Reversals: Changing Lanes

Letter reversals.

Letter Reversal is a controversial area, but has been related to higher orders of vision and visual processing. Reversal seems to be the most often feared problem by the parents. So many parents are convinced that this is a dyslexic problem, but in many cases its simply just vision and visual processing issues.

Let’s begin with the following: if a child read the sentence “I saw a Zebra,” it is a good bet that they won’t get the word saw backwards. They would certainly be confused if they read “I was a Zebra.” This problem occurs if you’re reading only one word at a time and if scanning RIGHT to LEFT. This in itself is a problem with the eye movements or ocular-motor skills.

Perhaps the child is a gambler. The odds are with her when guessing the letters since left sided letters (b) and numbers exceed right sided (d) and of course “e” is the most frequently used letter so a left to right guess is submitted. In other words, she has a better chance at guessing if she faces the letter to the right (b). This would be a problem of recognizing the letter in the “mind’s eye” or visualizing the individual letter.

Did you know that children that reverse words and letters tend to reverse the same letters and words consistently? The common letters are q,p,b,d,u and n. The common words are was, saw, no, on, pot, of and for and don’t forget stop and spot. The key to the word issue is that they are not randomly chosen, these words make sense when reversed. This not a neurological issue, it’s simply a problem with Spatial Discrimination.

Let’s look at some basic facts regarding reversal.

  1. It is normal to make reversals.
  2. Not recognizing Object Constancy is a reasonable cause.
  3. Inspecting of pattern from the right rather than the left is common for young children.
  4. Children don’t always grow out of their reversals.
  5. Frith, mentioned in 1971, ” that reversals have been found in some brain injury cases, especially those effecting the parietal and occipital regions.” This has certainly been the case with the large number of brain injury cases seen by this office.
  6. Finally, Moyer said, ” that reversals constitute about 45% of all errors of 4 year olds, 23% of 5 year olds, and drops to 7% of 7 year olds.”

It’s important to note that children 3 years to 8 will respond to the contour of a form before responding to the detail. Therefore, understanding of Visual Closure before Visual Discrimination seems to be the earliest concept. The orientation is not so important for the 3 to 5 year old’s. They don’t much care what side of the circle to put the stick on (l o l, b,d,q,p).

Reversals that are from writing or printing are considered to be kinetic or movement reversals. The other type of reversal is when confusion occurs from letter orientation or sequencing in a word as one reads. This would be called stationary reversal or static.

Stationary reversals tend to be associated with the problem of Visual Constancy. Here is an example, if you take a chair and turn it upside down, paint it black, and shrink it small, your result is what? A chair! A chair is a chair no matter what orientation, size, or color change is made. Now add in Spatial Awareness and you begin to see that moving from the 3 dimensional world to the 2 dimensional world becomes somewhat confusing. These children are not suffering from some deep neurological impairment but rather confusing a simple visual processing concept. Simner (1984) states “children must have an understanding of their own body imagery. If a child can’t differentiate between right and left, then he can’t be expected to differentiate b and d.”

As stated previously, Letter Reversal is a controversial area, but has been related to higher orders of vision and visual processing. The intent of this article was to help see the interplay of some of the visual and visual processing skills that are involved in the reversal of letters and words.

I would like to thank Ken Lane, OD, FCOVD author of Developing Ocular Motor and Visual Perceptual Skills for his terrific insight into Reversals.




When a Vision Related Learning Problem is not Convergence Insufficiency

Reading trouble.

It seems that when Vision Therapy is mentioned then the following condition seems to be automatically mentioned and that is Convergence Insufficiency (CI).  CI  is that binocular condition in which the two eyes have difficulty maintaining near demanded tasks. This condition may result in double vision, asthenopia, and headaches.  No wonder it would cause reading issues as well as learning related problems. But, you don’t have to have this visual condition to have a visually related learning problem.

General visual skills dysfunction can be comprised of inadequate teaming skills, inadequate eye movement skills, focusing (Accommodative) problems or visual processing skills.

Teaming skills can be inadequate. This means that the skills may not provide the desired ranges necessary  for free and easy binocular movement of the eyes. The eyes seem to fatigue easily, asthenopia or discomfort sets in, headaches may or may not occur, or the individual just has no desire to read for any length of time.

Eye movement skills may be inadequate.  Simple observation may reveal inadequate fixation or scanning skills.  Evaluation may include but is not limited  to Fixation tests such as the modified King-Devic test.  A timed test of displayed single digit numbers in an array called out by the patient.

Focusing problems may be exhibited by what the optometrist refers to as Accommodative Infacility.  AI is an inability to change focus rapidly from near to far and then far to near.  Usually the child is slow at copying information from the board. This exhibits a delay in focus slowing down the child as he waits to receive the distance information and then responds with the near activity which is in most cases writing the information down.

Visual Processing skills can be measured in a variety of ways;

1) Visual Memory

2) Visual Motor Integration Skills-Speed and Accuracy


4) Letter Reversals

Visual Memory can be tested in many ways but so much information is gathered when the memory test is presented as a set of symbols that must be memorized and reproduced on paper. Visual Motor Integration-SA is an evaluation that requires the gathering of information (eyes), the processing of the information (visual brain) and then the integration or the use of this processed information. Visualization is tested by manipulating shapes in the mind.  It is an important skill especially when incorporated with reading.  In order to retain the written word it must be visualized.  Letter Reversals is a controversial area, but has been related to higher orders of vision in respect to visual processing. Due to the complexity and controversy of the subject, Letter Reversals will be discussed in detail at a later date.

Teaming, focusing, and fixation skills along with visual processing skills may be at the core of most learning related problems.

Dr. Dan


Mothers- this one is for you!

Happy (belated) Mother’s day!

To all the moms out there, we know how hard you work. We see it every day in our office. We see mothers who come in and are doing everything in their power to see that their children are happy and healthy. We love it!

We know it’s a bit late, but we want to express our thanks and gratitude to all the mothers out there. This blog has been created to help many people, yet we know the vast majority of our readers are indeed concerned mothers. Those of you with children in vision therapy and those who are beginning to research the field, you’re on the right track!

We appreciate the schlepping back and forth between school and vision therapy, the hours spent assisting with homework and often dealing with your child’s frustration. It is our goal to help you find the answers and get the breakthrough you’re looking for in your child’s learning. We know it will pay off.  Without you and your dedication we wouldn’t be able to help get your child on track. We wanted to take this time to thank you for everything that you do.


So mothers, this one is for you. Happy Mother’s Day!


Keep an eye out for upcoming post on the “why’s” of vision therapy as Dr. Weinberg will be discussing the links between vision and learning.


Welcome to ThinkVision

Hello blogosphere, welcome to the official blog of Advanced Vision of Louisville! Through this blog we intend to share our appreciation for the art and science of visual rehabilitation and learning. The two are interwoven tighter than any known fabric and we would like to show you how. ThinkVision will feature interviews with developmental optometrist Dr. Daniel Weinberg O.D. FCOVD, insight from the vision therapists at Advanced Vision of Louisville, patient testimonials and much more! Future posts are already in the works so stay tuned.


“The more that you read, the more things you will know. The more that you learn, the more places you’ll go.”

-Dr. Seuss, I Can Read With My Eyes Shut.