Right now, my favorite vision therapy patient is an 8 year old boy, ES, who was referred by his occupational therapist. ES is (theoretically) in 3rd grade in a special education program. He receives occupational and speech therapies. His mom feels he is making progress but needs more help. He knows the letters of the alphabet but he can’t read more than a few simple words. He has difficulty writing. He has poor attentional skills and his mom and occupational therapist were wondering if his glasses are appropriate because he often behaves as if he can’t see things right in front of him.
ES was born prematurely, at 7 months gestation. He weighed just over 4 pounds and spent the first month of his life in the hospital. He has been seen by a pediatric ophthalmologist who prescrbed glasses and a patching regimen. Mom has noticed his eye turn out frequently.
His learning-related vision evaluation was done by a wonderful optometrist who is very skilled at working with young children, but even she had difficulty obtaining “findings.” With his glasses, his visual acuity was reduced and could not be improved with different lenses. It was unclear whether or not he had an eye turn because he had no ability to fixate on an object for more than 1 sec. Vision therapy was offered on a trial basis to determine if he would respond positively to a vision therapy program.
For the first 3 weeks of vision therapy, ES and I played limbo. I would try various activities with him and then modify them to make them easier. I kept lowering the bar. Now, this was definitely MY problem. Any vision therapy program should begin at a level where the child can succeed and then gently raise the bar! Luckily, ES is a super great kid and his mom is awesome. He comes in every week with a giant smile on his face. He’s always wearing his glasses. He will try anything I ask him to do. He rarely says “I can’t do that,” even though I was asking him to do things that were beyond his capabilities. It took 3 weeks, but I finally figured out where to place the limbo bar and in subsequent weeks I have been able to raise the bar ever so slightly.
After 10 weeks of therapy, we were able to obtain measurements that could not be determined at his initial evaluation. This, in and of itself, is a major improvement in ES’s visual function. His visual acuity improved, and I was able to see his eye turn because he was able to fixate on an object for 3-5 seconds. Yes, I am actually thrilled that he has a strabismus! His mom mentioned that his eye turns less frequently. A few days ago I had a conversation with his occupational therapist. She just completed a handwriting re-evaluation and she couldn’t stop talking about the improvement she has seen since ES began vision therapy. And, he was able to write a sentence instead of just a few words.
I am so excited to see the progress that ES is making. Now, my problem is maintaining realistic expectations and not raising the bar too quickly! I don’t want to play limbo with him. Time to switch games to Mother May I! “You may take 3 baby steps forward.”