Challenge for Today’s Optometry: Moving from Eye Care to ‘Brain Care’

From covered wagons to Ferraris and Teslas, rotary phones to iPhones, typewriters to MacBook Airs, time has changed inventions to make them better. We should wonder why old-fashioned eye testing equipment remains old-fashioned eye-testing equipment after 150 years.

Society and science have advanced in the past 100-150 years as will be shown in Mind-Eye Institute’s booth at the Los Angeles convention center in March during the 17th Annual Congress of the Society for Brain Mapping. However, eyesight testing has not. It still goes by 20/20 measurements of letters on a high-contrast, non-moving eye chart.

With the exception of some relatively minor instrument-design changes during the past decades, eyesight evaluation techniques have remained fairly stagnant since the 1860s. The general testing completely ignores peripheral retinal processing, which comprises an overwhelming percentage of a person’s visual awareness and is critical for awareness of movement and reaction time and, yes, survival in today’s society.

Having general awareness of where we are in our environment is highly dependent on peripheral eyesight. Unlike the landscapes of the 1800s when mountains, prairies and forests dominated one’s visual field, our modern, fast-paced society abounds in moving targets – from signs and lights whizzing past us in traffic to ever-changing GPS navigation screens and words rolling in and out of sight on scrolling web pages. We must use peripheral and central eyesight in tandem to scan and shift our gaze from place to place and to assess movement, shape, size, color, contour, and design of objects. Technology uses movement all the time – scrolling on a computer screen, using Smart boards and PowerPoint presentations at school, watching movies with special effects, driving with multiple lanes of traffic, etc.

Interaction of central and peripheral sight pathways in the brain is necessary for memory, planning, organization, decision-making and overall visualization and perception skills.

Peripheral eyesight works at both conscious and subconscious levels. Even when we are focused on something else, the corner of our eye remains “turned on” to be aware of movement or change and immediately assess speed and shape of an oncoming object. Instantaneously, our brains process the information, causing in us a cascade of emotions – such as fear or concern – and prompting us to react by running away (if a large, ferocious dog is moving toward us), pouncing on the moving object (if the house cat is escaping from our backyard) or instinctively stepping aside so that whatever is coming (like a slowly moving car) can pass by safely.

Experienced hunters, for example, must have sharply honed, conscious and subconscious peripheral retinas to catch movement in the brush or the woods within a wide field of vision. Persons who read quickly, with comprehension, have highly functioning peripheral retinas, which constantly scan sentences, paragraphs and the entire page, while their central eyesight locks onto the details of individual words.

Why is it that a person who is focused on a text message on a mobile phone while crossing a street will subconsciously step up onto a high curb to avoid tripping? Peripheral retinal processing, of course.

Why does an infant’s peripheral retina activate several months before its central eyesight develops? Because peripheral eyesight is what’s needed for awareness, reaction and survival. Mobiles placed on cribs within an infant’s reach are designed to develop peripheral retinal pathways in the brain. So why are eye-testing instruments designed to block off crucial peripheral eyesight?

Even those optometrists who conduct visual field tests to evaluate peripheral vision are only assessing a patient at a conscious level. The patient is told to look for a flashing light somewhere in his or her field of vision – nothing subconscious about it. That kind of testing is much like the eye check performed for a driver’s test. You look through a viewer and tell the tester where you see a light blinking – to your left or your right where your conscious awareness is placed.

Our peripheral eyesight is designed to be turned on at all times and to work in synchronization with central eyesight. Indeed, the retina is an extension of brain tissue and sends signals to more than simply the eyesight portion of the brain. Retinal signals combine (partially beneath a conscious level of awareness) with other external sensory signals – from hearing, smell, taste and touch. Further brain processing synthesizes that information and causes us to respond depending on other internal sensory signals.

If brain circuitry is out of sync because it has been disrupted by injury or disease, or is under-developed, people can become confused about their surrounding environment, have a narrowed perception and awareness, and exhibit inappropriate reactions and responses or experience difficulties in learning. When central and peripheral eyesight do not interact appropriately and the sensory systems of eyes and ears are uncoordinated, people have to continuously monitor their attention, and such constant effort becomes exhausting.

The connection between mind and eye is unique to each person’s processing system and experiences. Neuro-optometric rehabilitation is able to use this concept of mind-eye testing – versus simply eye testing – to prescribe therapeutic eyeglasses, filters, prisms or other optometric methods on a very individualized basis to stimulate the retina in ways that bring sensory systems into synchronization and alter a patient’s environment. By changing the way light disperses on the retina, optometrists can affect how the brain reacts to information about the environment and modify a person’s spatial awareness, body posture and selective attention to sound.

We have entered a new year – 2020. That means we are already about 20 percent into the 21st century. Our challenge as optometrists is to move from eye care to “brain care.” Join Mind-Eye Institute’s campaign to update eye testing to include subconscious peripheral awareness and eye-ear interactions! Let’s leave standard 20/20 eye acuity testing, which was developed 150 years ago, where it belongs – in the 20th century.

Deborah Zelinsky, O.D.
Founder, Executive Research Director
Mind-Eye Institute