What Neurology, Optometry, Psychology,Education and Psychiatry Have in Common

Q. What do neurology, optometry, education, psychology and psychiatry have in common?

A. All of these professions deal with the BRAIN and its operation, both physiologically and behaviorally.

Q. What role does optometry play in the brain’s ability to learn?

A . The brain receives the vast majority of its information through the eyes, through the process of vision. Vision, as we are using the word here, is a higher order Brain function and it is dynamic, quite different from sight, which is a lower order function, and which is essentially a static response. Eighty percent of what you know has come through your eyes. If a person’s visual processing is inefficient, optometrists are in a unique position to enhance a person’s learning ability.

Q. How does the brain learn?

A . The brain gets its raw information from experiences, the majority of which are highly visual-motor. It sorts and orders the data and forms it into percepts (meaningful units of information), which are further sorted and grouped into response patterns called operations, all this through a continuous cycle of input, processing, and output. We use these learned operations to act and react to our world experiences. The essence of who we are, Mind and Personhood, are largely built upon our percepts. The five professions noted above all deal directly and indirectly with this process of life perception.

A brain that isn’t learning efficiently is a brain that needs to change in some way. The question is: can it be changed?

Q. How does perception affect performance and personality?

A . School grades are one simple way by which we can measure the efficiency of brain function. (Most people aren’t condtioned to think of this in this way—especially teachers, who often undervalue themselves and their role—but it’s no less true.) When grades are off, it’s because the brain is “off” in some way or other. Martha Denckla, a neuroscientist, said, “Every teacher is a brain surgeon…making little dendrite sprouts and connect(ing) up neurons,” 1

Perception is as much or more a neurophysiological process as it is a psychological process, though it has elements of both. As the Brain wires itself, it may mis-wire itself. Misperceptions affect associations, which in turn affect the brain’s understanding of its environment—both the physical world and the social/emotional one, as well. Social relationships help to mold much of our ego concepts. Because of this, perceptual problems wind up contributing not only to learning problems but to interpersonal and ego problems.

Editorial Note: Please do not read this as saying that perceptual problems cause all psychological and psychiatric problems, far from it – but as A.M. Skeffington, the father of behavioral optometric science
often said in his lectures:
“A person insecure in his visual state will be a person insecure in his ego state.”

Q. How do we change the brain?

A . There are five primary ways by which we can deliberately affect the brain to make it change:

  1. Surgically: as they do in Parkinsonism, epilepsy, and unrelenting depression.
  2. Chemically: with medications (Ritalin, Cylert, Dexedrine, Prozac, Valium, antipsychotics, etc.). This is the most common avenue of deliberate intervention, used pyschiatrically.
  3. Retraining: education, rehabilitation, and experiential instruction. This is the basis of daily change in our brains. It is normally a slow, deductive and inductive, often random process which can be applied in a directed way. That’s when we call it TEACHING. (All educational strategies are actually rehabilitative and work to reshape brain circuitry.)
  4. Optically: via lenses, prisms and filters. They:
    1. Change motor responses to one’s space world;
    2. Change the ratio of action between the voluntary and involuntary nervous systems;
    3. Change the ratio of action between the sympathetic and parasympathetic nervous systems; and;
    4. Change the signal quality, altering the rate at which the brain processes input. (i.e., Purkinje Effect)
  5. Biofeedback: changes of muscle activity by internal modification of signals. (This is actually a retraining, but it is a self-generated neurophysiological reorganization.)

Q. Why does optometric therapy affect learning skills?

A. First of all, visual problems do not cause learning problems. No credible authority has ever said so.2 Yet, undetected visual problems can create a performance difficulty that can be a collateral part of learning problems. Most of the time, the effect is an indirect one. In this way, visual problems can mimic attentional problems. (ADD/ADHD). [Be aware that reading occurs at two levels: decoding alone, and decoding with comprehension. We’ve all experienced reading while we were fatigued and have gotten to the bottom of a page without any comprehension of what was read—yes, reading occurred, but no comprehension did. Visual problems—again, not sight problems—often affect the attending patterns of the underachieving student in the same way.]

Lenses and prisms, (and more rarely, filters) affect the perception of space, they alter the inborn response of the nervous system, and they reduce the detrimental impact of time upon the activities of the visual system. Visual-motor perception, farsightedness, and suppression of vision in one eye have all long been shown to relate negatively with school performance.3-5 The ability of perceptual therapy to remedy many academic problems has been known for some time6; orthoptic training has been shown to improve reading in at least one prospective study7; and visual therapy has been shown to affect self-perception8. A child who struggles with learning should be evaluated for possible visual (not sight ) processing problems as part of their workup.

Q. How do psychology and psychiatry fit in?

A . Children with learning difficulties have a higher prevalence of depression and other emotional problems9. One study found that learning disabled students were more often depressed about their school scene than a control population was10. Additionally, schizophrenics have poorer eye motilities and have dramatically altered spatial perception when compared to the general population11. There are case reports in the popular press that discuss the effects of visual rehabilitation in certain dramatic psychiatric situations12,13. Mental abuse and emotional stress are known to have direct structural effects on an area of the brain that affects learning and memory (the hippocampus)14,15. A mental health clinician may be consulted for these reasons, either for psychological measures, behavioral intervention, or both.

