Is “20/20” Perfect Sight?

Published November 24, 2020

Author: Dr. Denise Smith, OD

The Center for Vision Development, Austin TX

“Perfect sight” is frequently equated with the ability to see 20/20, despite the fact it is actually more than that, much more.

Most people don’t think about vision until they have difficulty seeing clearly— often due to a refractive condition like myopia (nearsightedness) which causes a reduction in visual acuity. Unfortunately, the common notion is that glasses are the cure for all vision problems.

Vision is not the same as sight

Vision comprises over 20 different skills. 

Vision is a complex subset of skills that go well beyond seeing “20/20”. While having “20/20” acuity is important, the other skills must not be discounted.

Vision skills include:

  • Eye tracking
  • Focusing
  • Eye teaming
  • Peripheral vision
  • Depth perception

These skills are critical for getting information from the eyes to the brain, where the vitally important processing of the visual image actually occurs.

What is visual processing?

Once the brain has received the visual information, it has to then process that information and integrate it with other sensory systems to give the information meaning and direct action. That’s where the visual processing, visual learning, and visual integration skills— including visual discrimination, visual memory, and visual-motor integration— are important.

The visual processing skills help us to identify what we see and make sense of it. 

When the visual processing skills are deficient it makes it difficult to comprehend and remember what we see, which can have a significant impact on learning, work productivity, and sports performance – despite having “20/20” acuity. 

Is the 20/20 vision exam enough?

Unfortunately, no.

Most vision exams only evaluate visual acuity, the need for glasses, and eye health. Therefore, most often, these essential visual skills are not assessed, resulting in unidentified visual deficiencies.

Only a full developmental vision evaluation will insure that all these necessary skills have developed to the age appropriate levels. For this reason, early assessment is essential so that deficient skills can be remediated.

The good news is, when the vision skills are not developing properly, all is not lost.

Vision skills can be learned

Something that most people don’t realize is that vision is learned. We are not born with all the visual skills we need to function effectively. Just as babies learn to crawl, walk, and talk, vision is learned and developed much the same way. Your visual skills, can therefore be trained and improved.

The toddler years are a critical period for vision development. Therefore, it is recommended that parents follow this schedule for their child’s first eye exams to insure their vision is developing properly:

  • First exam: by age one
  • Second exam: at age three
  • Third exam: at age five

While this is a recommended timeline, follow your eye doctor’s recommendations on how often to bring your child for an eye exam.

How does vision therapy help?

If deficiencies in the visual skills are identified, a vision therapy program can be initiated to improve the deficient skills and prevent years of struggling. 

Having said that, it is also important to note that because the vision system is active, dynamic, evolving, and plastic, it can be improved at any age and is not limited to young children.

Vision is the primary modality of gathering information from our environment, deriving meaning from the information, and directing the activities of people. You don’t get all that from “20/20”.