I don’t see clearly, what now?

By Dr Melodie de Jager

Some of the common visual conditions that you may be aware of may include:

• Myopia – nearsightedness
• Hyperopia – farsightedness
• Astigmatism – visual asymmetry
• Presbyopia – inability to focus at near associated with aging

Traditionally, investigating visual abilities was done using the twenty-one-point examination.  This examination included a number of visual tests and screening questions, such as, “Let me know when the letters blur, break and come together again” (Liberman, 1995).  The results of these examinations invariable lead to the prescription of spectacle lenses, which get made up and are ready for collection a few days later.

In spite of new lenses, many people continue to experience visual difficulties, which commonly include:

• Blurred vision
• Reading avoidance
• Eyes that just cannot adjust to new lenses
• The eyes may feel like they are pulling or the floor is tilting or the stairs are varying in height(distance)
• You feel as if your world is becoming narrow; and engaging with others become more difficult.

When vision is unclear, it does not only affect your ability to see, but it tends to also impact on your sense of self.  It influences who you are, what you can do, the clarity of your thinking and your confidence in yourself.  It may affect your academic performance, your performance at work, as well as your interpersonal relationships.

Is your only option to just accept your visual difficulties and that you need to adjust and make peace with it?

In order to know what to do with regards to your visual condition, it is important to first take a look at how vision works.

HOW VISION WORKS

Vision is often likened to a mechanical process that works in the same manner as the lens of a camera. When this process works well, there is clarity in vision, which is known as visual acuity.  When the process does not work well and the vision is blurred due to an error somewhere in the focussing process, this is referred to as a refractive error.  A refractive error is an inability of the eye to focus one clear image on the retina.  Some of the main refractive errors are conditions such as myopia (nearsightedness) where light focuses in front of the retina; hyperopia (farsightedness) where light focuses behind the retina; astigmatism (visual asymmetry) with more than one focus position and presbyopia (old-age vision) where the eye is unable to adapt to a near focus.

HOW VISION IS TESTED

Visual acuity is generally tested using two methods: an objective method and a subjective method.

With the objective method various techniques are used to focus light on the retina without the input of the client. One technique uses an instrument with a light source that is shone into the eye and optical lenses are added until the light (passing through the crystalline lens) falls directly on the retina and not in front of or behind the retina.

The subjective method involves input from the client where they have to respond to lens choices to determine best clarity between options, by responding to questions like: “Which is better: number one or number two?”

Vision is usually tested at a standard distance of 20 feet, as determined by Dr Herman Snellen who introduced the Snellen Chart to study visual acuity in 1862.  This distance is used because it is the distance at which the light rays are parallel when entering the eyes, which is called optical infinity. The focusing muscles in the eye are said to be totally relaxed when viewing objects at this distance or further.

WHAT DO THE TEST RESULTS MEAN?  

Normal vision is generally defined as 6/6 vision. Dr Snellen found that most people can read the smallest numbers on the chart at a distance of 6 meters. The first 6 refers to the 6 meters between the client and the test charts/images.  The second number indicates the distance at which a person with normal vision would see the same image.  For example, a result of 6/12 means that the person tested sees at 6 meters what a person with normal vision sees at 12 meters.  The first number stays the same because it is testing distance, but the second number may vary, and even deteriorate, depending on visual acuity.

The power of the corrective lenses is measured in diopters (D), of which the smallest unit is a quarter diopter (0.25 diopters).

If nearsightedness is to be corrected, a concave lens (moves light focus back towards the retina) is used and the power of the lens is indicated by a minus, for example -4.75 D.

If farsightedness is to be corrected, a convex lens (moves light focus forwards towards the retina) is used and the power of the lens is indicated by a plus, for example +4.75 D.

DO THE FINDINGS OF THE SUBJECTIVE AND OBJECTIVE TESTS ALWAYS MATCH?

The objective approach focuses on facts and disregards the possibility that the observer’s beliefs and state of mind may be affecting the measurements. Hence the correct lenses (objective) may cause discomfort (subjective), which indicates that objective and subjective findings do not always match.

Visual tests are often based on the mistaken assumption that vision is physically determined and that “we only see with our eyes and in so doing block out all  the non-mechanical aspects that make vision come alive” (Liberman, 1991).

If we assume that vision is a mechanical process and when it doesn’t work well that only lenses correct this process, then we assume that you can only use lenses, or in certain circumstances, surgery to rectify visual difficulties.  However, if vision is a function of the eye only, it may be difficult to improve vision; especially if the condition is due to hereditary problems.

BUT DOES VISION ONLY INVOLVE THE EYES?

