Choosing an Eye Doctor

A parent recently asked why I recommended that her child be examined by an optometrist rather than an ophthalmologist. The answer comes from my understanding of these two eye care professions and my personal experience.Both types of eye doctors examine and prescribe glasses, diagnose and treat eye disease, and can evaluate how well a person uses the eyes together. However, each profession is unique. Ophthalmologists are trained to do surgery. I credit one with saving the eyesight of my daughter, who at age five, sustained an eye injury. Optometrists are schooled in the behavioral (or functional) aspects of vision. They are more apt to use lenses, prisms and vision therapy to enhance and improve function. These interventions often improve children’s academic and other abilities.

Eyesight and vision are not synonymous. Eyesight is the sharpness of the image seen by the eye. Vision is the ability to focus on and comprehend that which is seen. Research has shown that most children with special needs do not have eyesight problems, while many have visual dysfunction. If a child has motor delays, vestibular difficulties, or health problems, vision is often compromised.

The American Optometric Association (AOA) recommends that children have vision examinations by six months. A good eye doctor can test many aspects of function at this young age and quickly effect changes with intervention. Most school vision screenings check only eyesight only at twenty feet, not at reading distance. They rarely tell us whether a child has a clear image at nearpoint or how the eyes work together. The only information they provide is whether a child can see the blackboard. Many vision problems thus go undetected when parents have false security and brag, “My kid’s eyes are 20/20!”

Vision is Learned: Vision, like reading, mathematics, and language, is learned. Giving meaning to what is seen begins at birth. In the developmental hierarchy, infants move without purpose, while their eyes learn how to work as a team, to sustain focus. Toddlers use movement to drive vision, such as shaking a rattle for its sound before looking at it. Finally, children can visualize without movement. Thus, for children to be successful in school, vision must purposefully direct their actions.

Vision Must Become the Primary Sense: We hear a great deal about individual learning styles. “My child is a kinesthetic learner,” a mother told me. She meant that her child is still using touch and movement to get information about the world. This learning style is more primitive than getting information visually. Well-functioning individuals store all types of sensory images and can visualize and retrieve them upon demand. They no longer need to touch and move to experience their world. Vision directs their thinking, organization, listening and actions. Vision Lays the Foundation for Language & Relationships: Vision plays a major role in language and social-emotional development. Children with language delays, attention deficits, pervasive developmental disorders and autism all have inefficient visual systems. If a toddler is not speaking or relating to others, a vision evaluation is essential.

A developmental optometrist can prescribe therapeutic and pleasurable activities to be done at home, during floor time, occup8tional and language therapy, or at day care. Combining the visual system with touch, movement, audition and social experiences benefits all areas. Begin Where They Are, a workbook designed by vision therapists and available through the DDR, has good ideas for pre-verbal children and toddlers.

Making the Right Choice: Scientific evidence indicates that interventions such as vision therapy, used by behavioral optometrists, work. The AOA publishes a monograph, The Efficacy of Optometric Vision Therapy, containing 238 references; it is available free of charge from the DDR. A number of organizations can help locate eye care professionals qualified to evaluate even the most difficult, non-verbal children. The College of Optometrists in Vision Development (COVD) certifies optometrists who satisfy strict criteria. The Optometric Extension Program Foundation (OEPF) offers post-graduate education to optometrists and educates the public about vision. They dispense free information and can make referrals to clinical associates in your area.

If your child has developmental delays of any kind, choose to have all aspects of vision evaluated.

[New Developments: Executive Director’s Column, Spring 1998]

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