This has been my experience, and those of many authors on the subject: When trout are keying on a specific hatch of mayflies, they often become "sippers". They lie in the feeding lanes, and, as those wings appear in their window floating toward them, they begin to rise up to "sip" the insect. So, it may not be directly below the fly, but it is under the water looking up through their window. Certainly not our vision.........viewing from perhaps 4ft. above the surface.
I guess a corollary might be: What convinces a trout, when caddis are on the water, to take a caddis pattern? Might it be the tent-like view from beneath?