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The Visual Evaluation

Have you ever been to the eye doctor?  If you have then you know how it goes.  Many offices now have technicians who use modern equipment to perform any number of the so-called preliminary tests. The sole purpose of most eye exams, besides assessing the physical health of the eyes,  is resolving the issue of distance visual acuity – seeing clearly across a room, particularly for those under the age of forty.

Behavioral optometrists understand that there is much more to evaluate than a person’s ability to read an eye chart across a room. The visual process, it has been said, is the result of a simple eye and a complex brain.  The visual process is pervasive in human behavior and development. The primary purpose of the visual process is to direct action.  Behavioral optometrists want to get a sense of how well a person has developed their visual abilities. We evaluate the degree to which a person uses the enormous potential of the visual process to carry out their daily activities.

Standard visual acuity is what we all know as 20/20. Most doctors are satisfied knowing that a person can see 20/20 in the distance. For one thing, it is uncommon for standard eye exams to even include a measurement of visual acuity at the reading distance when examining people under the age of forty. Certainly the ability to see clearly at various distances is useful, and unless the deficit is fairly severe many people function quite well without using any lenses.  In reality, distance visual acuity is not particularly important for many of the tasks that we do every day. Perhaps the most important issue in this regard is that we do not need good distance acuity to successfully read a book or use a computer. In fact, in most states, the distance acuity requirement for driving is not 20/20 but 20/40, which is half the level of clarity of 20/20.

The point is that it is very important to evaluate the entire visual process, especially when people are having issues such as learning problems, reduced performance, reduced comfort, decreased acuity or any number of other signs and symptoms that are often ignored when the only issue being addressed is that of distance acuity.

The importance of Behavioral Optometry

Behavioral optometrists want an in-depth understanding of the entire dynamic, elegant visual process. There are three much more important areas that need to be evaluated to begin to understand how a person is using the visual process. These are: eye movements, eye teaming and focusing.  Step one is aiming the eyes.  We must be efficient and accurate in pointing our eyes at an object of interest in order to obtain the maximum information from that object. This becomes the foundation of eye teaming (binocularity). We need to be pointing both eyes at the same thing at the same time. This is the preferred way to avoid seeing double and this is also how we are able to create a three-dimensional mental image of the world around us. If you cover one eye you may notice that the room no longer has the same quality of depth as it does with both eyes open. If not, you may want to make an appointment with a nearby behavioral optometrist sooner than later, since this could indicate that your eye teaming skills are less than optimal.  Also the eyes should be appropriately focused for the precise distance of the object for it to be seen as clearly as possible. Accurate eye movements, effortless and effective eye teaming and focusing skills are necessary to provide the foundation for seeing clearly as it turns out.

When the visual process is not automatically working at a fairly sophisticated level it can be an obstacle to even mediocre performance.  It can also be a source of physical discomfort.

This may sound fairly simple and hopefully the workings of the visual process happen for you in a way that eludes your awareness. That is how it should be.  However, none of this is very simple when it’s not working the way it’s supposed to. It can be a huge obstacle to even mediocre performance if the visual process is not automatically working at a fairly sophisticated level. It can also impede overall development and can be a source of physical discomfort. Some examples:  if the eyes are not aiming at the same thing at the same time, the result can be double vision or more likely the brain having to use a great deal of effort to eliminate one of the images from conscious awareness, since the brain simply detests double vision.  Reduced ability to sustain effortless eye teaming and/or focusing often results in headaches, eye discomfort and fatigue.

A quick test: hold one finger vertically about five inches in front of your nose and another vertically beyond that at arm’s length.  When you look at the far finger you should be aware of two near fingers and when you look at the near finger you should be aware of two far ones.  This is normal and is a sign that both eyes are transmitting signals to the brain simultaneously.  This does not provide all the details necessary to know if things are working optimally, but it’s a start.

Most eye exams are just that.  Examinations of the eyeballs.  Not that there’s anything wrong with that.  It is good to know that the eyes themselves are healthy.  It is also good to know that there is nothing wrong in the brain when people have frequent headaches, double vision or are unable to see properly out of one eye even with lenses.  Even conditions that most doctors assume to be structural in nature can often be resolved by fully understanding and properly treating a person’s eye movement, eye teaming and focusing conditions.  Many cases of dry eyes, eye fatigue, crusty eyelids and red eyes as well as headaches and double vision can be treated successfully with the proper therapeutic lenses and vision therapy – all without the use of drugs or surgery.

What I have described above is really just the tip of the visual process iceberg.  There are many other aspects involved.  There is eye/hand coordination, spatial perception, form perception, speed of perception, span of perception and much more.  Hopefully you are starting to get a sense of the complexity and the importance of the visual process in human behavior and development.

The type of thorough visual evaluation performed by a behavioral optometrist will provide a wealth of information regarding the possible causes of the kinds of symptoms mentioned above.  A good visual evaluation will also provide the basis for understanding and treating the various visual difficulties associated with developmental delays of all kinds, the visual conditions common in children on the autism spectrum, visually related learning problems and the kinds of visual issues that usually accompany acquired brain injuries.  Much of the fatigue many adults experience from all the close work they do all day, every day, can be traced back to the kinds of visual difficulties that standard eye exams will almost always miss.  A thorough visual evaluation is the only way to uncover many of these issues and provide options for improving or eliminating the symptoms by dealing directly with the actual causes.

Feel free to contact Dr. Gallop in Broomall, PA for more information about his visual evaluation, behavioral optometry in general, vision therapy, developmental, learning or stress relieving lenses or to make an appointment.

Dr. Gallop specializes in working with people of all ages including children with strabismus, learning problems, reading difficulties and children on the autism spectrum.