Taryn Erickson M.S., OTR/L
Taryn Erickson M.S., OTR/L

LKS & Associates
Occupational Therapist


True or false: Eyesight and vision are the same? 

False! While eyesight and vision are closely related, they are very different.

Eyesight is the ability that allows the eyes to capture or “see” a clear picture from the outside world. It involves the physical components and connections of the eye, as well as the performance of those components. 

On the other hand, vision is the process that allows us to understand what we see, how to react to what we see, and how to interact with what we see in the outside world. Vision is gained through experience and is practiced again and again. Through developmental motor activities like reaching, rolling, and crawling, the baby begins to understand and generalize concepts of distance, space, and about their own body (like how long their arm can reach). 

Difficulties related to vision and visual processing may go undiagnosed….here’s why:  

Children with “eyesight” problems are more easily detected because eyesight is the area tested at the child’s pediatrician’s visit or in the school nurse’s office. Eyesight is often measured in the form of ‘acuity’, which refers to the clearness of details the eyes pick up at different distances. Eyesight is often tested by having the person look at different forms or letters on a non-moving chart while covering each eye, one at a time. This is where that 20/20 eyesight score comes in and the reason why you can have a different score for each eye (like one eye being stronger than the other). 

Now here’s the crazy party- many children with ‘20/20’ or ‘perfect eyesight’ might not actually ‘see’ well or ‘see’ in the same way you and I do. This is because vision is the process that allows us to understand and make sense of what is seen. Without the ability to process what is seen, the world becomes a difficult place to understand and learn about.  In fact, this is what frequently occurs in children with CVI (or cortical vision impairment). Many children with CVI can have good eyesight but are unable to successfully process visual information from the outside world and integrate it into their brain and body. Thus motor, cognitive, and sensory systems are frequently impacted in children with CVI. 

Unfortunately, children with vision problems are less detectable because the child may be unaware their eyes “see” differently or the child lacks the understanding they are seeing incorrectly. Furthermore, the child may lack the ability to describe how their world looks and may also assume everyone else ‘sees’ the world in the same way. This is a tricky feat for the child to pull off, and thus all the more reason we need to take a more detailed look at vision and visual processing skills. If you have concerns about your child’s vision or visual processing skills, it is important to go beyond a basic “eye” exam by having your child’s functional vision assessed by a developmental optometrist. 

Watch me and then you try! 

Children are frequently taught through visual demonstration and then asked to ‘imitate’ or do the same thing. That’s because vision allows us to understand the motor action being performed, as well as the motor plan and sequence that the action requires. Successful interaction with others and with our physical environment requires our visual system and brain to communicate efficiently and effectively. 

In general, new learners benefit from a visual demonstration. When you are trying out a new hobby or activity, have you ever looked on YouTube to watch a video first, or have you asked someone, “Can you show me how to do that?” or “Can you give me an example?” Chances are, you probably have, and you probably ask this question often when your body and brain are learning to do something new or different. In fact, experts report that vision is involved in 80% of learning! 

Let’s say we are learning to ride a bike. First of all, we need to know what a bike is and understand that our body can do something that will make the bike move forward. You probably already know this because you have already seen someone ride a bike before (whether in person, a book, or video), otherwise you might not want to be the “guinea pig.” You have likely already seen this done and trust that it is possible you can do it too. 

Now let’s say you’ve been practicing riding your bike and you’ve finally got it! You give yourself one final strong push and now you’re off! You continue pedaling to maintain the momentum, but suddenly your foot slips off the pedal. You quickly look down at your foot and place it back in the right position on the pedal. When you look up, you realize there is a trash can on your right side and if you keep going you will hit it; so you speed up and turn the handlebars to the left avoiding the obstacle just in time. As you straighten out, you look up to see a stop sign at the end of the road and you remember the bike has hand brakes so you glance down at your hands to move them into position over the squeeze bars. As you approach the white line in front of you, you squeeze the breaks harder, screeching to a halt just in time, phew! You see a car coming in the distance and decide to wait for it to pass, it is going too fast for you to safely cross the road. 

