Was My Child’s Vision Exam Enough?

Comprehensive Vision ExamSo if I were to ask, “How many of you enjoy your child’s school conference with the teacher?” do you think I would get a large number saying that it is something they look forward to and enjoy? Probably not! For many parents of children that are struggling in school, it can be quite an anxiety producing event.

Hearing that your child is not the stellar student that you dreamed about him/her becoming is a heart wrenching, emotional experience. Both you and the teacher want answers! “Why is my child, this teacher’s student, not able to keep up with the rest of the class?” Parent and teacher will usually brainstorm some reasons and possible solutions. Too many times the problem is attributed to ADD/ADHD and medication is thought to surely make everything better. Although ADD/ADHD is a legitimate diagnosis and could contribute to a child’s trouble in school, it should never be the only consideration.

Maybe the teacher has noticed that the child squints or rubs their eyes and suggests that the child have his/her vision checked. At this point, the parent might respond by saying the child had a well visit at the pediatrician’s office, and nothing out of the ordinary was detected or they have already seen an eye doctor who said the child sees 20/20, perfect vision, no problems at all. At this point, any problems having to do with a vision issue are checked off the list.

Two Problems are Going on Here:

1) Pediatricians do not do vision exams! They are conducting a basic screening to make sure that the eyes are healthy, acuity tests that check near and distance vision and detection of any abnormal eye alignment. I am not suggesting that these tests are not important. Many times they discover visual abnormalities and then refer accordingly, which is crucial. What I am saying is that it is not enough.

2) It is the same situation when a child sees an optometrist or ophthalmologist that has not had the extra training that is needed to diagnose conditions such as; Convergence Insufficiency, Accommodative Deficiency, Pursuit and Saccadic Eye Movement Deficiencies. All of these can contribute to a child doing poorly in school.

  • Eyes that do not turn in comfortably for near work and cause pain and discomfort, as seen with a diagnosis of Convergence Insufficiency, can result in a child avoiding any and all work that requires reading.
  • Vision that is blurred when switching focus from the near to the far as with an Accommodative Deficiency results in a child’s inability to copy information from the Smart Board down to a notebook. It can cause a child to miss the information or copy it incorrectly.
  • Pursuit and Saccadic Eye Movement Deficiencies make words and sentences jump around the page making it next to impossible to understand without the need to read and re-read the material. At this point, so much emphasis is being put on trying to get through the text; the ability to comprehend is lost.

In our experience, we find COVD doctors to be better able to diagnose and treat vision issues that can impact learning but know that there are some really great non-COVD doctors who do diagnose and then refer to others that provide vision therapy programs

Once these diagnoses are corrected, we find that these students do better in school and many times, begin to enjoy reading! So if a teacher or other professional is recommending your child get an eye exam, make sure you find a doctor certified in The College of Optometrists and Vision Development. (COVD). Until this happens, a vision issue should never be checked off the list as a possible cause for a child’s issues at school.

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Marjorie A. Hunter, B.S. Ed. About Marjorie A. Hunter, B.S. Ed.

Marjorie is the administrator for The Sensory Learning Program and the Vision Improvement Program in Toledo OH.




  • Katherine Collmer

    Thank you, Marjorie, for sharing this informative, “family friendly” blog about these incredibly important, yet nearly always overlooked, vision issues!!! As an pediatric OT who specializes in the assessment and remediation of children’s handwriting skills, I run into this issue 90% of the time with the children who I serve. And, at times, there continues to be a brick wall to climb when I attempt to discuss the issues with parents, as their pediatrician tells them that vision assessments are simply a waste of money. I will share this link with them in the hopes that they will be able to make some sense out of vision! Again, thanks!

  • Marjorie Hunter

    Thanks for the positive feedback. I totally understand your
    frustration. I have never been able to figure out why there is a negative
    stigma with vision assessments and vision therapy. Doctors do not hesitate to
    recommend physical therapy if a muscle in the body, say in the lower back, is
    not functioning properly. If a child’s speech is poor, and inefficient muscles
    in the mouth are causing the problem, a speech therapist and speech therapy are
    prescribed. The eyes are muscles too and if not working together correctly and
    efficiently, can cause life altering or life impairing complications, just like
    a back injury or speech abnormality. Why then is vision therapy not recommended
    or worse yet, considered a waste of money? In writing these articles, I am hoping
    to provide more awareness of this very serious issue. Thank you so much for sharing with your
    patients!

  • Optometrist

    I appreciate the sentiment of your article but I am an Optometrist, and your characterization of non-COVD Optometrists is quite inaccurate. In fact in order to receive a license as an Optometrist in ANY state you have to be able to diagnose all of the conditions you’ve mentioned above.

  • http://special-ism.com/ Special-Ism

    It is wonderful that as an Optometrist, that you evaluate for and diagnose all the conditions mentioned within this article. Unfortunately, this is not always the case. Many children are evaluated for visual acuity and it stops there. Would love to discuss this further with you, please feel free to contact us using the link above.

  • OD in the Trenches

    There are good doctors, there are bad ones. Lumping all non-COVD doctors into a category saying they are not qualified to see children is offensive. As stated above, sentiment is appreciated, but you just offended colleagues that are potential referral sources. In fact many do go above and beyond a “typical” eye exam when needed or when the compliant warrants further investigation. If a referral is needed when it goes beyond what I am able to take care of in my facilities I am able to make that determination. Calling colleagues unqualified is bad form.

  • http://special-ism.com/ Special-Ism

    Margie’s intent was certainly not to offend and she has reworded her statement in the article above to prevent further unintentional misunderstandings. Again, we are very happy to hear that your practice and other practices that you network with are performing these comprehensive exams. However, that is not at all the case across the nation. As an example, I invite you to join the Facebook group entitled, “Convergence Deficiency/Insufficiency”, and you will find many reports from families who are not getting these evaluations. We also invite you to join us in raising awareness and spreading the word. Please feel free to contact us via our contact form above and we can find a way to collaboratively work together.

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