The burden of undetected vision problems
Common vision problems, such as poor distance visual acuity, farsightedness or gross binocular vision issues can be missed by traditional screening methods. Even when students with vision difficulties are found, vision care is often delayed or absent, as is timely follow-up of unfulfilled referrals and reports to teachers of which students in their class can't see well. Even worse, if the student passes a near vision test by reading a card for a moment, they can be certified "visually OK" despite the fact that reading problems occur. This misleading information, which obscures the more educationally relevant issue of sustaining clarity when reading, makes its way to special educators and occupational therapists.

With VERA's routine screening, common vision deficits are consistently identified and without a potentially misleading near vision test. In addition, your school nurse can easily report unfulfilled screening referrals to teachers, so that you can better accommodate these students in class and reinforce the vision referral to parents. A professional eye examination should always precede recommendations for learning support or special education.

Additionally, many children suffer with learning‐related "vision skills" problems which are unrelated to reduced visual acuity and occur in students who can pass a routine screening. Vision skills are based in muscular control of tracking, focusing and eye teaming and are associated with poor reading ability, comprehension, ADHD, dyslexia, and chronic behavioral issues. Only a small fraction of students with vision skills issues are now identified; usually during a chance encounter with a practitioner who tests for and treats these issues. Vision skills affect the most basic classroom actions, like reading, writing or looking from the desk to the board. They place a burden not only on students, but on teachers and therapists who need to understand the components of learning issues and to direct support. That's why it's so important to have the first reliable screening for vision skills that can be administered by someone other than an eye care specialist. Learn more about vision skills

Since vision skills difficulties are associated with behavioral issues, underachieving students are checked for behavioral characteristics of vision difficulties before taking the VERA skills screening. If they then fail the screening, they are candidates for home, school, and environmental support options as well as a professional vision therapy evaluation. Of interest to educators are sections of the VERA Teacher Guide which describe how to create a learning environment in which children with vision difficulties perform better. Included is information on specific associated classroom difficulties, activities for visual enhancement and integrating visual exercises with classroom instruction. The VERA Parent Guide describes how the school's efforts may be supported at home. These guides are included in the free VERA program download and accessed from the Windows program listing.

Appropriate ages for the VERA screening
All Vera tests can be done at any age level except for the vision skills accommodative flexibility test, where the normal decrease in focusing ability in adults over age 35 affects test results. VERA will prompt if a subject is older than those within VERA's database and compare screening results to the oldest subjects in the database. Since visual abilities plateau near Vera's upper database range, a good determination of visual skill can still be made. When a subject is younger than VERA's database, a developmental lag may be mistaken for a vision skills issue, and the screening is not recommended. See the VERA User Guide for additional information on interpreting the skills screening report.

Vision skills screening results are virtually independent of visual acuity, refractive error, intelligence and socioeconomic status. The skills screening provides an age-dependent normative comparison to its database, and the subject is scored as PASS, FAIL, or QUESTIONABLE. See the VERA User Guide for additional information on interpreting the skills screening report.

Referring identified students - Benefits and caveats
VERA's general population (routine) screening has been well accepted by public, private and parochial schools. Since proctors or nurses can choose which tests to run and which letters to send, VERA inserts well into almost every educational paradigm. As for the vision skills screening, research has proven VERA to be an effective screening when compared to teams of vision and reading specialists visiting the same schools and has demonstrated up to 90% sensitivity in identifying abnormal vision skills. Every year, thousands of students are helped by vision therapy to read and learn more easily. Even more go undetected, because most schools have lacked the right identification tool.

Of course, schools stand to benefit financially when students receive vision therapy, since fewer expensive special educational services will have to be provided. Nonetheless, some public schools may be concerned about payment for vision therapy. While there is no precedent for this, schools can insulate themselves from the issue by not referring directly to a vision therapy doctor. The VERA screening is not diagnostic; the specialist eye doctor will make the diagnosis and parents will decide on treatment and payment. Schools may wish to utilize a parental consent form before the screening which explains these conditions and which can mention being able to better accommodate identified children in class and deferring special education. Schools can also offer direction to organizations providing relevant information; information about vision skills and/or local practitioners can be found at www.covd.org, www.aoa.org and at many state optometric association websites.

Opinions of vision therapy
Some ophthalmologists or pediatricians may vigorously deny the proven value of treatment. Upon closer inspection, these opinions reveal themselves to be based in turf rather than efficacy issues or reliance upon flawed literature. Two articles commonly referenced by opposing practitioners are Learning Disabilities, Dyslexia, and Vision: A Subject Review from the American Academy of Pediatrics and Vision Therapy for Learning Disabilities from the American Academy of Ophthalmology.

These articles initially appear to present valid arguments but interweave associations and generalizations about learning disabilities, dyslexia, eye health and vision which are too broad to be completely true, or they omit relevant supportive data. It is not necessary to debate these articles here; it is done for us in a recently published rebuttal of these arguments which systematically identifies the flawed and misleading statements in these and similar articles.

Schools will make their own informed decision about referring for vision skills evaluation or about school and home support as an addition or alternative to vision therapy. Finally, no risks are associated with vision therapy, and schools should provide parents with information about any reliable community‐based treatment options which may be of benefit to their children.