Hyperopia as Physical Disability Part 2

Troubled Young Reader@2xIn the recent post, I focused on hyperopia as a physical disability. This notion, that non-blinding vision dysfunction is a disability will be a new idea to many readers. There are many reasons for this and these are worthy of several series of posts, but I’ll mention two big ones: Professional college curricula, so education of doctors and therapists on the one hand, and the arcane nature of vision, on the other.

The second point is easier to address quickly: People understand blindness – you just can’t see, sort of like when you close your eyes. That’s a very medical perspective of visual dysfunction, and certainly we, eye doctors, encounter this daily, even though it’s never quite so simple as ‘closed eyes versus open eyes’. Blindness is more complicated than that and each form of blindness requires its own approach in care and remediation. So, while blindness is complex, most people can grasp some notion of the concept. Still, the details are obscure and understood by only the few. Then, well beyond the medical notion of visual dysfunction, like blindness or strabismus, that is, the obvious things, we have a world of visual dysfunction that is most often invisible to the outside viewer, and often not perceived even by the afflicted until it’s corrected. This is the truly arcane aspect of visual function.

A favourite metaphor: You own a Ferrari, and you like to take good care of it. You put good fuel in it, change the oil, you maintain it regularly, and only take it to the mechanic who you know can service your cool car. Your car is great, and fun to drive, but you don’t have to know how it works, only that even though it’s complicated, all you really need to do is turn the key and go. Vision is like that: Deceptively simple, but that overt simplicity requires covert complexity. There are many elements in vision that can break down, and for most children, some aspect of vision is not functioning optimally ‘out of the box’.

Back to the first point, that professional college curricula are lacking: Behavioural vision is simply not taught in schools of education, psychology, occupational therapy, or medicine. It’s true that these fields do touch on aspects of vision, but in very limited ways – vision, in those domains, is a secondary concern, or one element in a larger paradigm of study. Psychology and occupational therapy, for example, will be especially concerned with ‘visual processing’, but these percepts are difficult to prove or measure, even though tools exist to do this sort of assessment. There will be no training in optometry, that is to say, the measurement of the physical and behavioural aspects of vision, which are very much tangible. As a glaring example of the deficiencies in professional training, consider that nowhere in psychiatry, pediatrics, psychology, education, or occupational therapy are therapists even encouraged to keep a record of the patient’s refractive state – one of the key elements in learning, cognition, and emotional self-regulation. Furthermore, referencing something so basic as refractive status is neither required nor considered in the assessment or treatment of childhood behaviour and learning concerns.

Other recent studies (see below) point to the fundamental importance of visual function in child behaviour and performance, and in particular, the very basics of refractive status (to what extent is the child nearsighted or farsighted, and what degree of astigmatism is present) and that of visuomotor deficits. These simple matters are of critical importance in determining why children struggle, but still, most pediatricians will be more concerned about the child’s weight, height, or cranial circumference.

This lack of attention of child development professionals to critical elements of visual function may be referred to as Vision Blindness. Vision blindness is structural, in that professional colleges neglect elements of visual function in their curricula, but it may also be self-imposed, as in ‘there are none so blind as those who will not see’.

An upcoming series of posts on Vision Blindness will illuminate this issue in more depth and attempt to explain why this represents the greatest failure of education, psychology, and health of our modern era.

Additional new studies considering the role of child visual functional status in learning and behaviour. See:

Reading Fluency in School-Aged Children with Bilateral Astigmatism; OPTOMETRY AND VISION SCIENCE Vol. 93, No. 2, pp118-125

Conclusion: ORF (oral reading fluency) is significantly reduced in students with bilateral astigmatism (Q1.00D) when uncorrected but not when best-corrected compared with their nonastigmatic peers. Improvement in ORF with spectacle correction is seen in high astigmats but not in moderate astigmats. These data support the recommendation for full-time spectacle wear in astigmatic students, particularly those with high astigmatism. http://www.ncbi.nlm.nih.gov/pubmed/26808282

ADHD and Vision Problems in the National Survey of Children’s Health; Optometry and Vision Science, VOL. 93, NO. 5, (Ahead of print.)

Conclusions:In this large nationally representative sample, the prevalence of ADHD was greater among children with vision problems not correctable with glasses or contacts. The association between vision problems and ADHD remains even after adjusting for other factors known to be associated with ADHD.

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