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Posted on 08-08-2013

Originally posted on June 18th, 2012

In the previous post I discussed the fact that there is much more to the visual process than seeing clearly. Seeing clearly is a wonderful thing, but without the rest of the visual process to back it up – to process information, generate thoughts and guide our actions – clear eyesight would have little purpose or excitement. The visual process enables us to orient our bodies in relation to gravity and in relation to what is going on around us at any given moment. It is the early warning system that alerts us to potential involvement with anyone or anything occupying our immediate vicinity. The visual process (hopefully) provides us with precise information about what is around us, what it means to us and what we might need or want to do with it. The visual process provides us with options for those interactions as well as the templates for those actions, which it then guides to completion. There can be myriad repercussions encompassing all aspects of human behavior, development and comfort when the visual process is not functioning at the expected level. This is true for people of all ages, but perhaps most unfortunate when it happens to children.

The primary purpose of the visual process is to direct action. The visual process is a critical aspect of human development. Human beings need action/movement in order to properly develop.

There is one main reason, one simple sentence that describes why my practice differs so greatly from the vast majority of practitioners: The primary purpose of the visual process is to direct action. That is the essence of the philosophy that drives behavioral optometry. That’s not the whole thing but that is the ultimate foundation. Bodily motion is action, thought is action and we rely on the visual process, whether we realize it or not, to direct all of these actions under normal conditions. We also rely on movement, and therefore the visual process, to stimulate our overall development.

Other important concepts include:

  • The visual process develops throughout our lives.
  • The visual process is responsive to therapy at any age.
  • The visual process is a dynamic process, not a passive one.
  • The visual process is a whole-body  process.
  • Development of the visual process is intimately linked to overall development

This is why the developmental evaluation of the visual process is much more thorough and dynamic than most, and unfortunately mysterious to many. I do the old eye chart test, which remains entirely adequate for measuring eyesight. I also evaluate how people engage when entering unfamiliar surroundings, when meeting a new person, how they move from the waiting room to the exam room. I observe how they grasp and follow instructions. I am then looking at the way they aim their eyes, the accuracy and fluidity with which they follow a moving target or look from one object to another. I investigate their ability to coordinate the two eyes and how stable and flexible the focusing system is. I also want to know how clearly they see across the room and at their normal reading distance as well as the reading distance I prefer them to use. I want to get a sense of the person not just their equipment. I talk with the parents, and as much as possible, with the child about their perspective on how the visual process is being used. I want to know what they see as the problematic behaviors and how they think these are affecting the child’s everyday life. Obviously, not all the people I examine are able to be tested in the same way so I must rely on what I learn from the child’s history, my clinical experience and observational skills to assess those who I cannot formally test in the usual way. Fortunately there are many ways to get the information I need to assess a child’s visual development and provide options for how to proceed.

I’m sure my parents would have been told to start me on medication to improve my ability to focus on schoolwork and to perform up to my potential. I spent most of the first thirty years of my life with undiagnosed visual issues that unquestionably interfered with my ability to read, study and pay attention in school.

I also prefer to evaluate and work with young people when they are not under the influence of their “learning meds.” I would much rather evaluate and interact with the real child than the medicated version. I know that some parents and even some children see these medications as a godsend because the change in ability to tolerate and in some cases succeed in school is dramatic. But at what cost? There are of course reports of depression, feeling like a zombie and weight gain. Some students who are grateful for the improvement it affords them choose to discontinue using because of the side effects. I’m not aware of any statistics but I doubt they would be pretty. How many failures of the medication are there for every success story? I’m certain I would have been offered such medication as a child based on my behavioral issues as a child. I also know that I had undiagnosed visual problems starting at a very early age. These visual issues went undetected until I was well into adulthood.

We are actually training attention deficit throughout our culture. Everything is quick sound or sight bites. We are conditioning our young people to grab tiny bits of mostly useless information in very short periods of time. Is it any wonder so many – and there are very many – can’t seem to muster the wherewithal to sit and listen to teachers talk about things most find tedious at best? Add to that a less than fully competent visual system and you have a recipe for trouble. Not only do most children diagnosed as ADD/ADHD or any other learning and developmental diagnosis, have visual development issues, but many of these children are actually misdiagnosed in the first place and would not be so diagnosed if their visual issues were accurately identified and addressed in a timely manner.

As I stated at the beginning of the previous post, it is extremely likely that a child on the autism spectrum has one or more visual issues that will not even be considered during a typical eye exam. These kinds of visual conditions are well understood by behavioral optometrists all around the world. Acknowledging, identifying and treating these visual conditions often results in stunning improvement in the quality of life children on the spectrum will be able to enjoy. The visual process is a critical factor in how all of us understand and interact with the world around us – the better it works the more options we are likely to have.

There is abundant research from numerous branches of science that supports the basis of behavioral optometric thinking and practice.  Unfortunately most of these researchers didn’t realize behavioral optometry existed while they were doing their work.

Article after article is appearing in sources including the Proceedings of the National Academy of Sciences, The Journal of Autism and Developmental Disorders, the Developmental Science journal, the Biological Psychiatry journal and many others. I think it will be a great day for children on the autism spectrum and those who care for and about them when all of these professions begin acknowledging the work that behavioral optometrists have been doing for the better part of a century. The pioneers of behavioral optometry put many of these pieces together a long time ago and immediately began to apply this knowledge clinically. Many branches of neuroscience have since verified much of what behavioral optometry has known all along about the relationship between the brain and the visual process. None of this research incorporated behavioral optometry and knew little if anything of its existence while substantiating so much of what we have been doing.

There are behavioral optometrists across the globe with the expertise and passion to work with children on the autism spectrum in ways that no other professional understands. Only behavioral optometrists understand the importance of lenses, vision therapy and the intricacies of the visual process to the degree necessary to improve the visual abilities of children on the autism spectrum.  There is no way to know ahead of time just how dramatic an impact improved visual performance and development will have for these children, but you can be almost certain that something good will emerge. If you are concerned about a child on the autism spectrum, do that child and yourself a favor and at least get an evaluation by a behavioral optometrist. You’ll all be glad you did.

Next time:  Are you looking at me?  Eye movements: More Than Meets The Eye

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