Archive | April 2013

What is lazy eye anyway? Some definitions.

One of the most persistent misconceptions I encounter is the idea that everyone who has an eye turn is termed to have a “lazy eye.” The easiest way to explain is to first define a few terms. “Lazy eye” is the lay term for amblyopia which the dictionary defines as “impaired vision with no discernible damage to the eye or optic nerve.” The result of that impaired vision is that the eye is not able to be corrected to 20/20 and the person compensates by using only the other eye. Eye teaming with an impaired eye is usually not worth the trouble and often the person doesn’t know how to use both eyes together anyway. The eye which is not being used turns in and is then considered a “lazy eye.” Opthalmologists treat the condition by patching the weaker eye, which sometimes improves the vision in that eye, but does nothing to help the eyes work together.

My diagnosis is strabismus, which the medical dictionary defines as “a visual defect in which one eye cannot focus with the other on an objective because of imbalance of the eye muscles. Also called heterotropia squinttropia.”  Choosing this definition allows the medical community to focus on correcting the defect with surgery. Successful surgery is defined as a cosmetic fix (no visible turn) but the eyes are still not focusing together, so the strabismus remains. If the patient is lucky enough to have vision therapy in connection with surgery, a cure becomes much more likely. An example of this would be my brother, who had three eye surgeries as a child and now has no eye turn, yet people ask him if he is looking at them. Strabismus can lead to amblyopia if the person uses just the dominant eye.

Nowhere in the standard dictionary definitions is there a real description of the WHY of strabismus. My understanding of why my eyes take turns instead of working together is that it is a compensating mechanism. If I choose to look out of both of my eyes at the same time, I actually experience diplopia, “a visual defect in which a single object is seen in duplicate; double vision. It can be caused by incorrect fixation or by an abnormality in the visual system.”  I mentioned in a previous post that I was creating diplopia, or double vision, by working on my own with the Brock string. Since I don’t want permanent double vision, we are concentrating on peripheral vision and strengthening other visual skills in vision therapy. Suppressing the sight in one eye (often by turning the eye) avoids double vision.

When I look out of my dominant right eye, my left eye now avoids double vision by turning in. If I switch to the left eye, the right turns in (and it’s a larger turn). No, my eyes are not lazy, they just don’t know how to work together yet more than 12 inches from my face. (And the deviation was not always as noticeable as it is now.) I actually can see the 3D effect in the Magic Eye books if I hold them really close to my face, but my doctor discourages that because we are working to extend my range of fusion. The inward turning of the eye is called esoptropia (es-uh-troh-pee-uh) or “strabismus in which one eye deviates inward.” Barbra Streisand is famous example of someone with esotropia. The opposite of this is exotropia or when one eye deviates outward (also called “wall-eye”). A well known person with exotropia is Martha Stewart.

martha-stewart      Barbra Streisand

Advertisements

Favorite Vision Therapy Resources

As an avid reader I have been introduced to several books that have been helpful in my vision quest. While they may not be in your public library (but please request them), they are all available on amazon.com. My public library only had the first book listed here.

These are my top picks (so far).  Top book for adult vision therapy patients:

Fixing my Gaze, by Susan Barry. This is my favorite book, not because it’s the first one I read on this topic, but because it’s about an adult (about my age) gaining stereovision. I was inspired and touched by her poignant experience of seeing the world anew. As a scientist, Barry is able to describe the complex mechanism of vision as well as detail the vision therapy process and relate the experiences of others. It’s the reason I began vision therapy! See http://www.fixingmygaze.com or  http://www.stereosue.com for more information. The resources section on the stereosue site is quite helpful.

Top book about children’s vision therapy:

Jillian’s Story: How Vision Therapy Changed My Daughter’s Life, by Robin Benoit with Jillian Benoit. I read this before I heard Robin and Jillian speak about their struggle to find vision therapy and the amazing difference it has made for Jillian. The book is great and hearing them in person is even better! They detail the process and share stories of other children who have had success in vision therapy. See http://www.jilliansstory.com and Jillian’s Story on Facebook.

