Words That Move Makes It Hard To Learn At School

Oscar* tells us the words move on the whiteboard and on a page and will sometimes appear double.  No wonder Oscar struggles to learn.

A Year 2 student, Oscar has a poor reading posture and tilts his head extremely when he reads.  He finds he can read better when he is moving, than when he sits still.  He often needs to use a cardboard cut-out to help him hold his place when he reads.  He gets tired easily when visually concentrating and will rub his eyes excessively if he is on his iPad, without a break or for more than one hour.

Oscar has poor depth perception and is frequently clumsy.  He plays tennis well but reports that he relies on his listening skills to track the balls movement, rather than his visual skills.

Oscar was dispensed non-prescription Irlen lenses sixteen months ago.  These lenses stopped the appearance of words moving.  Oscar improved academically and was able to match his peers in all academic areas at that time.

However, his Irlen lenses stopped working after three months.  He has tried different coloured lenses subsequently, all of which stopped working after a short period.

When Oscar was five years old, he was unable to interact in a standard Optometric eye examination.  An Ophthalmologist, when he was six years old revealed a red/green colour vision deficiency but no other visual issues.  When his parents asked about the use of Irlen lenses to treat reading difficulties, the Ophthalmologist advised against their use.

Oscar becomes overstimulated and fatigues quickly.  His behaviour deteriorates quickly when he isn’t wearing his glasses.  He has a lot of sensory issues and aversions.  He lacks empathy and has a blank personality.  Dr Nick was advised that Oscar is under investigation for Autism, OCD and ADHD.

When Oscar was a baby, he experienced delays with developmental milestones.  He never crawled and walked at eight months.  He refused to eat until he was 18 months and while he is eating better now, his BMI is in the bottom 10% for his age.  Oscar is a very active child.

Behavioural Optometrist findings

Dr Nick carried out a clinical examination of Oscar and found him able to carry out all age-appropriate tasks, focus on tasks and respond well to instructions.

Oscar has a poor ability to converge his eyes and compensates by over focusing. This is called Convergence Insufficiency.  The eyestrain from this will cause him to rub his eyes after short periods of visual concentration.

The high level of stress in his focussing system will cause transient blur on visual targets at any distance and eyestrain when he visually concentrates.

His eyestrain is so great that it also causes his vision to blur and the words to move around when he concentrates on them.  Oscar feels he needs to constantly move and adjust his posture when he reads to counter the movement he sees on the page.  This movement makes his image appear more stable.

Oscar has poor tracking, and this explains why he frequently loses his place when he reads unless he uses a cardboard cut-out as a guide.

His frequent loss of place when reading causes delays in the speed with which visual information is reaching his visual cortex.  This minimises the time available to process visual information leading to other observed symptoms such as difficulty in pronouncing longer words.

Poor ocular coordination causes extreme head tilts when he is visually concentrating which are often used to hide one eye behind his nose so that he avoids the confusion of needing to put two images together.  Unfortunately, this makes the image much more unstable, and his depth perception is diminished when he loses binocularity.

Dr Nick confirmed the previous diagnosis of abnormal colour vision, notably red/green vision deficiency.

Recommendations

Dr Nick has designed lenses for Oscar to wear all the time for general purpose.  This is to improve his ocular co-ordination skills, particularly his ability to converge his eyes.  This will allow a more relaxed visual posture and a smoother flow of visual information from his eyes to the brain.

During the examination, Oscar trialled the binocular vision correction, he demonstrated improved reading.  When the Irlen lenses were trialled, they made the print appear smaller both with and without the correction.

Dr Nick has added a digital coating to the correction which will enhance the results of the lens.  This coating blocks reflections and higher wavelength blue light.  This is useful with children who are very active and are overstimulated easily.

Even though Oscar has excellent distance vision without correction, his new lenses will alter his spatial awareness and force him to pay more attention to his visual world.  As he reconstructs his perception of his visual world, it will become more stable, and his clumsiness will reduce.

First follow-up session

In six months, Oscar has made some positive progress.  He is performing better at school having caught up with literacy and he is now ahead of his peers in Maths and Science.

Oscar says “I want to wear my glasses all the time, even on the cricket field at lunchtime.  I can see so much better than I could before.’

On examination, Dr Nick found a measurable improvement in tracking and depth perception (stereopsis).  These measurements are in alignment with the improved function demonstrated in the classroom and in his sport.

His spectacle correction was unchanged.

Dr Nick recommended Oscar to be reviewed in 12 months.

Visually related learning difficulties commonly present in children with binocular vision anomalies, such as Convergence Insufficiency.  Dr Nick often finds his patients improve their reading speed, fluency and comprehension when the visual stress from Convergence Insufficiency is relieved.

Is your child having learning difficulties?  Call Dr Nick on 4369 8169.

*The patients name has changed to protect their identity.

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