By Dr. William Moskowitz
Neil Simon, one of this generation’s most prolific and insightful playwrights, said it best in his play, “Same Time Next Year”, when he commented on the natural progression of life’s toll on our seemingly youthful and invincible bodies. The play chronicles the once-a-year — for a lifetime — liaison between a married man and a married woman who meet when they are relatively young. Once a year they not only share the passion of physical intimacies, but they catch up on each other’s lives, sharing the joys and heartaches of their respective families, their careers and their desires. Middle age arrives, bringing most of the angst encountered by us all. The man, an accountant, is unable to perform the “dances” of intimacy, and, in his frustration blurts out, “I always thought it would be my eyes that would go first!”
How many of us simply accept that our eyes are eventually going to fail us? Or are we surprised and worried when they do – at whatever age they do? Of course, we would like a lifetime warranty on all body parts – the cruelty is that the machine often hangs on long after its individual parts need repair or replacement. But what about the eyes? What is the normal progression of performance?
Within two weeks of birth, a baby’s eyes are moving in the same directions together (eye teaming). The infant learns to look from near to far (from its mother’s face to the stuffed animal across the room) and back again. Activities during infancy and early childhood develop this skill called accommodation, as well as others requiring eye-hand coordination, and the ability to see clearly for long periods of time while looking at near or distant objects (focusing). These are not skills that are programmed into us at birth – they must all be developed and perfected over time. Prior to entering school, it is essential that children have the opportunity to exercise and develop good gross and fine motor coordination, because good eye coordination is supported by the body’s overall motoric coordination.
The visual system is actually challenged when that child first sits down at a desk in school, usually in first grade, to do close work for extended periods of time. He must learn to keep the two eyes pointed together and move together while he attempts to decode signals – and learns to read. In about third grade, a reversal occurs- the child reads to learn. The pressure on the eyes to perform increases. In the fourth and fifth grades, the eyes finally adjust to close range work. At the same time, however, genetics kicks in and the child’s vision starts to show characteristics of the parents’ own visual systems and the child may require glasses for distance or for reading and other close work.
By the time a child reaches middle school, eye movements become more refined, for accuracy at near and distance. This is the time when a child learns to look out in space more (no, that doesn’t explain that “spacey” attitude that drives you crazy). He is more “out there” – expanding not only visual horizons, but personal ones, as well. His self-confidence improves with respect to increased visual comfort levels and this is when many children try their hands (or feet) at sports. Playing ball requires tracking ability, that is, visually following an object as it moves through space. Vision also impacts knowing where your body is in space and where your limbs are in relation to one another (kinesthetic awareness).
Remember high school? For those lucky enough to have found their stride during those physically and emotionally challenging times, vision was most likely a key player in their well being. This is a time when the visual system operates at its highest level of efficiency thus far; it is faster and better at looking from near to far and back again with no errors. The high school athlete can only be superior on the playing field if his/her visual skills, that is, eye-hand coordination, tracking (pursuit), and visualization (being able to determine where the ball, or opponent, will be at a future given time) are superior. And, academically, those thirty pound book bags attest to the extensive amount of close work required of our teens.
All this is in preparation for the new, and sometimes shocking, visual demands of college. Think back to when you had five courses and each professor assumed his was the only one that mattered and, therefore, it was perfectly reasonable, in his mind, to assign a hundred pages to read by the next class, two days away. A higher level of reading is now required, demanding not only precise vision, but also interpretive thinking and cognition (understanding what is being read). Visual accuracy must occur automatically now, more than ever. Imagine how incredibly difficult and distracting it would be to have to work hard to make your eyes do what they should be doing (focusing and tracking), while trying to do critical thinking at the same time!
By the same token a person who has entered the work force now has new stresses placed on his visual system, as well. His job may require rapid visual recognition, eye-hand coordination, or simply more sophisticated and refined use of the skills he has learned and developed over the years.
The twenties and thirties are a time of life when we begin to recognize the occurrence of visual adaptations. A person sees changes that are beyond his control – here, genetics takes its stand. But, there are also changes that are due to our choices in life. Neil Simon’s accountant, for example, chose a profession which requires constant close range work. Likewise, a person who sits at a computer all day will see changes in the focusing ability of his eyes. They will both eventually experience difficulty adjusting to seeing at a distance. A forest ranger, on the other hand, will not have to worry about that.
So, we can now see that environment and lifestyle do impact one’s vision. That is because our eyes are designed to be relaxed when looking far away. Doing close work causes the eyes to work harder, and the more close work we do, more stress is placed on the visual system, eventually creating the need for corrective lenses. Physiological changes in the body become very apparent in our eyes as we age into our forties and beyond. The crystalline lens in our eye is clear and flexible in our youth. It normally changes its shape for near and distance vision with ease. However, as we age, it loses fluid and becomes less flexible, making it more difficult to focus at the near range. Our arms seem to get shorter and we need to hold reading material farther and farther away. Reading glasses compensate for this lack of focusing ability by the lens (called presbyopia, which affects only near range vision). Those of us lucky to live long enough will need stronger and stronger lenses for focusing as this natural process continues. People who have always been moderately nearsighted (myopes) will notice that they are taking their glasses off more and more to see at distances. Women may find that they need to use eye drops, especially with extended use of their contact lenses, as they develop “dry eye”, a condition that parallels the reduction of other fluids in their bodies, as their level of estrogen declines.
Vision changes are normal throughout the course of one’s life. We should be aware of those changes and not panic. At the same time, in order to ensure the health and proper functioning of our eyes, it is critical to have comprehensive yearly vision examinations that include testing all the visual skills we need in order to maintain the activities of our daily lives, whether they be surfing the net or surfing the waves off the California coast.
Dr. William Moskowitz is a board certified developmental/behavioral optometrist who has been in practice for over forty years, providing specialized services for children with vision-based learning problems, as well as adults. He trained at the Gesell Institute at Yale University and is an expert in pediatric developmental optometry. He has lectured internationally and was a contributor to a textbook on pre-school vision. Dr. Moskowitz, whose practice specializes in the diagnosis and treatment of vision-based learning problems, is a popular speaker with parent and professional groups.