Vision Blindness – Preface

Sad_elephantVision. So what. What’s so special about vision? That is, it’s importance cannot be overstated, but as one family doctor told me one day when discussing a child who had recently been given medications for behaviour and emotional concerns, “what do his eyes have to do with his learning?”

Sight is truly simple: You open your eyes, and there you have it – The World. It simply works. The process behind getting that simple sight of the world is more appropriately called ‘vision’ or ‘visual process’.

Vision science is one of the broadest and deepest fields of study, and this acknowledges the great complexity and power of human vision. Yet fundamentally, vision to non-vision scientists is a simple tool: It siwmply works (that is, unless there is something medically wrong with your eyes or visual neurology, as in cortical damage, or problems with the optic nerve, or you have trouble elsewhere in the visual nervous system). In cases of medical impairment, either there is a cure, some form of prevention, palliation, or basically nothing else.

This is how we, a society of taxpayers, doctors, and scientists, tend to look at ‘vision’. There are, as it turns out, serious errors in this paradigm, mostly errors of omission, and these I will describe in the coming posts. While the medical perspective is a key element, suffice it to say there are high prices to be paid in ignoring something so fundamental as ‘how vision works’ when it comes to designing learning and health systems, and especially in the context of early childhood development.

My initial academic training was very heavily-based in pure science. My first degree explored neural science and neuropsychology, primarily. This I followed with a degree in education looking at modern implementation of learning theory in science instruction. All along, I carried on parallel studies in Information Technology, and have been involved in computer hardware and software implementation and development since 1990. I was among the early classroom tech adopters, and one of the first ‘virtual’ teachers in Alberta’s early forays into computer-mediated distance education.

When I’d finished my undergrad studies, I was comfortable speaking to visual neural networks, in the same way I could describe how computers work: This was connected to that, and this area on the motherboard has these pieces, and here are other pieces over here and when you turn it on, it works.” This was how I was taught and learned about tech, about medicine (from physiology to psychiatry), and initially, about vision.

This view of vision, as a mechanical and medical thing, made sense in the absence of further data and understanding. It was sufficient, and for those who could not be helped by that restrictive view, they had to accept options of ‘no possibility of change’ or ‘attempt at change with great risk’. In this context, we could speak of a number of visual conditions ranging from strabismus to learning and behaviour problems in the classroom. It is how I was taught to ‘see vision’, and how I saw vision, until I attended doctoral studies at a wonderful behavioural school of optometry in Forest Grove, Oregon.

I was both delighted and terrified to learn that vision was much more complicated than even I had realized; that for many, visual dysfunction was just ‘the norm’, and that for lack of proper care and attention, their lives were taking, or had taken, turns for the worse. Our technology-centric and over-simplified medical perspective on vision had meant, and means, that the lives of many children and families have been and continue to be irrevocably and negatively altered for lack of what amounts to basic attention to elements medical doctors, psychologists, and teachers were never trained to understand.

To use a simple and strongly visual analogy: Imagine a classroom of children before orthodontics. None of them have ‘the same’ teeth. Some have better dentition than others. Some have dentition that is unsightly and socially difficult but very functional, while other have teeth that are so badly developed, they struggle with eating and experience pain. The key difference here is that visual dysfunction has serious consequences for child emotional, cognitive, and physical development. There are several points to consider:

  • refractive state of each eye,(nearsighted, farsighted, astigmatism, and to what extent);
  • how these compare right vs. left eye (anisometropia);
  • amblyopia, and other medical forms of partial blindness
  • any alignment anomalies in the full range of movement, i.e. incomitancy, strabismus;
  • visuomotor skills including convergence insufficiency and other concerns of vergence, saccadic, pursuit, and fixation anomalies, accommodative dysfunction;
  • visual-motor status including somato-visual and vestibulo-visual inputs and integration, gross reflex status, gross-, mid-, and fine-motor integration;
  • bilateral integrative status, for example control at midline, definition of laterality;
  • Visual perceptual elements such as spatial perception and calculus required for motor planning and higher cognitive function.
  • Visual needs and tasking: What are we asking the child to do with her vision? What does the patient need to do with his vision?

The current status of vision assessment and management in health and education is akin to just turning a blind eye to dental health entirely and to be satisfied that rotten and crooked teeth simply don’t matter. We know that this is an untenable position to hold, but the reality is that the disregard for vision is even more significant to development and learning, and more destructive to families.

Well beyond the simple concept of vision as ‘eyesight’, vision is very complicated. Most often, people don’t realize they have any significant visual dysfunction until it is corrected, or compensated for via lenses or vision rehabilitation. The response to early intervention in most cases is one of amazement and wonder, and for many parents, after years of searching and agony, there are tears.

Still, with the volumes of research across many domains, countless clinical guides in visual rehabilitation, and daily success stories in how families are changed after finding appropriate care for visual dysfunction, the general trend is to disavow any importance to ‘invisible vision problems’ that extend beyond the basic elements defined in medicine, and the somewhat dubious elements described in child psychology. This is the vision blindness elaborated in the coming posts.

Here is the bottom line, in technology and in child development: Regardless of what the problem is, ALWAYS check the basics first. If it’s a computer, security camera, or anything that runs code: Save your work. Turn it off. Unplug from power. Check all the cables and connectors, unplug and replug. Turn it back on. Keep current on all your recommended updates. 99.9% of the time, it will work.

For children, love them actively: Feed them good food, teach them to cook. Exercise them, teach them to take care of themselves. Let them play, teach them to understand the world and their bodies. Read to them and do puzzles, teach them to construct more complicated ideas in their minds. And always ensure vision and hearing are strong. If they run in to trouble in learning and behaviour, these are the first to check first, and vision in particular should be considered in some detail. So, no, it’s not sufficient if eyes are white and a child can see pictures of a certain size at 10 feet.

This series of posts are technical, but also loaded with personal experience and frustration in my attempts to address the outstanding and unmet vision needs of children in Alberta. The posts are to educate and illuminate the obstacles that prevent kids from reaching their full potential, and the ways we encourage systemic abuse and neglect.

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’ – the very same people who have trouble defining something so simple as ‘myopia’, ‘hyperopia’, or ‘astigmatism’, let alone how these impact on behaviour and development. These same voices have threatened me personally for bringing up important concerns in schools, and have gone out of their way to try to silence me when I object to cruel treatment of children who have never had the benefit of a comprehensive program of visual functional assessment and / or remediation.

This series is for kids like S. who saw me just a few days ago. S. 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. No one had taken the time to assess his visual status, because it’s not required. In his case, like so many others, there were obvious visual impediments that rendered him visually impaired in one eye, and with a difficult prescription in the other. There are literally thousands of kids like S. in the Province today; the health and education systems must do more than offer scoldings and drugs to address this problem.

This series is equally written for myself, to tell part of this complicated and heartbreaking and frustrating story, and for my courageous colleagues who also struggle to bring truth to light; we all suffer the effects of extreme academic prejudice and dishonesty, and professional hubris, in our attempts to bring real solutions to difficult situations.

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