We often associate visual intelligence with visual processing, occurring at some mystical level within the brain. Convenient distinctions if not dichotomies have been made between so-called visual skills or efficiency, and visual perception or processing. How intertwined these are was evidence the other day when re-evaluating a four year old sweetheart with Down Syndrome whom we’ll call DS to preserve her annonymity. I had originally seen her three months ago when her mother arrived with a +5.00 sph OU Rx that DS was resistant to wearing. At that time I changed her Rx to +3.50 – 1.00 cx 180 OU with a +2.00 add.
Mother returned indicating that DS was much more compliant with wearing her bifocal Rx than with her prior single vision full plus Rx. I notice that a good deal of the time, DS tipped her chin upward to look through the add. She would do this most often when viewing out to a distance of about 12 feet. Beyond that point she would look above the line at which point her left eye would turn inward.
On the prior visit we had discussed the possibility of binasal occlusion and prism, but I loved seeing the way DS was using her visual intellect to massage her accommodative esotropia into alignment at progressively further distance, and accepting the plus that she was not able to accept at intermediate range initially. I may alter the Rx on the next visit but, for now I’m happy allowing DS to continue using her native intelligence. DS gave me the biggest smile on the way out the door, as we exchanged high fives all around.