Vision, Reading, and Dyslexia Evaluation

Detailed Description of Evaluation

CASE HISTORY 

Your first step is to complete a case history form to provide the doctor with clues on ways vision may be impacting reading.

EYESIGHT

Visual Acuity Explained (Reference: When Your Child Struggles, Chapter 2)

• 20/20 Vision Basics: Clear sight at 20 feet (e.g., classroom whiteboards) or for short tasks like reading a few letters.

• Key Limitation: While 20/20 acuity ensures brief clarity, it doesn’t guarantee sustained focus during reading—critical for Cobb County homework or extended screen time.

Refractive Error & Marietta Kids (Reference: Chapters 3 & 4)

• What It Means: Determines lens strength needed for crisp distance vision (e.g., seeing road signs on GA-120 or sports fields).

• Local Impact: Untreated refractive errors strain focus during activities like virtual learning or after-school programs common in Marietta.

Advanced Eye-Muscle Coordination Testing in Marietta, GA (Reference: When Your Child Struggles, Chapters 6 & 7)

Why Eye Coordination Matters for Cobb County Students
Fourteen eye muscles work together to maintain clear, stable vision. Poor coordination can lead to:

• Eyestrain, headaches, or double vision (even with 20/20 acuity).

• Reading struggles: Loss of focus, frequent rereading, or trouble recalling text.

• Learning challenges: Critical for kids with reading disabilities in Marietta schools.

Local Impact:

• High-demand tasks (e.g., advanced textbooks at Pope High School or STEM projects) require precise coordination.

• Fatigue from poor coordination worsens with complex material, slowing progress in Cobb County classrooms.

Specialized Tests at Our Marietta Clinic
We perform 15+ advanced tests rarely included in standard exams:

• • • Cover Test: Detects eye misalignment (strabismus/phoria).

    • Near Point of Convergence: Measures close-range coordination for tasks like homework.

    • Stereopsis: Assesses depth perception (key for sports or art classes).

    • Worth Four Dot: Identifies double vision or suppression.

    • Stereoscope & Randot Stereograms: Evaluate convergence/divergence for screen use (common in virtual learning).

    • Prism/Lens Tests: Gauge flexibility under stress (e.g., vergence facility).

Visual Attention & Eye Movement

What Is Visual Attention?
The skill of directing eyes precisely at targets (e.g., words on a page or classroom whiteboards). Poor accuracy forces reliance on peripheral vision, leading to blurred or confused information.

Why It Matters for Cobb County Kids

• Impacts reading fluency, homework focus, and participation in activities like Marietta Little League or art classes.

• Critical for classroom tasks: Following teachers’ pointers, solving math problems, or taking notes.

How We Test in Marietta

• Moving Light Fixation: Measures ability to track a moving target (mimics tracking words across a page).

• Age-Based Benchmarks:

  • Under 5: Struggles to focus without head movement (common in Marietta preschoolers).

  • Age 5: Focuses but uses head/face muscles (typical for Cobb County kindergartners).

  • Ages 6-7: Focuses without head movement but requires full concentration (key for 1st–2nd grade reading).

  • Ages 8+: Maintains focus while multitasking (e.g., math drills at Marietta’s Sawyer Road Elementary).

VISUAL TRACKING(See Chapter 8 of When Your Child Struggles)

Visual tracking is the ability to move the eyes along a line of print.  We evaluate the skill with the King Devick Visual Tracking Test.  The test uses numbers rather than words so we can tell how much of a tracking problem is due to eyes and how much is due to language skills.  In other words, we are trying to determine if poor spatial awareness is causing loss of place when reading and decoding or if there a language problem causing confusion and loss of place.  Some readers suffer from one problem or the other.  Some suffer from both. 

Visual Perception

(See Chapter 9 of When Your Child Struggles)

What Is Visual Perception?
The ability to distinguish shapes, letters, and words (e.g., “b” vs. “d” or “was” vs. “saw”). Critical for reading fluency in Cobb County classrooms, where letter reversals or word confusion can slow progress.

Why It Challenges Young Learners

• Young kids often see symbols like “b” and “d” as identical due to directional focus (“outward” vs. “inward”).

• Spatial awareness of right/left must develop before memory tricks (e.g., “bed” hand gestures) work effectively.

Local Impact in Marietta Schools

• Struggles with visual perception can lead to frustration in subjects like spelling at Sawyer Road Elementary or reading at Marietta Sixth Grade Academy.

