article albert a. sutton, on, ms, fcovn · albert a. sutton, on, ms, fcovn introduction in 1955, i...

~

Article

The Basis for Visual Developmentfrom Prenatal Through Infancy

Albert A. Sutton, on, MS, Fcovn

INTRODUCTION

In 1955, I had the privilege of participat-ing in a preschool vision study headed by Dr .Richard Apell at the Gesell Institute of ChildDevelopment. Drs. Orvin Ide, Bernard J ander ,Ray Lowry, William Moscowitz, John Streff,Harold Wiener, and I joined Dr. Apell to de-velop an appropriate visual examination forthe preschool child from ages 21 months to 5years. The results of this study were publishedin the book Pre-School Vi.S'ion by the Ameri-can Optometric Association. I In the 40 years

since we started that study, research and sci-ence have provided information to extend ourknowledge to the development of vision in theprenatal embryo and fetus and the postnatalinfant.

and intelligence. Arnold Gessel has said "vi-sion is so intimately identified with the wholechild that we cannot understand its economyand its hygiene without investigating thewhole child."2

The conservation of vision, particularly inthe young child, goes far beyond the detectionand correction of refractive error. Acuity isonly one aspect of the development of vision.We need to consider other aspects: How is thedevelopment of the child's visual system re-lated to the development of its other neurolog-ical systems? Are central and peripheral vi-sion in balance? Do eyes team coordinately?How does visual behavior compare with gen-eral behavior?

To answer such questions, we need a moreordered knowledge of the child as a growingorganism. The child's visual history begins inthe dark, warm, liquid environment of theuterus. The child's patterns of visual behaviortransform in an orderly sequence through thestages of development (Appendix 1).

At 18 days old, the human embryo is onlyabout one eighth of an inch long, but the eyesare already recognizable as bulges on the de-veloping brain. In a specimen only a few daysolder, the rudiments of the eyes would also bevisible as optic pits-outpouchings of the openneural plate. At 4 weeks, the optic vesicle hasfully invaginated and the cerebral hemi-spheres are already present. The retina beginsto differentiate about 2 weeks later. Up to thefourth month of development of the fetus,there is a close analogy between the layers ofthe cortex and those of the retina. At 16weeks, the vestibular system is operationaland necessary for ocular movement develop-ment.

THE COMPLEXITY OFVISION DEVELOPMENT

The development of vision in the child iscomplex. It has taken countless ages of evolu-tion of the human race to bring vision to itspresent, advanced state. The development ofvision passes through several phases in thefetus, the newborn infant and the growingchild.

Vision is not a separate isolated function.It is profoundly integrated with the develop-ment of the total action system of the child,including posture, coordination, personality,

This article was presented at the Annual Meet-ing of the College of Optometrists in Vision Devel-opment, Palm Springs, CA, October 27,1995.

Correspondence regarding this article should beaddressed to Dr. Albert A. Button, 7660 GranvilleDr., Tamarac, FL 33321.

80 Journal of Optometric Vision Development