Vision Skills in School Occupational Therapy

Have you ever tried doing even a familiar task with your eyes closed? What about trying to find something cluttered in a drawer when you are in a hurry? Vision impacts everything that we do in our daily lives! Now, I know you already knew that.  But, did you know that vision is highly complex and when even one aspect of it is not working properly there can be a significant impact in our students’ ability to learn? As OTs, we treat the whole child.  Thus, this critical area can not be overlooked.  Dr. Mitchell Scheiman is a nationally known optometric educator, lecturer, author and private practitioner who also works closely with occupational therapists in his practice. He stated, “To be maximally effective in their therapy, occupational therapists should understand the complexity and importance of vision and how visual deficits can interfere with occupation” (O'Brien, Kuhaneck, & Ball, 2020).  One major occupation for our kiddos is school!

With this strong statement in mind, I need the attention of all the school OTs out there! You can have an influence in this area. Vision is not outside of our scope of practice.  In the new online course, “Vision 101 for School-based Occupational Therapy Practitioners”(by Jaime Spencer, OT & Robert Constantine, OT), it was reported that 25% of children between the ages of five and seventeen have a vision problem.  That is an astonishing number!  You may ask, what are we looking for to help identify students with vision problems?  Below is a list of red flags that Jaime Spencer mentions in the Vision 101 course.  These should cause us to dig a little deeper.  This student:

  • shows no improvement with visual motor, handwriting, or fine motor skills
  • cannot catch a ball
  • turns head, rubs eyes, &/or blinks excessively during near vision tasks
  • exhibits letter reversals past 2nd grade
  • is often clumsy
  • complains of headaches
  • has difficulty learning to read
  • does not respond to ADHD medication

Furthermore, if a student has never had a formal eye exam, no matter the age or ability, it is vital that this be made a priority.  However, not just any eye examination will work.  Do your research before you make a referral to ensure that the provider, ideally an optometrist, includes three components to their exam: visual integrity, visual information processing, and visual efficiency.  It is so important that underlying vision issues are discovered before the child undergoes specific standardized tests in areas such as visual perception.  In fact, Jaime Spencer stated, “it makes no sense to test visual perception without ensuring that vision is accurate.”  In other words, if there are underlying vision issues, there is a strong likelihood that the visual perception testing will be skewed. As a part of the school team, the school OT can screen and evaluate the following vision areas:

  • eye movement problems
  • binocular vision
  • accommodation
  • visual motor and visual perceptual skills

Following the evaluation, OTs can develop goals and intervention plans, monitor progress, and provide direct intervention to help with any of these identified weak vision areas. This definitely opens the doors for us to make an even greater impact in the lives of our students.  

I certainly hope that this short blog has wet your appetite to learn more about the role that OTs can play in the process of evaluating and treating students with vision difficulties.  This topic is vast and will be one that we are all constantly learning new things. Below are some basic vision definitions to help you to “see” this topic more clearly and a few references & resources to point you in the right direction towards your own journey of learning more about “Vision skills in School Occupational Therapy”. 

Vision Vocabulary:

  • Tracking is the ability to control where we aim our eyes. There are three basic types of eye movements (all very important to reading): 
  • Fixations: ability to hold eyes steady without moving off target 
  • Saccades: the ability of our eyes to make accurate jumps as we change targets 
  • Pursuits: the ability of our eyes to follow a moving target
  • Accommodation: the ability to adjust the focus of the eyes as the distance between the individual and the object changes (looking at desk (near) and then the board (far)
  • Binocular vision: The ability to maintain visual focus on an object with both eyes, creating a single visual image.  Without it, a student has poor depth perception 
  • Convergence: the coordinated inward eye movement that occurs when you look at a nearby object in an effort to focus on it. Without it, the eyes do not work together (may drift outward) for tasks such as reading, writing. 


Vision Resources & References:


Author: Natalie Grooms, OTR/L

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Disclaimer: The information provided in this blog is for general informational purposes only and should not be considered as professional advice. The content is based on the author's personal experiences, research, and opinions. It is always recommended to consult with a qualified professional or expert before making any decisions or taking action based on the information provided in this blog.

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