Recently, the well-known Lakshmi Vara Prasad Eye Institute (LVPEI), known for its research and comprehensive eye health facility in Hyderabad, held a workshop on ‘Visual Assessment and Intervention’ for children with multiple disabilities. Professionals who work closely with children with special needs were invited to participate. The guest speaker, Dr. Lea Hyvarinen, a paediatric ophthalmologist from Finland, is particularly interested in the assessment of visual functioning for development and learning in children. Dr. Lea’s session included screening of videos that show her working with infants. One video was of particular interest, as it showed how professionals are often guilty of labelling children, since diagnosis is based on their behaviour.
False diagnosisThe video showed her attending to a four-month-old baby who was brought to her with a diagnosis of infantile autism. The baby did not make eye contact and had his head turned away from her. But when Dr. Lea gently fitted him with glasses, he was still for a moment and then made eye contact and gave a beautiful smile. One dreads to think what may have happened if his vision-related problem hadn’t been detected. He would certainly have been dubbed as ‘autistic’ in course of time.
Both teachers and parents attribute the failure of school-going children to perform at an age-appropriate level, to short attention span, hyperactivity or dyslexia — a reading disability — but seldom to a problem of sight. Eight-year-old Atul was identified as having attention deficit hyperactivity disorder (ADHD). While assessing him it was suspected that his hyperactivity may be the result of some vision-related problem. The parent was asked to get his eyesight tested by an ophthalmologist, and guess what — he had +1.75 in the right eye and +2.50 in the left. No wonder he was restless and fidgety in class! But poor sight is not the only reason for academic backwardness. There are many important visual skills such as eye teaming, adequate convergence, directionality and form perception that are important for academic success. Unfortunately, these skills are almost never tested by an ophthalmologist or an optometrist.
Let us understand the role of eyesight and vision: Eyesight is simply the ability to see something clearly at a distance of twenty feet, whereas vision is the ability to take in information coming through the eyes, process it and draw meaning from it. Since 75 per cent to 95 per cent of all a child learns comes to him through visual pathways, it can be assumed that any interference in these pathways will certainly hinder his academic growth.
During the comprehensive assessment of a student to identify the possible cause of him underperforming, when I suspect that he may have a vision-related problem, I ask the parent to get him tested by an ophthalmologist. The parent is annoyed and informs me that the child’s sight is fine, as he spends considerable time watching television without any difficulty. Nevertheless, he returns and reports that the doctor said there is no problem with his sight. Unfortunately, the doctor has merely tested his 20/20 eyesight, but not his visual skills. Therefore, this may handicap the child in one of his most crucial tasks — reading, since reading requires adequate visual skills and not just eyesight.
Rizwan, performed poorly in academics. His sight was found to be normal. On assessing him, it was found that he had tremendous difficulty with visual perception which was not identified by the eye professional. Visual perception is required in nearly every action of ours. Proficiency in visual perception helps children to read, write, spell, do math and to develop all skills necessary for success in school work. Reading is one of the most important skills that a child needs to learn. It is the foundation on which he builds new skills, expands knowledge and derives great pleasure. Reading demands that the two eyes move in unison smoothly and that the child be able to sustain an activity for more than 30 seconds. If it does not happen, then the images falling on the retinal area will not be linked together neurologically to be perceived as a single continued image. The child may see two images momentarily.
Reading and sightThe act of reading requires both the eyes to turn inward so that they focus on the reading task. Some children learn to do this properly while some do not. In some children, the eyes have a tendency to deviate outward. The child has to make a conscious effort to maintain fixation on the reading task. He may lose his place while reading, may leave out small words or add a word or two to make the sentence make sense. This brings on fatigue and the child avoids a reading task. This is the child who is fidgety or may look out of the window rather than pay visual attention. He is often accused of being hyperactive or having a short attention span or is simply labelled as having dyslexia.
It is important to be aware of the variations of visual development in children that can be corrected with vision therapy, so that the visual disability is not interpreted as a behavioural problem or an intellectual disability. When parents take their child to an eye professional, they must demand that his visual skills also be tested.
LVPEI is a WHO-collaborating centre, providing training to eye care professionals from different parts of the globe. I implore them to conduct workshops to sensitise ophthalmologists/optometrists to vision-related issues that impact academic learning.
(The writer is a remedial educator. rajfarida@gmail.com)
