Update: Vision Therapy Evaluation Appointment

I wrote previously about my oldest who was diagnosed around the age of three with accomodative esotropia. After a horrid experience at a “pediatric ophthalmologist” in the big city, our local eye doctor has successfully treated her by changing her prescription to cosmetically make her eyes look aligned while the lenses do the work of focusing, allowing her eyes to relax. At a meeting about the progressive lenses, I brought up the question of whether vision therapy would help her. After listening to my concerns, he suggested we go to an expert who deals with pediatric patients and vision therapy and get evaluated.

We had to wait almost a month for the first of four possible evaluation appointments. The first appointment was an intense eye exam. All the usual tests were done – with and without Child #1 wearing glasses. Her eyes were dilated and more testing and looking was done with all sorts of interesting devices. Child #1 was quite the trooper. The only tough part was when the doctor put on a kind of “miner’s helmet” complete with bright light. It was too bright for her dilated eyes and she couldn’t get herself to keep her eyes open. (I’ll admit that we ended up all (Child #1, doctor, & me) praying that she would have the strength to look past the bright light for three solid seconds so the doctor could get what she needed and move on.) It was tough, but she did manage two seconds of not rolling her eye up her head and we were able to move on.

The doctor (specialist) indicated that the prescription is exactly right, but that she does not believe in progressive lenses for children. She would rather have seen Child #1 in a bifocal. She also admitted that it might be a moot point for what we are doing. She pointed out that Child #1 sees JUST FINE close up (which is what I thought), but that her eye turn is HUGE when doing so. Our local eye doctor is trying to lower the eye turn by using the lens to take some of the focusing/strain off the eyes. The specialist said the eye turn is so large that it really doesn’t matter either way.

Another thing I learned is that Child #1′s esotropia is “constant” – in that it is always there and . . . here I didn’t take notes, so you’ll have to forgive me if I get this wrong, “intermittent” (or was it “alternating”?). Basically, Child #1 uses one eye at a time – but alternates between which one she uses. Her eyes don’t work as a “team.” There’s a term for it, but I can’t remember what it is (monocular?). (My spouse’s eyes don’t work together, either. He doesn’t remember them ever doing so. He compensates just fine.) The specialist said that if we wanted to have her eyes learn to work together, now is not the time to try it because of the emotional maturity needed for the treatment.

However, she wanted us to continue with testing at two future appointments. We are, in effect, skipping a visual evaluation appointment (#2 of 4) and continuing with Visual Perception testing (#3 & #4 of 4). After those, we will have an hour or more consultation with the specialist on what she recommends going forward. The next two appointments are in the upcoming weeks. Our consultation won’t be until near the end of October due to my spouse’s work schedule and the specialist’s schedule. I’ll let you know how it goes.

An Evaluation for Possible Vision Therapy

As I have written about previously, my oldest child has strabismus. She recently received progressive lenses which were hopefully going to help her see more clearly close up as well as continue to correct her eye alignment for farther away viewing. After getting the lenses installed over two weeks ago and a special educational and instructional session for us parents (so that we could help with tips on how to use them as needed), my evaluation is that she is doing the same as with the previous (single-vision) lenses.

In a candid conversation with my spouse several nights ago, our daughter asked, “Do you like to read?” When told that the answer was definitely “YES!“, she asked why. She then went on to explain that she no longer liked to read because she didn’t have the “patience” to try to read. This was a girl who was reading at a 2.8 reading level eight months ago.

Due to a question on a questionnaire for a doctor’s office, I tested her a few days ago with her new lenses to find that she was at the very minimum of the scale (1.2 grade level). We use the McCall-Crabbs book and I used Lesson A4. I gave her three minutes to read the small selection and answer as many questions as possible. She answered three of the eleven in the time allotted and I let her answer the rest without stopping her. She answered only one question correctly out of eleven (number four - past the time deadline). Zero correct is indicated at a 1.2 grade level – the lowest on the chart.

To further my knowledge-gathering, I had her sit back, close her eyes, and listen to me read the SAME selection again out loud. I asked her the very same eleven questions out loud and she got nine of them correct.

I repeated this test a couple days later with test A41 with similar results. Her coloring, despite how much time and patience she puts into it, is not getting any closer to being “in the lines.” When taking her turn at hitting the softball with her cousins at the farm, she was barely able to connect with even half the balls her next younger sibling did. I just can’t help but wonder if she is having trouble processing the signals her eyes are sending her and matching them to her movements.

After a consultation with our wonderful local eye doctor, we have an appointment in mid-September for an evaluation with a specialist to see if Child #1 would benefit from vision therapy. This doctor, whose office is about an hour and a half from our home, deals specifically with younger people, strabismus, and vision therapy. We have a myriad of forms to fill out and bring with us and it looks like it will be an expensive ordeal. But we both would like our child to have the bumps smoothed out of the road. We are disappointed that it takes so long to get in for the evaluation appointment, but time will fly by quickly enough. It could take up to four visits to determine a path to take and then up to a year for the therapy. I will write about it again when we have more information.

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?