Education in focus

Dr. Wanda Vaughn does visual exercise with patient About the photo: Dr. Wanda Vaughn, a developmental optometrist, completes a target push-up skill with Mark Andrews*. The exercise trains him to move his eyes inward and stay focused on an object. Mark has been diagnosed with convergence insufficiency, which means the eyes don’t turn in enough to get a clear, single image. Click photo for a larger image. Photo by Kaia Larsen, Times Record.

[Story, below, by Pam Cloud, Times Record; see further permissions and credits at end of story.]

A bright young pupil struggles with reading and comprehension in the classroom. He skips words or lines while reading and loses his place often. He is unable to write on the paper’s ruled lines and sometimes feels confused as he blinks, squints or rubs his eyes.

The school’s vision screening has determined the pupil has 20/20 eyesight. But, although his eyesight may be considered perfect, his vision could be below par.

There is a difference between eyesight and vision, according to Dr. Wanda Vaughn, a developmental optometrist with the Arkansas Vision Development Center.

“Many parents believe that if their child passes the school’s eye screening test that their child’s eyes are fine, when in fact there may be a visual problem,” said Vaughn, a graduate of Southside High School, the University of Central Arkansas in Conway and Northeastern State University’s College of Optometry in Tahlequah, Okla.

Vaughn said that 20/20 eyesight, which means that an individual can see a certain size letter at 20 feet, is only part of a larger picture.

“While seeing clearly at 20 feet away is important, it actually has little to do with how our vision systems are used while reading,” she said.

Many symptoms of learning-related visual problems ? such as making careless mistakes in schoolwork, not listening to what is being said, fidgeting and squirming in the seat and difficulty organizing tasks and activities ? are very similar to those of attention deficit disorder and attention deficit/hyperactivity disorder.

Vaughn said, most of the time, children are not aware they are seeing incorrectly, so the condition often goes untreated or even misdiagnosed as ADD or ADHD.

Dr. Wanda Vaughn does visual exam on patient Photo by Kaia Larsen, Times Record; click photo for larger image.
As a first-grader at Kress Elementary School* last year, Mark Andrews struggled with reading, writing and comprehension. His parents, Marsha and Daniel Andrews* knew their son was bright and should be doing better in school. They worked hard in trying to help their son succeed with his school work.

Mark suffered blurred and double vision, which can cause many of the same symptoms as ADD or ADHD. He doesn’t have ADD or ADHD, however; he has a condition called convergence insufficiency, which means the eyes don’t turn inward enough to focus on a clear single image.

“Normally, the eyes turn inward to focus on words or numbers on the page. When the two eyes focus properly, they see one image clearly,” said Vaughn. “If one eye turns in too much, or if one doesn’t turn in enough, the eyes are not focused on the same point and that can cause blurring.”

For the past three months, Vaughn has been treating Mark’s condition with vision therapy, which teaches Mark how to use his eyes correctly and how to process visual information efficiently.

His symptoms are markedly better, and his parents have noticed a great change in how their 8-year-old is learning and taking in information.

“Eighty percent of learning is visual,” said Vaughn. “If a child has a visual problem, it keeps them from learning efficiently in school. It is so important that a child’s visual system is working properly.”

Although basic eye and vision screenings now are mandatory in Arkansas schools, they sometimes are not enough. A comprehensive eye exam conducted by a licensed optometrist or ophthalmologist can detect visual problems, such as focusing flexibility for switching from reading on the board to writing on paper, tracking for following an object as it moves and teaming for directing both eyes at the same object at the same time.

“We check things other than just 20/20,” said Vaughn, who noted the American Optometric Association recommends comprehensive eye exams at age 6 months, another at 3 years, a third just before a child starts kindergarten and annual visits from ages 6 to 19.

The 1999 National PTA Convention estimated that more than 10 million children (ages 0 to 10) suffer from vision problems, and only 14 percent of students who started school last year received a comprehensive visual exam from an eyecare professional.

Vaughn encourages parents to schedule appointments for their children with optometrists or ophthalmologists for a comprehensive eye exam, to check for visual problems in addition to vision problems.

Often, the visual disorders Vaughn treats are covered by most medical insurance companies.

“These are medical diagnoses, not vision diagnoses,” said Vaughn, explaining that vision insurance is not needed to cover the medical diagnoses.

Vaughn is pleased when she is able to diagnose a visual problem, especially when the patient or the family has been told the problem is a learning disability.

“There is extensive optometric research that shows there is a strong connection between undiagnosed visual problems and poor performance in school,” she said. “This does not mean poor performance in school equals an undiagnosed visual problem, but it does mean that vision needs to be ruled out as a possible cause by an eye-care professional that specializes in testing all the visual skills required for learning.”

[*Lois’ note: Names and locations have been changed to protect Mark* and his family. Dr. Wanda Vaughn is the Optometrist who works with me in vision therapy as well. This story was first published on Friday, August 5, 2005, in The Times Record, a local newspaper based in Fort Smith, Arkansas; photos and story courtesy of the Times Record, used by permission Times Record, Marsha Andrews*, and Wanda Vaughn.]

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