Common Vision Disorders That Could Be Holding Your Child Back In School

If your child aces the eye chart at the pediatrician’s office, you might assume her vision is just fine. But some common vision disorders can’t be detected by a standard eye exam — and could be holding your child back in school.

When Jennifer Stone Hopp’s son Ethan was in first grade, his teacher told her that he had “all the tools to read,” but he “just wasn’t pulling it together.” When Hopp and her husband tried to work with him on reading at home, he’d refuse. “He skipped words everywhere. He couldn’t focus. We’d negotiate: ‘You read a line, then I’ll read a line.’ It was brutal,” she says.

In the second grade, Ethan was diagnosed with mild farsightedness and got glasses. The Hopps thought his reading would improve — but nothing changed. As elementary school progressed, Ethan continued to struggle as the family cycled through a series of professional tutors. “He had so much trouble with any kind of reading — even word problems in math class were difficult,” says Hopp.

At the beginning of fifth grade, Ethan broke down. “He said, ‘I work so much harder than the kid who sits next to me, and he gets A’s, but I’m getting C’s and D’s. What’s wrong with me?’ ” recalls his mother. She took him to yet another reading tutor — the only one in their New Jersey town that they had not yet visited. But unlike the others, this tutor didn’t just sign him up for regular sessions. “I don’t work with anyone unless I’ve checked their vision with a Visagraph test first,” he said.

A Visagraph uses specialized goggles that measure how the eyes work together when someone is reading — a process called binocular coordination. The test showed a significant problem with Ethan’s eye coordination, and the tutor referred Hopp to a nearby developmental optometrist, who diagnosed Ethan with a condition known as convergence insufficiency (CI). “He said, ‘It’s so severe that Ethan actually has double vision when he reads.’ I turned to him and said, ‘You see double?’ and he said, ‘Yeah.’ He’d never said anything — I guess maybe he thought that’s how it was for everyone,” Hopp says.

Binocular Vision

Some vision disorders that affect children — such as myopia(nearsightedness), amblyopia (lazy eye), and strabismus (a misalignment of the eyes) — usually can be detected on standard pediatric eye exams. But CI is different and easy to miss or misdiagnose.

It’s one of a group of vision disorders that have nothing to do with the function of the eye itself, but rather, with how the eyes work together. “These aren’t really vision problems as much as they are brain problems,” says Barry Tannen, the developmental optometrist who treated Ethan. “When we read, the brain needs to give our eyes signals to focus, converge, track, or not track — and this all happens because of a higher cortical mechanism that, in some people, we have to train the brain to control.”

In people with CI, the eyes have a strong tendency to drift outward when reading or doing other work close up. People with a related disorder, accommodative insufficiency (AI), have difficulty changing their eyes’ focus from near to far, or vice versa. Yet another condition, oculomotor dysfunction, occurs when the six muscles around each eye, which precisely control eye movements, do not work properly together, affecting the ability to do such things as hold the eyes steady or follow a moving target.

CI is the most common of these conditions, and studies show that it affects about 5% of the population. When other conditions like AI and oculomotor disorders are included, Tannen estimates that one in 10 students in any given elementary school classroom may have at least one disorder of binocular vision. (Many people have more than one.) These children frequently test as having perfect 20/20 vision on a pediatrician’s eye chart — but like Ethan, they struggle in school and find reading an exhausting, painful chore.

“The problems often really show up around second or third grade, when children start having to read books with smaller, more closely packed texts, and they do more reading for classes like science or social studies,” says Christine Allison, a professor of optometry at the Illinois College of Optometry and the president-elect of the College of Optometrists in Vision Development. “These children are often diagnosed with ADHD since they can’t sit still and look at a book — because it’s too hard to keep their eyes in line, and they can’t comprehend if they’re not reading well. In other cases, parents or teachers may assume that it’s behavioral — that their child is just rebellious or lazy and doesn’t want to read.”

Could Your Child have a Binocular Vision Disorder?