Case studies on multiple personalities, as described by Talbot (1991), indicate that: “visual acuity can differ and some multiples have to carry 2 or 3 sets of glasses to accommodate their alternating personalities. One personality can be color blind and the other not”.

These research studies imply that vision does not only involve the eyes; that vision can change; and that vision actually involves the entire mind and body system – it directly or indirectly affects thoughts, feelings and movements. The fundamental line between vision and movement seems to be posture (Liberman 1991).

Dawkins, Edelman and Forkiotis (1991) expands on the link between vision and posture by indicating that challenges in the visual system can often be detected in posture. “Your vision system affects your posture – and your posture affects your vision system. Warps, gaps or lags at any point in the vision system will distort the neurological impulses going to the neck and back. Usually such distortions lead to muscle tension, chronic muscle aches, dizziness, teeth grinding, bedwetting, claustrophobia or travel sickness”.

It naturally follows that your thoughts, feelings, beliefs, posture, movements and actions would be influenced by what you see or don’t see. The reverse is also true – what you think, feel, believe and do would also impact on vision. This may be the reason that spectacle lens corrections sometimes do not produce clear vision.

Remember, seeing is believing…

STRESS AND VISION

As early as 1920’s ophthalmologist Dr William Bates proposed that poor vision does not only originate in the eye, but is rather a combination of physical, emotional and mental responses to an environment of undue stress. One of the most common environments of undue stress is in the education sector. The wise words of Mark Twain illustrate this: “Education is not as sudden as a massacre, but more deadly in the long run”.

To illustrate the effect of education on the vision system, several studies by Gottlieb (1982) found that incidents of Myopia is much lower amongst peasants and farmers than amongst highly educated and professional people. The following statistics by Grovenor in Firkin (1991) supports the notion that the more educated one is, the more likely the chances of Myopia are.

 

AGE OR LEVEL OF EDUCATION	% MYOPIC
Birth	-1%
5 – 7 year olds	3%
10 – 12 year olds	8%
End of 8th grade	20%
High school graduation	40%
College graduation	60-80%
Graduate students	80%

Gottlieb (1982) corroborates these findings between education and Myopia further, stating that the correlation is so high that nearsightedness is viewed as a positive adaptation to civilization.

CAN VISION BE IMPROVED?

The Chinese noted the sharp increase in Myopia in the industrialized world and publicly committed to working towards the improvement of vision. In 1949, the People’s Republic of China implemented vision training twice a day for all students and factory workers and have proven that Myopia is reversible.

The answer is YES, it can be improved in a couple of ways:

• Lenses or surgical procedures
• Changing your thinking
• Changing your emotional state
• Movement

HOW DO LENSES HELP?

The eyes process visual information centrally and peripherally.  Central vision is what happens when one focuses on a specific object or point, it requires high levels of light and works optimally during the day.  Peripheral vision is what happens on the fringe of central vision: it scans; notices movement; is always in operation and does not need clarity or bright light to be effective.

According to de Jager (2006) each person has a preferred visual field: central or peripheral. With use, the preferred visual field becomes dominant.  It can become dominant to such an extent that changing focus from dominant to non-dominant field may become challenging. Over time, the dominant field and the supporting muscles maintaining that specific field, may become so strong that it may physically alter the shape of the eyeball. Such an alteration may lead to the eyes fixating either centrally, increasing the chances of Myopia; or peripherally, causing Hyperaemia (red eyes).

If you are far-sighted, lenses help to encourage the eyes to focus “near” so that you can read and spell easier; do math with more accuracy; stay focused for longer periods of time while writing tests or working at a desk or on a computer.

If you are near-sighted, lenses help to encourage the eyes to focus further away, enabling you to see the bigger picture; read from the board; follow the power-point presentation; identify the road signs and make eye contact.

Optical lenses alter the passage of light entering the eye to enable light waves to focus on the retina to provide clarity and focus. When there is a refractive error light does not focus on the retina and optical lenses are needed to change the focus position of the incoming light.  In addition, when the eyes change to different viewing positions, such as from far viewing to near viewing, the optical power needed to focus light on the retina eyes needs to change to remain in focus. As one ages, the muscles in the eye loose their ability to change focus (presbyopia) and that is why some people need glasses to help them see near. Bifocal and multi-focal lenses combine both distance and near viewing into one pair of glasses and rely on eye intelligence to make the necessary adjustments, spontaneously shifting from one optical centre to the next.

