Children Vision Problems and why some doctors don’t tell you… Answers found with Cats who Succeed

In my private practice that specializes in vision therapy, the majority (about 70%) of our patients find their way to my care from a direct referral from another doctor or rehabilitation professional. Yet there are a significant number of patients, (often children) who are referred by a parent of a past patient who recognizes behaviors in a child that looks like what their own child struggled with before coming to see us for vision therapy.

This represents about a third of our practice that come to us directly because of a parent, teacher or friend who saw behaviors or recognized the problems described by the other parent. That means many children somewhat serendipitously find their way to our care because of a thoughtful  ”goodwill ambassador” past patient or friend.

This group of patients are typically the kids with vision related learning problems. There can be a variety of clinically presenting conditions but some of the more common diagnoses are convergence insufficiency, accommodative dysfunction or oculomotor dysfunction or a combination of all three.They may also have a visual processing problem resulting in letter reversals, difficulty with visual memory and/or hand-eye coordination.

When a child has a vision related learning problem, it is also interesting to note that the diagnosis is typically very obvious as I will demonstrate to the parent directly their child’s trouble with the sample visual test  and then let the parent see for themselves usually how effortless the test is if they have normal abilities. Once we establish the diagnosis and determine that this child has a vision problem that can be effectively treated, there is typically a three part response by the child’s parents.

First there is a sense of relief that finally  a visual explanation has been found that answers why their child has struggled and it is not because their child was “not smart enough” or “not trying hard enough” and they are not ”bad parents”.

Second  there is a feeling of hope for their child’s future because the solution I present just makes sense. We provide the “best practice” delivery of care, doctor supervised office-based vision therapy that is a proven and effective treatment and I have a solid track record of 30 years experience in this specialty.

Thirdly the parents then experience a momentary feeling of regret and disappointment (sometimes anger) that their previous eye care professional who saw their child did not not recognize the problem in the first place. As a result of overlooking their child’s vision problem their child had to deal with often years of frustration and emotional side effects. It is this group of parents who will ask me, ”Dr. Fortenbacher, why did our child’s previous eye doctor not tell us about this problem with our child’s vision?” Often I can not honestly say why with certainty, but try to emphasize the positive, we can leave the past behind and move forward now to solve the problem.

However now I’m pleased to have a better response to this question. Thanks to my friend and colleague, Dr. Leonard Press who has written 3 wonderful articles on The VisionHelp Blog there is now an answer to  the proverbial question, “Why did our other eye doctor not tell us about this problem?” The answer can be found in CATS WHO SUCCEED.

CATS WHO SUCCEED – Part 1

CATS WHO SUCCEED – Part 2

CATS WHO SUCCEED – Part 3

Dan L. Fortenbacher, O.D., FCOVD

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Choose Prevention

Many disabilities, including visual disabilities, cannot be prevented.  They result from genetic disorders, disease processes, or aging processes.  But some disabilities can be prevented.

I am an avid cyclist.  Three weeks ago, I went for a bike ride with a couple of friends.  It was a beautiful morning.  We were riding on familiar roads, with very little vehicular traffic.  I remember the sensation of riding over some rough road and the realization that I was going to fall.  I don’t remember hitting the road.  I spent the next several hours in the emergency room of the nearest hospital.  I had road rash all along the left side of my body, multiple lacerations on my face, black and blue eyelids, a headache and a soreness along the left side of my head.  I was diagnosed with a mild concussion and I was able to walk out of the emergency room.

I WAS WEARING A PROPERLY FITTING HELMET AND PROTECTIVE EYEWEAR WHEN I CRASHED.  When I got home, I took a look at my helmet and my glasses.  The helmet had multiple cracks along the left side.  My helmet cracked but my head did not.  My “sports goggle”/prescription eyewear wasn’t even bent.  But most of the paint was scraped off the front of the frame and the lenses were deeply gouged.  The glasses will be replaced; my eyes, which cannot be replaced, required no treatment.

I don’t like to think about what would have happened if I wasn’t wearing a helmet and protective eyewear.  They may have saved my life.  At the very least, they saved me from far more serious injury and resultant disabilities.

Health care, particularly in the US, is focused on diagnosis and treatment.  Public health organizations do their best to provide education concerning prevention, and in a few instances, prevention is legislated (seatbelts, no smoking laws, etc.).  Most of the time,  it is the individual who must choose.  From my perspective, this is a no-brainer.  Choose prevention.  Wear a helmet and protective eyewear.  Invest in yourself, prevent a life-threatening injury or a lifelong disability.  You are worth it.

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The Hole in the Hand…a look into the neural software of the visual brain

Last Thursday, July 1, 2010 it was my pleasure to present to the 3rd year students in their Vision Therapy Course at my Alma Mater, Michigan College of Optometry.  As a Clinical Professor at MCO, the topic assigned to me for this lecture was about an interesting neural adaptation (anomalous correspondence) that patients can acquire when faced with the visual confusion of a disruption in binocular vision known as strabismus. Strabismus, or eye teaming failure, is often recognized by parents or doctors when an infant or toddler has an eye that appears “crossed” or “turned-out”.

Strabismus occurs in nearly 1 in 25 children and typically is the result of faulty neural development of the human visual brain. There are many different  forms of strabismus and as a result it is important for the “Doctors in training” to have the opportunity to experience some of the visual components to the strabismus puzzle.

As one might assume, the human brain is “wired” to function with the input from both eyes “streaming” together in a coherent fashion.  For those of us who have normally functioning binocular vision we only know that the world looks “normal”! We do not see it as a construct of two visual inputs combined. Yet our visual brain has “software” that enables the signals from both eyes to merge together as a single unified construct when we have normal binocular vision.

To demonstrate this really impressive “visual software” I showed the students the “hole in the hand” demo. All anyone needs to do is take a paper towel tube and hold it up to one eye and at the same time place their other hand adjacent to the paper towel tube directly in front of the other eye about 3-4 inches away. With both eyes open, what you will see may surprise you! Those with normal binocular vision will see the object being viewed by the eye looking through the tube as if it is actually projected through the hand that is in front of the other eye. This “hole in the hand” is an example of the neural software of the visual brain that gives us the ability to see with both eyes working together.

The visual brain is the dominant sensory system and integrates with every other sensory system. Therefore, any loss of binocular vision function can have a dramatic impact on the quality of life of the child or adult. This can occur on many different levels as the individual is forced to cope with “re-writing” adaptive neural software or develop “stress-response” avoidance behaviors in an effort to maintain homeostasis and reduce confusion.

So why bother with showing future Doctors, who are dealing with the rigors of 20 credit hours graduate school this simple “hole in the hand”?  First off, this lecture did expand into the difficult to grasp complexities of neural adaptations to binocular vision dysfunction. However, at the same time knowledge presented in a lecture or garnered from a book does not typically give the level of understanding that can be better gained through a personal experience.

The “hole in the hand” shows the elegance of our binocular vision “software”. Any disruption in this naturally acquired development of the visual brain (such as strabismus or other conditions) will result in sensory loss. Consequently the result of any sensory loss brings about an associated functional loss. In this unique demonstration, the “hole in the hand” may help our Doctors in training have a sense of empathy for their future patients. Possibly in this small way our future Doctors will garner a better understanding  that binocular vision does really matter to the patient.

Dan L. Fortenbacher, O.D., FCOVD

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