What is the role of the optometrist in the assessment and treatment of children with special needs?

by Kevin Rooney, Optometrist, Elizabeth House, North Terrace


Good vision is essential for a child to reach their full potential. More than eighty percent of the information children receive about the world comes through their eyes.

It is important for a parent or teacher to recognise the signs of vision defects, as often a child is not aware that they have a problem. Children lack the benefits of an adult’s experience and just assume that their vision is normal.

Ideally, all children should be examined by an optometrist before they are three years old and again before starting school. During the school years, a child’s vision can change rapidly and a thorough eye examination is recommended at least every two years. Typically, a consultation takes about 30 minutes and attracts a Medicare rebate.

The most common problems with children’s vision are those affecting the ability to see clearly and sharply. Myopia (short sightedness) causes difficulties seeing distant objects clearly and affects approximately 10 percent of children aged over 12 years. Hyperopia (long-sightedness) makes it difficult for a person to focus on close objects. Astigmatism causes objects to appear distorted and not sharply in focus. These problems will interfere with a child’s visual acuity and the role of the optometrist is to identify any reduction of visual acuity, correct with glasses or contact lenses and advise on the visual prognosis.

Optometrists, who undertake a four or five year University course, are also trained to identify eye disease that may interfere with a child’s vision and may refer a child to an appropriate eye doctor.

Another aspect of seeing clearly and sharply is called visual efficiency. Visual efficiency is the way the eyes move together as they change from looking from far to near, and back again, and how they are able to keep their focus on close work.

In fact, classroom studies have shown seventy-five percent of time in the classroom is spent on reading and writing at a near distance and on tasks that require the child to alternate focus from near to distance.

Inadequate visual efficiency may lead to specific signs and symptoms of visual fatigue. As the visual system fatigues, the psychological system also becomes fatigued, affecting motivation, attention and comprehension.

There are other vision problems that may interfere with a child’s ability to learn and are described as visual information processing problems. These may require investigation if a child is not performing to their educational expectations. A behavioural optometrist is an optometrist who has a special interest in vision and learning. They perform visual information processing investigations and may be assisted by a vision therapist.

Some of these evaluations may include assessments of the following.

Visual – Spatial skills
  • Allow a child to develop normal internal and external spatial concepts
  • Are important for the development of good motor co-ordination, balance and directional senses.
Visual – Analysis skills
  • Basic foundational skills that allow a child to learn to recognise letters and numbers, and eventually whole words.
  • Other visual-analysis skills include visual discrimination, visual figure ground, visual closure, visual memory and visualization. Visual memory and visualization refer to the ability of a child to recognize and recall visually presented information. Spelling requires recall of visual information, as does word recognition in reading, when we try to match the word on the page with an image that is stored in the brain. Visualization, or the ability to match a visual image, is important in reading comprehension and in mathematics.
Visual Attention and Processing Speed
  • Learning tasks require children to shift attention from one task to another. In reading, for example, a child’s attention must shift from image to image, word to word, paragraph to paragraph and page to page.
  • Visual processing speed refers to the amount of time it takes a child to analyse and interpret visual information.
  • Slow visual processing speed can interfere with automaticity of reading and can cause difficulty copying from the board.
Visual – Motor integration
  • The ability of a child to integrate visual information processing skills with fine motor movement. Examples include ball-catching but a more abstract, and higher level example, is hand writing.

These skills have been studied extensively in children and each child can be given a ranking that compares them with their age ranked peers. After assessment a therapy program may be recommended with the intention of building the skills that are showing deficiencies.

It must be acknowledged that both vision and learning are exceedingly complex functions, with difficulties in definitions and terminologies that are often confusing and confounding for parents and teachers who seek solutions for a child’s learning difficulty.

The role of the optometrist in the assessment of a child with a learning difficulty is to determine whether
there are any visual factors that may impact upon a child’s ability to learn.

It is now recognised visual factors that may reduce a child’s ability to learn include
1) reduced visual acuity
2) reduced visual efficiency
3) visual information processing inadequacies.

A comprehensive optometric examination will identify if there is a deficiency in any of these visual factors and provide therapy options.

It is important that if parents or teachers feel that the child has a vision related learning difficulty that they seek consultation with a behavioural optometrist.

More information is available at www.acbo.org.au

Click on the links below to see the roles of other specialists
Speech Pathologist
Class Teacher
Occupational Therapist
Educational Psychologist

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