What is Developmental Optometry and why do we so often refer children for an evaluation?

Is your child struggling in school and you just can’t seem to figure out why?

“What is the difference between my child’s ophthalmologist and a developmental optometrist?”

“But my child has been to their ophthalmologist and has 20/20 vision” 

Things we, as OTs, hear often… 

A developmental optometrist focuses on the entire visual function— not just visual acuity, but also the integrity of the visual skills.

The College of Vision Development is an excellent source of information regarding developmental optometry. 

There are 17 different visual skills necessary for reading, writing, learning, playing sports— and virtually all other visual tasks. These visual skills enable you to see clearly and comfortably. 

  1. Eye Movement Control is the ability to move both eyes together, to focus on an image, or path. Each eye has six muscles that work together to control eye movement and position.

  2. Binocular Coordination is the ability of the two eyes to accurately work together, at the same time, as a team. If one eye is weaker than the other, the child may develop a lazy eye.

  3. Saccades are quick, simultaneous movements of the two eyes between two or more focus points. This skill is essential for reading words and sentences across a page.

  4. Pursuits are smooth movements of the two eyes between two focus points. This skill is required for moving between paragraphs on a page or even looking up at the teacher and then back down to the class notes.

  5. Convergence is the ability of the two eyes to work together as a team, to turn in towards the nose and focus on a book or computer screen. This skill is essential for academic success.

  6. Accommodation Flexibility is the ability of the eye to continuously change its focus between near and distant objects.  This skill is needed for simultaneously seeing the blackboard clearly and then quickly changing focus to be able to read your class notes.

  7. Accommodation Endurance is the ability of the eyes to maintain focus for reading and other close vision tasks over extended periods of time. This skill is required for homework and for using a computer or laptop for many hours.

  8. Visual Memory is the ability to remember information such as words or images that have been seen in the past. Poor short-term visual memory can cause difficulty copying notes from the board and spelling difficulties.

  9. Visual Thinking, also known as visual/spatial learning or picture thinking, is the ability to think and analyze what you have seen. This skill is needed for comprehension and math abilities.

  10. Central Visual Acuity is the ability to see clearly and accurately. This skill is measured with the term 20/20 vision, the benchmark measure for “perfect” vision.

  11. Peripheral Vision (Side Vision) is the ability to see objects around us without having to turn our heads.

  12. Depth Perception is the ability to discern whether objects are closer or further away, in relation to one another. This skill is especially important for both academic and athletic performance.

  13. Color Perception is the ability to discriminate between colors. This skill is important for accurate interpretation of color-coded materials (such as charts and graphs).

  14. Gross Visual-Motor is the ability to move through space using your visual information to guide you— preventing you from bumping into things. This skill is essential for playing sports.

  15. Fine Visual-Motor is the ability to engage in close-up activities with accuracy by using your visual information (i.e. reading, writing, sewing, texting, etc.)

  16. Visual Perception is the awareness of your environment and what is going on around you in your visual field (what you can see). This skill measures your total width of vision.

  17. Visual Integration is the ability to combine your vision with your other senses, to perform complex tasks (i.e. copying, reading while walking on a balance beam, threading a needle, tying shoe laces, catching or hitting a ball, etc.)

The way you see does not only depend on your visual acuity, or clarity of vision, but also on how well your eyes work together and communicate with your brain to accurately process visual information.

Many times, children are mislabeled as ‘lazy’ or ‘learning disabled’ as a result of poor academic success, when really they may be suffering from a vision problem that is affecting their ability to read, write, and learn. Moreover, it is not uncommon for a child to be misdiagnosed with ADHD or dyslexia when a vision condition is at the root of their struggles. Many children also struggle on the playground or the sports field as a result of a vision problem— these children are generally mislabeled as clumsy, accident-prone, or simply “bad in sports.” 

Unfortunately, children with underdeveloped ocular motor and visual perception skills are at a disadvantage at school. When there is ocular motor dysfunction evident, a child may have difficulty with:

  • depth perception

  • visual attention

  • visual memory

  • visual perceptual tasks

  • visual scanning

  • spatial disorientation

  • eye-hand coordination

  • balance

  • reading and writing tasks as they cannot effectively focus their eyes on the required point. This might mean skipping lines of text, or easily losing their place when reading

Occupational therapists are trained to look for any abnormalities and/or any difficulties with visual and ocular motor skills during our evaluations, which often results in a referral to a developmental optometrist. 

While an eye exam with a developmental optometrist will include tests for visual acuity, it will also include an assessment of visual skills. Your child’s eye exam will focus on the following areas:

  • Binocular vision: This test will determine how well your eyes work together to transmit visual information to the brain. Your eye doctor will look at your ability to accurately focus your eyes simultaneously, for single vision— and look for signs of crossing, wandering, or misalignment.

  • Oculomotility: This test will evaluate your ability to control where you focus your eyes, and your eye tracking abilities— skills necessary for reading. Your eye doctor will look at your ability to follow a moving target smoothly as well as your ability to rapidly shift focus from one point to another.

  • Accommodation: This test will evaluate your ability to focus your eyes on objects at varying distances. Your eye doctor will look at your ability to change focus from near to distant images, both quickly and smoothly. They will also assess your ability to maintain clear focus during near vision tasks for extended periods of time, without experiencing fatigue or blurry vision.

  • Visual perception: This test will evaluate your ability to analyze and understand what you see, as well as your visual memory and visual discrimination abilities.

  • Visual-motor integration: This test will evaluate your eye-hand-body coordination.

  • Balance and coordination: This test will evaluate whether your visual systems are effectively transmitting visual information from your brain to your body’s motor centers for good coordination and balance.

Developmental optometrists diagnose and treat a variety of vision conditions. Many vision problems can be treated with vision therapy, occupational therapy, prism lenses or a combination of the three. 

Developmental optometrists not only treat the presenting problem, but also provide education on ways to prevent the development of vision problems, protect your vision, and improve your visual skills.

A primary goal of developmental optometry and occupational therapy is to ensure that patients enjoy clear and comfortable vision for school, work, sports, and virtually all aspects of daily living. 

Written by Julianne Maccarone, MS, OTR/L