The process of infant and toddler vision development was extensively explored at the National Australian College of Behavioural Optometrists annual conference, held in Sydney in mid-July.
Professor Glen Steel, Clinical Professor of Paediatric Optometry at Southern College of Optometry in Memphis, Tennessee, delivered an excellent seminar on infant and toddler development, beginning with an initial discussion on pregnancy and its complications before moving on to identify the expected norms of a newborn baby. He told his audience the behaviours of a new born baby are primarily primitive and concentrated on finding the food source from its mother.
He said it is not uncommon for short recoverable strabismic turns to occur in the first few days of a baby’s life, and stressed the need for good early optometric or ophthalmologic screening, commenting that paediatric visual screening in the United States was often insufficient to pick up some deviations or potential pathologies.
Prof. Steel proceeded to discuss the difference between growth and development, whereby the child might be growing but not necessarily developing. He said these growths and developments can be measured against expected norms – for example, in the first year of life, expected monthly developments can be used to monitor a child’s physical, mental and social progress.
He cited startling statistics from the USA where six million people have vision loss due to amblyopia and 75,000 new cases are found annually in three-year-olds. By age six, only 14 per cent of children had been seen by an optometrist or ophthalmologist; and 50 per cent had not had an eye exam by the time they completed high school (I believe our statistics are much better in Australia thanks to the Medicare system).
Prof. Steel strongly emphasised the need for comprehensive visual screening, stating that 20 per cent of school-going children in the United States have a learning disability with 70 per cent of those having a visual processing difficulty. He said vision was the major influence in a child’s development… so therefore ‘eye care is childcare’.
Prof. Steel said other important aspects of a child’s vision development were ‘tummy time’ and direct eye contact with parents – and that these were often neglected in the United States. He said research had found babies who have better eye gaze at six months go on to have larger vocabularies at 18 and 24 months.
Early Predictors
Prof. Steel proposed that many early social, emotional and visual patterns can predict some of the future development of the child. He said autism can be detected “quite early” from the behavioural patterns and aberrant visual behaviours in some of these children.
During the conference he demonstrated his ease and comfort with children, by examining a six-month-old and a four-year-old in front of delegates. He advised that his chief diagnostic instrument was a retinoscope and provided each delegate with one, enabling them to practise his preferred methods for determining a child’s visual behaviours and adaptations.
Comprehensive Screening
Prof. Steel spoke to delegates about InfantSEE, a comprehensive optometric screening program in the USA set up by optometrists for the eye health of children. The aim is to improve the standard of screening and reach out to more children. As a result of this program, 14 retinoblastomas have been picked up, making it not only important for vision but also potentially, for saving lives.
I found Prof. Steel’s conference presentation both interesting and highly useful. The factual, clinical information he presented confirmed many of my behavioural optometric findings while challenging others.
Many thanks to the Australasian College of Behavioural Optometry for bringing Professor Glen Steele to Australia.
Dr. David Evian O.D. F.A.C.B.O. is the NSW State Director Australian College of Behavioural Optometry.
