Understanding Different Types of Vision Problems: A Guide
Vision is about more than just seeing 20/20. Many individuals, especially children, struggle with hidden types of vision problems that affect their ability to read, learn, and perform daily activities. Developmental optometry focuses on diagnosing and treating these vision challenges, which often go undetected in standard eye exams. Here’s a guide to understanding different types of vision problems that a developmental optometrist can help address.
1. Binocular Vision Problems
Convergence Insufficiency, Convergence Excess, Exophoria, Esophoria, Binocular Vision Dysfunction etc.
Vision occurs when the eyes send signals to the brain. Usually the brain receives information from both (bi) eyes (ocular). The eyes transmit different information, and healthy eyes will help the brain judge distances, depth perception, speed of objects, and coordinate eye movements. You can see how much both eyes help you by closing one eye and trying to pour a glass of water or trying to touch two pen caps together.
How this may look: Tired or sore eyes, especially after school or work. Blurry vision or double vision. May not like reading because it is physically intensive. Headaches. Trouble concentrating, children with ADHD are 3x more likely to have convergence insufficiency. May also avoid homework or other near work.
How does vision therapy help binocular vision problems? Vision therapy teaches the eyes to work together. It changes how the brain coordinates the eyes to make binocular vision more efficient and effortless.
2. Eye Focusing Problems
Accommodative Insufficiency, Accommodative Excess, Accommodative Infacility
The eye needs to be able to change focus, from looking up close to far away, like looking from a desk to the whiteboard. This happens by the lens changing shape, somewhat similarly to a camera focusing in. Accommodation is the adjustment of the optics of the eye to keep an object in focus on the retina as its distance from the eye varies. For some people it takes longer and more attention to make things come into focus, which can hold them back.
Accommodation refers to the eye’s ability to change focus between near and distant objects. Some individuals experience accommodative insufficiency (difficulty sustaining focus on near work) or accommodative spasm (difficulty relaxing focus after extended near work). These issues can lead to blurry vision, fatigue, and difficulty in school or work settings.
How this may look: Headaches, eyestrain, up close vision that is blurry or goes in and out of focus, reluctance to read or avoiding reading, visual fatigue, sleepiness, poor reading comprehension.
How does vision therapy help eye focusing problems? Builds accuracy, flexibility, and sustainability of accommodation. Teaches the eyes how to focus properly in coordination with eye teaming.
3. Eye Tracking Problems
Oculomotor Dysfunction
Visual tracking is the eye’s ability to move, either in large movements like seeing a ball go across the sky or small movements like tracking from word to word on the page. In general, this refers to the ability to quickly and accurately look (fixate), visually follow a moving object (pursuit), and efficiently move our eyes so we can fixate on objects from point to point as in reading (saccades). Good tracking is essential for reading. The eyes have strong muscles to move them around, but the brain directs that movement. If the brain struggle to find its place, then the eyes will jump around as demonstrated below. This can lead to skipping words or lines, losing one’s place, and poor reading fluency. Children with this condition may appear to have reading difficulties or attention issues.
How this may look: Reluctance or avoiding reading. Poor reading comprehension; a child may read, but then have no idea what it was about when questioned. Frequently rereads the same word, may use their fingers to track where they are when reading. Skips over words or entire lines of text, often reads small words backwards (“was” for “saw”, or confuses b’s and d’s).
How does vision therapy help eye tracking problems? Vision therapy creates new neural pathways that improves fixation and saccadic movements, integrates oculomotor skills with vergence accommodative systems, and with information processing, and enhances visual information processing and spatial awareness to better guide ocular movements.
4. Strabismus (Eye Turn)
Strabismus occurs when the eyes do not align properly, causing one eye to turn in, out, up, or down. The eyes need to be able to work together, in coordination with the brain, so they can both fixate (keep their focus) and accommodate (clear an image) properly. Strabismus makes this a difficult task because the positioning of the eyes provides two different images from each eye. These images do not match up perfectly in the patient’s visual field, and they can suffer from blurriness or double vision. Early intervention for strabismus is helpful for relieving the symptoms for patients physically, emotionally, and socially.
How this may look: eyes that look misaligned or that do not move together. Frequent blinking or squinting, especially in bright sunlight. Tilting the head to look at things. Faulty depth perception and difficulty judging distances. Difficulty catching and throwing objects. Clumsiness. Double vision.
