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Your Child's Developing Vision: 
From Birth and Beyond

Vision is not an innate skill that we are born with. Many of us take our vision for granted, assuming that our ability to see clearly is a natural part of our development from birth into childhood and beyond. But having 20/20 eyesight is not necessarily all there is to having "perfect vision". The Snellen chart - used to measure distance acuity - was introduced in 1862. For such a complex process, such as vision, it does not seem right that we are using this same, centuries old, test as one of our only measurements of visual performance. When referring to other areas of eye performance and health, many have advanced technology to help with diagnoses. For example, in the past, glaucoma was diagnosed based only on high intra-ocular pressures. However, now we know that glaucoma is a much more complex disease process and involves measurements including corneal thickness, cup to disc ratio (measured by OCT for structural loss), VEP/ERG analysis for functional loss, visual field performance, and perfusion pressure.  Similarly, vision is a complex process that requires more than Snellen acuity testing to determine if there is a deficit. Vision involves the ability to take in, process and understand visual information. It includes eyesight (acuity), eye movement (tracking), eye teaming (vergence), eye focusing (accommodation), depth perception, peripheral vision, visual perception and processing, electrical and hormonal components, and the ability to integrate all of this information with our other sense. In fact, our vision is a learned skill that develops over the first years of life and requires stimulation and experience. Just like learning to walk and talk, children must learn how to use their vision effectively and efficiently. The visual system involves the whole body, not just the eyes - did you know that two thirds of the brain's functions are associated with vision?! The visual system interacts with the body to develop reaching, crawling, grabbing and walking in infants and toddlers. When the development of the visual system is delayed, these skills will be too. The visual cells of the brain require pattern stimulation in order to develop properly - inadequate stimulation of these cells can result in the inability of these brain areas to process visual information. 
Since vision is pervasive in almost every aspect of our daily lives, it is tied very closely to child development. Proper visual development in children leads to the development of fine motor and gross motor skills, and visual perceptual skills. Without good vision development, many cognitive stages of child development may be delayed and learning problems could arise. While each child will grow and develop at his/her own pace, visual milestones do occur in a predictable order and can help ensure the infant is on track to achieving proper visual development. 

Birth - 3 Months
The eyes and visual system are not fully developed at birth; a newborn is not able to focus their eyes, perceive depth or view colour. Unlike the vestibular system which is fully integrated at birth, the visual system needs meaningful visual experiences to fully develop. The peripheral/magnocellular system is the first to develop, while the central/parvocellular system (responsible for our ability to see 20/20 centrally) takes at least 6 months. Babies have to learn how to effectively move and focus their eyes in a coordinated way and the brain has to learn how to process all of the visual information it is receiving. It will take a few months for the newborn to learn how to focus and use their eyes as a team, track objects and shift their gaze from one object to another. By around 3 months of age, hand-eye coordination begins to develop and the infant will begin tracking a moving target and reaching for objects. 
Tummy time is incredibly important for infants - it's never too early to start! When lying on their tummies, the infant is encouraged to lift his/her head to explore his surroundings visually. This helps improve core and neck strength as well as expand peripheral vision and improve the ability to focus at different distances. As the eyes and neck start working together to locate and track objects, tracking skills improve - this becomes the foundation for the development of reading skills into childhood. Hand-eye coordination is also practiced on the tummy, as the infant reaches for objects in front of him/herself - this is a crucial skill for handwriting in childhood. 
To stimulate your babies vision at this age, use high contrast (black, white, red) toys and rattles and place them just far enough away to encourage reaching.

4 - 6 Months
During this time, the infant's eyes begin to move with more speed and accuracy, and focusing improves. Colour vision should be fully developed and the eyes should be working as a team and following moving objects with relative ease. The infant's brain is starting to understand the 3-dimensional world they are living in and hand-eye coordination and depth perception are greatly improved because of this. 
Continue to encourage tummy time at this age - their increased core and neck strength and the increased visual stimulation will encourage forward movement such as crawling and creeping. Also during this time frame, integration of the Asymmetric Tonic Neck Reflex (ATNR) (one of the primitive reflexes) takes place; failure of integration can have impacts on development of reading and learning into childhood. 
Remember - your infant should have his/her first comprehensive eye examination done at 6 months of age. The visit is covered by OHIP and the optometrist will check the health of your infant's eyes as well as the development of his/her visual system, including acuity, tracking, depth perception and eye teaming. Of course there is no expectation for your infant to read the eye chart at this age; the optometrist will assess all of the above areas through non-verbal interactions with your baby. However, if your child has any unusual symptoms such as a constant eye misalignment, extreme light sensitivity, excessive tearing, or red/crusty eyes, seek care from an optometrist as soon as possible. 
At this age, play "peek-a-boo" games to develop visual memory. Also, show and name different parts of your baby's body to him/her begin teaching where his/her body is in space (proprioception).

7 - 12 Months
Infants in this stage will be coordinating vision and body movements by crawling, grasping, standing and exploring the new and interesting world around them. Depth perception and ability to judge distances improves as movement through crawling continues. Crawling on hands and knees is an important step in infant develop - one that should not be missed or rushed through. Infants should crawl for around 6 months before progressing to walking. Delays in motor development, or skipping whole stages (such as crawling), could indicate a vision problem. 
As hand-eye coordination continues to improve, encourage playing with stacking blocks and chunky puzzles. Create "motor challenges" by setting up pillows and other small obstacles for your baby to crawl over, under and around.  

In order for our visual systems to be fully effective, vision must integrate with our other senses, one of the most important being the integration with our auditory system. If not properly balanced, vision and hearing can interfere with one another. At the Halton Vision Therapy Center, we offer specialty testing of sensory integration to provide the optimal prescription glasses that balances out the auditory and visual processing systems. Please contact us for more information on this type of examination. 

Overall, vision development follows a predictable course, but the timeline will vary for each individual. We look forward to meeting your newest additions and older children too to conduct a comprehensive visual assessment! Contact our office to book your children's OHIP covered eye examinations. 

A huge thank you to Dr. Deborah Zelinsky who traveled to HVTC this past weekend from Chicago. She presented an interactive seminar on the Mind-Eye Connection to 18 behavioural optometrists from across Canada. Her lecture and hands-on demonstrations were interesting, informative and engaging. 
Dr. Fink was honoured to be invited by the Ottawa Society of Optometrists to lecture on traumatic brain injury and concussions this past Monday. The event was a big success and was well received by 75 primary care optometrists. The discussion was geared towards optometrists who do not currently offer vision training/rehabilitation, and how they are able to assist their TBI patients in their recovery.
Wishing a very special Father's Day to all of the Dads out there!
Copyright © 2017 Halton Vision Therapy Center, All rights reserved.

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