Frequently Asked Questions - Visual Development

Visual Development

The answer to this question certainly depends on a number of variables, including what groups of children we are talking about and at which aspects of visual development we are looking. A study was done by the New York State Department of Education in conjunction with the New York State Optometric Association, in which they did testing on random samples of children in all socioecomic groups throughout New York State. It was found that around 23% of the general school population had visual development problems that were affecting learning in a significant way.

In this study, when you looked only at those children identified under public law 94-142 as needing extra help in school, the percentage climbed to 93%. In a study done in Baltimore with juvenile delinquents at the Hickey School in the late 1980’s, I found the number of these 14-18-year-old boys with visual development problems to be in the mid-90’s percentage wise. In another study in the late 1990’s in several Baltimore City public schools, it was found that over 80 percent of the children had primary visual development problems. Without the visual problems being addressed, simply reducing class size, getting better text books, finding better teachers, or changing the pay system to a merit system will not result in significant gains. The visual problems need to be addressed so that the children can then benefit from their education.

There is no simple answer to this vital question. Parts of it will be found in many areas and blaming one exclusively will not lead to a resolution of the problem for large numbers of children. The following is a list of some of the potential culprits and a bit about what types of problems they may be causing.

o Not enough self-directed movement while young: In our modern fast-paced society, families seem to always be on the go. So we transfer our young child from the baby carrier to the car seat to the stroller and we move them around for much of the day, rather then having them exploring the world around them with their own visually directed mobility.

o Attention demands too short: So many of today’s television shows geared for children are so fast-paced that they seem to flit from one thing to another almost like an MTV video, barely giving the child the opportunity to learn to sustain attention. Thus, they seem to come to school needing a "USA Today" version of school.

o Too many pictures supplied rather than constructed by the child: When a child gets to listen to a reader who orates in an interesting manner, using descriptive prose, the child gets the chance to learn to make, modify and recall visualizations and visual imagery, which will become the basis for spelling and reading later in life. When a child is given a steady diet of graphics and cartoons they become passive viewers of "interesting" content but they don’t get the opportunity to develop the necessary mental imagery skills.

We learn to use the visual process over time. Visual abilities develop as a result of life experiences that children have prior to entering school. We are a product of the environment we grow up in. Many of the skills and abilities we have began with meaningful life experiences as children. Visual skills and abilities are learned primarily through movement and interaction with our three-dimensional world. Novelty is critical for the emergence of a diverse set of skills and abilities.

A child with a limited set of experiences should not be expected to acquire skill merely as a result of surviving a certain number of years on this earth. Time alone does not cause development. Good development is the result of the appropriate meaningful experiences occurring at opportune times in a person’s life. Physiological maturity alone is not sufficient to guarantee proper development.

We cannot expect children who have never heard classical music to identify an oboe or a trumpet by their distinctive sounds. To do so they need the life experience of listening to these instruments in isolation and having someone properly identify the instruments for them. This needs to be repeated more than once to become a lasting skill.

Learning how to fixate on an object, shift visual attention from one point in the visual array to another, precisely align both eyes with ease for sustained periods of time, and shift attention from distance to near and back again are all developed skills. A child who has not had appropriate life experiences in meaningful ways may come to school without these requisite skills.

A behavioral optometric evaluation can be compared to taking an inventory of these visual abilities and skills and finding which are present and which may not yet have emerged. The lack of the emergence of these visual abilities no more represents a physical or physiological or mental deficit than it does in the music example above. In this situation, no one would diagnose a neurological music processing brain center in need of medication. There would be recognition that the life experiences necessary had not been encountered. (Of course there are isolated instances of such problems but these are few and far between.) The vast majority of what we see in clinical practice are visual development problems.

The visual process is the ability to derive meaning and direct action as triggered by light. The behavioral optometric use of the word vision or visual is very different than is seen by the majority of eye-care professionals and the public. Most people, when they think of what they do visually, think only of the clarity with which they see. They think of a trip to the eye doctor as a time to be reassured that their eyes are healthy and to allow for optical corrections in the form of glasses and/or contact lenses to be identified, prescribed and dispensed.

As a behavioral optometrist I do all this, but I also look at much more! From moment to moment we have things we are doing and things we want to accomplish. To do this we scan our environment with all of our senses, but the visual process leads this search and is responsible for building the spatial map of where we are in space, where our body parts are one relative to another and where the object or objects we are looking at, listening to or feeling are relative to us and relative to other things.

We then use this updated construction of reality to direct our actions. As seen from the perspective of a behavioral optometrist, when a clumsy movement or an inaccurate movement is made, it generally is not the fault of the motor system but is the fault of the guidance and control system, and is seen as a visual problem.

It has been said that most visual problems are problems of omission. This means that the information needed to properly identify and locate objects in space was there but it wasn’t taken in and used by the person. Due to a lack of inclusion of the necessary information, an error in the instructions sent to the motor systems results.

To do this well requires several fundamental visual abilities which include:

o The ability to move one’s eyes free of the rest of the body.

o The ability to easily shift fixation from one place to another.

o The ability to accurately point both eyes to the same place in space without excess effort and with a stable alignment. Unstable alignment often leads to the complaint of words moving on the page or momentary jumbling of the letters, or misalignment of numbers in math problems.

o The ability to sustain near-centered visual attention.