Even with the new lenses, the following may occur:

• Blurred vision
• Reading avoidance
• Eyes that just cannot adjust to new lenses
• Eyes that may feel like they are pulling or that the floor is tilting or the stairs are the wrong height

If the lenses do not support vision and engagement with the world, and confidence remains absent; it may mean that something else is needed.  What is needed may be a change in thinking or feeling. According to Jensen (1994), the old scientific model viewed the mind, emotions and body as three independent entities, each operating in isolation.

Jensen (1994) believes that such a model is outdated and that in reality, the three systems are interrelated.

Elmer Green (Pert, 1997) supports this thinking by stating that:

“Every change in the physical state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and conversely, every change in the mental emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state”.

Liberman (1995) is of the opinion that in the “quantum mechanical body any imbalances will simultaneously manifest physically, mentally and emotionally”.

So, what is the real cause of vision problems? Do they originate in the eyes, or in the mind and emotions, according to this new scientific paradigm?

I have found that body, mind, emotions, behavior and environment all interact in the emergence of vision difficulties.  But the problem really seems to begin when we fall out of a harmonious relationship with ourselves – when we lose sight of our relationship with the whole world.

To pursue this notion further is beyond the scope of this article but may be a relevant topic for further research.

If lenses have not been able to improve your vision; or provide you with a change of heart; or your thinking has not improved – then your vision is unlikely to be the cause of your vision problem. It may rather be that your visual system is not yet fully developed and that neurological immaturities may be present.

MOVEMENT AND THE DEVELOPMENT OF THE VISUAL SYSTEM

The way the eyes are used and the way in which the world is perceived through the eyes; is the result of a complex network of neural connections.  These connections depend on the maturation of the Central Nervous System (CNS) (Goddard, 2002).  These networks are complex.

The eyes are the last of the five senses to mature – building on the structure and functioning of the vestibular system. This becomes clear when we consider that visual input is modulated by the vestibular system; influenced by the limbic system (emotional brain) and controlled by the cerebral cortex.

The complex networks of the eye develop as a result of a variety of stereotypical movements, called primitive reflexes. 

THE REFLEX SYSTEM

The primitive reflex system is essential to the baby’s survival since reflexes act as basic training for all later skills, such as listening, talking, drawing, reading, writing, paying attention, playing and performing.  During the course of normal development, reflexes emerge sequentially; strengthen to fulfil a function; before inhibiting again. The responsibility of continued development is then passed on to the next reflex. This process is similar to a relay race, where individual athletes run flat out before passing the baton to the next athlete, and then is able to relax on the track.

Most reflexes are specifically designed to have a limited lifespan. Once they have completed their developmental function, they should retire and allow the rational brain to take control. However, when a reflex does not fully fulfil its function, it remains active and acts as a signal indicating some neurological weakness.

The reflex system develops chronologically, which implies that specific milestones should be achieved by a certain age. Developmental milestones, such as neck muscle strength, or the ability to roll, sit, crawl, walk and talk, are clear signals indicating the effectiveness of the baby’s neurological development. Failure to reach these milestones is an indication of neurological immaturity.

According to Goddard (2002), any interruption in the sequential attainment of developmental milestones will result in earlier reflexes remaining active in the system, disturbing the emergence of subsequent reflexes. As a result, all further neurological development will be built on weak foundations. The correct sequence is therefore crucial to neurological development, which in turn is a vital precursor to motor, perceptual, emotional and cognitive development.

If the reflex sequence is interrupted, the body will attempt to compensate, which requires a tremendous amount of energy and effort. When a person feels stressed and tired, he might not have enough energy to compensate, and the he tends to struggle to cope. This is why under these circumstances the reflexive behaviour often becomes more noticeable.

In order to understand what goes wrong when reflexes do not retire, but remain aberrant, it is important to understand the function of each individual reflex.

There are three types of reflexes that assist in neurological development:

1. Intrauterine reflexes, which appear, become active, and go to rest pre-birth.
2. Birth reflexes, which develop pre-birth, aid the birthing process, and go to rest by six months of age.
3. Postural reflexes, which appear when the earlier reflexes retire.

The master blueprint for learning unfolds in the period after these reflexes are stimulated, and before they retire. This unfolding process may be accompanied by certain signals, which serve to alert you to the fact that an aberrant reflex is still present, indicating a structural weakness.        

