Visual Development

Dr. Burke is one of Cincinnati's most trusted resources concerning visual development in children.

What does a baby see?

A baby is born with the eyes and the brain having the wiring diagram needed for vision. However, these circuits must be turned on and these systems used continuously to stimulate and fully develop the brain’s visual systems.

This means newborn infants are born with a potential to see and, as they use their eyes during the first years of life, the visual functions continually and significantly improve.

The maximum visual system potential is reached around 2 years of age but the brain's visual development does not become fully mature and stable until around the age of 8.

What must happen for a baby see?

The baby’s visual system is dynamic, constantly changing, and adapting through nature’s pre-programmed developmental cycle and through the use of the eyes that stimulate the brain’s development.

The baby’s ability to understand what is seen and being able to make appropriate responsive actions based upon that information is a learned behavior. That means that the sensory experiences from the external world influence the way the brain wires itself after birth. These visually driven experiences stimulate the development of the different areas of the brain used for facial and object recognition, perception of movement, color vision, and depth or 3-D awareness.

Visual experiences are crucial for the child's vision to develop normally. The infant’s visual system develops in a “use it or lose it” situation. Because visual development is so rapid during the first year, early detection of eye problems is critical so that treatment of childhood eye problems may begin as early as possible so that permanent visual impairment does not occur.

What is the typical visual developmental progression in infants?

Right after birth, the baby’s may appear to stare blankly and the eyes may appear to wander almost randomly. They typically show blinking or closing of the eyes in response to rapid increases of illumination.

During the first month or two, they may focus only on stationary objects close to their face. This is especially true when looking at your face. Although it does seem that they enjoy looking at faces, they are actually observing only gross facial details. The early visual system is more stimulated by and therefore interested in shapes, lines, and boundaries between the image targets. In this immature visual system, the nearness of the visual stimulus allows for magnification that permits the infant's best visual potential.

In the second and third month, they have learned to fixate well on faces and lights and then they begin to perceive larger distant objects. They also slowly develop the ability to fix and follow or track objects that are in motion.

By 3-4 months, the brain has developed enough to control of the eyes and head movements, which allows for the rapid integration of visual stimuli that permits the infant to respond so that their eyes appear well aligned and the tracking of their ocular movements are well coordinated most of the time. Also during this time, the baby’s visual attention and visual searching behavior begins which allows the infant to associate visual stimuli with a recurring event (such as a bottle “means” food).

By the time your infant is 4-6 months old, most visual systems should be functioning so that it appears that their visual interests and abilities are as good as an adult. But their vision is not as good as yours and their brain’s vision systems are not nearly fully developed. It is not until around 24 months of age that the eye’s and brain’s anatomic development reaches close to that of an adult. However, the brain's visual circuits do not reach full maturity and stability until around the age of 8 years.

What should you do if you suspect something is wrong with your child’s eyes or their vision?

Please remember that babies develop their abilities at their own pace and without regard to time tables that parents and grandparents often set for them. Even if your baby seems behind any of these developmental milestones (listed above), the probability is the visual functions and development will ultimately be normal.

However, if by 3-4 months of age your child's vision seems less than normal or if the eyes do not appear properly aligned, you should bring these issues to the attention of her primary care provider. If you really feel there is still a problem, even if your primary care practitioner feels it is probably normal, it is always worth getting an opinion from a pediatric ophthalmologist.

What are some of the factors that increase the risk of a vision problem in an infant?

  • Prematurity less than 32 weeks
  • Maternal history of diabetes or thyroid instability
  • Maternal use of illicit drugs and alcohol
  • Maternal exposure to or infection with herpes, toxoplasmosis, chlamydia, cytomegalic virus
  • Family history congenital cataracts
  • Family history of genetic diseases including neurofibromatosis, Marfans, optic atrophy, retinitis pigmentosa, Stickler’s
  • Family history of retinoblastoma
  • Known or suspected central nervous system problems including developmental delay, cerebral palsy, seizures, and hydrocephalus
  • Down syndrome
  • Family history of unusually high farsightedness
  • Family history of strabismus
  • Ptosis or any other cause of visual axis blockage

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  • Dr Burke, I wanted to give you an update on Elizabeth who was under your care from age 4 until a few years ago. When we left your office after she first saw you, she looked up and said, "I want to be a doctor just like Dr. Burke." Elizabeth is now in her third year of medical school and is still interested in pediatric ophthalmology. She started an ophthalmology club for the medical students and she volunteers at different events doing vision checks. You're such an inspiration to her she has said she plans on being a doctor, "Just like Dr. Burke."