By Eyecare NG

Definition   |  Types   |   Diagnosis   |   Treatment 

The link between vision and learning is widely documented.  In our Help Children Learn Material, we outlined some facts, including the following:

  • 60% of children with learning difficulties have an undetected eye problem.
  • About 80% of what children learn in school is based on what they see with their eyes
  • Children learn best when concepts are presented to them visually. Therefore, good eyesight (vision) is essential for learning and development.
  • Children with uncorrected eye problems encounter difficulties with learning and these could be serious enough to cause low grades and poor performance.

What are learning related vision problems?

Learning-related vision problems are vision problems that have the potential to affect learning. They occur due to deficiencies in how and what the eye sees, how visual information from the eyes are processed in the brain and how the visual centre in the brain coordinate with other parts of the body.  There are 3 categories of learning-related vision problems namely:

  • Refractive
  • Functional
  • Perceptual


Refractive vision problems

These are refractive errors; that is, optical defects in the eyes that prevent light rays from focusing exactly on the retina. They arise due to abnormalities in the curvature or length of the eyes and may result in blurry vision while looking at far objects ( myopia or short-sightedness), blurry vision while looking at near objects  (hyperopia or long-sightedness) or blurry/ distorted vision at all distances (astigmatism). Learn more about refractive errors.

Signs and symptoms of refractive vision problems

  • Blurry vision
  • Headaches
  • Brow ache
  • Head tilt
  • Fatigue
  • Pain
  • Tearing

Refractive errors are corrected with lenses (glasses or contact lenses). If not diagnosed and corrected, refractive errors can affect learning. A child who has difficulty seeing prints on reading materials or images on the classroom board clearly may have problems with reading, writing and comprehension.

Functional vision problems

These are problems that arise when the eyes have difficulties performing its specific functions or when these functions are not properly coordinated in the brain. When the eyes are unable to perform its functions like looking steadily at an object for as long as necessary (eye focusing), working together as a team to ensure binocular vision (eye teaming) or changing focus from one object to another / following a moving object with the eyes (eye tracking), problems such as double vision, blurred vision, poor depth perception, headaches and eye strain may be experienced. All of these symptoms can affect learning.

Signs and symptoms of functional vision problems

  • Blurred vision
  • Headaches while performing visual tasks
  • Double vision
  • Fatigue
  • Letters appearing to move, jump or overlap
  • Closing of one eye while reading or focusing on an object
  • Head tilt
  • Skipping lines when reading
  • Omitting words or losing place while reading
  • Using finger to point at words while reading.
  • Moving head excessively while reading or copying from the board

Perceptual vision problems

Visual perception is the ability of the brain to make sense of what the eyes see. It involves gathering visual information from the environment and integrating it with other senses to understand what is being seen or experienced.

Perceptual vision problems arise when the brain has problems processing or interpreting what is seen or when there is a dysfunction in the coordination of visual skills with other skills in the brain.

Having difficulties with recalling information, organizing information, locating specific objects in the midst of other objects or recognizing objects that have been seen before have a significant negative impact on learning as it affects reading, writing and comprehension. Problems like poor eye-hand coordination and poor eye-body coordination affect the performance of activities that require movements of the hands and other parts of the body such as writing, drawing and sports.

Signs and symptoms of perceptual vision problems

  • Difficulty completing puzzles
  • Difficulty responding appropriately to activities outside the direct line of gaze.
  • Difficulty differentiating between letters like b, d, p, q
  • Reversing letters and numbers when writing
  • Losing place on a page when reading
  • Difficulty differentiating between left and right
  • Difficulty remembering sequence of alphabets
  • Problem matching shoes and socks
  • Difficulty completing partially drawn pictures.
  • Sloppy handwriting and poor drawing skills
  • Poor spelling and challenges matching sounds with letters
  • Slow reading speed
  • Rotating body when writing and copying
  • Mistaking words with similar beginning
  • Short attention span


Examination and diagnosis of learning-related vision problems just like any other vision problem start with a detailed case history. This helps the eye doctor obtain a better insight into the likely problems the child may have and also guides the decision on the tests that should be performed.

Usually, for learning-related vision problems, a visual efficiency assessment is done. This includes all standard eye tests as well as tests that assess visual skills for learning. These tests include:

  • Visual acuity test to determine how well one sees using age-appropriate visual acuity charts.
  • Refraction to detect and measure refractive errors (if any).
  • Ocular motility test to determine how well the muscles of the eyes and their nerve supplies work.
  • Binocular vision assessment to determine how well the two eyes work together. These also include tests that assess functional vision.
  • Physical examination of the internal and external structures of the eyes for the presence or absence of diseases.
  • Visual perception tests that determine if there are disorders that affect the processing and interpretation of visual information as well as the integration of visual skills with other skills.

Learn more about comprehensive eye examination and its procedures.

Visual efficiency assessment may need multidisciplinary collaboration among different professionals including eye care practitioners, psychologists and occupational therapists.

Treatment and management 

Refractive vision problems

Eyeglasses are used prescribed for correction of refractive errors.  Contact lenses may also be given to children who are old enough the handle them if necessary. Small degrees of refractive error, especially hyperopia, astigmatism and anisometropia may need to be corrected if they interfere with learning and development.

Functional vision problems

Eyeglasses or contact lenses, prisms, vision therapy and a combination of these can be employed in the management and treatment of problems like amblyopia, squint and other binocular vision anomalies. Vision therapy is effective in the treatment of ocular motility problems and binocular vision anomalies.

Perceptual vision problems

The management of perceptual vision problems is targeted at treating or managing the identified deficits.

Some perception vision problems may be corrected with lenses and prisms. In some cases, vision therapy and educational cues may be employed. These may involve the use of adaptive tools and assistive technology. It may also involve teaching the child how to approach problems so as to reduce frustration, increase self-confidence and improve performance at school. Examples include:

  • The use of visual cues like coloured dots or stickers to help a child identify the side of a page he or she looking at
  • Use of reading guides and materials with directional arrows
  • Use of timers to pace a child
  • Use of graph paper to help with word spacing and sizing.
  • Highlighting lines to encourage correct line alignment while writing.
  • Eliminating clusters and clutter to keep the desks clear and avoid distractions
  • Keeping worksheets clear and simple and avoiding unnecessary decorations on books
  • Breaking visual tasks into simple steps
  • Outlining boundaries by using markers to enable the child to identify boundaries for colouring, mazes and cutting tasks.