Most helpful resource for parents and teachers in diagnosing the need for professional intervention:

When your child struggles: the myths of 20/20 vision, what every parent needs to know, by David Cook, O.D. This book is the reason I became convinced my daughter deserved vision therapy. She was among the lucky ones, who learned to read easily despite binocular vision issues. As I have mentioned in previous blogs, Abby exhibited signs of strabismus at age three and was prescribed glasses for far-sightedness. The eye turn went away and the optometrist assured us that all was well. I later asked about it again, even though she wasn’t really struggling in school and was still told she is fine.  However, when I read this book and asked the specific questions Dr. Cook suggests, it was clear that there was a problem. The questions: “Do you ever close or cover one eye when reading?” and “Do the words ever do this?” (a visual described in the book where palms are together and fingers move to show seeing double) received an affirmative answer. This was a complete surprise to me, since I had not observed her using just one eye to read. Children don’t know that letters don’t split apart (or move around) for everyone else.

• Important note: A comprehensive exam with an optometrist who specializes in vision therapy is the best way to assess these issues. My regular optometrist didn’t catch it! See a more comprehensive review on theviewfromhere.me. Dr. Cook’s website is http://www.cookvisiontherapy.com.

Top Teacher Support Resources:

Red Flags for Primary Teachers: 27 Neurodevelopmental and Vision Issues that Affect Learning with Activities to Help, by Katie Johnson. This book was written by a primary (elementary) school teacher with 40 years experience teaching and 15 years practicing the methods she outlines. This fascinating book is useful for educators who are familiar with *BrainDance since the activities she outlines are to be used in addition to the BrainDance exercises. (*BrainDance was developed by Anne Green Gilbert and is a series of exercises comprised of eight developmental movement patterns that healthy human beings move through in the first year of life. Repeating these patterns can fill in the missing gaps.) Any struggle you can imagine in a student is addressed in this helpful book. For some issues she suggests follow-up activities to the basics in BrainDance. For others she adds the recommendation that you seek professional intervention, i.e. vision or movement therapy. Appendix A reviews how to do BrainDance and why. Johnson also includes additional information about the “twelve ways the eyes need to work” in appendix B, followed by additional information regarding whether a child needs vision therapy, how to assess and do basic screenings. It has been reviewed on the Vision Help Blog as well http://visionhelp.wordpress.com/2012/10/09/red-flags-for-primary-teachers/. Katie Johnson’s website is http://www.katiejohnsonauthor.com.

During the days I was reading this book, I was also substitute teaching half days and noticed the red flags in each classroom. It was astounding to understand so much more clearly why the children were behaving in certain ways. At the same time, since I am not the classroom teacher or even better, the parent, I am not in a position to assist the child in receiving needed remediation:(

See it. Say it. Do it! The Parent’s & Teacher’s Action Guide to Creating Successful Students and Confident Kids, by Dr. Lynn F. Hellerstein. In this delightful book, Dr. Hellerstein provides 28 visualization activities parents and teachers can use to aid children in developing their skills. Dr. Hellerstein is one of America’s top vision specialists. She has used these techniques successfully for years in her practice and clearly explains the process and effect of improving visualization in children. The good news is that while it is geared towards children, it also works for adults! She explains visual development and how improving these skills can open up a whole new world. There are 28 visualization exercises that encompass school readiness as well as personal growth. They include sequencing, visual information processing, reading, spelling, creative writing, math, homework and tests, performance anxiety and building self-confidence. Definitely a must see, declare and do book! These exercises are not meant to take the place of vision therapy for those who need it, but can enhance the experience and work for everyone who wants to create more success in life. Dr. Hellerstein’s website is http://www.lynnhellerstein.com.

My Natural Yeast Adventure

One of the things I have done over the years, and particularly in the last few months, is study ways to eat more healthy myself and feed my family a more healthy diet. I still haven’t converted my family to green smoothies, but the quest continues! I recently took a class on natural yeast, otherwise considered “sour dough.” I found it fascinating because it takes us right back to our pioneer roots in food preparation. Our instructor gave us a start which dates back to early Utah settlers. I appreciated the class because the teacher,  Melissa Richardson, spent a good deal of time explaining the health benefits: natural yeast breaks down harmful enzymes in grains, makes the vitamins and minerals in grain more easily digestible, predigests sugars for diabetics, breaks down gluten for the intolerant and turns the phytic acid in wheat flour into a cancer-fighting antioxidant. (No, I did not remember this–it comes straight from Richardson’s recipe book The Art of Baking with Natural Yeast). The start is also very mild in flavor, as long as you feed it regularly, which is a plus for my family. Melissa recommended naming the start and treating it like a pet to encourage proper care.

