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This GUIDE and CHECKLIST has been prepared to assist all school personnel and consulting clinicians in making reliable observations of children's visual behavior that could be interfering with academic progress. It is most important for all concerned with children's school success to recognize that nearly all the visual problems that deter children will NOT be uncovered by the Snellen Chart, nor by most stereoscopic devices. These devices are important when properly used and interpreted, but their value lies in identifying those children who have already progressed so far into difficulty that they are now victims of "eyesight problems". Numerous studies have shown that "poor eyes" are very minimally correlated with
"poor grades".

Therefore, it is essential that all who read and use this Guide and Checklist recognize the significant difference between the terms "sight" and "vision". Sight is the mere ability to see, and the eye's responses to light shining into it. Vision is the result of the child's ability to interpret and understand the information that comes to him through his eyes. Many children can demonstrate 20/20 sight, and still have a critical and interfering vision problem!

It has also been shown that the informed teacher and school nurse make the very best "screening instruments" for identifying those vision problems that tend to cancel the teacher's efforts in the classroom. The areas of visual performance demanded in the classroom are described in this folder. The checklist related to these perform
ance areas will assist school personnel, and/or vision consultants, to make more critical observations and judgments of vision difficulties. These observations and difficulties can then be utilized to identify the children who need emphasis on readiness programs and/or referral for individual and complete clinical vision care BEFORE the basic problem becomes a complexity of major problems.

This material is based upon many years of clinical and classroom studies by educators and optometrists. It is presented with the hope that those children described as "smart in everything but school" can be identified early enough that they may become "smart in school" too.

(Ocular Motility)
See 3 A. on Educator's Checklist

Problems that a child may be having in this area of visual performance will most likely be observed while he is occupied with workbooks, reading, and other near-point tasks. If it is a readiness problem (lack of preparatory experience), improvements should be noted in a week or two. These improvements should come about if the child is given added opportunities to acquire general and special action skills, as well as visual and developmental experiences that can be provided by available classroom programs.

This is the skill of speed and control of visual inspection, and scanning of materials presented by the teacher, so the greatest amount of information may be obtained by the child with the least time and effort. If eye movements are slow, clumsy, or incoordinate -- if the eyes jump, miss, "stutter" or lose their place on all instructional materials -- the amount of information obtained by the child will be reduced.

If the child's problem is clinical in nature, he needs immediate referral for visual care. If such is the case, the observable difficulties and confusions will become more
obvious whenever the child must stay with a particular "paper" task for any length of time. Visually demanding materials will be avoided; there will be an increase in head turning while reading; attention span on visual materials will shorten, but will increase in fatigue and restlessness in all types of continued visual activities at his desk.

See 3 B. on Educator's Checklist

The human sight system is designed so the paired eyes and all their reciprocating muscles can work to such a high degree of "teaming" that the two eyes perform like
one. However this teaming is not guaranteed by the design! Teaming skill must be acquired by the child in the preschool years. If for any reason a child does not gain the skill and unity of full eye teaming, this deficiency can become a great deterrent to all judgments of spatial orientation, relationships, depth perception, and --more important - the immediacy and accuracy of clear, single vision for almost every object or symbol in the usual classroom program.

If a problem exists in this area of visual performance, the child's general clumsiness in classroom and on playground may be most significant. His squinting, blinking and extreme postures, and his poorer than expected pencil or crayon work, will also attract the teacher's attention.

If the problem here is due to inadequate readiness, improvements should be noted by the end of the first month of school. The first improvements will show in pencil and paper work with less tension. If the teacher feels there is some improvement, she can give considerable help to the child by instituting some of the simple eye movement exercises detailed in current educational literature.

The clinical problem will be quite obvious with decrease in competencies in all near-point, visually demanding tasks. The child may begin to fall behind the group in spite of his apparent potential; he may begin to show a preference and increased skill in "listening" activities; or lose interest altogether. This child MUST be referred as quickly as possible for a very thorough vision analysis. This examination MUST be complete enough to fully investigate this area of performance. A mere duplication of the tests already completed by the nurse will NOT uncover all of the problems here. This type of clinical problem can so influence the essential, primary academic skills that the student's entire school career may be jeopardized.

 See 3 C. on Educator's Checklist


This ability and any proficiency a child may attain in this area of performance is dependent upon the use, practice and integration of the eyes and the hands as paired learning tools. Out of this practice emerges the ability to make visual discriminations of the size, shape, texture and location of objects. Then the skill and accuracy of the eye-hand integrations, in producing drawn and written symbols, is developmentally essential and prepatory to the visual interpretations of the words and numbers appearing in workbooks and texts.

Any difficulties in this area of visual performance will especially be noted in the child's dependency upon his hand for inspection and exploration of materials. Further, his paperwork will probably show extreme lack of orientation on the page; and his inability to stay within the lines while coloring will be most evident.

If the problem here is a question of readiness, improvement can frequently be noted in the same class session as the child more fully understands the task before him. Gross tasks are done well, the difficulties being noted mostly in the more specialized tasks. Chalkboard work is more acceptable (form, continuity, neatness) than paper-work, and repetitions show improvement.