Visual perception and motor perception go hand in hand…now let’s break that down. 

From the example above, we can understand that riding a bike takes much more than just “seeing”. Instead, we are using our eyesight to understand what we see, which then allows us to make and execute a successful motor action. Vision is the dynamic process that allows the bike rider to judge the spatial relationships and distance between them, like dodging a trash can! Vision is what allows you to quickly look down at your foot and place it back on the pedal. When you saw the stop sign, you were able to read “S-T-O-P” as well as slow down in time to not pass the thick white line. Vision is what allowed you to judge the speed of motion of the oncoming car that made you decide to wait to cross the road. 

Successful learning requires visual processing skills that go beyond just eyesight…here’s how: 

Eyesight: Seeing “20/20” 

Eye Teaming: 

Having the ability to process and understand our world requires two eyes, but more importantly, it requires both eyes to work perfectly together as a team. When both eyes do not coordinate perfectly together, the picture is often distorted, processing is less efficient, and therefore learning and participation may be impacted. A child might see double, see blurry letters, or have difficulty judging distances (like how far away or high something is). Depth perception is a visual skill that requires good eye teaming skills. It is developed through motor activities like crawling and continues to develop as we learn to walk, run, climb, and jump. Children who have eye teaming issues and depth perception difficulties may not feel confident doing gross motor or movement activities, which can delay and impact overall learning and development. 

Eye Focusing and Steady Fixation: 

The ability to maintain a clear picture at all times and distances (even when moving through space). When a child can steadily fixate on an object, they can study the characteristics and details to learn and remember it. A child can focus on a picture of a ‘cow’ in a book and remember that a cow has black spots and says, “moo”. The next time the child sees another picture of a cow, they are better able to generalize the concept they have learned to the other ‘cows’ they will encounter in the future. Children with steady fixation issues often have difficulty with visual memory as well (remembering how to describe something without it being there for the child to see and talk about.) We call these “visual cues”, and some children are heavily reliant on them. Some children continue to be reliant on visual cues even when they have “mastered” a new concept. Without the information given by the visual cue, the child is lost. 

Eye Tracking: 

The ability of the eyes to both fixate and follow a moving target, smoothly and without too much effort. This is the skill that allowed us to follow the moving car on our bike and decide we did not have enough time to make it across the street. Tracking allows us to follow the teacher as she walks around the front of the classroom, and allows us to follow our own pencil as it draws across the paper. 

Look beneath the surface to really see what is going on: 

As a pediatric occupational therapist, my priority is to support a child’s ability to engage in daily, meaningful activities or occupations. Through the process of task analysis, I am able to break down an activity into component parts and determine underlying areas of difficulty and skill deficit.  I am constantly observing a child engage in an activity and then analyzing their performance- what was easy or hard for them? For example, a child with lower muscle tone may have more difficulty tolerating tummy time due to weaker extensor muscles (e.g. muscles in the back and neck). A child with sensory processing difficulties may have a harder time attending to a teacher’s directions in a busy or exciting environment. A child with speech and communication delays may have a more difficult time engaging in functional play. However, a child with vision issues may be more “hidden” and harder to detect. As a result, it is an important part of my practice to always consider and evaluate a child’s visual system as this could be an important piece missing from the puzzle. Through effective task analysis, we are able to determine why a client is having difficulty performing a certain activity, and therefore address it through a specific and targeted intervention plan. Vision is an important ability that leads to successful learning and participation throughout our day (remember vision is involved in 80% of learning!). 

Successful learning requires adequate processing and integration of visual information from the world and from people around us. If your child continues to show developmental delays or learning challenges, and you are unsure why you now have another place to look and dig a little deeper. 

You can find out more about visual processing by contacting the LKS office at 310-739-9337 or by email at admin@lksandassociates.com.