If your child struggles with reading and complains that it’s difficult or painful, yet sails through the pediatrician’s eye chart with no problems, then a binocular vision disorder could be to blame. If you pick up on any of these signs and symptoms, consider seeing a developmental optometrist for testing. (Find one near you at Does your child:

  • Complain that her eyes feel tired or uncomfortable when reading (or doing other close work)?
  • Get headaches or feel sleepy when reading?
  • Have a hard time concentrating when reading?
  • Have trouble remembering what she’s read?
  • Rub her eyes a lot when reading?
  • Act out, especially when asked to read?
  • Have double vision when reading?
  • See words move, jump, or appear to float on the page?
  • Notice that words blur or come in and out of focus when reading?
  • Lose her place on the page often, or have to reread the same line of text?
  • Resist reading and avoid it whenever possible?

You may have noticed some of these symptoms yourself. But for others — like the double vision and the floating words — you’ll have to ask your child. They will complain when they have a headache or their eyes hurt, but like Ethan, they don’t necessarily know that it’s not normal to see double when reading or have words appear to move on the page.


This can all be treated effectively. Sometimes children with one or more disorders of binocular vision may also need special glasses or prisms, but studies show that the most effective treatment is vision therapy — in-office exercises with a trained therapist, along with at-home reinforcement.

That’s what Tannen did with Ethan. Every week, Ethan visited the doctor’s office and went through a set of exercises with a vision therapist, and then he repeated those exercises at home throughout the week. Typically, vision therapy can last from 12 weeks to more than a year. Ethan’s case was so severe that more than 2 years passed before the problem was resolved.

“But we started seeing improvements very quickly,” says Hopp. “Ethan had actually developed an eye infection called blepharitis, because he was rubbing his eyes so much, and within a month that went away and never came back. And it wasn’t long before his behavior really started to turn around — he became much more calm and patient. Now, he can concentrate better in school, and his logic is so much better.”

Now 12, Ethan still works with a tutor to make up for vocabulary he missed during the first few years of elementary school. He’s been admitted into his school’s advanced math class, and he is determined to qualify for advanced history as well.

“And he’s organized now. The teachers used to complain about his desk, but now it’s all orderly and his backpack is the most organized thing I’ve ever seen,” Hopp says. She admits that Ethan still isn’t a passionate reader, but he no longer struggles with it: “He prefers nonfiction — recently he picked out a book about diseases. It’s all about finding things that interest him.”

Tannen stresses the importance of early diagnosis and treatment for CI, AI, and other binocular vision disorders.

“It’s about much more than reading. These kids take a huge hit in their self-esteem. It changes the way a child views himself,” he says. “You can do vision therapy and correct the problem when you’re 20, but you can’t go back to third grade. The successes or failures you had when you were that young — they stay with you.”

See What Your Child Sees

To get a sense of what a child with binocular vision problems sees when trying to read, Allison suggests the following exercises:

  • To mimic oculomotor problems, try reading a few lines of text that is written vertically, rather than horizontally.
  • For accommodative insufficiency, try crossing your eyes so the print appears double or blurry.
  • Convergence insufficiency is harder to imitate on your own (optometrists have computer screens that mimic the effect), but you can get a sense of the fatigue and eyestrain that happen if you try to read something complicated and technical, in very small type, while covering one eye.


WebMD Magazine – Feature Reviewed by Hansa D. Bhargava, MD on April 06, 2017



Visual Disorders, Anxiety, Depression and School Performance

Anxiety and depression in your child may be the result of a visual disorder. The physical, mental, and emotional changes that are going on at this age make it difficult to manage a disorder they usually don’t even know they have. Compensation, and particularly in school, is much more successful at a younger age, a much simpler time in their lives. Intelligent, bright children study for hours and still struggle. They often feel that no matter how hard they try, they will never be “good enough.” With so much effort going to their studies, they may feel they are missing out on having fun and being a kid. They feel resentful of their parents but mostly take these feelings out on themselves — feeling they are not smart enough, not good enough. This contributes to both anxiety and depression.

