The Link Between Reading and Vision

By Abbigail Willingham, Office Visionary based on Dr. Jesse Willingham’s Talk

You might have someone in mind while you read this, maybe it’s why you are looking into the link between reading and vision. If so, please feel free to connect with us to ask any specific questions about the individual. 

A lot of people think that if they have 20/20 vision, they have good eyes, but there is a lot more our eyes and brain have to do together in order to read. It is helpful to understand both how vision develops during a lifespan and how reading works before connecting the two.

How Vision Has Changed Over the Ages

For ages, humans used their vision to survive: looking at the horizon for trouble, working in fields, searching for food, sometimes making tools. There was relatively little near work and it was for short amounts of time. Most people didn’t read at all until the mid-1400s when Gutenberg invented the printing press and made books more accessible. After that, it wasn’t until the Industrial Revolution in the mid-1800s that more people started doing near work consistently. Our vision demands increased again in 1918 when all U.S. students had compulsory education. The current digital revolution has sent our vision into hyperdrive. 

Our vision developed over hundreds of generations to look far away outside. In the span of a couple of generations, our vision went from doing little near work to almost nothing but near work. It also switched from books, which have some depth, to two-dimensional screens. It isn’t what our vision developed to do or how we learn to see from a young age. The demands placed on our vision have changed and it places more stress on it daily.

1 in 10 children have a vision problem that can hold them back in school. 200 years ago, it wouldn’t have impacted their life significantly, but now it is hindering their ability to learn, read, and succeed.

Baby looking at mom

How Vision Changes Through One Individual’s Ages

Vision is a learned process. We are not born knowing how to see. At birth, we have poor visual acuity, but a baby mostly needs its parent and bottle, both of which are kept close to its face. Babies have no binocular vision when they are born, meaning they don’t know how to use their eyes together.

Our vision reaches a near adult level when we are one year old: the eyes start working together for distance viewing and can focus on things near and far. The demands aren’t high, so there’s a fair bit of room for error in the system at this early age. It isn’t until we get to school that our vision gets put to the test.

Our visual system can react to stress in a few ways:

  1. Overcoming – even if you are not initially ready, your vision can adapt and learn what to do. But if this doesn’t occur quickly enough or to a high enough degree, insufficient adaptations may take hold.
  2. Physical changes – the right kind of stress can change the shape of the eye. This is commonly seen in myopia (nearsightedness). The eyeball physically elongates, it doesn’t stop growing when it is supposed to because it reacts to the stress of needing to see up close. Another example is amblyopia or strabismus (lazy eye). If one eye can’t see as well or work as well as the other, the brain changes how it processes the information from each eye and doesn’t develop the normal wiring and structures that create good binocular vision, which can lead to double vision or decreased depth perception, or even significantly reduced vision in one eye.
  3. Compensation – this is the most common accommodation to visual stress. These children find other less efficient strategies to cope. They typically can see in the distance, but when it comes to looking up close, it is a struggle and sometimes painful. They may bring things up close to their face to make them look larger. They may shut an eye or cover it with their hand or hair. Since they are putting so much physical energy into the act of reading, their reading comprehension may suffer as their brain directs resources elsewhere. And they may complain of headaches or tiredness after even short periods of near work, especially more stressful school work (but often not less stressful videogames or fun books). The most common diagnosis is convergence insufficiency.
  4. Avoidance – this often occurs when compensation becomes so difficult that they want to avoid nearwork as much as possible. This can lead to children becoming disruptive or being the class clown, in an attempt to get out of reading and homework. ADHD may be suspected. In fact, children with convergence insufficiency are 3x more likely to be diagnosed with ADHD, and vice versa.

These undesirable outcomes can be overcome by a program of optometric vision therapy. Research has shown that vision therapy is the only treatment better than a placebo for convergence insufficiency, the most common problem of this sort. It’s important to recognize a visual problem early so that it can be fixed before it becomes a learning problem.

Child frustrated by homework

The Science of Reading

There have been several different philosophies about reading, some of which have undergone scrutiny recently as reading rates are plummeting in the U.S. Phonetics is a popular approach using the study of speech sounds, but it isn’t the full process of reading. Cueing takes some habits of the best readers and the worst readers and combines them.

Orthographic mapping starts with phonetics and decoding, then moves on to forming sight words. To be a good reader of the English language, eventually most words must become sight words. The most efficient readers don’t need to sound words out at all: they look at the page and know the word automatically. There are three basic requirements to make a word “automatic” like this:

  1. Know the sound
  2. Know the meaning
  3. Remember what it looks like

If you can’t consistently see the words, you can’t efficiently remember what the word looks like. Your eyes and brain have to do several things to see the words. The eyes have to be able to focus- when we switch from looking far away to up close, they have to refocus similarly to a camera. They have to track and move seamlessly from word to word and not dart all over the page. And they have to be able to converge inward together to look at the page. If those things are not happening efficiently, you will not be able to see clearly and consistently enough to recognize the word, even if you could previously sound it out and you knew its meaning.

The Link Between Reading and Vision

Reading is complex – children are even more complex. Reading involves several skills that combine to create an almost magical process: language, auditory, visual, and memory. But 80% of a child’s learning in school is visual. If a child can’t do everything involved to see efficiently, they can struggle with the whole process. 

A learning disability is suspected when there is a discrepancy between intelligence and achievement. It does not suggest the root of the problem, and a child can have more than one issue at play.

For example, when we think about reading, we often think of dyslexia. However, 79% of children diagnosed with dyslexia also have a functional visual problem, and the visual problem can be resolved. Dyslexia is something that you have to cope with or accommodate for, but the underlying visual problems can be fixed so they don’t have to be worked around.

In Summation

Every child who is having trouble reading deserves comprehensive, multi-faceted consideration. They should begin with visual testing because most testing that will follow uses the visual system. If you are already having trouble seeing, you will by default have trouble seeing the psycho-educational tests, where they are looking at school achievement or IQ. A child’s speech and hearing should also be tested. Dietary issues could also be a factor.

There are lots of things that can impact a child’s ability to read, but the impact of the visual system can be profound. Many children don’t need to continue struggling or working harder than they need to, their skills can be improved through optometric vision therapy. Being a good reader and having good vision goes beyond seeing 20/20, but if you haven’t learned the necessary skills, there is help available.

If you know someone who is having a problem, they should be tested by a developmental optometrist to ensure they are utilizing their vision to the best of their abilities. You can find a developmental optometrist through the College of Optometrists in Vision Development’s locate a doctor site. If you are in the Charleston area, Brighter Outlook Vision is happy to help.