When will identifying vision problems that affect learning become a new standard of care?

Why do certain well documented and frequently occurring vision problems, that have been found to affect a child’s reading, learning and attention, seemingly get overlooked as if irrelevant?  Indeed, those of us who have practiced in this field over the years have heard this all too often, “they just fell through the cracks”. Yes, a child can have 20/20 sight but still has a serious vision problem. In fact, passing the 20/20 eyesight test alone does not rule out a vision problem that can affect learning. Indeed, with well documented  research that shows a correlation between vision and learning, why isn’t it considered to be the medical/optometric “standard of care” to first rule out binocular vision disorder, accommodative disorder, oculomotor disorder and/or visual processing disorders when a child is struggling in reading, learning and/or attention and concentration?

Recently drawing a spotlight  in the medical and rehabilitation arena are the vision problems associated with concussion (mTBI). It is now well documented in neurology, sports medicine, rehabilitative medicine and optometry that binocular vision (eye teaming) disorders, such as convergence insufficiency, accommodative (eye focusing) disorders and oculomotor (eye movement)disorders are commonly linked with concussion (mTBI). As a result of these conditions a patient will experience symptoms of double vision, blurred vision at near, difficulty keeping the place when reading, poor reading fluency, difficulty with attention and concentration for reading tasks among much more. An example was published in Lancet Neurol 2014; 13: 1006–16 Neuro ophthalmology of Head Trauma.

The treatment prescribed that has been shown to successfully treat the visual problems associated with concussion (mTBI) is vision therapy as outlined in a recent paper entitled: Vision Therapy for Post-Concussion Vision Disorders

Therefore, given that these very same visual disorders occur with an even greater degree of prevalence in the general population due to delays in visual development, often negatively impacting  a child’s learning, reading and inducing behaviors of reduced attention/concentration including emotional side effects; why is there insufficient public and professional awareness for vision related learning problems?

Oh yes, there is plenty of evidence. For example, The American Optometric Association (AOA), The College of Optometrists in Vision Development (COVD) and the Optometric Extension Program Foundation (OEPF) have published numerous scholarly, evidence-based papers with descriptions and clinical practice guidelines, with one of the most notable being from the AOA entitled: Care of the Patient with Learning Related Vision Problems. Yet, in spite of the educational sphere of literature available to doctors, too many children senselessly struggle due to undetected and unaddressed developmental vision problems.

Is it possible that the attention of the optometric and medical community as a whole needs to have a “blow to the head” to realize that vision problems can frequently exist even without having a concussion (mTBI)?  And is that “blow to the head” metaphorically brought about by someone outside of the optometric  and medical community such as a professional who works in the educational community and also has personally seen and felt the impact of these conditions?

Would the wakeup call for doctors occur when the message comes from the well articulated words of an allied professional who has lived with the problem and witnessed the results of  vision therapy in the life of her own child? Wendy Rosen is an education consultant specializing in vision-related learning problems, metacognition, and environmental education and wrote the new book, The Hidden Link Between Vision and Learning, Why Millions of Learning-Disabled Children Are Misdiagnosed. Listen to an interview with Wendy Rosen along with Jason Flom, director of Cornerstone Learning Community in Tallahassee, Florida, on Student Centricity by Rae Pica by clicking here.










How many children’s lives must be affected before the “standard of care” becomes looking for the cause instead of blaming the behavior? The time has come to end the senseless struggle of developmental vision problems with proper diagnosis and appropriate evidence-based treatment.

Dan L. Fortenbacher, O.D. FCOVD

3 thoughts on “When will identifying vision problems that affect learning become a new standard of care?

  1. Dr. Fortenbacher, Even the pediatric providers who care for our children do not seek to find out more about vision problems and their effect on learning. I find it interesting that individuals involved in competitive sports have better access to this type of therapy than the majority of children. That says quite a lot about our priorities.

    • Thank you Mariangela for your thoughtful comment. Indeed, we can only hope that awareness of vision problems associated with concussion (mTBI) and the evidence-based vision therapy treatment now gaining acceptance across the medical arena will also help pediatric providers understand that these conditions also exist commonly due to developmental delays.

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