From Sight to Insight: Understanding Functional Vision

How Skills Beyond Clarity Help Our Children See Clearly

When considering the importance of our body’s senses, the sense that is arguably valued the most is vision. Those who have vision cannot imagine a life without it. Those who lose quality of vision, through age or trauma, realize that they took it for granted. Others still, who may have clear sight but do not adequately utilize their vision in their everyday lives, may or may not even realize that they have a visual deficit: in this case, a functional vision disorder.

This June, during which we acknowledge Child Vision Awareness Month, we take a closer took at functional vision impairments and how they can negatively impact children from a very young age. Read on to learn more about this condition and strategies in which to improve it.


Black on White: A High Contrast Book for Newborns, by Tana Hoban

The black and white high-contrast images in this best-selling baby book visually engage infants and toddlers and can help stimulate visual development.

Product: Building Blocks

Don’t underestimate one of the simplest forms of play…with blocks! Block play helps develop hand-eye coordination and spatial reasoning in childhood development and is vital in functional vision skills.

Quote of the Month

Keep your face to the sunshine and you cannot see a shadow.

– Helen Keller

A Close Look at Functional Vision Impairments

How reduced function of vision can negatively impact development and how to treat it

How well can your child see? For parents of children who have already had an eye exam, the question doesn’t initiate much concern. However, despite a stellar visual acuity score for many children, something about the way they see seems off. In these instances, it’s worth considering the possibility of a functional visual deficit. Functional vision, in fact, is different from visual acuity, and requires a distinct type of evaluation to analyze.

Visual acuity– what many believe to be the sole determinant of a person’s visual skills– is a measure of a person’s clarity of vision. It is expressed as a fraction, with the top number representing the distance from the chart and the bottom number representing how far away someone with normal vision can read the same line. It’s typically tested by seeing how well someone can see numbers and symbols on a white background from a set distance. Functional vision, on the other hand, is how well a person uses their vision in everyday activities. This includes recognizing objects, perceiving depth, tracking, focusing and visual discrimination, among other skills. Functional vision is complex and multi-faceted; yet, it is often undervalued and overlooked.

Considering all of the roles that functional vision serves, it should come as no surprise that when it is negatively impacted in a child’s development, it significantly affects their ability to learn, play and interact with their environment. While functional vision deficits can be present in very early childhood, they often

go undetected until a child is older, as academic difficulties are often the first notable sign that something is awry. Even then, functional vision is not always a primary consideration.

Skills Required for Appropriate Functional Vision

To elaborate on the aforementioned skills that functional vision encompasses, these include:

  • Eye Tracking: The ability to smoothly follow moving objects.
  • Depth Perception: The ability to see objects in three dimensions, including their size and distance from you, and to understand their relative position in space.
  • Focusing: The ability to shift focus between objects at different distances, while maintaining clear vision.
  • Visual discrimination: The ability to recognize differences and similarities between objects, symbols or shapes.
  • Eye Teaming (Binocular Vision): The ability to use both eyes together in a coordinated manner.
  • Visual Perception: The ability to interpret and understand visual information.
  • Visual-Motor Integration: The ability to coordinate visual information with body.

These deficits can affect even the earlier skills in childhood development: reaching, crawling, eating, walking and playing are just a few to be named. Per Jennifer Fortuna, PhD, OTR/L in her article, “How Impaired Vision Affects Childhood Occupations”:

Vision is the primary sensory system used to gather information about our surroundings. Foundational skills control voluntary eye movements, whereas higher-level skills help the brain to make sense of what is seen. Functional vision is dependent on the collaboration between all visual-perceptual skills. Dysfunction at any level impacts function at all levels. (Jennifer Fortuna, 2016)

Seeing Progress at Home

Easy ways to improve functional vision everyday…through play!

Improving functional vision does not just happen in doctor’s offices and in therapy: it can also be enhanced in daily activities that are FUN! Incorporate some of the following to strengthen and maintain progress:


Activities such as finding shapes in books, drawing, completing puzzles, flashlight tracking, playing “I Spy” and doing connect the dot pictures all help improve eye tracking skills.

Depth Perception

Catching and throwing a ball, climbing stairs, hopscotch, frisbee and playing “keep it up” with a balloon all help improve depth perception.


To improve visual focus, play matching games, Memory, mazes, and “I Spy.” Building with blocks and construction sets help children focus and improve spatial reasoning.

Visual Discrimination

Completing “What’s different?” activities helps a child to discriminate between subtle differences in two similar pictures. Color matching and sorting tasks, as well as tracing and handwriting tasks, also strengthen visual discrimination abilities, while simultaneously improving language and fine motor skills.

Identifying Functional Vision Difficulties

Functional vision deficits are not always obvious and can be mistaken for other issues like learning disabilities or attention disorders, as symptoms like academic challenges and difficulties focusing do overlap. Signs that a child might have a functional vision problem include:

  • Frequent headaches or eye strain
  • Difficulty sustaining attention during visual tasks
  • Excessive blinking or rubbing of the eyes
  • Frequent squinting or tilting of the head
  • Holding objects very close
  • Poor hand-eye coordination
  • Avoidance of reading or close-up tasks

Strategies for Intervention

With intervention, functional vision can improve, which can subsequently result in improvements in academic performance, daily activities, and social and emotional development. Strategies include the following:

  • Comprehensive Vision Assessments:
    For children demonstrating early signs of ADHD, developmental therapies such as occupational therapy (OT) and speech-language therapy can help identify some of the child’s strengths and challenges and address them via improving visual and auditory attention, executive functioning skills, emotional regulation and more.
  • Vision Therapy:
    Vision therapy is a customized program designed to improve visual skills. It includes exercises to enhance eye tracking, teaming, and visual-motor integration and should be performed by an optometrist who specializes in vision therapy for children.
  • Classroom Accommodations:
    Providing accommodations in the classroom supports children with vision deficits and help them manage difficulties. Examples include seating them closer to the board, providing large print materials, and allowing extra time for reading and writing tasks.
  • Integrating Visual Skills into Daily Activities:
    Encouraging activities that promote visual development, such as puzzles, drawing and building with blocks, can help improve functional vision skills.
  • Collaborating with Educators and Therapists:
    Maintaining tight communication with teachers, occupational therapists and vision specialists ensures that your child receives comprehensive, individualized support that will meet their needs.

Content of this newsletter was written by:
Megan A. Miller, M.S., CCC-SLP

Please contact Megan with any questions or comments at: