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The Promised Update

I promised an update and unfortunately that did not occur in a timely manner. I apologize for that. I had an evaluation by my vision therapy doctor and learned that I had not made any observable progress towards my goal of stereopsis. I became discouraged and stopped working on any vision therapy. I have told myself that I should start again, but have not followed through on that intention. The E.Y.E. unit, or Eyeport Vision Training system apparently did not help in my case. I went through the recommended 12 weeks of exercises plus a few additional weeks before my doctor evaluated my progress.

My doctor has recently encouraged me to try it again, so that will be part of my new regimen. I will also be looking for things I can do between phone calls in the off season at work. I have been working for the past 21 months as an insurance agent, selling medicare supplements over the phone. That means I am looking at a computer screen for 6+ hours per day. I feel like my vision has gotten worse and my eye turn is more pronounced, so it’s time to take action. Even though my doctor didn’t observe improvement, I felt like my eyes were improving while I was in vision therapy, and it was easier to do the limited things I could do (like fusion up to 12”).

Additionally, my daughter was evaluated at her yearly checkup and she had lost some ground. We had a few therapy sessions to get her back up to speed.  I guess my family is among those who need to keep doing vision therapy exercises at home in order to retain their results. Our doctor recommended she do therapy at home once a week. She continues to have great results from vision therapy. I have not been so lucky yet. Wish me luck!

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Does Vision Therapy Work? Yes! and I have proof!

Vision Therapy word artRecent visitors to my blog may have wondered whether vision therapy actually works. I am only one of the VT bloggers who are telling their story, and as adults, we all seem to be in the slow lane of this process.  Like most things, vision therapy is not an exact science. Therapy that works beautifully with one person may not work with another. And adults are even trickier, because we’ve had many more years of ingrained compensatory practice.

However, I have proof it does work in the form of my two children. Today’s post is about my eleven-year-old daughter, who did vision therapy at age 9 ½, graduating after 37 sessions. I am grateful I was doing vision therapy myself, because otherwise I may have never known it was what she needed.

Abby had glasses but didn’t always choose to wear them, which made me wonder about how helpful they were. She has always been a good student, learning to ready early without seeming to struggle. There were times she didn’t finish her work, but she responded to encouragement and didn’t complain much. So, I really didn’t notice much in the way of red flags.

I wondered if there were issues mainly because she had manifested an eye turn at age 3, just like me. That’s when I first took her to the eye doctor and he prescribed glasses for her far-sightedness. Like me, her eye turn went away with glasses.

When she was 8, I asked the optometrist to check her eyes for tracking. This was a doc who professed to have a background in vision therapy. I had been reading about vision improvement and doing home vision improvement therapy. I also wanted him to under-correct her vision to see if it would improve. He was resistant to this idea, but complied.  He told me she had a little tracking problem, but that she was “fine.”

A few months later, I began my own in-office vision therapy and started doing massive research into the issue to deepen my understanding. This included reading everything online I could find and any book I could get my hands on. So, my doc loaned me When your Child Struggles (see previous blog post about this book). I was initially interested because of what I was noticing with children in the classroom where I was the substitute teacher. I asked my daughter the questions on the checklist as a practice more than anything.

When she responded “Yes” to the question about the whether the words split apart when she was reading, I was stunned. My daughter was seeing double! I continued: “Do you ever turn your head to read.” “Yes.” “Do you ever cover one eye when reading?” “Yes.” Then she told me that she also reads in bed with one eye in the pillow, to avoid seeing double.

Basically, she was a master accommodator! So, her strabismus didn’t seem to affect her; she appeared to be doing fine visually. She would go without her glasses and sit really close to the tv, but we didn’t understand why. She would also blow up unexpectedly at times, reflecting a level of frustration that we could not understand.

When my husband took Abby to see Dr. Davies, he found she had esotropia, like her mom. She sailed through vision therapy, with wonderful results. And it turns out that the under-correction I had requested was actually helpful in the process!

