The foundation of the brain pathways formed between the eyes, the brain and the body is laid down during the prenatal and first years of life; the most critical stages of vision development occurring in the first year. The vision skills developed during this time are the same skills needed to read, write, ride a bike, play sports, and all the other things we do with our mind and body.

Early childhood development is an orderly predictable, interrelated, inter-weaving sequence of development that results in the capacity for learning. – Sassé

Vision Development

A baby does not even have the ability to see clearly (20/20) until at least 4 months of age when the fovea is fully developed. Some researchers think the baby’s experience in his/her world stimulates the fovea TO develop.

Vision is a dominant process in the growth, development and daily performance of children. It is a learned PROCESS that starts even before birth. It is pretty important, involving 65%-70% of all pathways of the brain, making it our dominant sense.

Every lobe of the cerebral cortex is involved in the processing of visual information or carrying out visual tasks. There are more areas of the brain dedicated to vision than ALL the other sense modalities combined (including auditory!), yet they are integrated and interlinked with all the other senses, especially your vestibular or balance system.

Cooing, sitting up and crawling are signs that your baby is growing. Your baby’s vision has stages of development too.

The development of vision occurs in a predictable and orderly sequence. These developmental milestones, though they may be reached at different times for different children, are essential in creating a solid foundation for more sophisticated ways to see more, observe more, experience more, remember more, learn more and become more efficient in everyday life.

Intelligence not only grows but CAN BE GROWN. – Landreth
Usually there are no observable signs to mark the progress, but rather signs and symptoms of problems once they occur. Good vision includes healthy eyes, age appropriate visual acuity, visual integration and visual skills such as eye teaming, eye focusing and eye motility. Our doctors can evaluate these components and help ensure your child reaches his or her potential.

Movement IS Learning

Neurological development and, therefore, vision development is based on movement. For example, creeping (mobility on hands and knees) is one of the most important movement patterns to help vision development. It is through creeping that the vestibular (balance), proprioceptive (feel) and visual systems combine to operate together for the first time. Laterality is the result of this integration, which is a cooperation between both sides of the brain.

Motor competence is a necessary precursor for visual attention. – Ingersoll
Without integration between the senses (vestibular, proprioceptive, vision), there would be no sense of balance, space and depth. Lack of integration affects body control, attention, eye-hand coordination, focusing, eye-teaming, visual perception, sequencing, organization and academic skills such as reading, writing and math.

The amount of sensory input, especially visual input, affects motor and cognitive growth. – Ludington

The Top 7 Vision Problems in School Age Children

  1. 23% Hyperopia (farsightedness of +1.50D or greater)
  2. 22.5% Astigmatism (-1.00D or greater)
  3. 19.6% Myopia (nearsightedness -0.50D or greater)
  4. 16.3% General Binocular Disorders (eye teaming problems)
  5. 10.7% Strabismus (eye turns)
  6. 6.8% Amblyopia (functional loss of vision – lazy eye)
  7. 6.5% Accommodative Disorders (focusing problems)

When looking at just the top 7 vision problems seen in school age children, 45% of the vision problems are missed on screenings that only use a distance visual acuity chart. When looking at the top 10, this number is over 50%!

The bottom line is it is crucial, particularly in those children that are struggling with development or in school, to have their vision fully tested beyond eye health and visual acuity. Our doctors will evaluate other visual skills that affect learning such as the following to ensure that the visual system is functioning appropriately:

  • Eye tracking (eye movement control)
  • Focusing near to far
  • Sustaining clear focus up close
  • Eye Teaming Ability
  • Depth Perception
  • Visual Motor Integration
  • Visual Form Perception
  • Visual Memory

Our Doctors Participate in the InfantSEE® Program

InfantSEE® is a public health program, managed by Optometry’s Charity™ – The AOA Foundation, designed to ensure that eye and vision care becomes an integral part of infant wellness care to improve a child’s quality of life. Under this program, AOA optometrists like our doctors, provide a comprehensive infant wellness exam within the first year of life regardless of a family’s income or access to insurance coverage.

The InfantSEE® program:

Provides no-cost access to an eye-care doctor who has the instruments and resources not available to general-care doctors like pediatricians and family physicians
Detects potential problems that, if undetected, may lead to learning and developmental issues later
Gives new parents the peace of mind that their infant’s vision is developing properly
Although infants cannot speak, InfantSEE® optometrists have the clinical education, training and experience, as well as the instruments and resources, to provide non-invasive eye and vision assessments for any non-verbal patients such as infants.

If any visual issues are found at the time of the comprehensive infant wellness exam, any additional follow-up visits and exams recommended by the doctor would be an additional fee. If further services or treatments are recommended, you may choose any eye care professional to provide those services, though we hope that you choose to continue your care with us so that we may watch your baby grow and ensure that their vision develops appropriately!

For more information regarding InfantSEE® program please visit www.Infantsee.org or call (888) 396-EYES (3937).

Risk Factors for Vision Problems

Some children are more prone to developing vision problems due to genetic, environment, or nutritional factors. It is especially important for those populations to ensure that vision has not developed erratically because of risk factors.

