Visual Processing versus Acuity

Acuity is the ability to see clearly, both near for reading and far for seeing the board. Visual processing is the ability to process in the brain what is seen. The acuity may be good for a person with other visual processing problems - a list is at the bottom of this article.

If a person cannot see clearly due to an acuity problem, an optometrist can prescribe glasses. Yet, in most states, it is not a requirement for children to see an optometrist to make sure the eyes are healthy and that vision is developing correctly. As a matter of fact, here in New York State, I have seen children who had been in special reading classes for years before someone asked the parent if they had taken their child to the optometrist for glasses. The child got glasses and then could read.

Hmmmmm. The child spent that time and the districts money while losing self-esteem, when all that was needed was glasses - for near-point acuity. To be able to read books. Who is checking for this (in most states)? Not the pediatrician; not the Kindergarten screening. They both check for far-point acuity when the chart is placed on the wall 20 feet away from them. (If your school or state has all children checked for near-point acuity - kudos!!)

Why doesn't the teacher or occupational therapist refer the parent to the optometrist? Actually, it is a matter of protocol. In a public school situation, if a teacher or OT tells the parent that their child should see the optometrist the school will have to pay for the appointment and glasses. The teacher or OT will get in trouble. However, if the teacher or OT refers the child to the school nurse for vision, the nurse can make the referral to the optometrist because she is another medical professional. In this case, the child gets what is needed and no one gets into trouble.

Why doesn't the pediatrician check for near-point acuity or send children to the optometrist or ophthalmologist? I honestly don't know. According to the American Academy of Pediatrics:

"Because children do not complain of visual difficulties, visual acuity measurement (vision screening) is an important part of complete pediatric eye care and should begin at 3 years of age. To achieve the most accurate testing possible, the most sophisticated test that the child is capable of performing should be used.  The frequency of examinations recommended is in accordance with the American Academy of Pediatrics "Recommendations for Preventive Pediatric Health Care." Any child unable to be tested after 2 attempts or in whom an abnormality is suspected or detected should be referred for an initial eye evaluation by an ophthalmologist experienced in the care of children."

http://pediatrics.aappublications.org/content/111/4/902.full.pdf

However, even though it is said that children should get their acuity checked by age 3, near-point acuity - for reading -  does not routinely happen.

If the family does not have money for glasses, the local Lions Club may be able to help. They are a service organization that has vision as its mission.

Beyond acuity, a person may not have developed good visual processing, resulting in one or more of the following issues:

• Amblyopia or Lazy Eye
• Astigmatism
• Tracking
• Convergence
• Diplopia and Double Vision
• Dyslexia
• Strabismus or Crossed Eyes
• Others

More information on these can be found in the newsletters this month as well as at www.covd.org. Next week I will be writing about tracking and the saccades - they are related to reading.