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Optometric Checklist for Educators, Parents, and Patients
This checklist of symptoms of visual problems observed at school, at home, and at work will help your optometrist understand how the child/adult performs visually in his daily activities. Please use the print-friendly version to open a new window with a form you can print out to take with you when you visit your doctor.
READING
- Fatigue with reading or comprehension drops with time
- Confusion of similar words of letters
- Omits words
- Short attention span while reading
- Difficulty keeping place while reading
- Holds head too close to book
- Slow reading or word-by-word reading
- Skips or rereads lines
- Uses finger or marker as a pointer
- Avoids reading
- Says the words aloud or lip reads
- Difficulty remembering what has been read
- Reverses words or letters
- Difficulty remembering newly learned words
- Poor sitting posture and posision while reading
- Excessive head turning while reading
- Frowning, excessive blinking, scowling, squinting, or other facial distortions while reading
- Rubs eyes during or after reading
- Tilts head to one side
- Turns head so as to use one eye only
- Closes or covers one eye
WRITING AND OTHER DESK TASKS
- Holds head too close to desk when writing
- Gross postural defects while seated at desk
- Restlessness while working at desk
- Difficulty copying from chalkboard or book
- Squints or blinks looking up at chalkboard
- Tilts head to one side
- Turns head so as to use one eye only
- Omits or repeats letters, words, or phrases
- Poor eye-hand coordination including poor writing
- Writes neatly but too slowly
- Reversals persisting in grade 2 or beyond
- Weight on the writing arm
- Does not use other hand to hold paper
- Immature pencil grip
- Poor finger movement in writing
- Draws with short sketchy lines
- Turns paper to draw lines in different directions
BODY POSTURE AND SPACE AWARENESS
- Unusual awkwardness
- Frequent tripping or stumbling
- Body rigidity while looking at distant objects
- Thrusts head forward or backward while looking at distant objects
- Confuses right and left directions
APPEARANCE OF EYES
- Crossed eyes-turning in or out
- Watering or bloodshot eyes
- Red-rimmed, crusted or swollen lids
- Frequent sties
GENERAL BEHAVIOR
- Short attention span
- Dislike for tasks requiring sustained visual concentration
- Nervousness, irritability, or restlessness after maintaining visual concentration
- Inattentiveness, daydreaming
- Unusal fatigue after completing a vision task
- Frequent signs of frustration
- Tension during close work
- Avoids close work
QUESTIONS FOR CHILDREN
- Does your vision get blurry at any time?
- Can you make it clear?
- Do you ever see objects double?
- Do you have headaches, dizziness, or feel sick to your stomach when you use your eyes, or do you get carsick?
- Do letters and lines "run together" or words "jump"?
- Do your eyes get tired after reading for a few minutes?
- Do your eyes ever feel hot or itch?
- Does light bother your eyes?
- Do you know where to catch a pop-up fly ball, how far to throw a ball, where the ball is going to be?
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