Not Every Vision Evaluation Is the Same

A message from Dr. Spokas

There is a big difference between a routine eye exam and a functional/developmental visual evaluation. When visual functional skills are not properly assessed or not assessed at all, a patient will often get a false sense of security that their vision, or their child’s vision, is fine and even “perfect.” Far too many times we have heard patient families say, “but we’ve already seen an eye doctor.” And among our adult patients, we can’t tell you how many tell me they have unnecessarily ended up in the ER or have been diagnosed with anxiety disorder or have been told that the symptoms they are experiencing are “all in their head.” Starting with a Functional Vision exam can make all the difference in treatment and relief.

The Importance of a Functional Vision Evaluation

When a child exhibits signs of reading and learning difficulties or an adult is suffering from poor visual performance which can show up as dizziness while driving or anxiety, the first step should be a Functional Vision Evaluation. After an in-depth case history, our doctors will perform an extensive assessment of visual skills such as eye tracking, eye teaming, eye focusing and visual processing. As in a standard eye exam, this evaluation also includes a thorough eye health and vision evaluation to assess visual acuity (eyesight) and refractive condition for appropriate corrective lenses, when needed.
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Only optometrists who have undergone advanced post-graduate training in the field of vision development and have the necessary equipment required to test for and treat functional vision problems can perform the detailed assessment of visual function. Our doctors have achieved this qualification which is also why many colleagues and other professionals refer their patients to us.

What Skills are Evaluated in a Functional Vision Evaluation?

Sensorimotor Skills

Binocular Vergence (Eye Teaming) Testing: A measurement of convergence, ranges of fusion and coordination of the two eyes working together.

Oculomotor (Eye Tracking) Testing: A measurement of pursuits and saccades (micro eye movement in reading and scanning the environment).

Accommodation (Eye Focusing) Testing: A measurement of eye focusing relating to the clarity of near vision, near visual attention, and looking near to far.

Stereopsis (Depth Perception) Testing: A measurement of the eye’s ability to accurately judge depth cues when used together.

Visual Integration Skills

Visual-Fine Motor Integration: The ability to analyze and integrate visual information with fine motor movements of our hands such as with handwriting.

Visual-Gross Motor Integration: The ability to analyze and integrate visual information with gross motor movements of our body, arms, and legs such as with propelling through space and with sports.

Visual-Auditory Integration: The ability to analyze visual information and link it with an auditory response such as with seeing a word and saying it out loud, or to link an auditory stimulus with visual information such as with hearing a word and being able to write it down.

Visual-Vestibular Integration: The ability to integrate the visual system and the vestibular system for proper orientation and balance.

Visual Perceptual Skills

Basic Processes: This tests visual discrimination, visual memory, visual spatial relations, and visual form constancy subtests. The basic processes are generally the first to develop and utilize similar processes for general perception.

  • Visual Discrimination: The ability to see likes from differences.

  • Visual Memory: The ability to visually remember the characteristics of a shape/object after a brief presentation.

  • Visual-Spatial Relationships: The ability to see the difference among forms based on orientation.

  • Visual Form Constancy: The ability to identify two of the same shape regardless of size differences.


Sequencing: This tests the ability to remember visually presented material of increasing complexity and length. The task encourages chunking of visual information as its most successful intervention for remembering visual sequence. This ability is foundational for spelling and comprehension.

  • Visual Sequential Memory: The ability to remember for immediate recall a series of forms in their specific order of presentation.


Complex Processes: This tests visual figure ground and visual closure, which are higher levels of perceptual skills that build upon the basic processes and sequencing. These skills are important for environmental organization and understanding the main idea when reading.

  • Visual Figure-Ground: The ability to perceive a form visually, and to find this form hidden in a clutter of background.

  • Visual Closure: The ability to identify the missing components of an incomplete image based on prior knowledge.


Visual Directionality: This tests the ability to identify language symbols based on their directional orientation.

Central-Peripheral Processing: This tests the ability to process information simultaneously within a scene to make navigating space easier and more efficient.

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The right vision exam can make all the difference.

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