How does vision therapy help strabismus? Vision therapy can help by retraining the eyes to coordinate and work together with the neuromuscular system. This is done through activities that work with the eyes monocularly (one eye), bi-ocularly (both eyes, but not together), and binocularly (both eyes together). Over time the patient can learn to control their eye movements, training themselves to fixate and accommodate properly.
5. Amblyopia (Lazy Eye)
Amblyopia, commonly known as lazy eye, occurs when one eye has reduced vision that cannot be corrected with glasses alone. It typically develops in childhood and results from poor visual development in one eye. Traditional treatments include patching the stronger eye, but modern vision therapy can enhance binocular function for long-term improvement.
How this may look: Noticeably favors one eye, may even cover their eye with their hand or hair. Tendency to bump into objects on one side, poor depth perception, difficulty judging distances, difficulty catching and throwing objects, clumsiness, squinting or shutting an eye, head turn or tilt, eye strain, or fatigue with near work.
How does vision therapy help amblyopia? VT activities involving patching* the stronger eye can help to “wake up” the amblyopic eye, as well as bi-ocular activities with red-green glasses. These glasses give each eye a different image while still working simultaneously to accomplish different tasks. When patients are able to use both eyes to their full advantage, they can fully develop a sense of depth in the world around them, which is important feedback to maintain clear, comfortable, and efficient vision.
*Note: At our practice, we rarely prescribe long-term or passive patching. We do utilize patching while doing active therapy. We also don’t use a full patch, instead we have glasses that obscure one eye, but that still allows some light to that eye without form. Our goal is binocular vision, and it takes two eyes for that!
6. Visual Processing Disorders
Visual processing refers to how the brain interprets visual information. Children with visual processing disorders may struggle with letter reversals, difficulty recognizing shapes and patterns, or poor visual memory. These challenges can impact reading, writing, and overall academic performance.
When visual information is incorrectly processed by our eyes and brain, it cannot be integrated with our other systems, which can lead to struggles with learning, difficulty in comprehension, or being a slow reader. Sadly, many people mislabel this as dyslexia or more generally as a learning disability. And 79% of children who do have dyslexia also have a vision impairment that can make reading and learning even more difficult.
Imagine trying to cross the road. You need to judge the distance between cars, how fast they are going, how far you need to go, and think about the order of things you need to accomplish. Someone with visual processing disorder may struggle with imagining such a thing and acting appropriately to all the visual stimuli.
How does vision therapy help visual processing disorders? Vision therapy helps with building and developing the neural software that enables us to take in information and integrate it. Treatment for vision problems or visual processing difficulties not only improves eye tracking skills, but can also help develop a stronger connection or new pathways from the eyes to the brain & body by introducing novel experiences and guiding patients through appropriate visual interaction and interpretation. Harnessing visual input through vision therapy is fulfilling to our patients because they begin to better understand what is really happening within them.
7. Myopia
Myopia, or nearsightedness, usually occurs because the eye is elongated, causing light to refract incorrectly and making vision blurry. More than 40% of Americans are nearsighted today, up from 25% in 1971. Researchers believe that if left untreated, by 2050 more than 50% of the world will suffer from this correctible vision problem.
When we spend so much time looking up close at screens or near objects, our eyeball physically changes, elongating. This is especially detrimental to children under 12 in the years critical to development, causing the problem to get worse and worse, with lifelong consequences.
How this may look: Frequently needs glasses prescription updated. Blurry vision when looking at distant objects or doesn’t seen aware of distant objects. Headaches and eyestrain. Persistently squints. Hold the book close to the or sits close to the television. Struggling at school. Blinks excessively or rubs their eyes frequently.
The best prevention for myopia is time spent outdoors, away from screens. If a child already has myopia, early detection and intervention are crucial. Myopia management can help slow the progression of nearsightedness and protect your child’s vision for the future.
Vision goes beyond seeing 20/20.
How Developmental Optometry Can Help
Unlike standard eye exams that primarily assess eyesight clarity, developmental optometrists evaluate how well the eyes work together and how the brain processes visual information to determine what type of vision problem is impacting their life. At Brighter Outlook Vision in Charleston, we look at over a dozen visual skills beyond 20/20. Vision therapy, a customized program of exercises and activities, can help retrain the visual system and improve function.
If you or your child experiences symptoms like eye strain, difficulty reading, or attention challenges, consider scheduling a developmental vision evaluation. Identifying and treating these hidden vision problems can lead to improved academic performance, better focus, and enhanced quality of life.
