Our developmental optometrist, Dr. Linda Dejmek has been specifically trained to use the following tests, for children and adults, to evaluate several important areas of vision that often go unchecked during a standard “20/20” vision acuity test. Our developmental vision examinations evaluate the following:
We test how clearly and accurately a person sees at both 20 feet and at a close reading distance. This is known as sight. Sight and vision are not the same. We really pay attention to vision. Vision is the ability to understand what is seen. Vision is when our brain organizes the information seen and gives it meaning. Vision is how we form our perception of the world. At A B See Vision Therapy Center we are concerned not only with your sight, but strongly emphasize how vision is actually working.
We test how well and quickly the eyes are able to adjust their focus on objects at different distances. The eyes’ ability – or inability- to rapidly and automatically adjust focus affects everything from participating in sports to reading and writing in educational and work settings. For example, children with focusing problems may struggle with school work. They will appear as if they have a short attention span. Accommodation is the ability to look quickly from near to far and vice versa without momentary blur, for example, looking from the white board to a book or from the dashboard to cars on the street. Sustained focus at near is also very important in maintaining attention. When the ability to focus or maintain focus is inadequate, complaints of blur, headaches, fatigue and tearing are common.
These tests assess how well your eyes work as a team. Problems with eye teaming can cause depth perception and eye-hand coordination difficulties. In order to have clear, singular, comfortable vision with good reading comprehension, the eyes must align accurately. Eye-teaming is the ability to point (fixate), focus, and move the eyes to the same place at the same time with input unified into one image. The ability to use both eyes together smoothly, simultaneously and accurately is paramount to visual success.
The ability to follow moving objects smoothly and accurately with both eyes, such as a ball in flight or moving vehicles in traffic. Eye movements that are slow, clumsy or uncoordinated or eyes that jump, miss, “stutter” or lose their place reduce efficiency. When tracking is poor there will be an avoidance of visually demanding tasks, attention span will shorten, and fatigue and restlessness during visual desk activities will increase. Comprehension while reading may be poor and many times the individual must re-read the paragraph to gain content.
The ability to quickly and accurately locate and inspect with both eyes a series of stationary objects, one after another, such as moving from word to word while reading. Problems in this area will show up as frequent loss of place, re-reading, word or letter reversals ("was" for "saw"), and reduced comprehension.
Eye Aiming Skills (Converging and Diverging):
This is the ability to turn the eyes inward or outward when looking from objects close up to objects far away and back again. These skills must be closely coordinated with eye focusing skills. Inadequacies in these areas will hamper reading ability and athletic performance. The ability to turn the eyes inward (convergence) is critical to reading. A major study entitled Randomized Clinical Trail of Treatments for Symptomatic Convergence Insufficiency in Children showed that vision therapy was the best choice for correcting convergence insufficiency.
These tests assess your ability to coordinate visual input with information from your other senses, such as touch (eye-hand coordination) and hearing (balance), etc. Having good eye-hand coordination is important for learning to write (poor handwriting is often related to poor eye-hand coordination). The ability is essential to good performance in most sports.
We test how well you mind your p’s and q’s, b’s and d’s and even short words like “was” and “saw.” When children over the age of 7 persistently confuse these letters, there may be a visual perception problem with laterality or directionality. Spatial orientation tests are very important in discovering this problem. Spatial orientation refers to the ability to orient oneself in space. It is an internal sense of “sidedness” from which directional judgments are made. Laterality is the internal lateral awareness that distinguishes one side of the body from the other. Directionality is the ability to project laterality into the physical world. Spatial orientation dysfunction may lead to reversals in reading (b’s for d’s), poor map reading skills and general confusion in many activities.
The ability to monitor and interpret what is happening around you while you are attending to a specific central visual task: the ability to use visual information received from a large area. The perceptional field test requires the individuals to look at a central target and inform the tester when a colored target is in view coming from their peripheral vision. They must identify the target accurately as to its color. The test is done at a near distance. If the field is constricted, balance may be affected as well as attention. Reading may also be affected. Treatments are available through vision therapy that can expand the visual perceptual field.
This testing examines abilities in visual perception. These abilities are essential for quick and accurate identification and discrimination of objects, for comparing similarities and differences, recognizing and generalizing forms, and coming to valid conclusions based on the accurate analysis of available visual information. Categories of testing are as follows:
Measures to what extent a subject can identify the distinctive features of forms including shape, orientation, and size. Poor discrimination would result in confusing similar objects, words or colors. One may mistake an "a" for an "o".
Measures the subject’s ability to remember single forms. Visual memory is the foundation for visualization and involves the ability to store and recall the visually presented information. This is important in spelling.
Measures the subject’s ability to do the following:
•Determine the correct direction of forms
•Orientating oneself in the environment
•Recall the spatial location of stimuli or to recall, identify, or reproduce a design or a dominate feature
•To perceive the position of two or more objects in relation to self and to each other
A test of visual spatial memory is the ability to remember the spatial location of stimuli. A test of spatial memory asks, “Where is it?” This is very important for math skills; addition, subtraction, algebra and geometry
Measures the subject’s ability to judge variations in form and to recognize that the visual information in a form is consistent, regardless of object or image size, location or orientation. This could affect identifying the same work in various type or style sizes (DOG = DOG). This ability is important in math, especially multiplication/division and calculus.
Measures the subject’s ability to remember a number of forms in a series. It is the ability to recall a sequence of objects, letters, words, or symbols in the same order as originally seen. Poor visual sequencing can result in poor spelling and recall. Example: “receipt” or “reciept”, or in a phone number, “250-8070” vs. “250-8007”. A test of visual sequential memory asks, “What is it?” This is important in listening and following remembered instructions.
Measures the subject’s ability to find a form when hidden among others. Without this ability, one will have difficulty in focusing on the important elements on a page while disregarding the “ground”. In reading, this translates to focusing on the word(s) being read without being distracted by the remainder of the page. This will have an impact by making it difficult to locate objects that are not well defined from the background. As an example, one may have trouble finding things in a cluttered drawer or room. In the woods one may have trouble seeing the deer among the brush.
Measures the subject’s ability to be aware of clues in a visual presentation that allows one to determine the final product without having all parts of the stimuli present. An example is completing a word when only part of it is seen, or identifying what is in a dot-to dot picture before it is completed. Visual closure is being able to predict with a reasonable degree of accuracy a letter, the ending of a word, the rest of a picture, or even the ending of a sentence that is only partially visible. Visual closure is an important component necessary for reading fluently that in turn helps comprehension. When struggling with visual closure, patients may confuse similar objects/words, be slow to complete tasks, and have poor comprehension. They may also have trouble finding objects which are partially covered.
Visualization goes a step beyond reproducing in the mind a replica of something previously seen to being able to mentally change the features or dimensions of an object to envision an altered or new object. When reading a narrative we visualize the story, or in math or science we might project, hypothesize and visualize how various approaches and conditions may influence the outcomes so that appropriate decisions may be made.
While working as an Occupational Therapist, I have seen the significant role that vision can play in balance, gait, and movement.
- Wendy Effa, OTR Occupational Therapist, Neenah, WI
Meet the Neuro-Optometrist