When her seven-year-old daughter, Zoe, struggled to keep up with school work, Mrs Michelle Clarke scheduled an appointment to have her eyes checked.

The 36-year-old stay-athome mum said: “Zoe was below average in class, and she was having a lot of trouble reading and writing. For instance, she would mix up her ‘b’s and ‘d’s. She did not like to learn at all.

“Her teacher highlighted that she was squinting a lot in class and felt she had some eye problems that were affecting her learning.”

Mention poor grades and, more often than not, learning disorders such as dyslexia and attention deficit disorder come to mind.

But what does your little one’s vision have to do with those persistent Band 3 or 4 scores?

Plenty, it seems. Vision and learning are closely related. For children to reach their full academic potential, good vision is important, said Mr Yap Tiong Peng, a senior consultant optometrist trained in behavioural optometry at Igard Group Singapore. He has 18 years of clinical and research experience.

Behavioural optometrists look at how the eyes and brain function as they process visual information and how that may affect development in children.

Studies showed that nearly half of the children who struggle to read and learn in school complain of vision-related issues, Mr Yap explained.

Optometrist Titus Wu of Titus Eye Care, who has been in practice for nine years, estimated that as many as one in four children he sees in his practice may have learning difficulties linked to their vision woes, which are mostly due to undetected myopia and binocular vision-related issues.

Binocular vision refers to the ability to process information when both eyes work together at the same time.

This is as important as having clear vision in each individual eye, Mr Wu said.

Senior consultant optometrist Rachel Kelly of Igard explained that if your eyes do not coordinate well, for instance, you may have trouble reading or maintaining focus on an object.

Children with such vision woes tend to feel fatigued and have headaches when reading and studying.

They may also skip small words when reading, reread sentences and insert words that do not exist in the text, said Ms Kelly.

She added: “The child may appear inattentive in class, avoid reading and studying, make careless mistakes and have difficulty completing assignments.

“Sometimes, the symptoms show up only intermittently when the child has to read a larger volume of text, especially when running up to the school examinations.”


As such, it is not unusual for parents and teachers to dismiss the child’s complaints as a behavioural issue when he may be struggling with poor vision.

A common misconception parents have is that their kid has perfect vision that allows him to read and write well just because he had aced his cursory eyesight test during school check-ups, said the optometrists.

Mr Wu reckoned that about 15 per cent of children who pass a vision screening test actually have a vision problem that requires intervention.

In Singapore, the Health Promotion Board conducts yearly eye tests for pre-schoolers.

Routine eye checks are also conducted in primary school.

The screening test involves reading off an eye chart from a distance to check for myopia.

Children also undergo threedimensional vision tests to screen for squint and other conditions.

Mr Yap said that while these routine vision screenings pick up refractive errors such as myopia, they may not detect other vision problems that can hinder learning.

Sometimes, the more subtle symptoms may also elude some eye-care professionals using standard eye examinations, he added.

In Zoe’s case, she was found to be suffering from an alignment problem of the eyes, which gave her double vision and affected her ability to focus.

Her optometrist prescribed bifocal spectacles to alleviate some symptoms, and Zoe underwent thrice-weekly vision therapy.

Vision therapy is a set of techniques used by optometrists to improve a person’s vision and the way they process what they see.

Depending on the specific problem, the intervention programme may involve the use of eye exercises and devices such as lenses, prisms and coloured filters.

“The aim of the treatment is to allow the child to gain control of his binocular vision by encouraging the two eyes to work together properly and for the whole visual system to work efficiently,” said Mr Yap, who was part of the team that treated Zoe’s vision problems.

Children who have problems with convergence and accommodation — these help us to see near and far objects clearly without double images — tend to have high success rates using vision therapy, with over 90 per cent seen at Igard resolving their vision problems and symptoms within a few months of therapy, Mr Yap shared.


But Adjunct Associate Professor Audrey Chia, Head & Senior Consultant of the Paediatric Ophthalmology and Adult S​trabismus D​epartment at Singapore National Eye Centre, cautioned: Be sure to have a healthy dose of scepticism before buying into treatment options not backed by strong scientific evidence.

“Some parents seeking a second opinion come into the clinic with a five-page report on what is wrong with their child’s vision.

“But when we examine the child, they do not have any pressing problems,” said Prof Chia, who also heads the eye clinic at KK Women’s and Children’s Hospital.

While it is important to ensure that a child has no major eye issues, over-diagnosis can be a double-edged sword.

Prof Chia said: “When you do 101 tests, you are bound to find something wrong. The question is, will the child’s learning really improve even when you try to resolve that one problem?

“Even when symptoms seem to go away after doing eye exercises, what might have really improved might be the child’s mental capacity to cope with learning over time.”

Prof Chia urged parents not to lose sight of what is most important for their child.

“Many of these programmes often make parents feel like they are doing something for their child,” she said.

But whether they are needed or whether a kid’s learning could benefit equally from quality time spent with their parents is debatable.

“Sometimes, we need to accept that our child will have strengths and weaknesses. No one is perfect,” Prof Chia said.