“Your child has 20/20 vision” is often a statement that many are excited to hear. Yes, that’s great news… but have you ever wondered what 20/20 is? And what exactly does “perfect vision" mean? How does that affect school performance?
There is nothing I get more passionate about and excited to share than the ins and outs of how the visual system plays a role in our school-aged children. It is an area of development that is so important, yet so heavily overlooked. Having practiced as a Vision Therapist and currently practicing as a School-Based Occupational Therapy Assistant, here are some of my thoughts on vision in our kiddos and how we can help to facilitate and develop healthy visual learning.
According to the American Optometric Association, up to 80% of a child’s learning in school is through vision! Let’s take a look at some of the main visual skills we require our children to use while learning.
- Fixation: The ability to fixate or hold gaze on a specific target for an extended duration, such as looking at something the teacher is pointing to on the board.
- Pursuit: The ability to follow a target in motion as you would follow a ball during a PE activity.
- Saccade: The ability to shift focus between targets like when reading a sentence and being able to look from word to word as you read.
- Accommodation: The ability to shift focus between targets. This includes looking from the board to the paper on a desk when taking notes.
- Binocularity: Using both eyes together because without our eyes working together, we could not perceive depth.
From my experience, often times, limitations or challenges in these visual areas can manifest in children in ways that seem as if they are inattentive, fatigued, or have poor postural control. They are often rubbing their eyes or closing one eye and their performance doesn’t match their potential. Their writing may also appear messy even though they do not have any physical fine motor limitations.
Some important ways we can help our children succeed visually include making sure that their visual environment is ideal. Start with proper seated posture (90-90-90 rule 90 degrees at the hips, knees, foot) and Harmon Distance. Research suggests a 20 degree tilt is the ideal visual angle to receive input. A slant board is great to help with this – or a DIY 3 inch binder works like a slant board as well! This also helps eliminate peripheral distractions. Lastly, making sure to avoid hairstyles that block the eyes.
There are also so many fun ways visual stimulation can be incorporated into activities both at school and at home. Some of my favorite activities include:
- Flashlight Tag: This one I love doing with my own toddler at home - we each have a flashlight and take turns shining the light on objects up on our wall. This requires so many of the vital visual skills, plus it’s fun and reinforcing for the lils! Doing this in the classroom will also help kids develop their vision because it requires a lot of visual skill to accurately aim the flashlight on a distant target. You can also play “tag” by putting two different colored filters or cellophane on each of the flashlights and have your child “chase” your light.
- Alphabet Ball: Blow up a beachball and use permanent markers to draw or write letters, animals, or colors on it. As you roll or toss the ball, have the child call out what the last thing they saw on the ball was before they catch it. Again, such a fun activity to work on fixation, pursuits, binocularity, etc!
- Near-Far tasks: Tasks/activities that require alternating between near and far objects are great practice for what our children will have to do a lot in schools. Even with my almost 2 year old, I will set up activities that require her to do something near-point like color a shape. Then I’ll have her look up at the wall to look at the “sample” picture in order to figure out what color to use next. This motion of looking from near point to far point will help develop their accommodation skills.
- Obstacle Courses: I LOVE obstacle courses! We turn anything and everything into an obstacle in our home. Searching for a puzzle piece in our rice bin, climbing over the couch, through a tunnel, over a table, and placing the puzzle piece into the puzzle – all of the visual planning and skills that are required to successfully maneuver through an obstacle is amazing!
- *Pro Tip: Whenever you are doing an activity with your child, you can always add a visual stimulation element to it by having them fixate, track, or pursuit an object you are using in the task (i.e., during a coloring task have them find the crayon they want to use, then you can take that crayon and slowly move it in figure 8’s, horizontal, vertical, and circular motions in front of them while having them follow it with their eyes or follow it with their eyes and while pointing at it – moving their finger along with the moving object will help them fixate more accurately).
In answering the initially posed questions, 20/20 means the child is able to see the “20” sized line at a distance of “20”ft which is considered clear sight. What 20/20 doesn’t tell us is all of what was discussed above – can the child fixate, pursuit, make saccadic movements, shift focus accurately, and use their eyes together? I see it as the difference between SIGHT vs. VISION. Sight will tell us how clearly our children can see, but vision tells us more of what they understand. Pediatrician offices and school vision tests generally only do the 20/20 screening, so it is important for us to be vigilant as parents and make sure to get comprehensive eye exams done on our children starting at about 6 months of age to assess their vision!
Lina Awshee, COTA/L, COVT, is a Certified Occupational Therapy Assistant practicing in a School-Based. Prior to becoming a COTA/L, Lina practiced as a Certified Optometric Vision Therapist for 8+ years in the pediatric setting. She is now a mother to her almost 2 year old toddler and enjoys finding ways to incorporate developmental skills into fun, everyday play activities.