REPORT to The 1960 White House Conference on CHILDREN AND YOUTH from The American Optometric Association Committee on Visual Problems of Children and Youth THE IMPORTANCE OF VISION TO A CREATIVE LIFE IN FREEDOM AND DIGNITY P. N. DeVere, O.D., President Committee on Visual Problems of Children and Youth Lois B. Bing, O.D., Chairman Marguerite Eberl, O.D., Milwaukee, Wisconsin Daniel Woolf, O.D., New York, New York H. Ward Ewalt, Jr., O.D., Trustee Consultant, Pittsburgh, Pa. 273 FOREWORD Once a decade, since 1909, the President of the United States has met with leaders in the child health and welfare fields to consider ways and means for making this a better country for all children, and thus a happier society and a more effective democracy. The American Optometric Association is proud to participate in the 1960 White House Conference on Children and Youth as the representative of a profession whose members believe deeply in the concept of this Conference that every child deserves the fullest possible opportunity to achieve a creative life in freedom and dignity. In company with other groups participating in the Conference, however, we are profoundly aware of the wide gap which still exists between the achievement of the goal we seek for all children and the hard realities of our society. The obstacles to the goal are economic, social, educational, psychological and physiological, varying from child to child, from family to family, and from area to area. Fortunately, many, if not most, of the obstacles to full development of every child can be removed, if knowledge and techniques now available to us are put to full use. In the field of visual abilities, for instance, there is no longer any valid reason why millions of children handicapped by defects in vision or retarded visual development cannot be helped to achieve a better or a complete adjustment to their learning problems or to other problems caused by vision difficulties, if only professional examiners can have the opportunity to uncover the children needing help. It is truly tragic that any child should be deprived of his heritage, an opportunity for a good life, because of a correctable but neglected or undetected vision difficulty, yet this is happening to untold numbers of children throughout the country because of parental and community failure to understand and to take advantage of vision care now available. The 21,000 members of the optometric profession, located close to the child's home in every locality in the nation, have dedicated their art and science to the goal of removing correctable vision inadequacies from among the obstacles which still bar many children's path to their full development. The progress which has been made in this field in the last few years has been heartwarming, dramatic, when children once thought hopeless from an educational standpoint have been helped into becoming contributors to society rather than "problems" to it. In the brief 10 years since the last White House Conference on Children and Youth, optometry working closely with pediatricians, psychologists and educators helped produce the first blueprint of the development of visual performance in children, making possible the developmental appraisal of vision from 16 weeks to 10 years through a series of visual performance tests. This, in turn, has led to improved guidance programs and methods of preventive care, as well as new techniques not only in the education of children with visual deficiencies (as the result of brain injury) but in the establishment of guideposts toward improved learning procedures for all children. At least 80 percent of all learning takes place through the visual process. A process which develops through maturation and learning experience. Yet millions of children with seemingly good eyesight, perhaps even the so-called "perfect vision" of 20/20 visual acuity at distance, have not learned to see efficiently at near-point, that is, to maintain binocular visual performance so as to make effective use of the impulses signalled by the eyes to the brain. Often, these children are scolded and humiliated as "lazy" in their school efforts when actually they desperately require professional vision training to learn how to use their eyes more effectively. It is urgent that parents, educators and the community generally recognize the existence of this all-too-common but often neglected problem in an area of vision care which optometry has pioneered and developed as a distinct and unique professional specialty. Of great social import at this time is the startling relationship which has been found to exist between vision difficulties and the baffling problem of juvenile delinquency. Statistics reveal that more than 80 percent of delinquent and pre-delinquent children have not achieved satisfactorily in reading. Research further reveals that in 50 percent of those encountering reading difficulty, vision is a contributing factor. Certainly this does not indicate that every child with a reading problem is a potential delinquent. Rather, it does indicate that such children should always be examined promptly for the existence of a vision difficulty, and particularly those children whom society has not been able to "reach." It is not enough to know if the child can see and read a one-third-inch-high letter on a Snellen chart at 20 feet with or without correction. It must also be determined whether the child can focus readily on the printed words of a book held at 12 to 16 inches and maintain binocular vision for long periods of time. So many children with behavior problems have been discovered to be unable to accomplish this feat without special lenses and/or visual training, that their misbehavior may well have stemmed from a desperate effort to escape from an intolerable school situation. Meanwhile, the incidence of need for professional vision care for children is increasing at a rapid pace. Extensive research is necessary to provide us with clear explanations for such phenomena as the increasing incidence of myopia, particularly at college-age levels. Optometry is pioneering in efforts for the control and reduction of this widespread problem with encouraging hope for improved preventive and corrective measures, including some promise in the new contact lenses. Furthermore, it is initiating new programs of specialized help for college students and pre-school children, supplementing its expanding and highly successful program for elementary and secondary school children. But to be effective, new knowledge and new techniques bearing on factors affecting children in their growth and development must be shared broadly with all professions and disciplines concerned in this vital matter. They must be understood by the general public. It is particularly important for parents to become aware of early danger signs in visual growth patterns in their children so as to seek professional help promptly. Moreover, we need greater public recognition of the importance of effective and reliable mass screening programs as described in this report, to identify school children needing vision care. We need greatly expanded research into all phases of visual development. Preventively, we must determine if we can do a better job of designing classrooms, school furniture and equipment for maximum visual comfort and efficiency. We must find out whether we are attempting to teach children reading skills before many of them are visually ready for reading. These are some of the issues which we seek to explore within the context of the 1960 White House Conference. In the preparation of this report, the optometric profession has undertaken a critical and comprehensive self-appraisal of its services to children and the public generally, of its standards of professional training, and of the degree to which it has succeeded in its conscientious efforts