I recently met with an eighth-grader scheduled by his parents for help.  This client had terrible anxiety about being in school. S/he had difficulty in math, and reading took a tremendous amount of effort.  Reading passages over and over and over again, s/he often memorized them before beginning to understand them. This client studied from the time s/he got home until bedtime.  Anxiety about whether or not the information had been understood and retained would take hold the following day. Testing took longer to complete than for others, and so anxiety about finishing on time was prevalent on test days. Anxiety would continue to build over the fretting about resultant test scores and overwhelming thoughts of a negative outcome. When scores were revealed, a hampster wheel of self-deprecation ran on and on about how much better others did, the state of her/his GPA, and how much smarter everyone else must be. I remind you, this is an eighth grader. 

In the first session, I did a simple visual assessment to see if her/his eyes were “working together.” This is not about vision, but coordinated eye movement. It appeared that the eyes were not, in fact, working together, and I referred this client to Dr. Brian Thamel (in Spencer), a Developmental Optometrist. Dr. Thamel confirmed that my client had a Disorder of Convergence. What does this mean? Well, the eyes are designed to focus together on the same point in space. With both eyes doing so, we have both recognition and comprehension. We have both sides of the brain processing information. But if our eyes don’t focus on the same point in space, then each eye is seeing something different. The brain, not at all happy with the mental confusion this creates, shuts off the information coming from one eye.

People affected by this disorder have reading recognition but struggle with comprehension. In math, we need both the right brain (to see patterns) and the left brain (to understand the logic).  With only half of the brain working at any time, there’s bound to be trouble. This disorder can cause other problems, such as an inability to see life patterns in thinking and behavior, and to then make generalizations to correct our course for greater success. People who are undiagnosed have no idea of the amount of stress and irritability that is created, on a daily basis, as they try to focus their eyes together for any length of time. Sleepiness while reading or studying is common. They might be easily distracted by noise: a lawnmower, dishwasher, voices.

And for school-aged children, no matter how long and how hard they study, they are going to struggle in school. It doesn’t make sense to the parents because their child is so smart, and so they tend to push. These youngsters feel a constant sense of defeat and hopelessness as they try every harder, often with teachers and parents who believe, because of a child’s intelligence, that they are not trying hard enough. Visual disorders like a Disorder of Convergence are not are not tested for in schools. Children suffer with them and never know why school is so difficult for them. School should not be hard. It should be exciting, interesting and challenging in a way that creates a passion to learn.  

Back to our eighth grader. While working with Dr. Thamel on eye exercises that took no more than ten minutes a day, the client worked with me on anxiety and limiting beliefs (depression). Seven sessions later the client was ready to terminate therapy. S/he reported an absence of anxiety (my part), and that studying had become easier (Dr. Thamel’s part). Educational materials made sense and were easy to read and comprehend. Test anxiety had decreased significantly, and this youngster believed s/he would do well on tests and in school. It doesn’t get any better than that!


Communication and Conflict

I often work with couples and families. One major issue is the way people talk to each other. The choice of responses sets up conflict before either party knows what happened.   Let me give you an example with Joe and Jane.  Joe attempts to address a behavior in Jane that bothers him. Jane responds with some thing like, “What about you?” or “You do it too” or “I don’t do it that much.” In first two instances, the behavior that Joe was trying to address has been ignored and the subject has been changed from Jane back to Joe. In the last instance, the subject has been changed to how much the behavior occurs rather than how it effects Joe. This is infuriating to Joe who is trying to make a point because the issue Joe was trying to address never gets resolved when the subject gets changed. Ongoing conflict around unresolved issues ensues and Joe continually brings up these issues because they are never resolved. Jane becomes angry because Joe has a memory like a computer and can never move on. He is stuck in the past with a backlog of unresolved feeling and issues.

Another problem is the use of global labeling. Global labeling is the use of terms like “always,” never,” everyone,” “no one.” For example, Jane tells Joe, “you always bring up the past.” or “you never help around the house.” Joe feels unappreciated for the times he has attempted to stay in the present and for the times he has helped around the house. Joe’s response is to bring up the past to defend himself. It’s a vicious cycle.

The argument that, “everyone we know is (doing something)” or “no one else (does that or thinks that way) can also cause anger. If Joe is talking to Jane about something he wants or needs, not only is the subject changed to other people but it can be experienced as quite critical that Joe is not like everyone else.

