When speaking with parents about their child’s eye coordination instead of speaking about problems with vergence, accommodation and oculomotor function, terms that will automatically trigger a “deer in headlights” look, I’ve learned it is far better to refer to these essential visual skills as “teaming…tracking…focusing”.
These three eye coordination abilities are essential for reading fluency. Specifically, when referring to these visual functions, Eye “Teaming” is another way of saying we have two eyes and they must work together in what is known as binocular vision. The skill of using our binocular vision is referred to as “vergence” which is commonly thought of as convergence or divergence. When an individual has trouble with convergence they may demonstrate under convergence, known as convergence insufficiency, or over convergence known as convergence excess.
The vergence system also must work synergistically with eye “Focusing” otherwise known as accommodation. When a child or young adult has trouble with accommodation that is referred to accommodative dysfunction which can also be an under-focusing ability, accommodative insufficiency or poor focusing flexibility, accommodative infacility.
Eye “Tracking” is another way of saying our eyes need to visually fixate (look at), follow in a smooth pursuit (follow) and saccade (move spot to spot). Problems in these visual tracking skills is known as an oculomotor dysfunction.
This week I saw a 9 year old boy going into 4th grade who was referred to me by his primary care optometrist with a condition of accommodation-vergence dysfunction involving convergence excess and oculomotor dysfunction. He had no refractive error, 20/20 visual acuity at distance and near and normal healthy eyes. He complained of headaches, eye strain, period words overlapping when reading and poor attention for reading. He was a bright boy who did well when presented with oral learning but got exhausted when trying to read. His referring optometrist had tried reading glasses but they didn’t seem to make any significant difference in the boys reading or symptoms. His parents both attended my exam and where noticeably concerned and frustrated by his struggles in reading and battle with homework.
Indeed no surprise that my examination concurred with his referring doctor. His problem wasn’t with his eyes (per se) or his eyesight. He had a relatively common visual dysfunction of eye teaming, tracking and focusing. The good news is that this condition is completely treatable with vision therapy and with office-based treatment it will make a dramatic difference in his life.
Even though this story is a common occurrence in the clinical practices of offices of developmental optometrists who provide vision therapy, in reality around the US, most of these children who have visual based reading problems are overlooked. They fall through the cracks of the educational assessment system because they pass the visual acuity test (20/20) and further testing of their eye teaming, tracking and focusing is not even checked. But as of July 19, 2018 published in the JAMA Ophthalmology a research paper was published by prominent researchers from Boston’s Children’s Hospital and Harvard Medical, entitled: Frequency of Visual Deficits in Children With Developmental Dyslexia, found deficits in visual function in binocular, accommodation and oculomotor abilities of those children with developmental dyslexia vs normal readers.
In addition to this new research, to help parents and professionals, the VisionHelp Group has created the VisionHelp Vision and Learning Project which provides additional information.
As outlined in a previous post, entitled: Solutions for your child who struggles in school starts by knowing what to ask your eye doctor, every child who struggles in reading should have a comprehensive eye health and vision evaluation by a doctor of optometry who will also ask questions about your child’s reading abilities and perform the necessary testing. No child should have to endure the struggle of an undetected problem with eye teaming, tracking and focusing!
Dan L. Fortenbacher, O.D., FCOVD
I guess it would be too much to expect the medical community to retract its position papers that are contradicted by this important research.
Thank you Dan for your comment. Indeed, as someone who has led the charge on this issue with your eloquent rebuttal in 2010 in the AOA Journal, we can only hope so!
This is another complicated issue for parents to deal with who are already overwhelmed. Your explanations and new reference add clarity and documentation. Thank you.
Thank you Gary!
Let’s just keep doing what we do and soon the evidence will be overwhelming.
Thank you John! With this addition to the multitude of other research, surely we are reaching that tipping point of confirmation that vision problems such as binocular, accommodative and oculomotor problems affect reading fluency.
Great article, Dr. Fortenbacher. After seeing results in this area for forty years, I sometimes forget that vision therapy is still new news to many. Thanks to the Internet and the hard work of doctors such as yourself, however, we are indeed at a tipping point.
Thank you Dave for your thoughtful comment and your dedication to continue to help the profession understand the intricacies of vision problems and the impact on reading and learning.
Sharing this with reading specialists, classroom teachers, school nurses, and administrators is a must since this is not taught or discussed in teacher preparation programs and/or professional development.
The invited commentary to the JAMA Ophthalmology article by Scott A. Larson, MD is quite revealing: “Before we subject 7% of all children, especially those with good visual acuity, to expensive and time-consuming testing, it seems reasonable to consider what confounders may be present in the study by Raghuram et al, or any studies like it that are performed with children.” While some eye care professionals seem forever willing to withhold medically necessary testing to reading disabled children because of expense, time, potential confounders or a child’s “good acuity,” Dr. Fortenbacher’s imperative seems all the more reasonable: “Every child who struggles in reading should have a comprehensive eye health and vision evaluation by a doctor of optometry who will also ask questions about your child’s reading abilities and perform the necessary testing. No child should have to endure the struggle of an undetected problem with eye teaming, tracking and focusing!”
Reblogged this on Mindsight and commented:
COVD Fellow Dr. Dan Fortenbacher’s latest post on the VisionHelp Blog explains some of the visual skills kids need for learning! Here are some steps you can take to make sure your child’s eye teaming, tracking, and focusing get plenty of practice time this summer:
1) Take the Pledge to build visual skills with the kids in your life for a #SummerofSkills at covd.org/august to celebrate Vision & Learning Month!
2) Locate a Doctor at covd.org and schedule a comprehensive vision exam!
Reblogged this on GWilliamsFamilyEye.