Vision is More Than 20/20

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Vision-is-more-than-just-20-20This information is taken directly from the following website as to date there is insufficient information available on statistics in SOUTH AFRICA



Vision is More Than 20/20

Parents and educators often incorrectly assume that if a child passes a school vision screening, then there is no vision problem. However, school vision screenings often only test for visual acuity. In reality, the vision skills needed for successful reading and learning are much more complex. A child who can see 20/20 can still have a vision problem.

Vision is a complex process that involves several visual skills, and more than 65% of all the pathways to the brain. One in four children have undiagnosed eye problems which can interfere with learning and lead to academic and/or behavioral problems. However, it is important to know that these children frequently do not report symptoms because they think everyone sees the same way they do.

Often a child with a vision-based learning problem has excellent verbal skills, causing parents and educators to think the child must be lazy, have ADD/ADHD, or is learning disabled. The possible misdiagnosis can be due to similar symptoms, but the causes are not the same.

  • 25% of students in grades K-6 have visual problems that are serious enough to impede learning.” – American Public Health Association
  • “When vision problems go undetected, children almost invariably have trouble reading and doing their schoolwork. They often display fatigue, fidgeting, and frustrations in the classroom—traits that can lead to a misdiagnosis of dyslexia or other learning disabilities.” – American Optometric Association
  • It is estimated that 80% of children with a learning disability have an undiagnosed vision problem.” – Vision Council of America
  • “Early diagnosis and treatment of children’s vision problems is a necessary component to school readiness and academic learning; and that vision screening is not a substitute for a complete eye and vision evaluation by an eye doctor. Comprehensive eye and vision examinations … are important for all children first entering school and regularly throughout their school-aged years to ensure healthy eyes and adequate visual skills essential for successful academic achievement.” – National PTA Policy Statement 2005, Elements of Comprehensive Health Programs
  • “Early testing for vision problems is key to preventing learning disabilities or, in some cases, significant visual impairment in children.” – Ned Calonge, MD, MPH, Task Force Chairman, Chief Medical Officer and State Epidemiologist at the Colorado Department of Public Health and Environment.
  • “A three year study of 540 children found that those children who had visual perceptual and eye movement difficulties did poorly on standardized tests.” – Dr. Lynn Hellerstein, FAAO, FCOVD, Developmental Optometrist and Past President of COVD.


Eye Problems Checklist for Educators, Parents, and Students

20/20 eyesight determines how well we can see to drive or to see a blackboard. It tells us if we can see a newspaper or a computer screen. But there are many things 20/20 eyesight will never tell us.

It will never tell us if your child:

  • sees clearly all day long
  • can focus back and forth to the whiteboard and book
  • sees single rather than double
  • can read without getting a headache
  • can follow words on a page without losing his place
  • can read without wanting to fall asleep
  • has healthy eyes

Do you think that these things would be important to a student or anyone for that matter? Of course they are! When children do not move their eyes properly across the page, they lose their place, get discouraged and give up.

The following checklist of visual symptoms will help you understand how your child performs visually in his daily activities.



  • Fatigue with reading or comprehension drops with time
  • Confusion with similar words or letters
  • Omits words
  • Short attention span while reading
  • Difficulty keeping place while reading
  • Holds head too close to book
  • Slow reading or word-by-word reading
  • Skips or rereads lines
  • Uses finger or marker as a pointer
  • Avoids reading
  • Says the words aloud or lip reads
  • Difficulty remembering what has been read
  • Reverses words or letters
  • Difficulty remembering newly learned words
  • Poor sitting posture and position while reading
  • Excessive head turning while reading
  • Frowning, excessive blinking, scowling, squinting, or other facial distortions while reading
  • Rubs eyes during or after reading
  • Tilts head to one side
  • Turns head so as to use one eye only
  • Closes or covers one eye


Writing and Other Desk Tasks

  • Holds head too close to desk when writing
  • Gross postural defects, such as leaning head to one side, leaning head on arm, or moving head as he reads.
  • Restlessness while working at desk
  • Difficulty copying from whiteboard or book
  • Squints or blinks looking up at chalkboard
  • Tilts head to one side
  • Turns head so as to use one eye only
  • Omits or repeats letters, words, or phrases
  • Poor eye-hand coordination including poor writing
  • Writes neatly but too slowly
  • Reversals persisting in grade 2 or beyond
  • Weight on the writing arm
  • Does not use other hand to hold paper
  • Immature pencil grip
  • Poor finger movement in writing
  • Draws with short sketchy lines
  • Turns paper to draw lines in different directions


Body Posture and Space Awareness

  • Unusual awkwardness
  • Frequent tripping or stumbling
  • Body rigidity while looking at distant objects
  • Thrusts head forward or backward while looking at distant objects
  • Confuses right and left directions


Appearance of Eyes

  • Crossed eyes-turning in or out
  • Watering or bloodshot eyes
  • Red-rimmed, crusted or swollen lids
  • Frequent sties


