Focusing Problems
(Accommodative Problems)

What is a focusing problem?
It is not enough to have 20/20 vision or be able to see the board or a book clearly. Vision is a dynamic function and in order to see properly, we have to change the focus of our eyes every time we look from one object to another. Most people are not even aware we have to focus our eyes because the eye’s focusing system operates so well, objects always appear in focus.

However, in reality, a focusing adjustment is made every time we look from one place to another. This adjustment is made with the help of a muscle in the eye called the ciliary or focusing muscle. When a child looks from the board back to his desk, for instance, he must constrict or contract this muscle, which changes the shape of the lens in the eye and allows the child to see the print in his book clearly. When the child wants to look back to the board, he must relax the focusing muscle which permits clear vision at a distance.

A focusing problem occurs when the child is unable to quickly and accurately constrict or relax the focusing muscle, or if the child is unable to maintain this muscle contraction for adequate periods of time.

What types of focusing problems can occur?
Three types of focusing problems can occur in children and young adults. A common problem occurs when an individual loses the ability to contract the focusing muscle for adequate periods of time. This is called a focusing or accommodative insufficiency.

A second problem occurs when the focusing muscle actually goes into a muscle spasm. This is referred to as a focusing or accommodative spasm.

The final type of focusing disorder occurs when the child has difficulty with both contraction and relaxation of the muscle. This is referred to as focusing or accommodative inflexibility.

How common are focusing problems?
Approximately five to ten percent of children and young adults have focusing problems, which are significant enough to cause some of the complaints described below.

What are problems and symptoms associated with focusing issues?
People with focusing problems may complain of the following:

• Eyestrain after reading for a short period of time
• Headaches after reading for a short period of time
• Inability to concentrate when reading
• Short attention span
• Rubbing or closing an eye
• Words moving or swimming on the page
• Good decoding skills, but poor comprehension

Focusing problems resulting in these symptoms actually have more impact on learning than vision problems causing a lack of clarity. Unfortunately, most school vision screenings are only designed to detect vision problems, which cause a lack of clarity. Very few school screenings even test for focusing disorders.

How are focusing problems treated?
There are currently two methods used to treat focusing problems. Sometimes eyeglasses alone can be prescribed to provide relief from the complaints associated with focusing problems. These glasses are usually prescribed for just reading and must be removed for seeing the board. With very young children, who have trouble removing and putting glasses on multiple times throughout the day, bifocals can be prescribed. A bifocal allows the child to wear glasses at all times while in school.

Often eyeglasses alone are not sufficient to completely solve focusing problems. Although glasses may provide some relief, the focusing problems symptoms may persist and another form of treatment must be used. This is referred to as VISION THERAPY. 

Vision therapy is a treatment approach, which involves weekly office visits. During these visits, carefully selected and sequenced activities are practiced by the patient. This treatment restores normal coordination, flexibility and function to the focusing system and leads to improvement of symptoms. The success of vision therapy has been well documented in scientific literature.

What Are The Problems And Symptoms Associated With Tracking Problems?
People that have tracking problems may complain of the following:

• frequent loss of place when reading
• skipping lines
• trouble copying from the board
• need to use a finger or guide when reading
• normal decoding skills but poor  reading comprehension
• a short attention span.

Tracking problems which result in such symptoms actually have more impact on learning than do vision problems which cause a lack of clarity.  Unfortunately, most school vision screenings are only designed to detect vision problems which cause a lack of clarity.  Very few school screenings even test for tracking disorders.

How Are Tracking Problems Treated?
Because eye movement problems are unrelated to the optics of the eyes, the use of eyeglasses is not an effective treatment approach.  Rather, a treatment approach called Vision Therapy must be used to treat eye movement disorders. 

Vision therapy is a treatment approach which involves weekly office visits.  During these office visits carefully sequenced activities are practiced by the patient.  This treatment is designed to develop accurate and efficient eye movements.

The success of vision therapy has been well documented in the scientific literature.

07.29.2010