to achieve with other disciplines an interprofessional approach to the problems of children, even when that sometimes entails some compromise of professional prerogatives for the sake of the public good. Optometry looks back upon the 10 years since it last participated in the White House Conference on Children and Youth as years of great progress in concepts of vision care, and in the effectiveness of its services to children and youth particularly. We regard the next 10 years as a period of even greater challenge to our profession and to every profession dedicated to the welfare of children and to service in behalf of humanity. Obviously, if the challenge is to be met, all groups working with children must keep open the channels of communication and the avenues of cooperation one with the other. We pledge our continued full efforts in that direction. LOIS B. BING, O. D., CHAIRMAN American Optometric Association Report to the 1960 White House Conference on Children and Youth By the American Optometric Association's Committee on Visual Problems of Children and Youth THE IMPORTANCE OF VISION TO A CREATIVE LIFE IN FREEDOM AND DIGNITY PART I. New Concepts and New Techniques-Identifying and ******************* "Vision is the Key to the child's whole individuality...To understand the child, In every hospital nursery, there is tolerant amusement among the nurses at the repeated spectacle of the proud father smiling, grimacing and waving at his newborn infant through the thick glass window. The new father frequently feels let-down by the failure of the infant to at least acknowledge the affectionate greeting, let alone smile back in filial devotion. But the disappointed father soon learns that the infant cannot see him or anything else in the surroundings. In this respect, infants are like the heathen idols described in the One Hundred Fifteenth Psalm: "Eyes they have, and see not." LEARNING TO SEE The infant is aware of areas and patterns of light. He learns to turn toward bright spots or shadows, to attempt to follow moving lights or bright moving objects, to move the eyes without moving the head, to reach out to touch and to feel things the infant vaguely sees, to begin tentative coordination of hands and eyes. The infant, in other words, is beginning to learn to use his eyes in order to learn to see. Thus the visual process begins in the child's life as a learned process which develops and improves with growth, development, maturation, and trial-and-error experience. The visual process he is learning to master is the same process which will in turn become his main road to the learning of other skills and of most of the knowledge he will obtain throughout his life. For authorities agree that at least 80 percent of all learning takes place through the visual process. Millions Fail to Learn to See Effectively Unfortunately, millions of children in the United States do not succeed in learning to use their eyes well enough to enable them to cope efficiently with the demands made upon them for successful achievement in school, or made by the culture, economy and society in which they will live. There are those children who are handicapped by injuries or malformations of the eye structure, or by brain damage, rendering them blind or partially-seeing. Blind children (those having acuity of 20/200 or less with best correction) number one in 5,000; partially seeing children (those with corrected vision ranging from 20/70 to 20/200) number one in 500. [46] These children manifest their problems in unmistakable fashion. Usually they receive prompt professional attention and are helped in school either through the establishment of special classes or by visual aids intended to enable them to continue in the regular classroom with specialized assistance. But at least four out of every 10 children in our schools and colleges are visually handicapped in one form or another for adequate school achievement. [46] Yet we know today, as a result of research undertaken primarily in the past 10 years, that most children with vision difficulties can be helped to overcome or helped to cope successfully with their vision problems. Obviously, therefore, to assure a creative life in freedom and dignity for every child, we must use the knowledge and techniques now available to us to search out all visually handicapped children and to give them the professional help they need to succeed in school and in life. We can no longer afford national neglect of so many children for so unnecessary a handicap. CHANGING CONCEPTS IN VISION CARE In its report to the 1950 White House Conference on Children and Youth, the American Optometric Association described earlier investigations into the relationship between vision and school achievement. [19] In the 10 years since then, we have come to a fuller realization of the importance of the relationships not only between vision and achievement but between vision and safety, and vision and recreation as well as the significance of vision problems themselves. "Your infant's eyes are very wonderful little organs-almost as wonderful as your child himself. In fact, his eyes, and the vision that results as he learns to use them to see and gain information, will have great influence upon his future performance and success. How he grows and develops and how well he learns to use these bright and shining windows to the world around him will determine the visual abilities which must carry him through his lifetime. Every experience in which he participates helps him to learn to use his eyes. These visual experiences will provide the foundations upon which vision becomes the dominant factor in his successes and achievements." [22A] Attitudes Before World War II Prior to World War II, the responsibility for vision care of the child was placed almost entirely on the parents, while educators and school administrators had only a slight interest in determining the visual abilities of their students. Many screening programs were in effect, but even those were of limited effectiveness. Usually only those children with extreme deficiencies of vision and those with obvious need for one or another type of corrective lenses for distance sight were uncovered as a result of screening in the schools. As long as a child could read a one-third-inch-high letter on the Snellen chart at a distance of 20 feet (20/20 visual acuity) he was able to pass the screening examination with flying colors, taking home a note announcing to his parents he had "perfect" vision. Many such children, despite the accolade of "perfect" vision, were visually handicapped, some severely, in their ability to use their eyes together efficiently for reading the printed words in a book held at 12 to 16 inches. We shall never know how many unfortunate youngsters have been scolded, humiliated and condemned as "lazy" in their school situations because of the failure of their parents and/or the community to discover in early school years the existence of a vision problem handicapping these children in tearning the all-important reading skill. We shall never know, either, how many potential scientists, mathematicians, psychiatrists, and optometrists or other badly needed professional people have been lost to our society because undetected vision problems discouraged otherwise qualified students from undertaking the rigorous studies required. How many school "drop-outs" can be traced to ignorance of the existence of vision problems which made school work for them a daily confrontation with bitter frustrations? Even today the problems persist, and visual inefficiencies and retarded visual development generally remain undetected because of inadequate mass screening programs. But at least we now understand better than we did a few decades ago that vision care is not achieved merely by the correction of refractive errors for distance sight. |