Q. What can be done for learning disabilities?

A . All barriers to learning need to be addressed. Evaluation for sensory operating problems, emotional concerns, physical health needs (including a child’s nutritional state), and/or poor academic readiness, may be appropriate. Two areas of great benefit in rehabilitation are retraining of perceptual skills and binocular visual therapy. Problems in these last two areas may affect one half to two thirds of children with learning problems and a university-proven program is available which results in rapid remediation6.

Teachers need to recognize when to teach to strength learning modes and how to recognize the symptoms of visual and perceptual dysfunction. They can then refer those students with learning skills problems to rehabilitative care, since use of visual-auditory-kinesthetic-tactual (V-A-K-T) strategies and “teaching to strengths”—used alone—have yet to be demonstrated to have positive outcomes over the long run16. Therapeutic educational techniques may be considered, as well.

Behavioral, developmental, or neurodevelopmental—no matter what it’s called—optometric retraining (using lenses, prisms, filters and biofeedback) has had—arguably—the greatest impact on learning problems out of the five professions with the five intervention strategies. Optometric visual therapy can be a powerful healing tool in many, many learning problems. It results in the most rapid response, frequently in mere weeks, sometimes in months. Ultimately, learning must operate in a hospitable environment in the home as well as the classroom for it to flourish, mediated by well-developed learning skills.


1. TV interview for Dana Corporation’s “Exploring Your Brain”, 1998.
2. Wold, R; Vision and Learning Update, Tape Series, Am. Optom. Assn., 1973.
3. Helveston, E; The Draw-a-Bicycle Test, J Ped Ophthalmol & Strab 22(1), 917-919, 1985.
4. Rosner J, Rosner J; The Relationship Between Moderate Hyperopia and Academic Achievement: How Much Plus is Enough?, J Am Optom Assoc, 1997 Oct; 68(10):648-650.
5. Benton, C; in Dyslexia : Diagnosis and Treatment of Reading Disorders, Keeney and Keeney , Eds., CV Mosby, NY 1968.
6. Rosner J; The Development and Validation of an Individualized Perceptual Skills Curriculum, LRDC Publication 1972/7, U of Pittsburgh, 1973.
7. Atzmon D, Nemet P, Ishay A, Karni E; A Randomized Prospective Masked and Matched Comparative Study of Orthoptic Treatment Versus Conventional Reading Tutoring Treatment for Reading Disabilities in 62 Children, Binoc Vis Eye Musc Surg Qtrly 1993; 8:91-108.
8. Bachara, G, Zaba, J; Psychological effects of visual training, Academic Therapy, Vol. XII, No. 1, Fall 1976.
9. Walzer S, Richman J,; The Epidemiology of Learning Disorders, Pediatric clinics of North America, 20(549-566) 1973.
10. Abrams J; An Analysis of Learning Disabilities and Childhood Depression in Pre-adolescent Students, doctoral dissertation, Indiana University of Pennsylvania, 1990.
11. Flach, F, Kaplan, M Bengelsdorf H, Orlowski B, Friedenthal S, Weisbard J, Carmody, D; Visual Perceptual Dysfunction in Patients with Schizophrenic and Affective Disorders Versus Control Subjects, J Neuropsych, 1992, Fall, 4(4) 422-427.
12. Flach F; Resilience, Fawcett Columbine, NY, 1989.
13. Flach F; Rickie, Ballantine Books Edition, NY 1991.
14. Bower B; Child Sex Abuse Leaves Mark on Brain, Science News, 1995 June , 147(340).
15. Sapolsky R; Why Stress is Bad for Your Brain, Science, 1996 August 9; 273(749-50).
16. Tarver SG, Dawson MM; Modality Preference and the Teaching of Reading: A Review, J Learn Dis, 1978, Jan. 11(1) 17-29.

Additional information may be found in the following resources:

1) Parents Active for Vision Education (P.A.V.E.) National Headquarters 4135 54th Place San Diego, CA 92105-2303 (619) 287-0081 / FAX (619) 287-0084 or 1-800-PAVE-988 + You may also contact P.A.V.E ® at
2) Optometric Extension Program Foundation, Inc.; 1921 E. Carnegie Ave., Ste. 3-L; Santa Ana, CA 92705-5510; (714) 250-8070
3) Neuro-Optometric Rehabilitation Association International, Inc.; P.O. Box 1408; Guilford, CT 06437
4) American Optometric Association; 243 North Lindbergh Blvd. St. Louis, MO 63141; Voice: 314-991-4100 Fax: 314-991-4101
5) College of Optometrists in Vision Development; 243 N. Lindbergh Blvd. Ste. 310; St. Louis, MO 63141; 1-888-COVD-770; email:; or at:

© 2011 - 2018 Merrill D. Bowan, O.D. All rights reserved


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