School Vision

Reading is a skill that can be taken for granted and those who find it difficult have been labelled in the past as being ‘slow’, ‘stupid’ or having special educational needs. However, it may be that the eyes are just not aiming properly.

School Vision is the study of the relationship between visual performance and the occupation of reading. The predominant visual skill in reading is aiming and it should be carried out by the dominant eye. Without stable eye dominance attention will continually swap from one eye to the other. At the moment of swapping, the letter or word will shift position in space. You can demonstrate this by aiming at a distant object with your finger. When you close one eye everything remains stable when you close the other eye either your finger or the object will appear to move. When this happens unintentionally while reading you loose your place in the sentence or paragraph. It becomes difficult to learn to spell because the letters won’t stay in the right order. It’s a bit like unintentionally trying to use your ‘wrong’ hand to do a physical task – it’s just so much harder. Put simply Schoolvision seeks to stabilise the dominant eye with corrective spectacles. The effect is usually measured by an instant increase in the rate of character recognition on the Comparative Rate of Reading Speed Test (CRST), (the speed at which a random selection of 60 letters can be read at high and low contrast).

The CRST also measures the relative effect of serif and non-serif characters on different types of visual deficiency.

THE THEORY

By applying established eye testing techniques, specifically at the reading distance we can cause a positive effect on the rate of character recognition; people, most importantly children, read faster and more accurately.

At this point we have to gently consider that highly emotive word “dyslexia”.

The simple definition of dyslexia is: dyslexia/disleksi / noun, a disorder involving difficulty in learning to read or interpret words, letter, and other symbols (The Oxford Dictionary). When this simple definition is related to the effect of reading glasses on the rate of character recognition it looks like two sides of an equation coming together – problem and solution.

It changes our understanding of the causes and effect completely. Dyslexia as it is understood in psychological terms is a complex family of disorders including dyspraxia, dysgraphia, dyscalcula, attention deficit and even some manifestations of autism, as well as many other related psychological disorders. This family of disorders have unknown aetiology but are thought to be a congenital problem with higher cortical processing in the brain which in turn gives rise to the characteristic signs and symptoms including reading difficulty.

Now it seems psychologically defined dyslexia is just a complex family of disorders secondary to simple dyslexia and that if simple dyslexia is treated all the other signs and symptoms will recede.

For example simple dyslexia is due to poor coordination between the eyes. Dyspraxia is due to consequently poor eye body co-ordination. Dysgraphia is due to poor co-ordination between the eyes and hand. Dyscalcula follows; it is very difficult to add up a column of figures if they don’t stand still. If you add this to the frustration of bright children who do not understand why they can’t read and inappropriate punishment that may be meted out by well meaning teachers, there is a recipe for behavioural problems and a disregard for authority.

The principles of schoolvision are simple but the effect is profound. In research we found that 60% of the children in a deprived area of Wolverhampton had the predisposing signs of dyslexia.

It is quite likely that dyslexia is part of the normal human condition and the reason it has become such a concern to society is the increasing demand of technology and the dependence on reading skills. All this has happened in very recent times and as a hunter-gatherer species we may simply not have evolved to cope with all this activity 20 to 40 centimetres from our nose.

THE EVIDENCE

The breakthrough in the understanding of eye dominance and dominance type (Type 1 right eye dominant, right hand and foot also dominant. Type 2 anyone with a tendency to left dominance in eye, hand or foot) came from research in two sports, tennis and clay pigeon shooting; this led to the proposition of the two primary occupational visual skills of aiming and anticipation.

The way in which visual correction or lack of it affects athletes depends on whether they are Type 1 or 2. A three-year study at Moreton School in Wolverhampton followed where these principles were applied to reading in about 200 year 7 children.

Since then diplomas in sport and schoolvision have been developed by optometrists and dispensing opticians, which over two hundred colleagues mainly in sport vision have now attended. Increasingly colleagues are finding that they can solve problems in all occupations importantly in sport but now in reading, by using this logical approach. We have a growing portfolio of case records from sport and school vision including the Moreton report.

THE DISCOVERY

Why hasn’t this been discovered before?

As a profession optometry looks very much to medicine and Ophthalmology for its justification and GOC contract. Research in Optometry is predominantly about the vision and health of the single eye. The key to understand the effects of dyslexia is understanding how the eyes work together which medicine does not need to know, except where there is an obvious misalignment (squint) of the eyes (it is not obvious in dyslexia).

Binocular vision is a subject, which our profession as a whole finds difficult to understand. This has been made more difficult because it cannot be fully understood unless eye dominance and its relation to dominance type is taken into account (that is our recent discovery)

THE OPTICAL PROFESSION

Why hasn’t the optical profession picked up on this?

We are so respectful of medical opinion that at the heart of our binocular vision assessment we use a technique, which paralyses normal binocular function, called cycloplaegia. The dreaded drops make it impossible to make a proper measurement of the way the eyes work together and respond to the normal process of focussing.

Consultant eye doctors need this drug as a precursor to surgery and it is administered by orthoptists whose job it is to assess squint angle. These measurements have nothing to do with dyslexia and yet as a profession we feel duty bound to administer it because the
hospitals do. We generally defer to orthoptists when we are worried about binocular dysfunction and yet a binocular assessment cannot be carried out without doing a refraction (measuring someone’s optical prescription). Orthoptists are not trained to do this that is why they have to use cycloplaegia. Orthoptists are trained to give eye exercises, which include patching, to encourage the vision in the weak eye. Exercises effectively are treating a symptom without understanding the cause and patching breaks down binocular vision completely and forces children to continue their studies with blurred vision at one of the most important stages in their academic career.

Another fundamental misunderstanding about normal vision function is the ability of the eye to focus or accommodate. Based on very little evidence we have all been taught that people need reading glasses at about the age of 45 and that people under that age can read perfectly well without. It is quite clear from our work that many children cannot focus properly at near.

Traditionally new ideas take a long time to break into the establishment and are often fiercely and ruthlessly resisted. For a long time people thought the world was flat and stars revolved around us. Darwin resisted publication of his theory of evolution for many years because of his justifiable fear of attack by his scientific colleagues.

Schoolvision studies the way children’s eyes work as they read; in particular the relationship between their vision and dyslexia and Schoolvision opticians are trained to help your child beat dyslexia

A concentration of reading and writing is a modern phenomenon and our eyes haven’t yet evolved to deal with so much close work. Because of this they sometimes need help.

When we read, just one eye should take over the job of aiming at the words. But if both eyes try to do the same job, the words and letters appear to shift out of order sending confused messages to the brain which can cause difficulties in reading and spelling.

Using established sight tests and corrective spectacles, Schoolvision works with children to reinforce the dominant eye and improve their ability to read and interpret words

TYPES OF DYSLEXIA

Defined the simplest way there is only one type of dyslexia. Its severity depends on two variables, native wit and the extent of the binocular vision deficiency. The complex family of disorders, which emanate from simple dyslexia, are therefore all amenable to treatment. Indeed it is very important to eliminate problems, which have a simple binocular vision origin to avoid inappropriate medication and to determine those much rarer conditions, which are in need of urgent referral. Referral might be ophthalmology, neurology, and psychology and could extend to nutritionists and occupational therapists.