• Delays may affect performance in activities like Cobb County library reading programs or homework assignments.

HAND-EYE COORDINATION 

(See Chapter 10 of When Your Child Struggles)

How well do your child’s eyes guide his hands and body?  If the eyes do not properly guide the hands, then learning to write is difficult despite proper instruction.  Catching a ball or learning to ride a bike may be difficult.

If hand-eye coordination is difficult, one step is to insure that good visual attention, perception, and eye-muscle coordination allow the patient to use vision to guide the hands.  Another step is to insure that the eyes and hands are coordinated with one another.  We evaluate fine motor coordination using the Motor Speed and Precision Subtest of the Detroit Test of Learning Aptitude.  We evaluate visual motor integration using the Beery Test of Visual Motor Integration.

VISUALIZATION 

(See Chapter 11 of When Your Child Struggles)

What Is Visualization?
The ability to mentally create images, such as:

1. Spelling HOUSE backward.

2. Transforming CAT to FIN by swapping letters.

3. Picturing a cowboy scene from words like COWBOY or HORSE.

Why It Matters for Cobb County Readers

• Helps decode challenging words (e.g., saw vs. was).

• Builds comprehension for complex texts used in Marietta schools.

• Supports spelling and creative problem-solving.

How We Test in Marietta

• Informal Exercises: Simulate classroom tasks (e.g., mental word manipulation).

• Monroe III Test: Measures detail retention for advanced reading skills.

READING SCREENING   

We do not assess which exact decoding skills are missing.  We will not, for instance, determine if your child knows that the eigh in neighbor and weigh makes the “long A sound.”  We will not assess the exact vocabulary skills of your child. If your child easily understands when being read to, vocabulary is less likely a problem.  If your child does not understand when read to, you will need a language evaluation as well.  We will instead look at some skills commonly missing in children who do not “teach themselves” to read during a standard reading program. 

Phonemic Awareness

Phonemic Awareness the ability to break down a stream of sound into its parts.  If you cannot recognize the sounds in a word, it is difficult to match symbols (letters) with those sounds.  Test questions for this area may include such commands as “Say ‘steamboat.’  Now say it again but don’t say ‘boat.’” “Say ‘pick.’  Now say it again but don’t say ‘p’ [make p sound].”   Or “Say ‘scat.’  Now say it again but don’t say ‘C’ [make k sound].”  We assess phonemic awareness using the Rosner Test of Visual Analysis Skills. The test examines the basic types of phonemic awareness skills necessary for learning phonics.  Different skills are expected in kindergarten, first, second, and third grade.  

Automatic Naming

What Is Automatic Naming?
The ability to quickly recognize symbols (like letters/numbers), recall their names/sounds, and produce them aloud.

Impact on Cobb County Students

• Reading Aloud Struggles: Slows fluency, common in dyslexia.

• Phonics Challenges: Makes “sounding out words” harder.

• Workarounds: Visualization strengthens sight vocabulary (e.g., picturing HOUSE instead of sounding it out repeatedly).

Why It Matters for Marietta Families

• Repetitive phonics struggles (e.g., rereading the same word) may signal:

  • Poor eye teaming (common in vision-related reading issues).

  • Weak visualization skills.

  • Perception challenges.

How We Test in Marietta

• King-Devick Tracking Test (Section 1): Uses number sequences connected by lines to isolate rapid symbol naming from tracking skills.

Informal Oral Reading

Dr. Cook listens to paragraphs read from the Gates Oral Reading Test.  He looks for an approximate word-calling level and for what types of errors are made.  Sometimes he checks how using a pointer to maintain accurate fixation helps.  He checks how covering one eye affects reading: does the child’s reading improve when not having to coordinate two eyes?  He is interested in gaining a feel for both basic reading skills and how vision is affecting reading.

Summary

When the evaluation is complete, Dr. Cook will go over the results with the parent or parents.  If vision therapy is likely to improve reading performance, he will suggest that a consultation be arranged during which both parents, if possible, to go over a written report and get their questions answered.

Is there an undetected visual perceptual or eye-coordination problem contributing to the reading issue? Could your child’s struggle be related to amblyopia vision therapy or need targeted amblyopia exercises? For those with convergence insufficiency, sustaining focus on text can be a challenge despite interest. Visual processing difficulties, such as letter reversals or poor eye-hand coordination, may also play a role.

At Cook Vision Therapy Center, we address these questions and more, aiming to improve both visual skills and reading comprehension.