Vision and Development: What’s Old is New Again Part I

Part I

I recently stumbled upon old Optometric Extension Program (OEP) books that detailed vision development and perceptual assessments of children, and realized that there is so much value in old literature and theories.

As new graduates, we are so focused on learning new technology and using computers as diagnostic tools, that we often forget the value of observation, and good old pen and paper testing to learn about our patients.unnamed

With the school year just starting, and October being “Learning Disability Awareness Month,”  I think it is a great time to review how to examine children who can see 20/20, but are still struggling visually.

This article will chronicle perceptual areas that we must observe in our patients when doing a complete visual workup, and next month’s article will discuss the testing to go along with it.

Before we move forward, I’d like to share a few clinical pearls from Dr. Homer Hendrickson from “Visual and Perceptual Aspects for the Achieving and Underachieving Child,” to remember:

  • It was found that the eyes weren’t at fault as much as how the eyes operated, how they worked with each other and together with the brain, and in turn with the whole child.
  • The human is a total being, never segmented.
  • Movement is the key to learning.

Keeping these clinical pearls in mind, you can appreciate the reason behind making perceptual testing part of our visual work-up. We must understand the child as a whole to understand how they are visually functional. Here are some of the areas that I test for in my visual information processing work-up:

  • Perceptual Speed:
    • This is a skill that translates into a child’s ability to observe and comprehend things visually in a succinct amount of time. A paper written by L. Bender in 1938 found that “slow visual processing produces an incomplete perception of the stimulus, resulting in a more primitive response.”
  • Motor Skills:
    • The development of motor skills in children have been well documented with the age appropriate milestones laid out. It is crucial to make sure that a child has not skipped any steps in their motor development as this can then translate into poor oculomotor function and spatial/body awareness.
  • Visual Form Perception/Recognition:
    • These skills are essential in building the foundation to read, write, and comprehend.
  • Auditory Perception/Processing/Memory:
    • Vision and auditory processing are intertwined entities that are crucial in learning. It is good practice to toggle out any signs of auditory processing issues in your patient.
  • Visual Memory 
    • Memory is an integral portion of learning and maintaining our skills.
  • Visual Motor Integration
    • We must understand the patient’s ability to use his/her eyes to guide his/her motor movements. VMI is key in developing gross and fine motor skills for visually demanding tasks.
  • Laterality/Directionality: 
    • These skills are pervasive throughout a child’s life giving rise to body awareness and letter/word recognition.

For more information on perceptual testing, I encourage you to read Mindsight, the COVD Blog, for great articles. A few of my favorites are the following:

A blog I wrote a few years back about perceptual testing here called “The Rare Beast: The Simple Convergence Insufficiency.”

What I can tell you is that the mastering of prescribing a vision therapy program takes time and practice, but is an essential part to guarantee your success.

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About Miki Lyn DAngelo

Miki Lyn DAngelo
Miki Lyn D’Angelo, O.D. graduated with honors from the SUNY College of Optometry in New York, receiving the VSP Excellence in Primary Care and Excellence in Vision Therapy awards. She then continued her education by completing a residency in vision therapy and rehabilitation with Dr. Barry Tannen, OD. She has extensive experience in family eye care with a specialty and passion for pediatrics, vision training and neuro-rehabilitation with traumatic brain injury patients. She recently just opened a private practice cold with a partner on the Eastern End of Long Island. In her spare time she loves cooking and working on the farm with her fiancé.

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