Mind-Eye Response to Article in Indianapolis Star
The December 2 article by Shari Rudavsky concerning nearsightedness in children misses two critical points. First, eyeglasses are not primarily appliances for achieving 20/20 clarity, even though many eye professionals continue to perpetuate that concept by using 160-year-old eye testing and evaluation methods. Secondly, a failure to test how well eyesight and listening ability are coordinated – not simply myopia — is what’s causing many children to struggle in the classroom.
To the first point: only about six percent of our visual awareness comes from conscious focus on specific objects. Most environmental signals passing through our retinas emanate from peripheral space – the space all around us. Unfortunately, society continues relying on a testing system developed in 1862 when much of the nation remained unsettled, overland travel was by horseback or horse-drawn wagons, and prairies and mountains dominated individuals’ peripheral sight. This 20/20 system addresses central eyesight by having the patient consciously look at non-moving letters on a screen across a darkened room, but ignores peripheral retinal processing, which comprises 94 percent of a person’s visual field.
To my second point: most states have laws mandating evaluation of a child’s eyesight and hearing before they enroll in school, but such testing usually is performed separately. Testing does not determine how well the two — hearing and eyesight — work together. Did you know that many children now labelled as learning-challenged and placed in special education classes could return to the regular classroom if only their visual and auditory signals were coordinated?
Our sensory systems are like musicians in an orchestra. Each musician may be highly skilled in a specific instrument, but without a conductor synchronizing what they are playing, the result is simply noise – not music.
In the school setting, a student must be able to maintain awareness of a teacher’s facial expressions, body posture and movements while looking at information presented on a classroom screen or board and simultaneously listening and comprehending what the teacher is saying. At the same time, shifting gaze – and attention — from teacher to desktop has to be automated. Meanwhile, all these tasks must be synchronized and accomplished by “tuning out” distractions, such as the whispering of nearby students, sounds of others shuffling papers, even the changing light coming through classroom windows as the sun goes in and out of the clouds.
The retina is made of brain tissue and sends signals to more than simply an eyesight center. Retinal signals combine (partially beneath a conscious level of awareness) with other sensory signals – from hearing, smell, taste and touch. The hypothalamus, brain stem and other brain structures receive these signals and synthesize the information. Such brain-processing activity, in combination with other internal sensory signals, then determines how a person will react and respond to his or her environment.
When intact, retinal processing enables people to understand and interact appropriately with the world around them. If brain circuitry is out of sync because it has been disrupted — or, in the case, of younger children, perhaps under-developed — people can become confused about their surrounding environment and exhibit inappropriate reactions and responses to sensory changes.
Children act on the basis of their level of attention and the expansiveness of their awareness. The broader a child’s awareness, the easier for distractions to shift the child’s attention – and focus — away from the work at hand. Too frequently, a child who struggles to learn is diagnosed as having a problem, such as attention deficit hyperactivity disorder (ADHD), and is transferred into a special-education program, when what the child actually requires is testing to determine how well his or her eyes, ears and other sensory systems are integrated. This is an issue not simply resolved by correcting nearsightedness. If nearsightedness were the only problem with learning problems, why are the majority of children with learning problems seeing 20/20 and told they don’t need glasses?
Even people who do not need glasses for seeing clearly can benefit, because therapeutic eyeglasses – “brain” glasses — can be prescribed for comfort – not clarity – by stimulating the edges of the eye in addition to the eye’s center. Advances in science are helping us better understand how variations in the way light disperses across the retina can affect the brain’s reaction to the environment.
We are in the 21st century, understanding much more about brain plasticity and the role of the retina as a two-way portal into the mind and body. Those are concepts not adequately addressed by 1862 testing standards to determine whether a person is nearsighted – or farsighted. It’s truly time to leave 20/20 eyesight evaluation where it belongs – back in the 20th century.
Deborah Zelinsky, O.D.
Executive Research Director
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