For years, patients walked out of Dr. Meenal Agarwal’s exam rooms with perfect vision on paper—and still came back saying something felt wrong.
I’m overwhelmed in crowds.
My child avoids sports.
I get lost without GPS.
Driving makes me anxious.
As someone who runs three practices in the GTA while balancing teaching and speaking engagement, Dr. Agarwal was quick to recognize how these weren’t textbook complaints. They pointed to something beyond typical diagnosis.
“I was noticing a pattern across so many patients,” she says. “At first, these seemed unrelated, but eventually I realized they all pointed toward an underlying issue: the brain’s ability to orient in space.”
What followed was three years of research and, coming this fall, a book—Stuck in a Flat World. In it, Dr. Agarwal explores how patterns like rising myopia, accommodative and binocular vision problems, and growing anxiety might be connected in ways the profession hasn’t yet fully explored.
The book doesn’t offer a verdict so much as it explores a major societal shift, one that Dr. Agarwal believes could change the way optometrists think about visual function and the patients sitting in front of them.
The Architecture of Orientation
To understand what Dr. Agarwal was encountering in her exam room, it helps to understand what she means by “the brain’s ability to orient in space.”
Simply put, spatial awareness is how the brain processes where your body is in relation to the world around you. It’s how you judge distance and movement and navigate unfamiliar environments. According to Dr. Agarwal, it’s something we build through real-world experience, not simply through vision. She describes it as “your brain’s internal GPS.”
There’s no single part of the brain responsible for spatial awareness. Instead, Dr. Agarwal points to a network of systems working together—the parietal lobe, the vestibular and proprioceptive systems, the dorsal and ventral visual pathways, and the amygdala. It’s the constant conversation between these systems that allows us to judge space, movement, and whether our surroundings feel safe or overwhelming.
When the Pattern Got Personal
That last sentiment is what Dr. Agarwal’s patients kept communicating to her—feeling anxious, disoriented, or simply “off,” despite having healthy eyes.
The pattern didn’t stay confined to her patients, either. The more Dr. Agarwal listened to their stories, the more she began recognizing similar changes in herself. Busy environments that had once felt routine became increasingly overwhelming. She found herself driving less, becoming more withdrawn, and even avoiding trips to Costco because the sheer volume of visual information felt exhausting to process.
What started as a series of curious clinical observations had become something personal. Determined to understand what connected her own experience with those of her patients, Dr. Agarwal set out to explore how the brain processes space, movement, and visual information.
Along the way, she began referring to this collection of symptoms as Spatial Awareness Processing Disorder (SAPD), a framework she developed to describe the difficulty some people experience interpreting and responding to the space around them.
Through the Looking-Glass
Giving the pattern a name was one thing. Understanding why it had become so common was another.
“I don’t believe we’re witnessing a generation that’s fundamentally more anxious or less resilient,” Dr. Agarwal says. “I believe we’re witnessing brains adapting to a world that has become increasingly disconnected from how humans evolved to learn, move, and connect.”
For Dr. Agarwal, that disconnection traces back to one major shift in particular. Of all the changes our generation has experienced, few have been more profound than the role screens now play in everyday life. They shape how we work, learn, communicate, navigate, and spend our free time. In Dr. Agarwal’s words, our world has flattened: “We’ve replaced three-dimensional exploration with two-dimensional interaction.”
She isn’t interested in framing screens as the villain, nor does she suggest abandoning the digital world. “They’re incredible tools,” she says. “They’re not the enemy. The problem is when they replace the experiences the brain evolved to depend on: depth, movement, exploration, uncertainty, and face-to-face interaction. We’re exercising our brains differently than previous generations.”
Dr. Agarwal points out how a significant proportion of teens who don’t drive cite fear as the primary reason. To her, that fear isn’t a personality trait so much as a brain struggling to process traffic lights, lane markings, and oncoming cars all at once—the same mechanism at work in a crowded store or an unfamiliar city, where a system that hasn’t had enough practice reading three-dimensional space starts treating it as a threat.
Beyond the Prescription
If Dr. Agarwal is right that technology is reshaping how the brain processes space, then optometrists—who spend their days evaluating one of the systems involved—are in a position to notice it first.
“Listen to what patients tell you beyond their prescription,” Dr. Agarwal says. That means paying attention not only to what patients can see, but to how confidently they move through and respond to their surroundings. A child who avoids looking up in an unfamiliar exam room, a teenager who is afraid to drive, or an adult who feels overwhelmed in a busy store may be offering clues that would never appear on an eye chart.
It doesn’t mean every symptom points to the same diagnosis. She’s simply asking optometrists to remain curious—and to recognize the broader role vision plays in movement, behaviour, and neurological health.
“We evaluate one of the brain’s primary sensory systems,” she says. “As our understanding of the eye-brain connection grows, optometrists can play an important role in recognizing early changes in visual function, spatial processing, and overall neurological health.”
Optometrists may not yet have every answer, but they are already hearing the stories that can help identify where support is needed. And that’s important because, in Dr. Agarwal’s view, spatial skills are not fixed—they can be strengthened through movement, play, navigation, and other activities that challenge the brain to engage with three-dimensional space.
“That should give us hope,” she says, “because if our environment helped create the problem, our environment could also become part of the solution.”
Continuing the Conversation
Dr. Meenal Agarwal is a practicing optometrist and the owner of Stouffville Family Eye Care, Pickering Town Center Optometric Clinic, and Promenade Optometric Clinic. She is also the host of the Uncover Your Eyes podcast, where she explores the connection between eye health, brain function, and overall wellbeing.
Her book, Stuck in a Flat World: How Screens Rewire Our Brains, Spatial Awareness, and Sense of Safety, was recently published by Page Two Books. It is currently available on Amazon Canada and Amazon U.S.
One of OSI Group’s greatest strengths has always been the knowledge and experience shared by its members. Whether it’s a new clinical approach, a business lesson, or a different way of thinking, those conversations help move the profession forward.
Dr. Meenal Agarwal’s work is a perfect example. By sharing both her clinical observations and personal journey, she invites colleagues to explore new questions. We’re grateful to feature her story and look forward to the conversations it sparks throughout the OSI community.
