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EDUCATOR'S CHECKLIST
             OBSERVABLE CLUES TO
         CLASSROOM VISION PROBLEMS


Student's Name ______________       Date__________

1 .  APPEARANCE OF EYES:

   
       One eye turns in or out at any time  ______
          
Reddened eyes or lids ______
        
  Eyes tear excessively  ______
          
Encrusted eyelids  ______
          
Frequent styes on lids  ______

2.  COMPLAINTS WHEN USING EYES AT DESK:

           H
eadaches in forehead or temples ______
          
Burning or itching after reading or desk work  ______
          
Nausea or dizziness ______
          
Print blurs after reading a short time ______

3.  BEHAVIORAL SIGNS OF VISUAL PROBLEMS:

     A.  Eye Movement Abilities

          (Ocular Motility)
          H
ead turns as reads across page ______
         
Loses place often during reading ______
         
Needs finger or marker to keep place ______
         
Displays short attention span in reading or copying ______
         
Too frequently omits words ______
         
Repeatedly omits "small" words ______
         
Writes up or down hill on paper ______
         
Rereads or skips lines unknowingly ______
         
Orients drawings poorly on page ______

   B.   Eye Teaming Abilities
          (Binocularity)

         C
omplains of seeing double (diplopia) ______
         
Repeats letters within words
______
         
Omits letters, numbers or phrases ______
         
Misaligns digits in number columns
______
         
Squints, closes or covers one eye ______
     
    Tilts head extremely while working at desk ______
         
Consistently shows gross postural deviations at all desk activities ______

   C.   Eye-Hand Coordination Abilities

          M
ust feel of things to assist in any interpretation required ______
         
Eyes not used to "steer" hand movements (extreme lack of orientation,
          placement of words or drawings on page)       ______
         
Writes crookedly, poorly spaced: cannot stay on ruled lines ______
         
Misaligns both horizontal and vertical series of numbers ______
         
Uses his hand or fingers to keep his place on the page ______
         
Uses other hand as "spacer" to control spacing and alignment on page ______
         
Repeatedly confuses left-right directions ______


D.     Visual Form Perception
         (Visual Comparison, Visual Imagery, Visualization)

    
    Mistakes words with same or similar beginnings ______
        
Fails to recognize same word in next sentence ______
        
Reverses letters and/or words in writing and copying ______
        
Confuses likenesses and minor differences ______
        
Confuses same word in same sentence ______
        
Repeatedly confuses similar beginnings and endings of words ______
        
Fails to visualize what is read either silently or orally ______
        
Whispers to self for reinforcement while reading silently ______
         R
eturns to "drawing with fingers" to decide likes and differences ______

E.    Refractive Status
        (Nearsightedness, Farsightedness, Focus Problems, etc.)

        C
omprehension reduces as reading continued; loses interest too quickly ______
       
Mispronounces similar words as continues reading ______
       
Blinks excessively at desk tasks and/or reading; not elsewhere ______
       
Holds book too closely; face too close to desk surface ______
     
  Avoids all possible near-centered tasks ______
       
Complains of discomfort in tasks that demand visual interpretation ______
       
Closes or covers one eye when reading or doing desk work ______
       
Makes errors in copying from chalkboard to paper on desk ______
       
Makes errors in copying from reference book to notebook ______
       
Squints to see chalkboard, or requests to move nearer ______
       
Rubs eyes during or after short periods of visual activity ______
       
Fatigues easily; blinks to make chalkboard clear up after desk task ______


        OBSERVER'S SUGGESTIONS:

 

 

Signed (Print) ________________________________________
(Encircle) Teacher, Nurse, Remedial Teacher, Psychologist, Vision Consultant, Other
Phone __________________________________________________________
Address_______________________________________________________

Copyright 1985 by
Optometric Extension Program Foundation, Inc.
2912 South Daimler, Santa Ana, CA 92705-5811
- B -

I'd like to say a special thanks to the Optometric Extension Program Foundation, Inc.
for allowing us to use the materials for "Educator's Guide to Classroom Vision Problems"
as well as the "Educator's Checklist."

 

 

 

 

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