As I have mentioned in previous posts: in my experience only behavioral optometrists will correctly diagnose and treat strabismus. Abby enjoys great normal vision now! She loved her first 3D movie experience, Life of Pi. (See my blog post on other reasons to see a 3D movie).

Abby seems happier, less prone to dramatic outbursts, and easily completes her work. Piano seems easier now too. Results would seem more impressive if she had been visibly struggling before, but it was all below the surface.

Best of all, she won’t be subject to the life-long struggles of her mom, including my present eye turn and her therapy took just months, not years.

Strabismus in the movies: Mike Myers in “View from the Top”

I haven’t seen strabismus mentioned specifically in a movie until I watched View from the Top with Gwyneth Paltrow, Candice Bergen, Kelly Preston, Rob Lowe, Christina Applegate, Mark Ruffalo and comic Mike Myers. I frequently pick up movies at garage sales for $1 and was attracted to this 2003 movie because it’s “In the hilarious style of Legally Blonde and Sweet Home Alabama,”  movies which I enjoyed. I am not a big Mike Myers fan, but I like the other actors. I was caught off guard when Myers first appeared on screen, because of the marked strabismus he exhibited. I’m sure his fans have seen his cross-eyed antics, but it was new to me.

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View from the Top: left focus

There is a scene in the movie that was so familiar to me, where he is interviewing job applicants and they give him “that look.” You know, the one where they try to decide which eye he is looking at them with. There’s also the familiar “look over your shoulder to see if he’s looking at someone behind you” moment. The clip on youtube is here: http://www.youtube.com/watch?v=cLm4oCbovsE. He makes the strabismus joke in this clip too. A strabismic can appreciate how true-to-life this moment really is. I felt his pain throughout the movie because his strabismus held him back from achieving his dream. And the movie is not even about him! (I had an infant in 2003 when this movie came out, my sixth, so it’s no surprise I missed it then.)

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Right focus

Other images of Myers on the internet don’t show this pronounced eye turn, so I speculated for a while on how he has the eye control to be that cross-eyed at will. A closer look at other photos indicate that he is right-eye dominant (like me) and his eyes look pretty straight when he uses his dominant eye. But, in this movie he chooses to use his left, non-dominant eye, and the turn is quite pronounced. I’m speculating because it’s something I have noticed in myself, but these photos illustrate what I’m talking about: focusing with the right eye vs. the left.

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Right focus

The clip actually cuts out Kelly Preston’s character’s last remark, which is also so accurate to what I have experienced. She mentions his eye and then says “Oh, I didn’t notice.” Yea, right.! It’s over the top in making fun of the airline industry as well as strabismus. Rated PG-13 for language and sexual references, I may let my younger children see it and fast forward through the objectionable parts. They were watching when I was looking for the clip though and thought it was “stupid.” In this type of comedy, that’s pretty much the point.  Legally Blonde is equally extreme in it’s characterizations.

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

Aperture-Rules!

Today’s vision therapy appointment showed that the previous theory that my eyes are not really near-sighted was probably not accurate. Dr. Davies dilated my eyes with some really strong drops to take a closer look at my eyes. The other advantage of dilation is that it paralyzes the muscles so that theoretically my eyes should be straighter. Well, I am not observing them to be straighter, but it is somewhat easier to do certain exercises. As for the shape of my eyeballs, apparently my eyes adjusted to being overcorrected when I was young, and now they appear to be that elongated (near-sighted) shape.

As for the exercises that are easier, one is the aperture-rule. I got one of my very own today so I can work on it at home. I was able to fuse several more images than previously. I am hopeful that my eyes remember what to do when they are no longer dilated. We’ll see when the drops wear off.Image I found an interesting video on the aperture-rule on youtube (Aperture Rule.wmv). It explains the process pretty thoroughly. There are several related videos posted by vision therapy students as they demonstrate and learn the process.

I observed my son (who had convergence insufficiency) do the aperture-rule in a therapy session one day several months ago and it took him quite a while at first (a couple of minutes at a time) to achieve fusion, but he kept at it until he did. A couple of minutes sounds short until you stare at the images for 120 seconds. During most of Andrew’s therapy I was doing my own session, so it was good for me to watch him at work. It let me know that it’s ok to be patient, keep looking, relaxing and training my eyes to work like they should.

