When it comes to your child’s eyesight, “they see fine” isn’t always the whole picture. Many children can see clearly on a basic vision chart, but still struggle with reading, focusing in class, or even understanding what they see.
According to Dr. Sophia Capo, our pediatric eye doctor in Kelowna, these issues often come down to eye coordination, not eye health or clarity. And since kids don’t always have the language to describe what’s happening, these problems often go unnoticed.
Here’s what every parent should know about the three most common coordination challenges affecting kids’ vision: convergence insufficiency, strabismus, and amblyopia (lazy eye).
Convergence Insufficiency
Dr. Capo calls this one of the most underdiagnosed causes of reading difficulties. Convergence insufficiency (CI) is when a child’s eyes struggle to turn inward and maintain focus on something up close, like a book, tablet, or worksheet.
To understand CI, Dr. Capo uses a great analogy: Think of your eyes like they have a “posture.” Some kids have what she calls “slouchy eye posture,” meaning their eyes naturally drift outward and must work extra hard to point inward and focus. If your eyes start farther out, you’ve got to work harder to get them to converge.
And just like someone trying to lift weights at their limit, a child with weak visual stamina might get tired fast. The result? Blurry or moving words, headaches, skipped lines, and an intense dislike of reading.
“It’s like doing bicep curls with your max weight,” Dr. Capo explains. “You won’t last very long.”
CI doesn’t affect visual acuity, which is why it’s missed on standard screenings. It’s all about how the eyes function, not how clearly they see.
Strabismus
While convergence insufficiency involves difficulty keeping the eyes aligned, strabismus is when one eye physically turns inward or outward, either all the time (constant) or occasionally (intermittent).
Strabismus often becomes more noticeable when a child is tired. Parents may see one eye drifting outward (exotropia) or inward (esotropia), especially during reading or screen time. Some kids can realign their eyes when prompted, but fatigue makes it hard to sustain that alignment.
Strabismus has a stamina component too. “The eye wants to turn,” Dr. Capo says, “and it takes constant effort to hold it straight.”
Depending on the severity and type, strabismus can sometimes be managed with special glasses, prism lenses, or vision therapy. In other cases, an ophthalmologist may recommend surgery.
Amblyopia
Amblyopia, often called lazy eye, is when the brain doesn’t build a strong connection with one eye, even if the eye itself is physically healthy.
Here’s how it can happen:
- If one eye has a much stronger prescription, the brain starts favouring the better eye and ignoring the blurry one.
- If one eye is turned (from strabismus), the brain may suppress its input to avoid seeing double.
The danger? A child won’t complain. They’ll just use their “better” eye without realizing anything is wrong. And because amblyopia usually develops in early childhood, there’s a limited window (before age 7) where treatment is most effective.
Treatment usually involves:
- Glasses to correct the prescription difference.
- Patching the stronger eye to stimulate the weaker one.
- Sometimes, vision therapy or drops are used to further support progress.
Why Vision Problems Fly Under the Radar
What’s especially tricky, Dr. Capo explains, is that kids can’t always describe what they’re experiencing. “They’ll say reading is hard, but not that words go blurry or shift on the page.” Many children who present with symptoms of ADHD or learning difficulties are later found to have unaddressed visual coordination issues.
“Just because your child doesn’t say they’re seeing double, doesn’t mean they aren’t struggling,” she says.
Dr. Capo even shares that some parents have cried in her office after discovering the root cause of their child’s academic or behavioural issues was vision-related.
How Pediatric Eye Exams Can Help
A basic vision screening isn’t enough to detect these issues. Dr. Capo emphasizes the importance of a comprehensive pediatric eye exam, ideally starting at 6 months, then again at 3 years, before school, and annually thereafter.
Dr. Capo doesn’t just check clarity; her exams include testing for:
- Eye alignment
- Focus ability
- Tracking
- Stamina
- Visual processing
She also uses dilation drops to accurately assess prescription in young kids who may not sit still or communicate easily.
Early Detection Matters—Book an Exam!
Want to hear the full conversation? Watch Dr. Sophia Capo explain these vision challenges and how early detection can change everything in her interview on pediatric eye coordination:
Schedule an eye exam for your child at A B See Optometry and Vision Therapy. Early detection means early support and a smoother path to success.