Vision Therapy Parental Consultation

We had our long-awaited parent consultation meeting for Vision Therapy (VT) this week for our oldest. Let me start by saying that if I had to do this all over again, I would definitely ask for the evaluation again. That said, we are probably not going to go forward with VT for our daughter. I will go into the reasons after I lay out the testing results and the therapy recommendations. I plan to break this into several posts for ease of reading.

Why Ask for Vision Therapy? [Summary]
Child #1 has alternating accomodative esotropia in botheyes. She wears glasses (withprogressive lenses) that help correct her eye turn and help her see 20/25 or better bothfar and near. She does not have a “weak eye” – bothwork, just not together or at the same time. She has “monocular vision.” I have written some previous posts about her eye sight. The reason I asked about Vision Therapy was because as I work everyday withher, I see things. Things that most parents may not notice because they aren’t there with the little details all the time. I am not a detail person, but a picture was being painted and I wanted to ask the experts what it meant. I have a whole post on this that I’ll put up later in the week.

Process for Us
Our local ophthalmologistreferred us to someone he has worked with previously and though a lot of. the first of what ended up being three (could have been four) evaluationappointments was a dilated, in depth eye exam.

Here are the tests performed at that appointment:
Eye Health examination with dilation
Visual Acuity – Distance and Near
Refraction
Oculomotor Evaluation

Then, we went to two one-hour appointments where our child took a series of normed, some timed, some untimed activities/tests. These were designed to find out where she is compared to her peers (four month span around her age) to diagnose if she has visual, visual-integration, or visual-motor processing issues. There were fine motor, gross motor, balance, coordination, visual memory, reading, phonetics, spelling, and other tests.

Here is the list of them:
Beery Developmental Test of Visual-Motor Integration (VMI-5th)
Tests of Visual-Perceptual Skills (non-motor) – 3rd Edition
Wold Sentence Copy Tests
Piaget Right/Left Awareness Test
Grooved Pegboard Test
Reversal Frequency Tests
Dyslexia Determination Test
Auditory-Visual Integration Test
Bilateral Integration Test (Angels in the Snow)
Test of Word Reading Efficiency
Test of Silent Word Reading Fluency

Results
Our daughter’s glasses prescription is right on. This doctor disagrees with our local doctor in regards to giving “progressive lenses” to children. Lined bifocals are preferred because then the child and adult can tell what level of magnification the child is using to look at something. (At least, that is what this specialist told us.) Our child’s eyes do not work together. One eye focuses, then the other. They do not have to “team” and our child is not at a good age (too young) to work on this. Eye focus is slower than average and eye movement (“tracking”) is not smooth. These two things can be addressed with vision therapy.

The other tests showed that our child is mostly an “average” child – tracking around her age group with a few skills where she performed higher than her peers and a handful of “red flags.” The “red flag” results will be in my next post.

Her official diagnoses were:
Developmental Delay
Developmental Dyslexia
Esotropia (Alternating)
Suppression of Binocular Vision
Visuo-Motor Dysfunction

In summary, they believe our oldest “evidences functional and perceptual visual deficiencies in eye-hand coordination and visual directional concepts.” In addition, they believe she “has a visualization deficit that causes spelling and sight word recognition problems.” More information in the next post.

Update: Vision Therapy #2

Child #1 completed her first visual perception / acuity testing session at the doctor’s office. I did not get to be present as I had to watch the other three children in their waiting room. The room Child #1 was in was more of a closet than a room. She described having to read, stand on one foot while crossing her arms, stand on one foot while crossing her arms with her eyes closed, drawing, matching, and other such activities. She pointed out that it was hard work and that they made her have a headache.

The doctor’s office indicated the testing would be “about an hour.” Child #1 took one hour and fifteen minutes. The extra time was explained by the fact that some of the tests are timed, but “some are not.” This was code word for “Your Child Took A Long Time To Do Them.” I understand. I’m her teacher, remember? Isn’t that one of the reasons we are here?

We have one more of these visual perception testing sessions and then a three week wait for our debrief meeting with the doctor to discuss a game plan for possible vision therapy.

I did get a chance to speak to a couple other parents in the waiting room about the process. There was a five-year old with intermittant (in his case, happens when he is tired) exotropia (eyes turn outward) who had just started his therapy. It was too early to see much difference, his mother said. Another mother came in with an eight year old who is 33-weeks into an estimated 36-week therapy. He is in the home stretch and she expressed much happiness with his progress.

Strabismus: Accommodative Esotropia & Progressive Lenses?

About three years ago, an observant neighbor noticed our eldest child’s eyes were both turning inward. I dismissed it to the neighbor, but passed along the mention to my husband. I hadn’t known that he had problems with his eyes when he was younger. He immediately jumped into the situation. Our pediatrician immediately referred us to a pediatric ophthalmologist in a big city about 1 1/2 hours away. The experience there was horrific and I am reduced to tears remembering the impatience of the doctor, how he didn’t listen to a word I said, the screaming of our child as she had to be held down to get drops in her eyes, the fifteen minutes in the waiting room calming her down, and the screaming when she realized she had to go back into the back office again. We came away scarred – with a prescription for glasses in our hands.

Once back at home, I called a local optometrist who attends our church. He assured me that he could treat our child locally and she did not need to go back to that doctor’s office again. Our local doctor is patient, understanding, and very hands-on. He answers all our questions about our daughter’s accomodative esotropia (intermittant turning in of the eyes). Admittedly, my husband is much more educated about her condition. I’m the one who doesn’t think of the tough questions or question any decisions. I just know when she wears her glasses, her eyes don’t turn inward much anymore.

We used to go every few months for an eye check and new prescription. Due to a slip of my memory, what was supposed to be a six-month interval became a 10+ month interval between appointments. On Wednesday, I dutifully brought the four children for her latest appointment. Her far vision has been corrected as much as it can be, but the doctor found that her close vision was blurry.

In the midst of trying to keep the toddler and crawler busy, my ears perked up. He held some lenses in front of her glasses and she reread the close eye chart. This time, it appeared, she didn’t have nearly the trouble as last time and got many more correct. The light bulb went off in my head.

You see, our eldest child’s reading took off in the middle of last year and I couldn’t keep her from reading books late into the night with her reading lamp in her room. Then, after about three months, I would check on her to find her asleep almost immediately – no book in sight. She preferred to go straight to bed to reading. I thought perhaps she was just tired. Instead, was she starting to have trouble focusing on the words and it was now too much trouble to read her precious books?

The doctor prescribed progressive lenses – something neither my husband nor I have any experience with. My husband had ten or more questions that I had not thought to ask. I have been told she will not have any trouble after the first few days adjusting to them. I am apprehensive, but hopeful.

When I was looking up some links for this blog article, I ran across several “success stories” about Vision Therapy. I know my husband has asked about therapy before, but I don’t remember much about the answer. I plan on bringing the subject back up when we go to pick up her new progressive lenses.

I want what is best for my child. Doesn’t every parent?