strabismus, Vision Therapy

Post 1: Something is Wrong

blue-telescope-lens-curves.jpgThe Boy Who Reads with One Eye

Hindsight is 20/20. Pun intended. I first took action related to my 7-year old son’s vision in August 2017 as he sat reading a passage with his tutor at my dining room table.  I looked over and saw him closing one eye in order to read and it struck me as extremely strange.  I asked my son (I’ll call him “Mac”) if he could describe why he was doing that and he answered that the words were more clear if he only looked through his left eye and he closed his right eye. I talked to his dad about it and he said he had also noticed little signs with Mac doing strange things with his eyes.  And when I thought about it, I had noticed things too  – but never took action to get to the bottom of it.  I think everyone was resting comfortably in several previous eye exams where Mac was determined to have 20/20 vision and we thought that was all there was to it.  The 20/20 label was enough to cause me to ignore a slightly cross eyed look that I saw for a fleeting moment or in some (but not all) pictures.  Or a glance at me across a room where it looked as though he was looking past me rather than at me.  But reading with one eye closed was finally enough for us to take him to an Ophthalmologist for an exam.

A Surgeon’s Perspective

The “one eyed reading” incident occurred on a Tuesday, we had him to the Ophthalmologist by Thursday and were told that he had intermediate, alternating, exotropia (basically crossed eyes that are taking turns turning out rather than in which is also known as being “walleyed”) and that surgery – on both eyes – was the only option.  The Ophthalmologist said that the surgery would fix the issue – although we were to expect him to need the surgery multiple times between childhood and adulthood to keep his eyes straight.  The diagnosis and treatment left me shaken and scared.  I started reading up on surgery for extropia (as did my mom) and was not comforted by the success rates that I was seeing online.  My mom (who is her grandson’s best advocate) pushed me to get a second opinion from someone who did vision therapy – and that turned out to be great advice.

An Eye Therapist’s Perspective

About a week later, Mac was evaluated by an Optometrist who does vision therapy.  This doctor explained that nothing was wrong with my son’s eye muscles.  The issue was that his muscles were not coordinating to help his eyes work together as a team.  He is essentially looking through one eye at a time rather than using both eyes together which creates challenges to him in reading and in tasks that require depth-perception.

The doctor compared the issue of Mac’s eyes and surgery to the difference between a concert pianist and me (a very beginner piano player). Performing surgery on the muscles in my hands will not make me into a concert pianist (sadly!).  The difference between me and a concert pianist has nothing to do with our muscles but rather the ability of our brain to coordinate our muscles in each hand to flawlessly execute a piece of music.  He assessed Mac and estimated that with a course of intense vision therapy (two hours per week in his office), my son could improve his vision dramatically.  He estimated that between 65 – 80 hours of vision therapy could make a difference for Mac that could last a lifetime.

The Optometrist presented Mac’s case in with numerical values on a several binocular vision dimensions. I won’t bore you with all the numbers (plus I don’t understand them well enough to write much). But there was one value called Convergence (Base Out) that he said is the value that shows how well the overall visual/brain system is working together.  Normal values are between 120-150.  Mac’s value is a -160 (negative 160) which indicates that his vision system is a far cry from what would be considered normal.

The Optometrist recommended that I read a book called Fixing My Gaze by Susan Barry. I voraciously read the book in a single day as it’s the story of a 48 year old woman who was able to correct her vision issues thru therapy. I highly recommend that book for anyone who is facing these issues for themselves or for a child or loved one. The author also has a nice TED talk if you want the highlights of the book in 17-minutes.

My Emotions & My Kid

Since finding out the severity of the situation, I have had trouble getting a good night’s sleep and have had to shut my door at work to let the tears flow a few times.  My son is a high-functioning kid (scoring in upper percentiles for reading and math on 1st grade standardized tests), talking a mile a minute, a constant ball of energy who is generally joyful and ready-to-go (and a very sweet kid to boot!).  How could this kid have such a severe problem for so long?  But then I think about the clues – his extremely poor handwriting and spelling, his complaints about not wanting to read, his propensity to memorize his piano songs with his fingers rather than look at the sheet music, his quick-to-get-bloodshot eyes, his poor tracking of pop ups in the outfield, his refusal to look at words on the “word wall” in his first grade classroom, his trouble completing classroom assignments. The list goes on. And when I looked back at the standardized test scores, I saw that he started off first grade in the 90th percentile in the first quarter but ended in the 80s by the end of the year.  Was his worsening vision contributing to the decline?

Watch for Early Walkers

One other interesting thing that I learned from the Optometrist is that one huge clue about my child’s increased risk for developing binocular vision problems was that he walked early.  Mac was walking at 10 months – and before that, he was a baby who did the “military crawl” (crawling with one knee down and one foot down).  He told me that babies who essentially skip the normal crawling stage are skipping a portion of neurological development when the eyes learn to coordinate with the brain.  We always thought early walking was a wonderful thing (and maybe it is!) but it may also come with some drawbacks. Oh hindsight! You sly dog, you!

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