The burden of undetected vision problems: Although most learning is dependent on vision, some students who need eyeglasses may be missed by vision screening or lost to a lack of follow-up. Since vision screening is compartmentalized as a school health requirement, screening results may not be adequately communicated to teachers or administration. As a result, these vision difficulties place an unnecessary burden on many students, on teachers and on the financial and special educational resources of schools.
Other learning-related vision problems (involving tracking, focusing and binocular vision skills) which are unrelated to the need for eyeglasses usually go undetected by routine vision screening, by eye doctors who do not treat these issues and by specialized educational testing. These common vision skills difficulties are associated with poor reading ability, comprehension, ADD, dyslexia, truancy and chronic behavioral issues. They affect the most basic classroom abilities, like reading, writing or looking from the desk to the board.
Vision skills and learning: Poor vision skills can occasionally be due to a crossed eye, amblyopia, severe refractive error or neurological dysfunction; issues which will usually be picked up by the pediatrician or eye doctor in the child’s early years. But most children with deficient vision skills have had the neuromuscular control of their otherwise normal 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 can be exceeded. They are at first distracted and later disabled by the effort necessary to keep their vision single and/or clear. While some students will find compensatory ways to maintain acceptable levels of school performance, others will acquire poor work habits, avoid schoolwork and/or behave poorly. Since many of these students can force themselves to see adequately well, perhaps even 20/20, for the moment their visual acuity is tested, they pass a routine vision screening. When considered for special services, an underachieving student with a vision skills deficiency will often been certified "visually O.K." by routine screening, when indeed they are not. |
 |
Studies by the American Optometric Association, the Vision Council of America, the National PTA, the American Public Health Association and both optometric and ophthalmologic research journals cite dramatic statistics: About 10,000,000 children in this country suffer from undetected vision problems that may cause them to fail in school. 80% of the children with diagnosed learning problems having undiagnosed vision-based learning problems. Up to 50% of youngsters who find themselves entangled with the criminal justice system have vision problems that were undiagnosed prior to their run-in with the law. Among the 20% of school age children who have a learning disability in reading, 70% have some form of visual impairment, such as ocular motor, perception or binocular dysfunction, which may be interfering with their reading skills. Overall, vision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition in children.
VERA screening protocol: First, all students are given VERA’s universal routine screening, which will often detect additional vision difficulties requiring an eye examination and then facilitate referrals (see School Nurse section for details). Once eye examinations are completed and visual acuity is corrected as needed, underachieving students in grades 2-8 with normal or corrected visual acuity have a provided checklist of behaviors filled out by teachers and/or parents. If behaviors characteristic of vision skills difficulties are noted, the vision skills screening is given. |
 |
Vision skills screening results are virtually independent of visual acuity, refractive error, intelligence and socioeconomic status. (As an aside, most adults do not perform well on these VERA tests as the demands require the greater speed and flexibility of young eyes.) At the completion of the skills screening, the student is scored to one of three groups:
1. PASS = Adequate Vision Skills. A low likelihood that the student's vision skills are interfering with their schoolwork.
2. QUESTIONABLE = A moderate likelihood (50%) that the student's vision skills are interfering with their schoolwork. Parents can be advised that an evaluation for specialized vision care may be helpful.
3. FAIL = A high likelihood (80%) that the student's vision skills are interfering with their schoolwork. Parents can be advised that an evaluation for specialized vision care is very likely to be helpful.
Once students are identified, then what?: Some students will have access to professional “vision therapy” and some will not based on the cost of the programs and location of specialist practitioners. In any case, the following will apply:
Students with visual skills difficulties need attention to the process of doing schoolwork and not just the result. Support for these students creates a more idealized learning environment in which they can stop failing and be successful. It can be as simple as emphasizing auditory and conceptual learning over increased reading demands, and an appreciation of the student as a “cannot” vs. a “will not”. For a list of support options, please review the VERA User Guide and Teacher Guide, which accompany the program and which can be downloaded from this site. The guides contain suggestions to create a more idealized learning environment in which some students have been shown to perform more effectively. |
 |
Practical considerations: The number of students supported as a result of the VERA skills screening will be quite manageable and considerably less than estimates of the prevalence of vision problems in students. With VERA, identified students are underachieving, are in grades 2-8, demonstrate behaviors characteristic of vision skills difficulties and “fail” the skills screening. Therefore, students are excluded if they are in high school, working at or above grade level, have other identifiable and manageable conditions, do not manifest characteristic behaviors or pass the VERA skills screening.
VERA’s 2-8 grade range limit is itself a practical consideration. Younger students may have a developmental lag and not an actual vision skills issue and yield a false positive, while older students generally have issues which are more deeply ingrained and therefore less amenable to school-based support. (Middle school students who are older than VERA’s database range can still be screened with reasonably good results.)
Professional treatment is subject to the availability of suitable practitioners and the ability of parents to bear the associated costs for these services. As an aside, the school should not be expected to pay for these services as these are vision problems (albeit learning-related) and the school does not pay for other vision problems (eyeglasses), and school payment for special vision services is not regulated. Another consideration is that some (medical) eye practitioners will deny the value of treatment, but this is largely a financial turf issue rather than an efficacy issue. It is the school’s responsibility to present a student to all legitimate community options which may be of benefit. Even if a referral for specialized vision care is not forthcoming,
Schools that have responsible practitioners of vision therapy among their community referral options can benefit the most. Educators may delay or modify expensive evaluations or special educational services for students whose vision skills difficulties are confirmed and treated. Once treated, these students have improved reading ability and academic performance. For additional information and to locate practitioners providing appropriate treatment, please consult www.covd.org and www.aoa.org |
