Hidden visual function deficits

Problems of the visual appreciation (vision stress) and their effects on schooling performance disorder as well as delayed development in the fine- and crude motor function.

Reading is an essential factor in the uptake of information, which is leading to "knowledge". The uptake of knowledge plays a crucial role all ones' life.

Approx. 80 % of all sensory input is appreciated by the eyes. Therefore it is particularly important that the visual appreciation can be in function without stress and fatigue.

According to an American survey, the Near-Vision of schoolchildren had an increase of approx. 60 % in comparison with their parents generation.
Therefore visual function deficits have a major effect than in former days.

For affected schoolchildren, the undetected and the uncorrected visual function deficits could lead to a substantial vision stress which could be a significant handicap.

The evaluation of the visual quality is being, at most extremely simplified, reduced to the (central) acuity of the two single eyes at the view in the distance and in the proximity.
In many cases after a routine checkup a well and truly acuity is being attested. So the parents are certain, that the visual appreciation of their child is good. But this could be sometimes illusive. However the vision consists of many connected complexly single- and two eyes functions in interaction with many brain regions.

Visual function deficits, which cause or enforce school problems, are very often "hidden" and therefore they slip often the eye routine checkup.

A complete analysis for all important visual functions which are important for reading and learning, requires extensive tests and measurements which lacks a time exposure of about 1 h to 1,5 hours.

Which symptoms and observations could point to "hidden" visual function deficits?

Frequently expressed complaints of the children:

• The writing is anxious and fuzzy
• Eyestrain and / or headaches during reading and writing
• The writing sometimes seems to redouble

Frequent objectively observations during reading:

The child ...

• reads slowly and instable or swiftly but flighty (words which are not in the text)
• slips in the line
• leaves off the endings
• confounds similar and / or allegorical laterally reversed letters, for example "b" / "d" and "p" / "q" and "m" and "n"
• overleaps short words
• reads very unwillingly
• reads in very short distance ("with the nose")
• acquires poorly the meaning of the read text

Frequent objectively observations during writing:

bad, inconstantly type face (words and letters are written "higgledy-piggledy") with increasing duration the type face is getting worse and the number of spellings mistakes increases bad orthography (one and the same word is being written wrong in various types in the same dictation)

Frequent general objectively observations:

• The child fatigues brisk
• Generically dislike of school
• The child is getting nervous and "fidgety"
• The ability to concentrate is limited
• Bad fine- and / or crude motor skills (for example problems or rather disinclination at crafting, problems with catching a ball, general "daftness"

Which "hidden" visual function deficits we could notice at school problems like dyslexia?

Notation:
The visual function deficits as noted below are therefore referred to as "hidden", because their effect on the visual appreciation is not primary in a noticeable fuzzy vision.
The potential effects of these visual function deficits in the field of "reading and learning" are very subtly and therefore they are frequently not recognized as the consequence of a visual sense problem.

Longsightedness, coll. "farsightedness" (hyperopia)

Anisometropia

Astigmatism

Potential effects on school problems:

• The script becomes blurred and seems to be turbulent
• Reading is stressful

Excess/ Lack of Accommodation

The accommodation could not be controlled so exactly, that the streams of light could impinge on the "fovea centralis".

Frequent effects on school problems:

• The writing becomes blurred and is turbulent
• Reading and writing is stressful

Imbalanced binocular vision

School problems, as well as motor deficits in the development and attendant symptoms like headaches appear frequently with problems of the interaction of the both eyes.
These visual function disorders often slip the attention of an eye routine checkup.

Convergence absence / Convergence overage

The pair of eyes places themselves during reading not far enough or too far inwards.

Frequent effects on school problems:

• The letters seem to move
• The order of letters is interchanged for example "ie" and "ei"
• Mirror imaged confusing (e.g. "b" and "d")
• The writing and letters reduplicate (e.g. "n" to "m")

Delayed visual acuity and ocular angle change-over between different distances

The both eyes attune after a switching gaze only after a certain time (sometimes after seconds) on the same object (e.g. a word) in such a way, that the word is seen exact and congruent.

Frequent effects on school problems:

• Difficulties at copying from the desk or copying from the book into the exercise book
• Many spelling mistakes and a high time need for writing

Inexact and uncoordinated saccadics and pursuit movements

Exact Saccadics and pursuit movements are very important for exact word picture storage in the phase when the child learns to read.
After our visual function analysis we notice that many children with school problems have deficits in the precise accord of the motoric function of gaze.

Frequent effects on school problems:

• Slow and analytic reading
• Frequent backwards saccadics, especially with long words
• Inexact (diffused) word picture storage

Associated phoria

Notation:
Unsettled by corresponding school problems frequently the children are brought to an eye specialist. Mostly after the examination very good eyesight is attested or upon farsightedness a weak pair of glasses is enacted.

