Learning Related Vision Problem
If your child has been recommended for a neuropsychological assessment or is having academic difficulties, a functional vision assessment including vision acquisition and processing deficits need to be considered.
Laterality, Reversals, Dyslexia, and mathematics all require spatial awareness and directionality.
Successful reading requires mastery of many important visual skills, not just 20/20 eyesight. Proper childhood development (crawling, walking, talking) results in good timing, rhythm, balance, gross and fine motor formation, and primitive reflex integration. Deficits in any of these areas can lead to difficulties crossing the midline, poor handwriting, headaches, eyestrain, lack of endurance and ADHD symptoms.
Vision is developed throughout a person’s life and if FUNCTION occurs before DEVELOPMENT (ex: excessive near work before the child is ready), there will be compensations the child makes resulting in deficits in proper visual motor integration. This often manifests as poor fine motor and gross motor relations. An example may be delay in tying shoes, or a strange pencil grip.
20/20 eyesight needs to integrate with other visual efficiency skills and all other senses in order for “vision” to emerge. Integration of vision with speech-auditory and other senses is a part of normal development. Speech deficits are often linked to visual deficits. Visual processing leads and integrates with the body and mind for efficient learners. Auditory or kinaesthetic learners are less efficient as there are many more neurons in the brain dedicated to vision than all other senses combined.
Very often, developmental visual / sensory issues lead to behaviours such as anxiety (at homework time), meltdowns, depression, suicidal thoughts, and psychoneuroimmunology problems. Such issues are exacerbated by digital devices and the effects of blue light emissions. Blue light affects the serotonin and GABA levels of the brain and also influence the visual processing system.
Types of Vision problems associated with learning:
Eye movement problems: The information obtained by the child will be reduced if eye movement are slow and clumsy. If the eyes “jump” the reader will lose their place. Words may look blurred, doubled or unstable.
Eye teaming problems: Eye teaming is learned and must be acquired by use during the school years. Lack of eye teaming skill interferes with comprehension and spatial relations.
Eye-hand co-ordination: Lack of skills in drawing and writing is a strong indicator of oculomotor delays. Vision leads motor, and poor hand writing is a symptom of spatial discrepancy.
Visual form perception: These issues are a result of lack of ability to discriminate visual likenesses or differences. Confusion with similarities leads to reversals in reading and letter forms leading to difficulties in reading and spelling.
Refractive status problems: Nearsightedness (Myopia) and farsightedness (Hyperopia), Astigmatism and focusing problems affect performance in the classroom. These problems can be developing even if the child sees 20/20 on the eye chart. They require prompt attention by your developmental Optometrist who can treat both vision and sight.
Amblyopia and Strabismus
Symptoms of an eye teaming problem include:
- Blur of one eye
- Poor academic endurance
- Excessive head movements while reading
- Poor attention skills/ ADD/ADHD
- Misjudgement of distance, clumsy
- Motion sickness
- Slow reaction time and poor timing
- Eye turn or straight eyes
Vision Therapy acts by breaking the active suppression of the poorer seeing eye by training the brain to use both eyes as a team.
Brain Injury / Concussion
Those who have suffered from Traumatic Brain Injury due to Stroke or injury share a common sensory outcome. Visual symptoms are summarised as PTVS, Post Traumatic Vision Syndrome. Symptoms often include convergence insufficiency, midline shifts, sensitivity to light, motion sensitivity, decrease in peripheral awareness, difficulty concentrating on visual tasks, pain in eyes, headaches, double vision, fatigue. PTVS significantly impacts activities of daily living.
Vision is responsible for disturbances as the visual system plays a primary role in spatial awareness working in tune with the Vestibular and Proprioceptive systems. Re-training Vision realigns space to help brain injured patients get back to life by re-establishing a strong relationship with gravity and re-grounding the body. Through collaboration with allied health professionals vision therapy compliments a holistic approach to healing and positively impacts other issues such as depression, decreased cognition (impact), decreased physical stamina and ringing in ears.
As the primary sense, vision interacts with all other systems in the body as we develop. Most conditions and diagnoses have a visual component as the body is always changing and learning from its experiences.Spectrum disorders, pregnancy birth trauma, nutritional deprivation, limited maternal movement during pregnancy, difficult labour, mold toxicity, food sensitivities, immune systems deficiency, gut-brain, heart-brain all have an impact on visual development and vision responds to each of these issues in a unique way. Visual behaviours are manifested symptoms, a product of coping skills the person uses in their body to achieve homeostasis. Reduction of visual space, prevention of looking, inability to focus are all serving a purpose within the body. For example, reducing visual space is an effort to reduce sensory stimulation
“Stimming” is purposeful engagement of peripheral vision to calm used to calm oneself when over focused. Toe walking is a spatial coping strategy. As vision leads motor development, people who have worn leg braces or whom are in wheelchairs will have a different visual experience. wheelchairs will not get the same experience for visual development. In order for a person to achieve full visual development a number of necessary meaningful visual experiences must occur. When they are not achieved naturally, vision therapy provides these experiences to move development forward.
Critical period myth
Many families are advised visual conditions are subject to a critical period for treatment. Critical period infers after a certain age, a child can no longer change their visual system. This concept has been repeatedly debunked by research and experience and is currently outdated. Neuroplasticity studies show us we can develop, change and rehabilitate the brain at ANY age. The concept of the changeable brain is infiltrating treatment plans in all areas of medicine. Since the eyes themselves are part of the brain, Vision Therapy can be done at any time. The only urgency is when there is widening of the academic gap with same-aged peers. There is no rush to have surgery. The risks and benefits of any surgery should be carefully considered and undertaken without coercion and with full informed consent.
Notes on Strabismus Surgery and Labelling and Pharmaceuticals
Western medicine has become specialized and at times may lose sight of the concept of the patient as a whole organism functioning in harmony or synchronicity. If you look at the body in pieces, you cannot understand the function. Each system in the body reacts to and interacts with all other parts within the body. In order to treat, we have to consider the whole organism - the whole human being. All forms of treatment will ricochet throughout the body. Labeling conditions and diseases excludes and limits treatment options.
Vision development is a continuous ever changing process that spans from birth to death and is directly linked to movement. Starting in-utero primitive reflexes initiate movement. Peripheral vision forms first as it relates to spatial orientation and gravity. The macula, the part of the eye responsible for clear vision, forms last. Vision consists of light and shadows at first. After birth, development of retina depends on interaction with environment. Activities such as sucking and crawling, tummy time all provide opportunities for visual development. As a child begins to move, binocularity emerges. This is also the time that binocularity can breakdown and infantile esotropia occurs. Guiding development is possible, there is no critical period where intervention is too early or too late. The neuroplastic brain continues to change as we age, and is dependant on movement to keep working to its potential.