Vision and Learning Quiz
How often does your child experience the following symptoms?
. Place a checkmark in the column that best describes your child.
How often does this happen? / Never0 / A little
1 /
Sometimes
2 / A lot3 / Always
4
1. Headaches during school or homework
2. Words move or get blurry when reading
3. Rubs eyes during close work
4. Fatigues quickly during reading and homework
5. Head tilt or closes an eye when reading
6. Loses place while reading
7. Avoids reading or writing activities
8. Leaves out small words when reading
9. Uses finger during reading
10. Burning, red or watery eyes after reading
11. Poor reading comprehension
12. Reading or writing distance too close
13. Complains that eyes hurt during reading or homework
14. Sloppy handwriting
15. Difficulty copying from the board
16. Leaves out problems on tests or worksheets
17. Homework takes too long
18. Doesn't finish classroom assignments on time
19. Knocks things over, poor depth perception
Multiply total marks in each column by: / x 0 / x 1 / x 2 / x 3 / x 4
Score for each column / ____ / ____ / ____ / ____ / ____
Total Score for all columns ______*
*Total score greater than 20 indicates the child is at higher risk for a vision-based learning problem. Further evaluation by a pediatric optometrist is recommended.