Year 1 Student with Stalled Reading

Thomas* is a bright, enthusiastic boy but when it comes to reading, he is fidgety and anxious.  9 months into Year 1, his reading has stalled at the same level as when he finished Kindergarten.

Physically, both his mother and teacher notice Thomas will squint when reading, as well as change his posture, often tilting his head or moving closer to the page.  They also notice he will use his finger to hold his place on the page.  Thomas complains of blurring after reading or writing and would come home from school tired, often needing a sleep.

Thomas’s reading is slow, he needs a lot of support with unfamiliar words and when reading out loud will stretch out words.  He confuses words with similar beginnings and endings and then will have difficulty recognising these same words on subsequent pages.  He has a poor ability to sustain attention when completing fine detail tasks and rubs his eyes frequently after visual activity.

Thomas was prescribed reading glasses by another optometrist.  The glasses have improved his ability to see the classroom board, but there has not been any improvement to his headaches while reading.

Behavioural Optometrist findings

After a thorough clinical examination with Dr Nick, Thomas was able to carry out all age-appropriate tasks, focus and respond well to instructions.

However, Dr Nick found three areas of concern for Thomas –

  • Thomas under focuses when reading which explains his blurry vision and headaches. This can lead to eyestrain and will limit his reading time.
  • Thomas has poor tracking (following the words on the page while reading) which explains why he loses his place and needs to use his finger as a guide.
  • Testing also uncovered Thomas over converges his eyes. This affects the ability of his two eyes to point to an intended position in space.  This is why he brings the page closer, especially with fine print.

Recommendations

Thomas has Accommodative Insufficiency – also known as a focusing weakness.

The excessive effort for Thomas to read was reducing his maximum reading time, delaying the speed with which visual information was reaching his visual cortex and leading to difficulties with visual information processing skills.

Dr Nick designed a different lens configuration in his glasses to improve his ocular co-ordination skills, particularly his ability to focus on near work.  This will allow for a more relaxed visual posture and a smoother flow of visual information from the eyes to the brain.

First follow-up session

In two months of wearing the glasses prescribed by Dr Nick, Thomas’ mother, reports a big improvement in his ability to read for a longer period, less stumbling over harder words, as well as a new confidence to read in front of the class.  Thomas’ reading posture is improved and his reading distance has been pushed back to a normal distance.  There is a reduction in the number of his headache symptoms, and Mum does not see dark circles under his eyes since wearing the glasses.

Thomas’ teacher has never seen a child improve their reading as much in such a short period of time.

Thomas’ mother could not believe the change in his enthusiasm for reading, ‘He now wants to read all the time’.

Dr Nick assessed Thomas and found an improvement in his vergences and word tracking, but other baselines remain unchanged.  He recommended Thomas continue to wear the glasses and follow up in 6 months.

Second follow-up session

Thomas is wearing his glasses more often and does not need to be reminded to put them on.  Reading level has improved to just below average level for age.  He is getting extra help with literacy, numeracy, and attending extra reading groups.

His teacher continues to see his confidence grow.  He is not afraid to speak up in class, reads in front of the class, puts his hand up and show his work to the principal.

Dr Nick’s assessment found Thomas with improved depth perception and tracking.  Thomas was given new glasses with a reduced prescription to encourage further development in his visual system.

Thomas will be monitored regularly by Dr Nick to ensure Thomas’ vision continues to make progress.

Does your child display any of these symptoms while reading and learning?  Dr Nick, our behavioural optometrist can assess your child to see if your child is experiencing any visual problems affecting their development.

*All names have been changed to protect the identity of the patient.

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