When consulting parents about developmental vision and eye coordination problems, I find it far better to keep the dialog “parent-friendly.” That is to say; instead of referring to their child’s condition as poor binocular vergence, oculomotor dysfunction and/or accommodation insufficiency, I refer to these important visual skills as problems in their eye “teaming, tracking, and focusing.” These three eye coordination abilities essential for reading fluency, but what do they mean?
Eye “teaming” or vergence is another way of saying we have two eyes and they must work together as a team. When an individual has poor eye teaming skills, they may have one of two conditions, convergence insufficiency or convergence excess. The eye teaming system must also work together with the eye “focusing” system, otherwise known as accommodation. The eye focusing system helps us focus on objects and see images clearly. When a child has trouble with eye focusing, they may have either accommodative insufficiency or accommodative infacility. Eye “tracking” is another way of saying our eyes need to fixate visually (to look at), follow in a smooth pursuit (follow) and saccade (move spot to spot). Problems in eye tracking are known as an oculomotor dysfunction.
Recently I saw a 9-year-old boy in 4th grade, who was referred to me by his primary care optometrist with a condition of accommodation-vergence dysfunction involving convergence excess and oculomotor dysfunction. He had no refractive error, 20/20 visual acuity at distance and near and normal healthy eyes. He complained of headaches, eye strain, words overlapping when reading and poor attention for reading. He was a bright boy who did well when presented with oral learning but got exhausted when trying to read and learn. His referring optometrist had tried reading glasses, but they didn’t seem to make any significant difference in the boy’s symptoms and didn’t improve his reading. Both of his parents attended my exam and where noticeably concerned and frustrated by his struggles with reading and battle with homework. Indeed it was no surprise that my examination concurred with his referring doctor. His problem wasn’t with his eyes (per se) or his eyesight. He had a relatively common visual dysfunction of eye teaming, tracking and focusing. The good news is that these conditions are entirely treatable with office-based vision therapy! However, what does the research say about eye teaming, eye focusing and eye tracking?
On July 19, 2018, the Journal of the American Medical Association (JAMA) Ophthalmology published a research paper by prominent researchers from Boston’s Children’s Hospital and Harvard Medical, entitled: Frequency of Visual Deficits in Children With Developmental Dyslexia, found “…that deficits in visual function [vergence, accommodation and oculomotor (eye teaming, eye focusing and eye tracking)] are far more prevalent in school-aged children…” with developmental dyslexia vs. normal readers. Their research concluded that eye teaming, eye focusing, and eye tracking problems occur in nearly 75% of children who struggle with reading!
Still, most children with visually based reading problems are unfortunately overlooked. They fall through the cracks of the educational assessment system because they pass the visual acuity test (20/20) and further testing of their eye teaming, eye focusing and eye tracking are not even checked!
Every child who struggles in reading should have a comprehensive eye health and vision evaluation by a doctor of optometry who will also ask questions about your child’s reading abilities and perform the necessary testing. No child should have to endure the struggle of an undetected problem with eye teaming, eye focusing and eye tracking!