Accomodative Problems (Focusing)

It is not enough to have 20/20 vision and be able to see the board or a book clearly.  Vision is a dynamic function and in order to see properly we have to change the focus of our eyes every time we look from one object to another.  Most people are not even aware that they have to focus their eyes.  This is because in most people the focusing system of the eye operates so well that objects always appear in focus.

However, in reality, a focusing adjustment is made every time we look from one place to another.  This adjustment is made with the help of a muscle in the eye called the ciliary muscle or “focusing” muscle.  For instance, when a child looks from the board to his desk, he must constrict or contract this muscle, which changes the shape of the lens in the eye and allows the child to see the print in his book clearly.  When the child wants to look back to the board he must now relax the focusing muscle to permit clear vision at a distance.

A focusing problem occurs when the child is unable to quickly and accurately constrict or relax the focusing muscle, or if the child is unable to maintain this muscle contraction for adequate periods of time.

Four types of focusing problems can occur in children and young adults.  A common problem occurs when an individual loses the ability to contract the focusing muscle for adequate periods of time.  This is called a focusing or accommodative insufficiency.

A second problem occurs when the focusing muscle actually goes into a muscle spasm.  This is referred to as a focusing or accommodative spasm.

A third problem occurs when the focusing muscle over contracts when looking up close.  It is known as an accommodative excess.

A final type of focusing disorder occurs when the child has difficulty with both contraction and relaxation of the muscle.  This is referred to as focusing or accommodative infacility.

Common Symptoms

People that have tracking problems may complain of the following:

  • Eyestrain after reading for a short period of time
  • Headaches after reading for a short period of time
  • Inability to concentrate when reading
  • Short attention span
  • Rubbing or closing an eye
  • Words moving or swimming on the page
  • Good decoding skills, but poor comprehension
  • Blurry vision after reading or doing near work

Currently there are two preferred methods used to treat focusing problems.  Sometimes eyeglasses alone can be prescribed to provide relief from the complaints associated with focusing problems.  These glasses are usually prescribed for reading and are removed for seeing the board.  For a very young child who would have trouble removing and putting on glasses many times each day, bifocals can be prescribed. A bifocal allows the child to wear the glasses at all times while in school.

Often eyeglasses alone are not sufficient to completely solve focusing problems.  Even when glasses provide some relief, persisting focusing problems will require a treatment known as VISION THERAPY.

Vision therapy is a treatment approach that involves weekly office visits.  During these visits, the patient is given carefully selected and sequenced activities.  This treatment restores normal strength, flexibility and function to the focusing system and usually leads to complete relief of all symptoms.  The success of vision therapy has been well documented in scientific literature.

Exam / Visit Expectations

Comprehensive Eye Exam

A comprehensive evaluation of a patient’s level of vision, need for possible glasses correction, and a thorough evaluation of ocular health.  Additional testing of eye alignment, depth perception, and color vision are performed.

Visual Motor Skills
A comprehensive evaluation of the patient’s visual motor system’s ability to track and change visual fixation, maintain and accurately change focus, and to maintain the efficient use of two eyes functioning together.

Patient Resources or at home actions

College of Optometrists in Vision Development

Other Extension Program Foundation

Parents Active for Vision Education

Symptom surveys CISS