If the problem is more severe, needing clinical attention, the indications of an interfering vision problem will not diminish. Time and repetition of the classroom activities will not bring the expected improvements. This type of clinical problem can eventuate into a very severe perceptual problem, which in turn can produce expressive disorders in later grades. A most careful examination is indicated, and neither teacher nor parent should accept a report from an examiner, limited to the statement, "His eyes are healthy and he has 20/20 vision".

(Visual Comparison, Visual Imagery, Visualization)
See 3 D. on Educator's Checklist

The child's first symbols are images and pictures which allow him to mentally hold fleeting reality. This skill of visual imagery allows the child to relate his primary experiences to the pictures and words he sees on the printed pages of all his classroom books. Skillful action in the previous three areas provide perceptual information that permits the translation of object size, shape, texture, location, distance and solidity into understood pictures and words. Visual form perception is a derived skill -- not a separate and independent ability. Its ultimate purpose is the immediate and accurate discrimination of visible likenesses and differences, so comprehension can be immediately followed by appropriate actions.

Frequently a problem here is blamed upon "a poor memory" or "carelessness about detaiIs". 
The most common sign the teacher can observe is the confusion of similarities, or the inattention to the slight differences that really count. The next most common sign is the reversals of letter forms and/or letter sequences in words that are not phonetically specific.

If the problem is due to a lack of experience (readiness), the child will demonstrate almost immediate improvement in discrimination of symbols when he is given the opportunity to use pencil or crayon to draw it out for reinforcement and clarification. He is probably progressing as he should, if he erases frequently in trying to make his paperwork "look more like it should". Further, he is developing skill in this area if his writing and drawings become neater and more acceptable after a few repetitions.

In contrast, there is need for clinical assistance if the full use of hands in pencil or crayon work does not produce observable improvement in just a few trials. Concern should be expressed if all paper work continues to be sloppy and erratic, with simple forms distorted and incorrect. Referral must be made if the child becomes too quickly discouraged and upset by his lack of ability to "make good pictures".

SPECIAL NOTE: Understandably, the kindergartener and beginning first grader may not be expected to demonstrate a high degree of skill in this area; but if he is obviously poorer than his group, he will need special attention. If perceptual form ability is not reasonably well acquired by second grade, this lack of skill can become a hindrance in all academic areas, particularly in spelling and writing. It is imperative to state here that all form perception training must be done in the basic underlying processes of ocular motilities and eye-hand coordination, rather than in repetitive practice on the symbols and forms themselves.

(Nearsightedness, Farsightedness, Focus Problems, etc.)
See 3 E. on Educator's Checklist

This is more than a skill area; like Visual Form Perception it is generally the end result of inadequacies in the other areas of visual performance. The resulting distortions, or inadequacies, in visual performance can alter the visual information signals which the child must match and compare with auditory and tactual signals every moment of every class day Such distortions can greatly hinder the child's comprehension processes. In fact, some of the distortions can so
completely override the auditory and tactual signals that comprehension will be entirely voided.

The most obvious signs here are the child's avoidance of as much desk activity and workbooks as he can manage. The teacher should also be alert for the appearances or complaints itemized in sections 1 and 2 of the Educator's Checklist.

There is no differentiation possible between a readiness or a clinical problem here. These are all vision problems needing immediate clinical attention. Prolonged delay of professional vision care can reduce school achievement as the child avoids further discomfort by avoiding more and more school work. Or, he can sacrifice visual abilities by making an adaptive increase in any refractive distortions he might have, to maintain achievement. In either case, he suffers the consequences.
A thorough visual analysis must be obtained even though the child may
demonstrate 20/20 on Snellen charts.


If this material was designed with any group in mind, it would apply especially to those children who enter first grade with high readiness scores, do well in the first two or three grades, and then collapse academically in the fourth or fifth grade. Since the earlier grades are usually less visually demanding than are the later ones, visual performance deficiencies may slip by unnoticed in the brighter children. It is sincerely hoped that this material will assist all school personnel, and others who are likewise deeply concerned with children, to observe and obviate beginning patterns of academic failure long before they become manifest and entrenched.

The Educator's Checklist may be used, however, for any student in any grade. It may even be useful for some of those in later grades who consistently fail to achieve at or near their individual capabilities.

Granting the teacher's very busy schedule, it would be well if each pupil who comes within her purview be kept under casual observation as she goes about her daily teaching tasks. Satisfied that these danger signals do not apply to a portion of her group, she can then concentrate her observations upon those whom she suspects do fall into the category of visual difficulties. The rest of the group should not be completely ignored from that time on, however, since many of these signs can develop as the stress of the school year increases.

Additional copies of this guide and checklist should be obtained for everyone concerned with a child's academic progress or problems. One copy of the teacher's observations can be placed in the child's school record for comparison with later observations. One copy of the checklist should be sent home with the child for the parent's information. This copy should also accompany the child to the vision specialist so he will know what the teacher has already noted in the classroom.
Additional copies of this guide or of the checklist may be obtained from:

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

Optometric Extension Program Foundation, Inc.
2912 South Daimler Street
Santa Ana, California 92705-5811
(714) 250-8070

(A nonprofit foundation for education and research in Vision)
Prepared By: Section on Children's Vision Care and Guidance
ADAPTED FROM: The Primary Visual Abilities Essential to Academic Achievement
Copyright.  Optometric Extension Program 1985  B201




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