General Behavior

  • MELTDOWN at homework time
  • Short attention span or avoiding task when doing near work, such as reading and writing
  • Dislike for tasks requiring sustained visual concentration
  • Nervousness, irritability, or restlessness after maintaining visual concentration
  • Inattentiveness, daydreaming
  • Unusual fatigue after completing a vision task
  • Frequent signs of frustration
  • Tension during close work
  • Avoids close work


Questions for Children

  • Does your vision get blurry at any time?
  • Can you make it clear?
  • Do you ever see objects double?
  • Do you have headaches, dizziness, or feel sick to your stomach when you use your eyes, or do you get carsick?
  • Do letters and lines “run together” or words “jump”?
  • Do your eyes get tired after reading for a few minutes?
  • Do your eyes ever feel hot or itch?
  • Does light bother your eyes?
  • Do you know where to catch a pop-up fly ball, how far to throw a ball, where the ball is going to be?



Equipment: Time Commitment: 5-8 minutes daily / 8-12 weeks

  • Pencils or pens
  • Stopwatch
  • Time Chart
  • TEXT in large font
  • Large Notebook / Slant Board


Child’s eyes should move smoothly and in sync. To screen for possible eye teaming / tracking issues:

  1. Have child sit up straight with head and eyes focused forward. Without moving head, have child’s eyes follow a point (eraser on top of pencil is a good one / at Harmon distance – length from elbow to hand) as you slowly move the pencil horizontally, then vertically, diagonally and in a circle slightly wider than the child’s face. To check periphery vision, gradually increase size of circle, inquiring often if child can still see the point.


Child’s eyes should move smoothly and in sync. Note excessive blinking, watery eyes, head tilting, and/or eyes darting from point.

  1. Hold pencil directly in front of child’s face at Harmon distance (length from elbow to middle knuckle) and instruct child just to stare at the fixed point. (Ages 6-8, hold for about 10 seconds; 8-10 years / 15 seconds; 10 to 12 / 20 seconds).

Note excessively blinking, watery eyes, head tilting, and/or eyes darting from point

  1. Slowly bring point (eraser) towards child nose, watching to see if both eyes converge / cross when point reaches nose.

Note excessive blinking, watery eyes, head tilting, uneven eye movement, and/or eyes darting from point. 

This screen is also an effective vision exercise tool that can be done with parent and child and/or depending on maturity, the child on his own.

To improve eye “teaming”, tracking, provide opportunities for both eyes to focus together on a moving point:

Print text in 16 point font. Have child circle the vowels, then consonants, then blends (“ing” “ed” “sh” “ch”, etc.) Write between words by going above, then underneath words, losing points if pencil touches any letter.

As vision skills improve, decrease size of font and “white space” between lines.


To increase peripheral vision:

Have child practice “thumb circles,” by extending hand out and horizontal with body, with thumb up, visually following in a circular pattern keeping face forward, only using eyes to follow thumb.


To improve visual tracking / fluency:

Extend hand at nose level, then direct child to look at “pinky”, “pointy”, middle, ring, thumb finger, in random order.


To improve focus shift / near to far focus:

“SPY HOLE” – with thumb and index finger, alternate between viewing with both eyes / one eye at a time, focus for 10 seconds on far spot on wall, then transfer to near point for 10 seconds.

”PENCIL PUSHUPS” – Hold pencil at arms length, stare for 10 seconds, then bring pencil in half way, stare for 10 seconds. Repeat ten or more times.

Visual motor activities: “Pick UP Sticks”, Jacks, hopscotch, etc., mazes, word search, balance “bongo” board.

To increase VISUAL MEMORY:

Have child look at picture for 5 to 10 seconds. Then write or tell the objects / details they can remember / play visual “MEMORY” games.

Encourage reading and writing at “Harmon distance” – length of arm from elbow to middle knuckle.

Use a sloping work surface such as a notebook, to divert glare from overhead lights.

ONLINE Vision Activity sites: Remind your child to sit up straight, head and eyes focused forward, no head movement…….. ONLY EYES!

Additional vision skill exercises at


Proper posture for reading and writing is determined by the HARMON Distance………… the distance from the child’s elbow to his middle knuckle. If your child tends to read or write closer than his HARMON Distance, this posture may indicate eye problems.

If you observe your child leaning to one side, covering one eye as he reads or writes, or moving his head as he reads, his behavior may be compensating for his eyes not working as a team. For the brain to see print clearly, the two eyes must give the brain one picture, meaning the two eyes (binocular vision) are in sync with one another across the line of print. If one eye is slightly off, the brain receives two pictures rather than one. Print can appear blurry, “dancing on the page,” or moving in a circular motion.

By leaning to one side, or covering one eye, or moving his head as he reads, the child’s posture compensates by using only one eye (monocular vision) in order for the brain to make sense of the text.

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