VISUAL DEVELOPMENT

If you’re like most people and most doctors you’ve probably given little if any thought to visual development.  Why would you?  Visual development just doesn’t come up in many situations unless someone has an obvious problem.  Even when a child is having problems developmentally, academically, poor coordination, headaches, blurry eyesight, and many other symptoms or issues, the subject of visual development is unlikely to come up unless a behavioral optometrist is involved in the conversation.

Humans can see fairly clearly at birth.  We don’t necessarily know what most of it means right away, but we can see it clearly if it’s close by.  But the visual process is much more than seeing clearly.  It’s about deriving meaning and directing our actions as a result of interaction with light.  We all must develop these abilities throughout our lives, perhaps more so in our early years.

Just as we must learn to walk, we must learn to see – or more accurately, to use the visual process up to its potential.  Even those of us born with healthy legs must go through developmental stages before walking; we must develop the musculature and the neurology.  In fact, proper crawling is important for brain development.  Proper crawling helps integrate the two sides of the body and the brain though this does not guarantee we will all attain the same level of agility or refinement in our movements.  Some people are able to become ballet dancers or high-level athletes while others of us can barely walk and chew gum at the same time.

If you’ve never heard this before, it’s a little thing I’m fond of:  walking is basically falling and catching yourself before the fall is completed.  That takes a certain amount of neuromuscular sophistication.

The visual process is active in the womb.  Just how active we may never know.  We do know that the eyes are moving in there.  We don’t know why they’re moving necessarily as I imagine the scenery is quite limited.  We certainly don’t know what thoughts occur in the womb if any.  Whatever level of sophistication there may be at birth, it is a far cry from what is to be.  A newborn can see with a reasonable degree of clarity at short distances, which is all that is needed at that time.  It is a short distance from the breast or bottle to the face.  Soon we begin to explore our new environment but much of our early “seeing” is done with our mouths.  Everything must go in there to be experienced and understood.  We hopefully augment that approach in short order by manipulating things with our hands as we begin to inspect them with our eyes.

Behavioral optometrists use terms like reach, grasp, manipulate and release when evaluating visual interactions.  We use such terms because once we develop past the stage of manipulating our environment mainly with our hands, using our eyes as back-up, we begin leading with the eyes and using the hands only when necessary.  We want to be able to reach out for things visually, hold sight of them, even manipulating them visually as we may visualize or imagine unseen aspects of them and then releasing them as we visually move on to something else.

The transition from hands leading eyes to eyes leading hands is a common place to get stuck.  Many young people continue to use their hands to “see” any number of things because they have not successfully integrated and completed this stage of developmental. 

I’ll never forget one of my first patients, Eric.  While asking his mother about her perception of Eric’s visual issues and his developmental history, one of the things that came out was his tendency to get eye infections.  I asked if Eric often touched his eyes because dirty fingers can easily transfer unwanted substances into the eyes, causing infection.  The answer was, “No he never touches his eyes.”  From the beginning of Eric’s visual evaluation it quickly became clear that he did in fact touch his eyes quite a bit; I had to constantly ask him to get his fingers away from his eyes, as well as constantly asking him to grabbing everything within reach in my exam room.

Two things were likely at play here.  First, since Eric was less than visually proficient, it is likely that he experienced some amount of physical discomfort around his eyes; it’s possible they got dry or irritated from the stress of struggling to get them to do what he wanted them to do.  Second, even though there may not have been any actual physical issue with the eyes themselves, stress can cause secondary physical problems due to emotional stress and what better place for the brain to send this stress than to the eyes, since they are in fact directly involved in the process in question.

Eric appeared to be what we now so cavalierly label ADHD.  He was all over the place and he had to get his hands on everything in my office.  Eric’s behavior was primarily related to visual developmental delays.  He was not getting consistently reliable input as a result of poor eye movements, unstable eye teaming and focusing and reduced peripheral awareness.  It became clear by the end of the evaluation that Eric was much more comfortable – and probably more successful – using his hands than his eyes for processing information.  He used his hands as a substitute for his poorly developed visual process.

Children like Eric are often misdiagnosed, or have their problems written off.  Many doctors tell parents that these children will simply outgrow these problems.  They rarely do.  What often happens when these problems continue without proper treatment, is the person learns to adapt as best they can.  This may mask the underlying issues.  With luck, the person will do reasonably well, but with reduced efficiency and often reduced comfort.  It is likely that at some point symptoms will emerge because the brain eventually tires of all the extra work it is doing to compensate.  This may take years or even decades to become an obvious issue.  I have seen this countless times in my practice.  In fact, I was one of these people, with an undiagnosed eye teaming problem before the age of eight.  I was never symptomatic, besides becoming very nearsighted, until I was in my twenties.

Unfortunately, they (and/or their parents) will assume that things are working the way they should be.  This is only because they have no way of comparing the way they are functioning with the way they could be functioning if the visual process was working the way it was meant to work.  Only behavioral optometrists understand all the issues involved.  Behavioral optometrists are skilled in diagnosing and treating these kinds of problems using therapeutic lenses and vision therapy.

Next time:  Visual Development, Part 2