This examination at the ophthalmologists does not replace the examination on other "more hidden" visual function deficits like e.g. "associated phoria"! This should be made as well.

Glasses, which correct just a current farsightedness upon additional associated phoria, are in most cases unhelpfully and disliked by the child.

How could be headaches caused by hidden visual function deficits?

Headaches appear very often on associated phoria but also on other "hidden" visual problems.

When reading, writing and working on the computer the accuracy of the eye motor as well as the demand on the focusing, which leads to an adequate imaging in the brain is claimed more than during watching TV.

This is the reason why many children suffer from headaches during reading and writing but not during watching TV. Understandably many parents and teachers think in this case that this is just an excuse in order to not to do the homework.
Frequently the headaches appear in the area of the temples or "behind the eyes". Before correction of a visual function deficit with glasses or implementation of a specific visual training it is necessary to exclude an eye- or any further disease as the reason for the headaches.

Visual training

In cases in which due to our visual function analysis a special visual training is promising, we offer an effective optometric training routine, which was developed in the USA and is realized there since many years with big success.

Hereby the ability of the brain is trained to perform more easily the specified visual functions which are necessary for reading, writing and learning.

Interdisciplinary cooperation

The correction of a visual function deficit with glasses or the realization of a visual training is insufficient at school problems. But with these sanctions the assumption is created for fatigue-proof visual sense which leads to an improvement of the reading skills and the word picture storage.

Further necessary sanctions e.g. an ergotherapy or a reading-spelling training is hereby not replaced. They should be realized when it is advised.

An interdisciplinary cooperation between us as well as:

• Ergotherapists
• Teachers
• Ophthalmologists
• Peadiatricians
• General practitioners
• Educators

are therefore very helpful for the access.

In the case of a visual function deficit does the child have to wear the glasses the whole day? This is case by case different and depends if there is a visual problem just in the proximity or also in the distance. We advise you in any case referred to the problem of your child.

Have the glasses been worn a whole lifetime?

This question could also not be answered with yes or no. If your child is visual defected in terms of near-sighted or farsighted it has to wear his lifelong glasses or maybe in future contact lenses in order to view exact. If there is an additional visual function deficit so this is corrected together with the ametropia in one glass. If "just" a visual function deficit like associated phoria is corrected with glasses it is important that your child could learn reading and writing without visual stress. If the reading skills are brought under control and the word pictures are saved and if there are no attendant symptoms (e.g. loss of concentration or headaches) than your child can dispense with glasses.

Could also the adults have "hidden" visual function deficits?

Yes! They often affect in the form of:

• Headaches
• Tired eyes
• Fast overfatigue during reading or working on the computer
• Heightened aversion to light
• Problems to convert from "proximal" to the "distance" and contrary.
• Red, overstrained eyes
• Shoulder- and neck tensions

Which costs do I have to take into account?

Our highly-qualified and extensive visual function analysis contains many points which are not covered in the accounting list for health insurances. As we have fair prices for glasses and eyeglass lenses we do not calculate the service effort hidden in the prices for glasses but calculate the optometric service separate. The first execution of an individual visual function analysis makes use of time of about 1 hour to 1,5 hours and is calculated with 62,- Euro to 85,- Euro (according to the effort).
For smaller children on which we could not realize all tests at full volume the costs are according to the effort between 24,- Euro and 41,- Euro.
Upon a visual function deficit glasses or a visual training is prescribed, every 6 to 8 weeks after receipt of the glasses a check up should be made every year. Check ups are invoiced with 24,- Euro. The costs for our computer-aided visual training including the necessary controls amount to 168,- Euro.

Epilogue:

The experience which we have gained with the optometric test and appreciation of visual-indused school problems base meanwhile on several thousands examined school children. Most of these children have been examined by us because of school problems mainly in the area of reading and spelling and/or because of deficits in the development in the fine- and/or crude motor function.
Our line of action on "hidden" visual function deficits which are often ignored at eye routine examinations is unique in this compilation.
She has been permanent changed and refined and she is nowhere realized exactly like that. Some measurement- as well as analytical methods have been undertaken from American optometrists and some have been modified by us for the special visual situation during reading and learning. Our experiences with involved children have partly shown that medical and/or (orthoptical) perceptions are vetoed. Parents of involved school children are unfortunately frequently made insecure when they find a doctor, on the occasion of an according eye medically examination of their child, who can not comprehend our optometric sanctions and therefore decline them. This happens because of ignorance of the detailed coherences between visual function problems and school problems. At the worst a necessary measure such as glasses or a visual training are averted. For many years we are trying hard with great success to clear up about the importance of extensive visual function analysis by one-on-one interviews, seminaries and lectures for professional groups which work together with school children.

Please note:
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