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Have you ever tried doing even a familiar task with your eyes closed? What about trying to find something cluttered in a drawer when you are in a hurry? Vision impacts everything that we do in our daily lives! Now, I know you already knew that. But, did you know that vision is highly complex and when even one aspect of it is not working properly there can be a significant impact in our students’ ability to learn? As OTs, we treat the whole child. Thus, this critical area can not be overlooked. Dr. Mitchell Scheiman is a nationally known optometric educator, lecturer, author and private practitioner who also works closely with occupational therapists in his practice. He stated, “To be maximally effective in their therapy, occupational therapists should understand the complexity and importance of vision and how visual deficits can interfere with occupation” (O'Brien, Kuhaneck, & Ball, 2020). One major occupation for our kiddos is school!
With this compelling statement in mind, I need the attention of all school OTs! You can make a difference in this area. Vision is within our scope of practice. In the new online course, “Vision 101 for School-based Occupational Therapy Practitioners” (by Jaime Spencer, OT & Robert Constantine, OT), it was noted that 25% of children aged five to seventeen have a vision problem. That is a staggering number! You might wonder, what should we be looking for to help identify students with vision issues? Below is a list of warning signs that Jaime Spencer highlights in the Vision 101 course. These should prompt us to investigate further. This student:
shows no improvement with visual motor, handwriting, or fine motor skills
cannot catch a ball
turns head, rubs eyes, &/or blinks excessively during near vision tasks
exhibits letter reversals past 2nd grade
is often clumsy
complains of headaches
has difficulty learning to read
does not respond to ADHD medication
Furthermore, if a student has never had a formal eye exam, no matter the age or ability, it is vital that this be made a priority. However, not just any eye examination will work. Do your research before you make a referral to ensure that the provider, ideally an optometrist, includes three components to their exam: visual integrity, visual information processing, and visual efficiency. It is so important that underlying vision issues are discovered before the child undergoes specific standardized tests in areas such as visual perception. In fact, Jaime Spencer stated, “it makes no sense to test visual perception without ensuring that vision is accurate.” In other words, if there are underlying vision issues, there is a strong likelihood that the visual perception testing will be skewed. As a part of the school team, the school OT can screen and evaluate the following vision areas:
eye movement problems
binocular vision
accommodation
visual motor and visual perceptual skills
Following the evaluation, OTs can develop goals and intervention plans, monitor progress, and provide direct intervention to help with any of these identified weak vision areas. This definitely opens the doors for us to make an even greater impact in the lives of our students.
I certainly hope that this short blog has wet your appetite to learn more about the role that OTs can play in the process of evaluating and treating students with vision difficulties. This topic is vast and will be one that we are all constantly learning new things. Below are some basic vision definitions to help you to “see” this topic more clearly and a few references & resources to point you in the right direction towards your own journey of learning more about “Vision skills in School Occupational Therapy”.
Vision Vocabulary:
Tracking is the ability to control where we aim our eyes. There are three basic types of eye movements (all very important to reading):
Fixations: ability to hold eyes steady without moving off target
Saccades: the ability of our eyes to make accurate jumps as we change targets
Pursuits: the ability of our eyes to follow a moving target
Accommodation: the ability to adjust the focus of the eyes as the distance between the individual and the object changes (looking at desk (near) and then the board (far)
Binocular vision: The ability to maintain visual focus on an object with both eyes, creating a single visual image. Without it, a student has poor depth perception
Convergence: the coordinated inward eye movement that occurs when you look at a nearby object in an effort to focus on it. Without it, the eyes do not work together (may drift outward) for tasks such as reading, writing.
Vision Resources & References:
Author: Natalie Grooms, OTR/L
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