Many people have heard that there is more to vision than just 20/20, but it is still greatly underestimated how complex “vision” really is. After spending 4 years of a doctorate program where I studied not only eye anatomy and physiology, but also how the entire vision system worked throughout the brain, I knew that even I had underestimated the vast complexity of our visual system.
While 20/20 is very important, the 20/20 component is really the only component that many screening exams look at and children are left with many visual problems that leave them plagued with symptoms that hold them back in school.
The worst part is that children do NOT OUTGROW these disorders that cause the other visual problems. So there is a large percentage of our population that is still. It never ceases to amazing me how many adults are still plagued by disorders they have had their whole life.
Their stories are heart breaking because they often include the fact that the adult struggled in school, most likely never went to college, has found their job difficult and is concerned that they will never promote because certain tasks can just be too difficult for them, and there are still countless daily activities that are a struggle for them and have been their entire life.
As I type this, I am reminded of a 55 year old male patient that I treated with Vision Therapy for convergence insufficiency in Philadelphia while I was working towards my doctorate who had a vision disorder that held him back his entire life. (To read about his story, click here)
And the entire time… he had perfect 20/20. So what was wrong? Why was this kind, brilliant, and eager man unable to read even 2 pages of a book without getting headaches? It’s because vision is so much MORE than 20/20.
When you think of vision, I want you to think of it as recording and processing a 3D movie because that is basically what our eyes and brains are doing. Our eyes are the two cameras and our brain is the processing system or computer, that then takes those 2 incredibly detailed images and pieces them together AND then created the perception of our 3D world in our brain AND integrates it with our other senses and cognitive processing skills.
So wow, yeah, a lot more than 20/20. Optometrist spend 4 years studying this process from eyes to brain. Dialing in a prescription to 20/20 is already incredibly complicated, but then what goes on behind the eyes is even more so.
Before we go through the skill though, there just 2 key parts of the eye that I want to mention and explain.
The first is the retina. The retina is the sensory tissue in the back of the eye. This is made up of several difference types of nerves that detect light, decipher a bit of what is seen, and send the information back to the brain. I often tell patients that you can think of the retina as the film in a camera.
The second part I want to point out is the lens. The lens is adjustable like the lens in a camera and allows us to see clearly at different distances. (To learn more about the focusing system in our eye, click here)
So let’s break down all of the other skills that everyone needs.
1. Eye Movement Control: The ability to move both eyes together to point at an intended target or follow along a path, like a line of text. This is checked at every comprehensive vision exam with an optometrist as there.
2. Simultaneous Focus at Far: Forming a clear image of something in the distance. This is our ability to relax that lens inside of our eyes and bring objects in the distance (street sign, tree, board in a classroom) into crisp and clear focus.
The complexity of this is more than many realize though as this is more than just bringing distance into focus. It is important to remember that our brain has to coordinate two cameras (eyes). So the lens in each eye has to be relaxed or focused at the exact same distance as the other eye. If one is even slightly different from the other, the you would see blur and possibly the perception of double vision. With this issue, your depth perception would be off and you could suffer from many other symptoms including headaches.
3. Sustaining Focus at Far: Keeping an image of something in the distance clear and being able to effortlessly hold that focus and keep those lenses in our eyes relaxed.
This may seem like at easy task by the sounds of it and I must admit that I would have never thought that this could be an issue until I was in my doctorate. For those who suffer from accommodative (when the lens focuses at near) spasms, sustaining distance vision is very difficult and can lead to many visual disturbances and symptom like blur, double vision, headaches, and more.
4. Simultaneous Focus at Near: Forming a clear image of something close to the eyes. This is obviously the opposite of relaxing our focusing system and instead requires us to adjust the lens at a near object.
While we have spent time talking about the work that they eye has to do in adjusting the lens, it is important to remember here again that the brain is behind the scenes pulling a lot of strings and directing the coordination between our two eyes. Just as the brain has to coordinate the lenses in both eyes at distance, it must do the same at near.
5. Sustaining Focus at Near: Keeping a clear image of something close to the eyes such as reading a book or working at a computer and keeping the typed font clear and in focus.
Nowadays it is incredibly important to be able to sustain near as our word and work is so near. Whether you are reading a book, studying for an exam, or doing working on your computer, our eyes and visual system must be able to do this effortlessly so we don’t interfere with our work.
6. Simultaneous Alignment at Far: Lining up both eyes at the same point the distance just as a director would need to line up two 3D cameras at the exact same point but just from different angles.
This ability to pull our eye apart is called divergence. (To learn more about
Keeping the eyes aimed at the same thing is incredibly important in preventing double vision. Some patients can have delays in the coordination of their eyes and this can greatly slow down their ability to judge the distance of an object in front of them, see it clearly, comprehend and read notes on a board at school, and countless other things.
