, A young child runs around in class and is called disruptive, while another student says he doesn't understand what is on the black board. In another class there is some one who avoids reading and home work and prefers to watch TV very close. Frequently, children like these are classified as poor students, disruptive or behavioral problems. While they may be that way, there is also another possibility.

Avoidance behavior is a normal reaction when something hurts us, or we are uncomfortable performing an act. Children are not in a position to know or understand that they may have a visual problem that is causing their discomfort. I usually advise a complete eye exam by an Optometrist that is experienced with children and behavioral vision. Unfortunately, well intended parent may take their children to an eye doctor who is not well versed with these visual conditions and may give a clean bill of health to the child. They may see 20/20, but still do not function well under visual stress.

Asthenopia is a condition that describes visual anomalies relating to the visual system, not just the actual eye sight. There is a difference between vision and eye sight. Sight is simply what we see, while vision incorporates sight with how it is interpreted in the brain. So some one may see well, but not function well visually. As with most conditions a problem won't be found if you don't look for it.

Frequently found problems with the visual system are Accommodative Infacility (focusing irregularities), Exo or Esophorias ( eye turns), Oculomotor Dysfunctions( eye movement irregularities) and Convergence Insufficiency's ( inability to turn the eyes in at near to read). Only a complete evaluation of the visual system can uncover these conditions. The symptoms may include double or blurry vision, head aches, difficulty reading due to an inability to follow the line of words smoothly, and poor eye/hand coordination.

Recent studies on Autistic and Hyperactive children have concluded that they may have these conditions secondary to the medications they take for their disorders. Their vision is often 20/20, but they can not function well because of these anomalies. The first step is to diagnose these conditions and the second is to treat them.

The best treatment modality for these visual disorders is Vision Therapy. VT is a therapeutic method that retrains the visual system to function properly. It most often involves working with an eye doctor 2-3 times per week for a period of several months modifying the treatment on a regular basis. While the different conditions must be worked on separately, they are all inter related. Helping one part of the system will affect another. For example, improving the ability to converge will also strengthen the accommodative system. The eye movement will likewise help the eye converge better. All of these will make eye hand coordination better and thus tracking will also improve.

The bottom line is that if a child or adult complains of visual issues despite seeing 20/20, they should be evaluated for these other conditions. Frequently, something else will be found that will improve the situation. Then a "bad" student may become the next star! My wife is a science teacher and she often will find a student that has been given a clean bill of health by their doctor only to be diagnosed later on with an eye condition just described. In addition, hearing should also be tested.

As practitioners we need to think globally in order to give the best possible eye care to our patients.