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Functional Vision Exam



The only way to ensure that all the essential visual skills are working correctly is by having a Functional Vision Exam.

The Caring Vision therapy center provides a professional eye and vision examination, one that includes a comprehensive assessment of visual information processing, binocular function and other visual skills.

In adults and children, a Functional Vision Exam is necessary whenever symptoms of vision problems are exhibited. To be proactive, the exam should be performed in the Baby at 6 months, Child Annually.

What is Functional Vision?
Functional vision is how your entire visual system -- the eyes, the brain, the visual pathways -- work together to help you interact with your environment. Functional vision includes the following visual skill areas:

Eye Teaming
Occurs when the eyes align to focus on the same point on an object and work together in a coordinated and precise way. Good eye teaming allows efficient, single, comfortable vision and depth perception.

If the two eyes are not both aligned at the same point, the brain won’t be able to correctly combine the image from each eye. When this happens, a person will experience double vision and lose 3D depth perception. Poor eye teaming may also lead to eyestrain and fatigue

Eye Focusing
This encompasses your ability to see an object clearly, and your ability to shift focus between objects at different distances.

For example, a person may have difficulty keeping reading material in focus and may experience intermittent or constant blur. Or a student may be able to see the text in a book clearly but have difficulty shifting focus from the book to the board and back.

Eye Movement
This includes your eyes ability to maintain fixation on a moving object through space, move fixation from one object to another, or sustain fixation on a stationary object.

Following a fly ball into your glove and moving your eyes across this line of text both require accurate and efficient eye movements. Maintaining eye contact when listening is an example of sustaining fixation on a stationary object.

In order to better understand a patient’s visual system, a set of standardized tests is used to evaluate visual information processing. Below are the various aspects of vision that may be evaluated. Since vision is a learned process, these areas can be improved through vision therapy.

The following areas may be assessed:

  • Visualization – the ability to form mental image and manipulate details in one’s mind. This is important in reading comprehension and math.
  • Visual–Motor Integration – evaluates the ability to match motor output with visual input. It is crucial for handwriting accuracy and efficiency as well as eye-hand coordination in sports.
  • Visual Sequential Memory – the ability to remember objects or words in the sequence they appear. A deficit in this area may result in misreading words such as ‘saw’ and ‘was.’
  • Visual Discrimination – the ability to differentiate between two similar looking objects, shapes, or words such as ‘horse’ and ‘house.’
  • Visual Closure – the ability to have part of the information and infer the rest. This is an important skill in reading speed and math.
  • Spatial relations – the ability to perceive the position of two or more objects in relation to each other and in relation to oneself. This is an important skill in problem-solving, high-level math, and proper spacing between words when writing a sentence.
  • Spatial Orientation – required in understanding and recognizing the direction of objects. A deficit in this area lead to letter (b, d, p, q) and number (6 vs. 9) reversals.
  • Laterality – the understanding of rights and lefts on the patient and in space.
  • Directionality - understanding the proper orientation of letters and numbers.

At Caring Vision Therapy, we take a developmental approach to our vision therapy program. For that reason, we want to make sure the patient’s visual system has matured from all developmental levels. For this reason, we assess certain primitive reflexes (that developed in-utero and early post-natal) that may still be hindering the visual development process. If primitive reflexes are still retained (or present), the patient will be given a series of movement activities to integrate them. This gives the patient control over their movement and cognitive process!

We assess the following primitive reflexes:

  • Moro – aka: startle reflex
  • Tonic Labyrinthine Reflex – leads to the head-righting reflex
  • Spinal Gallant – may lead to fidgeting and bed wetting if retained
  • Asymmetric Tonic Neck Reflex – leads to crawling and cross-pattern movement
  • Symmetric Tonic Neck Reflex – helps the visual system aim near to far
  • Palmar Reflex – may lead to poor handwriting or speech delays if retained


For more information, see the Primitive Reflexes paper by Sally Goddard, et al.

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