Last week I saw a 17 year old girl for a new patient comprehensive vision evaluation. While most patients find their way to our practice as a referral from an eye doctor or an occupational therapist, this patient landed in my exam chair due to the determination of her mother to find an answer.
You see, our patient - lets call her Mary, is a bright, articulate high school senior who wants to go to college next year, but due to her difficulty reading, she and her family are concerned that she will be unable to handle the college work load. What's more, her avoidance behaviors and mannerisms started to make her mother suspect something was "a miss" with Mary's eyes, even though she had had previous eye exams and was fit with contact lenses for nearsightedness. Mary complained of words overlapping and would turn her head or cover an eye when trying to read.
Thanks to the persistence of her mother through her own personal research, she began to find the answers to her troubling questions. Why was her bright daughter complaining of words moving on the page when reading? Why did she turn her head or furrow her brow when doing her paper pencil tasks? What she learned was that there exists specific types of vision problems that can cause bright kids to demonstrate reading and learning performance problems. One thing led to another and the family found our specialty practice; dedicated to the diagnosis and treatment of the vision related learning problems.
My examination revealed that Mary's eyes were healthy and her existing contacts properly corrected her eyes for a mild condition of nearsightedness. But, in spite of her 20/20 corrected eye sight, Mary was unable to coordinate her two eyes at near. She in fact had double vision for objects within 18-20 inches from her face! To further complicate this, Mary demonstrated poor eye tracking, eye focusing and poor visual processing skills. The diagnosis for Mary was convergence insufficiency, accommodative dysfunction,oculomotor dysfunction plus delays in visual information processing.
In spite of having the diagnosis, which explained why Mary struggled with reading and learning, it was painful for Mary's mother when she realized that Mary had been struggling with these symptoms since she was in 3rd grade. Thanks only to the determination of her mother through home schooling, Mary received the individual attention which enabled her to progress academically, albeit in spite of many compensatory strategies.
To restate the case, Mary's vision problems are not eye sight problems or eye health problems. Her eye muscles are normal and strong. Her neurology is normal. Instead, her vision problems are developmental. That means at age 17, Mary had simply not acquired the expected eye coordination and visual processing abilities that most us gain naturally through a process of normal childhood experiences.
The treatment required for Mary is office-based optometric vision therapy (VT). VT is scientifically validated and proven safe and effective. Once Mary receives this treatment protocol, research has shown that she will not require any further treatment for these problems of eye coordination. Yes, there actually is a cure!
What makes Mary's case disheartening is that her visual issues could have been recognized early on. Mary should never have had to struggle for years with this binocular vision problem - convergence insufficiency. As a consequence of her binocular vision problem, Mary and her family have unnecessarily gone through years of frustration. They had to adjust their family around a home school model to support Mary's needs for individual attention primarily because she could not use her vision to apply herself academically.
On a positive note, Mary will soon be starting treatment...office-based vision therapy. And while she has had to tolerate her symptoms associated with these vision problems for years, within 4-5 months of treatment, I'm confident that Mary's binocular and other related "eye-coordination problems" will be resolved. What's more because she is bright and capable, once Mary no longer has near point double vision, she will be better prepared for the visual demands of college!
Fortunately, more eye doctors are becoming aware of the critical importance to recognize, diagnose and properly manage patients like Mary. For example, Dr. Dominick M. Maino, Editor of the journal Optometry and Vision Development and Professor of Pediatrics/Binocular Vision at the Illinois Eye Institute/Illinois College of Optometry has recently written a compelling journal editorial emphasizing this to the profession entitled, The Binocular Vision Pandemic.
Dr. Rochelle Mozlin, Associate Professor at State University of New York, State College of Optometry with a Masters Degree in Public Health also recently wrote on the COVD Blog, Vision Therapy — Where is the Evidence?, listing the evidence based Clinical Practice Guidelines, written by a team of optometric experts, and published by the American Optometric Association.
With greater professional and public awareness of the impact of binocular vision problems on reading performance, fewer children like Mary will have to struggle for years without getting the help that they truly need. For more information go to www.covd.org
Dan L. Fortenbacher, O.D.,FCOVD
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