Studies of animal models have demonstrated that abnormal visual experience can lead to abnormal visual development. The provision of normal optical experience for human infants and children requires an understanding of their typical retinal image quality in the natural dynamic environment. The literature related to this topic is reviewed.
Keywordsinfant; accommodation; retinal image quality; visual experience; aberrations; emmetropization A large literature now suggests that abnormal visual experience leads to abnormal visual development in animal models. Visual experience can influence both the refinement of synapses in visual cortex 1, 2 and the growth of the eye [3][4][5] . The manipulations of visual experience used in these experiments cannot be implemented in studies of human development and therefore direct evidence of the impact of abnormal visual experience on otherwise typically-developing infants and young children is much harder to gather. Infants receiving abnormal experience are typically only identified if the cause is detected easily (e.g. ptosis, cataract or strabismus 6-9 ). We have only minimal evidence from humans regarding the natural history of other conditions, such as anisometropic amblyopia 10,11 , where the signs of abnormal experience are less obvious. As a result, approaches to prescribing spectacles for apparently asymptomatic infants and young children have primarily been derived from a combination of clinical consensus 12, 13 , the typical distribution of refractive errors during infancy and early childhood e.g.14 , and the refractive error found at the diagnosis of an apparent consequence (e.g. amblyopia) 15,16 . The goal of this perspective is to review our current understanding of the retinal visual experience of human infants and young children, and to pose questions that need to be answered if we are to promote normal visual development by providing 'normal' visual experience to young patients.Much public effort in research, screening and healthcare is currently aimed at detecting and treating the apparent consequences of abnormal visual experience -primarily amblyopia and some forms of strabismus [17][18][19][20] . However, studies of form-deprivation and chronic defocus in animal models suggest it may instead be possible to prevent these consequences in humans with appropriate intervention at an earlier point. In attempts to explore this possibility and provide normal visual experience there have been three large-scale human population studies of randomized spectacle correction for hyperopia in infancy, with differing outcomes. These studies have suggested that it may be possible to reduce the prevalence of amblyopia at age three or four years with preventative use of spectacles [21][22][23] , but the results with regard to the incidence of strabismus are not consistent. Ingram's group, who included infants aged 6 months with 4D of hyperopia or more in any one meridian, corrected one group with 2D less than their cycloplegic refraction and left another group untreate...