7. Sustaining Alignment at Far: Holding both eyes lined up at the same point in the distanced maintaining that alignment while the person absorbs the information they want at distance.
Whether you are driving or looking across a classroom at a distant board. There is a great need at countless times during our day to be able to maintain our eye alignment at distant objects.
8. Simultaneous Alignment at Near: Lining up both eyes at the same point up close to keep the item single and prevent double vision.
When a student changes their gaze quickly from the board to their paper to take notes or someone driving glances quickly at their dashboard to look at their speedometer, this skill is crucial. A delay will cause instant double vision. In school, this could lead to missing information in a lecture. When driving, this could lead to an unsafe situation. Either way, our brains incredibly ability to so flawlessly line up our eyes so instantly is a skill that we shouldn’t take for granted as a deficiency in this skill is sadly common and can be life changing.
9. Sustaining Alignment at Near: Holding both eyes lined up at the same point up close with ease and without symptoms of strain.
Just because someone can be given a reading card and read 20/20 in and instance, doesn’t mean that they could then read that card for an extended period of time comfortably.
10. Central Vision (Visual Acuity): This is where “20/20” vision comes in!
The ability to see 20/20 is a good indicator that the eye is most likely healthy. Again, I say “most likely” because there are several vision threatening conditions that can lead to complete blindness that still allow someone to see 20/20 in early phases of the disease. This is why it is incredibly important to see an Optometrist for a comprehensive exam every year. When cause early, many conditions can be treated and even cured. When cause too late, there is sadly often times no way to recover vision that is lost.
11. Peripheral Vision: Being able to see what’s on either side of you while your eyes are pointed forward.
This skill is obviously in credibly important in countless situations. Any time someone is moving, the wider their peripheral vision range, the safer their movements can be. Glaucoma is a disease that progresses with vision loss starting on the outside and works it’s way inward. It is a perfect example of why you should see an Optometrist every year. Optometrists can diagnose and treat glaucoma conveniently at your annual eye exams. The importance of finding glaucoma early is that the vision lost can NOT be restored, so it is incredibly important to catch it early and slow down or hopefully stop the progression.
A fun note about peripheral vision is that although it can’t be increased, our brain’s awareness in our peripheral vision can be increased with sports vision training.
12. Depth Awareness: Being able to tell that things are further away or closer up than each other (also know as depth perception).
This is a great example of one of the brain’s processing skills. In order to judge depth, so many things have to be going perfectly. Multiple skills above must be occurring in order for the eyes to be aligned at the exact same point and be focused (lens focusing) on the same point for clarity. Then, the brain still has to have the ability to take these two images (we’ll consider them videos because, in life, we are always moving) and decipher and process them in order to tell how far away something is from us.
Interesting fact, the skill of proprioception is learned heavily from vision and responses to our environment. To learn about our sense of “proprioception”, click here.
13. Color Perception: Being able to tell different colors apart (if you are not color-blind).
Our ability to tell color is an amazing skill. Those who are sadly lacking it are luckily still able to decipher most colors, but have problems distinguishing between a phew.
14. Gross Visual-Motor: Moving yourself through space without bumping into things by using information from your vision.
Here’s where proprioception and motor skills can really come into play. When we talk about gross visual-motor skills, we are talking about walking, swimming, jogging, riding a bike, and performing tasks that are , more or less, moving are larger limbs.
15. Fine Visual-Motor: Writing, sewing, texting, and doing other small and close-up activities with accuracy by using information from your vision.
We attach “vision” to “gross-motor” and now “fine-motor” because all of these actions, in a non-visually impaired person, start with the sense of vision and the visual processing of that information. As I type on my keyboard now, my fingers know where to go without me looking because I have seen the keys enough times to memorize their location and because, even if I close my eyes, my visual processing is still working hard to create the visual world that I am in. This is why it is more logically appropriate to call a skill eye-hand coordination instead of hand-eye coordination. Using this proper naming shows that you have a better understanding of the actual neurological process that is underway as the neurological reactions all start with the eye taking information and end with the hand completing a task that the brain has made the decision to tell it to do ONLY after processing the visual information.
16. Visual Perception: Being aware of your environment and what is going on around you in your visual field (the area you can see).
Sadly, just because someone is physiologically (meaning no damage to their actual eye) capable of full peripheral vision, doesn’t mean that the visual processing system in their brain is capable of perceiving the information delivered to it and using it in a meaningful way.
17. Visual Integration: Bringing together your vision and your other senses to accomplish complex tasks, like reading while walking a balance beam.
This is certainly a higher level of visual processing that is a skill that everyone should master in order to better navigate through they every day activities in the most comfortable manner.
This is another area that can be enhanced with sports vision training for athletes looking to improve on their visual processing.
Remembering that vision is MUCH more than just 20/20. As a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read. And when it comes to learning, 80% of what children learn is take in visually.
So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills.
Feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today to schedule a complete and comprehensive eye and vision exam.