of thought if the student disagrees with test results
• Provision of proper work environment; specifically lighting, seating and posture
• Adjustments to length and complexity of visual tasks to enable success
• Providing high contrast presentation of information (ex: white board with black marker)
• Providing guidelines on papers
• Confirming eyeglasses are being worn when appropriate

Special Educators: additional support

• Delay or reduce special education initiatives pending outcomes of parent and teacher support
• Emphasize auditory and conceptual learning
• Incorporate visual exercises into learning program
• Reinforce option of behavioral vision evaluation to parents

Parents: home support:

• Discussing the child's schoolwork regularly to reinforce learning in a positive manner
• Maintaining a relaxing home study environment with few distractions to reduce the pressure and stress associated with learning
• Decreasing clutter in work area
• Encouraging good posture and providing proper lighting during homework. ex: providing a slantboard for improved posture during reading and writing
• Having the student's eyes examined (even if their vision acuity is 20/20!) to rule out refractive or medical conditions
• Confirming eyeglasses are being worn when appropriate
• Initiating a vision therapy evaluation and possible treatment
• Providing appropriate lighting

Additional Information on providing home and school-based support can be found in the VERA Teacher's Guide and VERA Parent Guide.

Professionally Designed Program

VERA's design team has over 60 years combined experience in the eye care industry, the fields of vision skills treatment and analysis and program design and coding. A distinguished advisory panel of experts in education and educational administration, school health practice, biometrics, systems analysis, behavioral vision care, and hardware and software design have also participated in the development of the program.

Research and development for the products have involved various parochial and public elementary schools in Pennsylvania, New Jersey, Georgia and California. Funding or administrative and testing assistance has been provided by Philadelphia ELWYN, the Ben Franklin Technology Centers and the Eye Institute of the Pennsylvania College of Optometry. Assistive protocols are based on time-proven strategies used by educators and behavioral vision specialists.