Soon after the class, my mother went on vacation for two weeks and asked me to care for her start. Since it has to be fed every three days or so to stay healthy, I agreed. I wasn’t sure how to use the start, so I kept feeding it and before I knew it I had seven jars (partially full) in my fridge. I discovered that if you feed the start and leave the jar three-fourths of the way full, it escapes as it grows. Healthy start will double in volume; hence the partially-full jars. I had visions of what would happen if this pattern continued, so baking day was in order.

IMG_3502

I wish I would have taken photos of the seven jars, and the overflowing that happened before I got to that number, but I didn’t. This image is from Melissa Richardson’s blog, thebreadgeek.blogspot.com. (You get the idea. . . ) I baked whole-wheat bread, pizza crust, English muffins, pancakes, waffles (twice), and crepes, all in the space of two days. It takes much longer because most of the items need a much longer rise time. The waffle recipe I used needed at least two hours, while breads and English muffins needed 8-12 hours, with two additional hours for the second raise. I froze some of the items and by the time I got the start under control again, my family wasn’t sure they ever wanted to eat any more natural yeast products!

There is a learning curve to this process, and I also realized that some recipes are better than others. Perceived shortcuts, like putting the bread in the oven on warm to encourage faster rising, resulted in failure. The bread looked great, but had a big hole on top and the rolls fell. It’s been over a month now, and my family is still complaining and telling me to throw the start away.  I finally ordered the cookbook The Art of Baking with Natural Yeast by Caleb Warnock and Melissa Richardson through Amazon. I’m glad to report that some of us like the new pancake recipe better than the previous one and I may be able to keep the start under control after all. There is a pancake recipe and a waffle recipe that use straight start (no extra flour) which makes it easy to use a lot of start quickly. While some family members are still complaining, I plan to keep experimenting until everyone is happy.

For those who want to venture into this territory, I endorse a slower beginning. In their book, Warnock and Richardson recommend that you practice feeding the start for the first month, then try recipes such as pancakes and waffles for a month, and finally tackle bread in the third month. I must be a gluten for punishment to try it all at once. The idea of throwing anything away is so contrary to my frugal mentality! I got to that point after my experimental stage though and threw the contents of a third jar away before feeding since it smelled a little strong anyway. Reducing the start before feeding it is imperative! I decided that Melissa’s recommendation that you either use it or send it to the compost or down the drain is a survival tactic, not just a convenient idea. I also recommend the recipes in The Art of Baking with Natural Yeast over the free recipes I found on the internet. The recipes and other helpful tips accommodate real life baking with a busy family lifestyle.

Baking with natural yeast may not help my eyes work better together, but at least we’ll all be healthier!

My Pet Peeve

Last night I went to a social event where we were all seated randomly and given conversation starters so we could get to know each other. One of them was “What is your pet peeve?” I didn’t share mine there but I will now because it’s the reason I started this blog in the first place. My pet peeve is that binocular vision disorders affect at least 10% of the population of the WORLD and no one seems to know there is a cure!  Indeed, it seems we are oblivious that it’s even a problem at all!

I didn’t share last night because 1. The pet peeves people were sharing were things like “I hate it when my children read the paper over my shoulder. . . “ and 2. I had already shared the most brave thing I had ever done and it effectively killed the conversation so I didn’t feel like a repeat performance was in order.  What was my conversation killer? I gave birth to my last four children at home, by choice, with a midwife. Yeah, that choice seemed better than risking a car birth trying to get to the hospital in time.  .  . So I chose to stay quiet yet again.

Monday I substituted in a 6th grade classroom for the morning. A couple of the children approached my desk and one girl asked if I have a glass eye. I kindly explained that my eyes don’t focus together but that I am doing vision therapy to teach them how. She seemed apologetic that she had even asked, but this is not a new thing for me. It happens a good percentage of the time in elementary classrooms. Sometimes I just hear them talking to each other about it, and other times they actually ask me. I could have taken it to the next level and had a little mini-class on strabismus, but I refrained—again. Not sure why except that I haven’t enjoyed drawing attention to my issues.

I could have also included my personal experience with my dad having a glass eye following cancer. It was difficult to tell his eye was not real. The prosthetic eye was painted by an artist and looked just like his other eye. The eye muscles performed the same way they did before, so the eyes actually moved together, giving a very normal appearance. People didn’t have a reason to ask if he had a glass eye, but the loss of vision was a difficult adjustment. Still, he didn’t complain, even when the cancer returned and claimed his life.

That would have been a little too much for the kids, but it certainly has shaped me and molded me into who I am today. I want to make him proud so I press on.