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Children and Accommodative Dysfunction

Accommodative dysfunction is an often-overlooked functional vision problem that makes classroom learning difficult and interferes with performance in school. When parents contact us they often wonder how their child could have a vision problem that interferes with learning when their family optometrist or school screening did not detect anything wrong with the child’s eyesight.

We understand that, as a parent or carer, you rely on professionals to diagnose problems and advise you on the best course of action for your child. But the optometrist that examined your child is probably not trained in behavioural/developmental optometry, functional vision care, or vision therapy. Their job is primarily to check for eye health and prescribe glasses if needed.

The visual system is complex and routine vision screening do not mimic the classroom environment. To do their work and follow lessons in a classroom setting, students must sustain visual focus over extended periods of time and shift focus from one place to another throughout the day.

If your child sees the board clearly and sees the paper on their desk clearly, they may pass a typical screening with 20/20 eyesight. But everyday classroom tasks require vision skills beyond a quick glance at an eye chart. In order to complete their schoolwork, a child has to maintain focus on their books or papers long enough to read paragraphs and pages of text. And while in the classroom, students have to focus on the board long enough to follow the lesson and look back and forth between the board and their paper to copy notes.

Weak accommodative facility refers to difficulty with visual focus. In normal healthy vision, a child can sustain visual focus for an extended period and shift focus as needed from near to far and back again. If our visual system is functioning as it should, we don’t even think about maintaining focus or focusing our eyes as we move them. Focusing happens automatically and almost instantaneously without much effort.

But what happens automatically for most of us takes strained effort in someone with accommodative dysfunction. The ‘focusing’ (ciliary) muscle must expand and contract efficiently to change the shape or curvature of the lense as needed to see clearly.

If your child is struggling with accommodative facility, the focus mechanism in their visual system is either not fully developed or has been weakened. While reading, their eyes may lose focus overtime, causing the text to become blurry. If so, they will have to strain to regain focus again and again, leading to fatigue and frustration. While copying from the board or from a book to a page, the focus adjustment period is slower than normal, which is also frustrating.

Signs or symptoms of Accommodative Dysfunction include:

* Complaining of blurred or fuzzy vision, especially towards the end of the day
* Rubbing, squinting eyes, or closing eyes whilst reading
* Missing more questions at the end of a test
* Copying from the board slowly or with lots of mistakes
* Poor attention span, fidgeting, and behaviours often mistaken for ADD/ADHD
* Bending close or bobbing and tilting head while reading
* Headaches or aching eyes
* Avoiding reading or near work, especially with small print 

If you suspect your child might have trouble with visual focusing, schedule a full vision assessment with a trained behavioural/ Developmental optometrist right away. If diagnosed, vision therapy treatment can result in significant improvement in a relatively short period of time.