There are many more examples of errors in communication. For the most part, I would say that people know not what they do, only that they have trouble communicating without fighting or distancing. Counseling can help people see the patterns and practice correcting them.

The Perils of Not Parenting Your Child

Many parents are finding it difficult to discipline their children. They don’t want to hit or hurt their children. Often parents have very stressful lives, managing to work full or part-time, take care of the house, the children, and try to make time for leisure activities. Stress, feelings of guilt and the desire to be loved by your child can interfere with parenting. Parenting means to prepare your child for the real world. If an adult were to yell, cry, kick their feet and pound their fists, most people would be appalled. However, many parents don’t know what to do with temper tantrums. They feel they are a reflection of their parenting, they are embarrassed and often they can’t tolerate the noise, so they give in. What the child learns is that if they kick and scream, eventually they will get their way. Fast forward to adolescence and you have a real problem on your hands. Temper tantrums now involve an adult body with adult language and adult skills of manipulation. Teens throw things, yell, say hurtful things, slam doors, run away, put holes in walls and other property damage, and flat out refuse to do what you ask. Why? Because they can. They have done it for years.

Start setting limits with your children when they are young. Limits are what you are willing to tolerate and what you are not. Give choices to your children. i.e. “If you continue to scream and yell, we will leave the store and you will not have milk for your cereal in the morning. It is your choice.” If they continue to behave inappropriately, remove them from the situation even if it is inconvenient. Perhaps you are shopping and just want to finish and go home but, it is worth the extra time, now and in the long run, to take the child out of the store, sit in the car and wait for them to calm down and drive home. Keep extra supplies on hand and if you don’t have milk in the morning for their breakfast, remind them that that was their choice. Consequences should be natural and logical, “If you don’t get dressed now to be on time for the bus, you will have to go to bed 1/2 early tonight so that I can wake you up earlier tomorrow. It’s your choice.” If your child is into electronics (phone, TV, games), you may have a rule that they are not to be used until homework is done. Choices put ultimate control in the child’s hands. They may regret the choice they made later but, it was their choice. Children who have clear limits and choices feel safe and loved. Bribery is not a choice. Bribery teaches children to do things because they get something for doing it, not because they need to do it to be a member of the family (chores) or of society (school) or to move forward in the furture. When you ask them to do something and they respond, “What do I get for it?” you’ll see my point.

In the real world, if you behave badly, no one wants to be around you. If you go to work late, you have to stay late. If you don’t go to work, you don’t have the money to pay for the things you enjoy (privileges). Basic stuff. Your child may be angry at the limits you set, but children need limits to feel safe. Without them they feel anxious. It is too much for a child to be put in charge.



Anger, Everybody’s Got Some

Often people come to me and they say they have an anger problem. They often tell me they are just like one of their parents, they inherited this. Did you know that there is no anger gene? Anger is a learned behavior and as long as you practice getting angry you will be very good at it. Anger is not a “get out of jail free” card allowing you to say whatever you want to say and behave in any way that suits you at the moment. Whoever you have been angry with remembers what you have said and remembers that you thought that about them. They don’t forget any intimidating or violent behavior, or if you just walked away. Your anger can leave others feeling hurt, abandoned, afraid, and angry themselves. If you are trying to solve a problem with anger, you are likely not having much luck. As children, we learn that anger works to get people to stop doing what they are doing. If your mother or father became angry with you, generally you stopped what you were doing. As adults, being angry with other adults is pretty ineffective though. (You may have noticed this with your teenagers in particular)

The feeling of anger may be your personal notification that a line has been crossed and you need to set a limit for yourself. That limit is more likely to be heard in a discussion rather than a yell-fest. If the person you are speaking to doesn’t understand what you are trying to communicate, try a different way of saying the same thing as opposed to repeating yourself. Remember that someone can understand you and also not agree with you. Understanding and agreement are not inextricably linked. Ask the person to repeat what they heard. Ask them what they think. Be open to modifying your request based on their thoughts and feelings. You are not in the relationship alone. If you become frustrated, take a break, go for a walk, think things through. Think about what it is you’re really wanting from the other person. Then go back to the discussion. Practice calm discussions and behaviors and you’ll get good at those.