Vision Therapy Patients and Tomatoes

Today’s guest blogger is Jennifer Mullen.  Jennifer is a  certified optometric vision therapist at Eyecare Professionals P.C. and The Tannen Center for Vision Development with Dr. Barry Tannen in New Jersey. This article also appears in Visions, which is COVD’s newsletter. 

When my oldest son started pre-school, I was a nervous first time mom.  I had the good fortune to have a conference with an experienced pre-school educator.  When I sat down for the conference, she had three tomatoes sitting on her desk.  One was completely red and ripe, one was that sort of pale orange of a tomato just starting to ripen, and one was green.  We had our conference and I found out my son was doing fine (whew!).   When I asked if the tomatoes were part of a project the kids were doing, she explained that she always puts them out for the first conference because so many parents worry about how their children are developing.  She told me, “These tomatoes are from the same plant, picked at the same time, but regardless of how they look now, someday they all will be red.”  From that day forward I always think of that when I begin to worry about my children in comparison to someone else.  I also have applied it as an important lesson that we as therapists can remember when working with our patients.

Over the years I cannot count the number of times I have had patients with the exact same diagnosis, prescribed the same amount of sessions, progress in very different ways. For instance, two patients are both diagnosed with a convergence insufficiency but by session 6 one of them can converge to the nose with effort, while the other is still struggling to converge at 8 inches.  When I first started working as a vision therapist, I spent countless hours riddled with anxiety over this.  Why wasn’t the other patient progressing?  Why weren’t the same therapy techniques working and accomplishing  the same thing in the same amount of sessions?  How would the patient that was having trouble ever be done with VT at this rate of progress?  One of the things that helped calm me down was to think of the patient that progresses a bit more slowly as a green tomato.  The other was to realize that as a therapist, it was my job to figure out what I needed to do a little differently to get that tomato to turn red!

When we get a new patient, we are usually handed a pile of testing that tells us what a patient CANNOT do.  He can’t converge, he can’t track, he can’t reproduce a picture, he can’t find a picture hidden among other things, he can’t remember what he sees, etc., etc.  As therapists we need to figure out what each patient CAN do and start from there.   This involves a lot of listening and observation on our part.  Often it is a little bit like searching for clues and solving a mystery, but that’s one of the things that makes vision therapy always interesting.  All of our patients are like a jigsaw puzzle; we have to find the pieces and figure out how they go together, but it’s never the same.  For instance, we had a patient in our office diagnosed with  convergence insufficiency.  Her near point of convergence at her initial evaluation was 24 inches.  So obviously her “can’t” was convergence.  We started treating her, and no matter what we did, she could not converge.  One of the most unusual things about this patient was she loved to read, and in spite of her CI she was an avid reader.  During therapy I chatted with her about this.  I asked if she ever saw double during reading, she told me no, never.  So here’s where the mystery really kicks in, because in all of our therapy sessions, whenever we did binocular tasks, she never suppressed either.  How on earth was she reading without seeing double?!  I asked her to show me how she usually reads at home.  She took the book, put it in her lap, looked down at it and started to read.  Ah ha!  She could converge a little in down gaze!  From that point on we started training convergence in down gaze, and then slowly worked into primary gaze.  By the end of therapy, she could converge with good control.  The green tomato turned red!

Albert Einstein said, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”  All of our patients have different learning styles, different abilities, and different experiences.  We need to find out about all of these and use them to best serve our patients.

 

 

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SUNY Student Changes a Life

Yesterday I was examining young patients in the Pediatric Service at SUNY’s University Eye Center, along with 3rd and 4th year students.  One of our patients was an 8 year old boy with complaints of blurred vision, difficulty focusing, and words moving around the page when reading.  Although he was reading “on grade level,”  he was struggling to keep up with his peers.  Mom felt like he was always swimming upstream.  Now in 3rd grade, it was becoming more difficult for him to maintain that effort.  This child never had an eye examination.  He passed every vision screening because his visual acuity was never worse than 20/40.

The examination revealed 5 diopters of uncorrected hyperopia.  In order to see clearly, especially for reading, he had to make an extraordinary effort to focus his eyes and then sustain that effort.  My student described this to mom with a wonderful analogy.  Imagine running a marathon while carrying an extra 20 pounds on your back.  By prescribing lenses, we are getting rid of the extra 20 pounds.  Can you imagine how much better he is going to perform in that marathon (of schoolwork)?  Can you imagine how much better he will perform in his LIFE if the simple act of seeing clearly no longer wears him down day after day?

I looked at my student and told him, “You are going to change a life today.”  His response: “Yeah, I like that.”

Me too!  I like that….. changing a child’s life by simply prescribing lenses.  When I thought about it, I realized that optometrists all around the world are doing this every single day.  It might not be as simple as prescribing lenses, but we are changing lives.  But then I looked at it from another perspective.  Can you also imagine how this child’s life might have been different if he had a comprehensive vision examination before entering kindergarten?

If your child is struggling in school, do not feel secure that it is NOT a vision problem because he/she passed a vision screening.  Give that child the gift of a comprehensive vision examination.  Do it today.

Read more about vision screenings here.

Read more about learning related vision problems here.

 

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