The following reflexes are involved with visual development:

REFLEX		FUNCTION
	MORO	Divergence/peripheral vision
	ROOTING AND SUCKING	Eye teaming skills Convergent/central focal  vision
	TLR	Near/far and far/near accommodation Vestibular-Ocular Reflex Arc
	ATNR	Eye-hand coordination Arm-length focal vision Horizontal tracking/ocular pursuit
	STNR	Binocular vision Vertical tracking
	LHRR	Fixation Visual attention

The vestibular system is at the core of all functioning. It develops at 8 weeks gestation (in-utero), becomes operational at 16 weeks gestation (in-utero), and is myelinated at birth. These networks develop in a hierarchical manner; observable 5 weeks after conception, when the embryo responds to stimuli by withdrawing. This withdrawal is a total body reaction. Body reactions and posture are mediated by the cerebellum (responsible for movement), together with the vestibular system (responsible for balance, direction and orientation). Problems in the cerebellum and/or vestibular system will affect all sensory systems as well as posture “because all sensations pass through the vestibular mechanism at brain stem level before being transmitted elsewhere for analysis” (Goddard, 2002).

King and Schrager (1999) reiterates the importance of the vestibular involvement in vision, by stating that 90% of the cells in the visual system respond to vestibular activation. Both the vestibular and the reflex systems act as substructures upon which ocular-motor, visual-perceptual skills and eye-movements are built (Goddard, 2002).

It then follows that specific movements (as stimulated by the reflex system) develop and strengthen the complex nerve networks, which are at the foundations of optimal vision and improved posture.

MIND MOVES® AND THE DEVELOPMENT OF THE VISUAL SYSTEM

If primitive reflexes are still functional (aberrant) in a person older than 12 months, a reflex inhibition program is necessary to develop the corresponding immaturities in the CNS (Blythe, 1979; De Jager, 2006; Goddard, 2002).

Mind Moves is a reflex inhibition program, using simple physical movements to mimic the natural reflexive patterns seen in babies. As each reflex is responsible for the development of a specific part of the CNS, the purpose of Mind Moves is to activate those aberrant reflexes that are causing neurological immaturities.  With repetitive activation of the aberrant reflex(es), the corresponding parts of the CNS can be developed, and the function of the reflex would be fulfilled. The reflex would then become inhibited, and stay in a state of rest, ready to be reactivated should injury to the CNS occur due to injury or trauma.

As with emotional or mental barriers to clear vision, neurological immaturities cannot be addressed with lenses only. Lenses may enable a person to compensate for neurological immaturities, but to promote a flexible visual system – a reflex inhibition program is recommended.

Once you have eliminated the impossible, whatever remains, however improbable, must be the truth. – Sherlock Holmes

MIND MOVES TO STIMULATE AND INHIBIT PRIMITIVE REFLEXES AND POSTURAL REACTIONS INVOLVED WITH VISUAL DEVELOPMENT

REFLEX	FUNCTION	MIND MOVES
Moro Reflex	Peripheral vision	Rise and Shine
Rooting & Sucking	Eye teaming skills Central focal vision	Power on
TLR	Near/far and far/near accommodation Vestibular-Ocular Reflex Arc	Focus Adjuster
ATNR	Eye-hand coordination Arm-length focal vision Horizontal tracking/ocular pursuit	Visual workout
STNR	Distant vision Binocular vision Vertical tracking	Mouse Pad
LHRR & OHRR	Fixation Visual attention	Abs Trainer

 

Bates, W. 1020. The cure of imperfect sight by treatment without glasses. New York: Central Fixation Publishing.

Blythe, P. & McGlown, D.J. 1979. An organic basis for neuroses and educational difficulties. Chester: Insight Publications.

Dawins, H, Edelman, E. & Forkiotis, C. 1991. Suddenly Successful: How behavioral optometry help you overcome learning, health and behavioural problems. Santa Anna: Optometric Extension Program Foundation.

De Jager, M. 2006. Mind Moves – removing barriers to learning. Johannesburg: The ConeXion Pty (Ltd).

De Jager, M. 2009. Mind Moves – moves that mend the mind. Johannesburg: Mind Moves Institute.

Fiorentino, M.R 1976. Reflex testing methods for evaluating CNS development. Illinois: Charls C, Thomas.

Goddard, S. 2002. Reflexes, learning and behavior. Oregon: Fern Ridge Press.

Gottlieb, R.L. 1982. Neuropsychology of myopia. Journal of Optometric Vision Development, 13(1).

Jensen, E. 1994. The learning brain. Northriding South Africa, Lead the Field Africa (Pty) Ltd.

King, L.J. & Schrager, O.L. 1999. A sensory and cognitive approach to the assessment and remediation of developmental learning and behavioral disorders. Paper presented at Symposium, Atlanta Georgia.

Lieberman, J. 1995. Take off your glasses and see. New York: Three Rivers Press.

Pert, C. 1997. Molecules of emotions. London: Simon & Schuster Inc.

Talbot, M. 1991. The holographic universe. New York: Harper Collins.