  • Family History of learning disabilities and/or visual problems
  • Poor prenatal care & lifestyle (smoking, drinking, drugs during pregnancy)
  • Poverty and/or Malnutrition
  • Complications during pregnancy (preeclampsia, systemic infections, medications, anesthetics at birth, obstetrical trauma, toxemia, hypoxia and many others)
  • Children of low birth weight (LBW) or premature birth
  • Failure to Thrive
  • Postnatal factors including infections, metabolic disorders, chronic disease, environmental hazards, and hazardous medical events, (seizures, abuse, head injury, etc.)
  • Lack of opportunity – Rich sensory-motor experiences are decreasing in our culture due to increased time with movement restricted activities involving:
  • car seats
  • bouncing/vibrating seats
  • playpens
  • activity saucers/walkers
  • strollers
  • restrictive clothing/shoes
  • TV/Computer viewing
  • Beyond Infancy

A strong neurological foundation allows for individuals to have greater mastery of themselves and their world. Mastery creates better self-esteem, thinking and reasoning skills and independence in our children.

The degree of a child competence…required for learning can be predicated at age three with few exceptions. The education system however essentially ignores the formative years despite the fact that it is very difficult to compensate for a poor beginning. – Harvard Study

Toddlers learn by observing the world around them, yet they often are not aware that they have a vision problem. A child assumes that what is seen is what everyone else sees, since they cannot look through other people’s eyes to compare. What is normal for an individual may not be what is considered normal for most. This is why it’s especially important for parents to recognize signs of vision problems.

Red Flags – Signs of Interference in Development in Toddlers (ages 1 to 3 years)

  • Has milky colored or cloudy pupils (emergency)
  • Crusty lids
  • Red eyes
  • Squints to see when there are no bright lights or glare
  • Tilting or turning head to one side
  • Clumsiness
  • Lack of interest or avoidance of books, puzzles, and other visual activities
  • Rubbing eyes when not tired
  • Sitting too close to television or computer
  • Holding books or toys too close or too far
  • Closes or covers one eye often
  • Tearing not related to crying
  • Eyes that constantly move back and forth

In pre-school good teachers are helping to develop the appropriate skills needed for kindergarten, such as cutting, pasting, identifying colors, shapes, numbers and letters. They can often tell a parent if a child is behind in the skills necessary for school. Pediatricians can also be a resource in knowing whether or not intervention might be appropriate if there are any signs of delay in development.

Too often, however, parents are told to wait and see when they bring up concerns about their child being behind. This occurs because many skills have a broad timeline range of development. Unfortunately, it is usually the Kindergarten teacher that will tell a parent that their child is not ready to move on to the first grade because many skills have not been mastered.

As a parent, if you are recognizing patterns of developmental interference or your child has several risk factors, my advice is to be pro-active and have your child tested (Occupational Therapist, Speech Pathologist, Behavioral Optometrist). Many times, if there are signs of developmental delays, a child will not grow out of them. They will often build compensatory patterns instead. Have your child tested because you will either know that your child is on the right developmental path, or that your child needs intervention. Either way, you will be able to provide your child with what he or she needs. The earlier you identify and treat dysfunctions, the less likely an individual will struggle in school. This means less possible ramifications such as low self-esteem, special education services, misdiagnosis of disorders such as ADD, etc.

Red Flags – Signs of Interference in Development in Pre-school (ages 3 and 5 years)

  • Toe walking
  • Cannot jump easily or balance on one leg for a few seconds
  • Can’t ride a tricycle
  • Transfers objects between hands instead of crossing body
  • Poor balance, clumsy and/or not coordinated
  • Difficulty with rhythm and timing
  • Turns head to view targets at extreme angles
  • Rubs eyes and blinks excessively
  • Holds crayon in a fist-like grip
  • Cannot draw a circle
  • Does not have a preferred hand by age 4
  • School Readiness

Once the neurological foundation is set in the infant and toddler years, pre-school is a period of refinement of the following skills necessary for achievement:

  • Movement
  • Balance
  • Body and space awareness
  • Visual processing & perception
  • Auditory processing & perception
  • Fine motor movement
  • Rhythm & timing

Well developed visual skills through rich sensory-motor experiences are directly related to reading readiness. Vision is fundamental to written language and visualization, or Imagery, is fundamental to overall learning, but particularly affect reading comprehension.

School readiness is not a question of age, but of the neurological development of the child. The challenge is our public school system relies on age to determine grade level, rather than developmental level. Some children are developing appropriately, but not at the age set by the school. These children fit the “wait and see” model and do quite well in school, but are held back in Kindergarten to give them a bit more time to develop.

Developmental Delays Can Have a Profound Impact

  • 1 in 4 school-age children (10 million children) suffer from undiagnosed vision problems found to interfere with learning
  • 95% of first grade nonreaders had significant vision problems, which was 2.5 times (250%) more than first grade high achievers.
  • As many as 80% of children who are reading disabled or labeled dyslexic have a vision deficiency in one or more basic visual skills.
  • Children with convergence insufficiency alone, one type of eye teaming problem easily remediated, are 3X more likely to be diagnosed with ADHD.
  • Developmental Delays Can Be Prevented or Corrected

Any developmental red flags manifested along the way can be indicative of later learning delays ahead. These developmental delays can be corrected by improving the reception and processing of sensory information to allow for more mature patterns of response. Neuro-optometrists do this with neuro-visual training. Visual inefficiencies due to immature development can be eliminated with intervention regardless of age.

Success of Neuro-Visual Therapy

The success rate of therapy depends on the diagnosis, but research shows that vision therapy has a 75-95% efficacy rate. However, sometimes treatment can be as simple as a good pair of glasses. Seeing clearly or getting the system to work in better balance can make the world of difference.

A human brain, given a good foundation, can continue to adapt and expand for a lifetime. – Piaget