The Importance of Vision Assessments
by Lisa D'Arpino
It is amazing how much we unknowingly rely on our visual systems for performance of tasks. Most gross and fine motor activities require assistance from our vision. There are many contributing factors which comprise vision performance, including ocular motility, visual perception, discrimination, and attention (to name a few). Visual motor weakness and visual processing problems are frequently overlooked during assessment and treatment and typically have implications on task performance. There is a high correlation of children with overall low tone and ocular motor weakness; after all, our eyes perform movements because of muscles. These muscles aid us in tracking across a page for reading and following a ball for catching. If our visual attention or visual memory is impaired it would be very difficult to recognize letters. Figure ground and perception are important in writing and drawing. Assessing a child's vision skills could give insight into visual motor delays as well as motor planning and body awareness issues and is imperative for a complete evaluation.
Three areas of vision:
Acuity: Vision correction, which can be detected when a child has difficulty reading regular size print. OT's should not treat this, please refer the child to an eye doctor.
Peripheral Fields: Ability to see objects in the far right and left fields of vision. OT's can treat this utilizing compensatory strategies, such as turning head to see objects.
Ocular Motor: Eye movements including tracking and range of motion, convergence/divergence, pursuits (smooth eye movements), and saccadic movement (smooth ocular movements between points). Ocular motor control impairment usually affects the areas within the OT realm. This is the area that occupational therapists typically address in their treatment sessions.
Possible problems which can be a result of vision difficulties:
- Letter recognition
- Puzzles
- Letter production
- Reading
- Decreased balance
- Difficulty processing motion
- Copying tasks
- Matching
- Headaches
- Distractibility
- Clumsiness
- Overshooting while reaching for objects
- Perception tasks
- Visual memory
- Writing and drawing
- Trips on uneven surfaces
- Crossing midline
- Ocular fatigue
- Performance of mazes
- Visual inattention to tasks
- Avoidance of eye contact
- Sizing and spacing of letters
- Graphomotor difficulties
- Blurred or double vision
- Object manipulation
- Body awareness/body in space
- Disassociation of head and eye movements
Some testing strategies:
- Tracking an object in the form of the letter “H” (be sure to cross midline)
- Assess convergence and divergence
- Copying a shape from the top of a page to the bottom
- VMI-perception and visual discrimination
**Remember to re-assess periodically.
Simple, fun ideas to incorporate into treatment sessions:
- Mazes- making them large
- Flashlight games
- Moving cars on a track
- Ocular tracking utilizing desired objects
- Drawing lines to matching objects across a large area
- Tracing in shaving cream
- Hitting a ball hung on a string
- Place beanbag on head while tracking
- Clock skills
- Convergence/divergence activities
- Zoomball
- Tennis/baseball
- Catching/throwing
- Bingo, looking up to see letter called
**Please share any other activities you may use.
Visual information processing definitions:
http://www.lifetimeeyecare.net/documents/process.html
Developmental Optometrists:
NYC
Dr. Thau 212-685-2457
Henry Ettinger, O.D., FCOVD
2 W. 47th St. , 2nd Flr.
New York , NY 10036, US
PH: (212) 265-4609
Andrea Thau, O.D., FAAO, FCOVD
77 Park Avenue
New York , NY 10016, US
PH: (212) 685-2457
33 West 42nd Street
New York, NY 10036 , US
PH: (212) 780-4022
Ida Chung, O.D., FCOVD
SUNY College of Optometry
33 West 42nd Street
New York , NY 10036, US
PH: (212) 938-4140
Marilyn Vricella, O.D.
77 Park Avenue
New York , NY 10016, US
PH: (212) 685-2457
Cristina Llerena, O.D.
University Optometric Center
SUNY State College of Optometry
33 West 42 Street
New York, NY 10036, US
PH: 212-938-4169
Fran Reinstein, O.D.
77 Park Avenue
New York , NY 10016, US
PH: (212) 685-2457
Search for a developmental optometrist in your area: COVD.Org
Helpful Information:
The following are informational websites on vision therapy. These sites are an excellent resource for vision checklists, explanation of a variety of visual impairments, answers to common questions, description of vision therapy, informative articles on vision and learning, Autism, and ADHD, and finding a developmental optometrist in your area.
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