(An excerpt from the Preface to Nearsighted White Kids)
It’s common for books such as this to offer living examples of the thesis, in this case, examples of children who have struggled needlessly, or failed to thrive, for lack of vision assessment or intervention. My colleagues will agree with me that there are literally too many of these to count, that we are talking not so much about isolated cases affecting a portion of one percent of children. As a general useful guide, we can say that one in four, that is 25% of school-aged children have one or more of the following concerns:
- An undiagnosed problem with vision that they are not aware of because their ‘normal’ is not unusual to them, that they simply presume that all others have the same visual schema. (Visual Schema is a term coined by a colleague, and represents the whole of the current global state of vision function, be it labored or easy and fluid).
- An undiagnosed refractive problem, such as significant nearsightedness (myopia), farsightedness (hyperopia/hypermetropia), astigmatism, anisometropia (significant differences in refraction left vs. right), aniseikonia (differences in magnification left vs. right).
- An undiagnosed focusing concern where they cannot easily move focus near-far, far-near.
- An undiagnosed ‘lazy eye’, more properly known as amblyopia, where one or both eyes are not seeing well for lack of appropriate development of the retina or associated cortex.
- An undiagnosed alignment disorder, such as Convergence Insufficiency, where the eyes cannot fixate near targets, such as is required for reading.
- An undiagnosed visuomotor skills deficit where the eyes are not targeting and ‘tracking’ well enough for the task at hand and which is interfering with reading.
- An undiagnosed visual dysfunction syndrome that is fully preventing learning, or which has led to a DSM-V-based diagnosis of developmental or learning disorder leading to medication or other spurious treatments.
- An undiagnosed visual dysfunction which is leading to trouble at school, trouble at home, and suicidal ideation.
As an author, I would be remiss in not providing at least a few examples, and I will oblige you, dear reader, with brief accountings of a few notable cases as the following chapters unfold. There is little doubt that vision drives behaviour and personality development, and I will agree with many of my colleagues that these effects have more or less universal impact, regardless of gender or culture, and that furthermore these have variable impact over a lifetime. The lack of research in this area speaks volumes about our fascination with other things.
For example, and this is all too common, I have been told by people with no training in vision science or vision rehabilitation, that vision doesn’t matter and that vision rehabilitation ‘doesn’t work’. Typically, these are the very same people who have trouble defining fundamental concepts like myopia, hyperopia, or astigmatism, let alone how these impact on behaviour and development: Vision, to these practitioners, is an eye chart and the lack of ‘pink eye’, end of story. These are the teachers who recommend ‘medications’, and the doctors who offer them by the tonne annually for troubled kids, but have no record of their refractive state (are they just farsighted?). These are the child development professionals who have nothing to learn and who are happy with their brand of professional hegemony, the bias of systemic momentum and culture – and the power of the DSM-V.
Some of these same voices have threatened me personally for bringing up important concerns in schools, for speaking out against systemic racism and neglect. Some have gone out of their way to try to silence me when I have objected to cruel treatment of children who have never had the benefit of a comprehensive program of visual functional assessment and / or remediation before being forced to stare at a computer monitor for hours upon hours. My own strident voice comes from many years working in child education, technology, and vision rehabilitation, and from weekly encounters with kids like Sam, Nolan, and Charity.
Sam is a 9 year-old who had been scolded, chastised, isolated and punished for his inattentive behaviour in class, even though he was performing above grade level. He would power through his work, then refuse to sit there and look at the material on his desktop/computer, preferring to wander and scan. No one had taken the time to assess his visual status, because it’s not required by either parents, schools, psychologists, or family doctors. In his case, like so many others, there were obvious visual impediments that rendered him low vision in one eye, and with a difficult prescription in the other. Farsighted astigmatism is a common and often neglected visual impediment and has potent negative impact on near work.
No doubt, concerns of suicide in children are multifaceted, but difficult vision is one major and simple obstacle to remove as a primary concern. Nolan was a 5 year-old in Kindergarten who also struggled with high farsightedness, but in both eyes. He would run around and play, but had a very short temper and did not tolerate near work at all. We diagnosed him, offered assistance with spectacles and vision rehab, but his parents were unable to follow through on all elements. He became so frustrated with his teachers insisting that ‘he was not behaving well’ that he internalized this and become suicidal by the time he hit Grade 1, running out into traffic to try to kill himself. At that time, his parents sought additional psychiatric help and were considering anti-depressants along with something for ADD/HD, then something else to aid with sleep.
Chastity was 3 years old and living on a nearby First Nations reserve when she was jabbed by a stick in her right eye, blinding her and leaving her with chronic pain. Her left eye was also affected by high astigmatism, common in her community. Over the years, the children in her traditional schools and her reserve school were unbelievably cruel, taunting her as a monster, a Cyclops, and this eventually led to hospitalization in a psychiatric centre for threats of suicide. No one had ever formally pursued vision management with her beyond the surgical needs, and this left her in a state where what she learned in class was a matter of what she could remember hearing – study after the fact was nearly impossible. After adequate compensation with lenses and guidance in management of pain and vision loss, Chastity, now 15, is a mostly independent and confident person, but with so much lost time and emotional scarring, it is unlikely she will ever reach her full potential, or become financially independent.
Archie is a good friend of mine, and we’ve remained close since we first met in Kindergarten. He’s one of the funniest people I know, and the sense of humour is a sure indicator of intelligence. Still, Archie struggled for years and was happiest being a class clown. Academically, he came from an educated and intelligent family, but he worked to maintain focus and would rarely see marks above 70% without extreme effort. I can recall Archie rocking a pencil case full of pencils across the frontalis muscles in his forehead, and complaining of headache as a matter of course – it’s just what Archie did. In Grade 11 (yes, that late), Archie again attended a family doctor regarding headache – he had attended public health facilities on numerous occasions for this concern since he started school, and had had all possible scans and blood tests possible at the time. This particular MD tested his eyesight and suggested that he might benefit from an eye exam. Archie went for this exam where it was discovered that he had asymmetric significant astigmatism: He could not make things clear at any distance, and the effort in trying was at the root of his chronic lifelong headaches. He was prescribed glasses and two weeks later we all noticed a great change in his demeanor: He was more relaxed, more serious, and no longer anguished over his headaches.
There are literally thousands of kids like Sam, Nolan, and Charity, and Archie in the Province of Alberta alone, and countless others in other jurisdictions. The health and education systems must do more than offer scoldings and drugs to address this problem. This is not so much a matter of opinion at this point as a recognition of the stark facts of the situation: Society (all populations) is, for the most part, blind to the fundamentals of how vision works, and this leads to the ongoing neglect and abuse of countless kids, while simultaneously leading to countless millions in wasted taxpayer dollars. Declarations of human rights widely advise that all persons should have equality and equal access, but this has never been the case, not for those with undiagnosed visual functional concerns.