The goal for me is to become competent in doing the convergence (one aperture) fusion and then move on to the two aperture divergence training.

Why I’m still on this road

I have avoided posting for some time because I have been in frustration mode regarding my lack of progress in vision therapy. I have been screaming on the inside (and sometimes I have actually said it) that I don’t want to be the poster child for vision therapy. Well, guess what folks? I am. I just am. And I recognize that acceptance of who I am is one of the steps to healing. My children successfully completed vision therapy months ago but I have not yet seen the transformation I am after.

Why am I on this journey? Well, it started when I became aware that it’s possible to train our eyes to see in new ways and the road was paved as I read Susan Barry’s entrancing book Fixing my Gaze. As I read, I realized that I was about the age she was when she began vision therapy and I had been doing some of the exercises she describes in the book. “I can do this too!” I said to myself. I wanted to experience the utter amazement she describes as she sees with new eyes. One of my favorite examples is the following:

“I rushed out of the classroom building to grab a quick lunch, and I was startled by my view of falling snow. The large wet flakes were floating about me in a graceful, three-dimensional dance. In the past, snowflakes appeared to fall in one plane slightly in front of me. Now I felt myself in the midst of the snowfall among all the snowflakes. Overcome with happiness, I forgot all about lunch and stood quite still, completely mesmerized by the enveloping snow.”

Barry relates many additional instances of seeing the world in a whole new way and shares the experiences of others who have also learned to see in 3D. My deepest desire is to join their ranks!

I had a little glimpse of it several months ago when I was talking to my daughter in her bedroom one evening. I was lying on the bottom bunk of her bed looking up and the bars of the upper bunk seemed to be popping out at me. I stared at the sight for a long time in wonder. It sounds odd to someone who has stereovision, but to me it was a miraculous sight. I haven’t had more of these breakthrough moments, but I plan to soon!

It’s more in the family than I thought!

I promised some time ago to share how my youngest daughter, Abby, age 9, became involved in vision therapy, so here is the scoop! (I mentioned it in the revision of my November blog “All in the Family.”) What I’m discovering is that there are many more hidden vision problems than I ever dreamed.

In January, my vision therapist shared a book with me entitled When your Child Struggles: The Myths of 20/20 Vision, (What Every Parent Needs to Know). I was interested in it because as a substitute teacher, I noticed reading problems in my students and wondered if they were connected to vision issues. I wanted something to share with the principal at the school where I was substituting long-term. After reading the book, I decided to ask Abby the questions listed in the chapter on eye teaming. She had an eye cross when she was about 2 which was remedied by putting her in glasses. She was far-sighted at the time, and is now near-sighted. When I inquired at last year’s visit, the optometrist told me she had a little trouble tracking but that “she is fine.” This was from an optometrist who claimed to have a background in vision therapy.

I asked Abby whether the words ever split apart so she sees double. The question is actually posed as a visual question with your hands. You place your palms together and then slide them slightly so the fingers are alongside one another rather than superimposed. She said “yes.” Then I asked her if she ever covers or closes one eye when reading and she also responded “yes.” I had not observed her doing this. I asked if she holds the book to one side or turns her head to one side when reading so that both eyes cannot see the print at the same time and she also said “yes.” I was blown away! Abby has never had any trouble with reading; she learned early and has always been way above grade level. She never complained of any difficulty in seeing the words: indeed the only reason I asked was because she sometimes skips a line in scripture study and once she jumped over to the next column for a couple of words. The other family members thought it was really funny, but it caused me concern.

I have another daughter who also sometimes skips lines, so I had my husband take both of them in for a checkup. Dr. Davies found Hayley’s vision to be normal, but Abby has esotropia, just like her mom. He calls her a mini-Denise. I think if I had had vision therapy at age 9 instead of 48, it would have been just as easy for me. It’s been a couple of months, and Abby’s vision is much improved. We’re thinking it will only be a couple more months and she’ll be done. Her brain is learning rapidly how to use her eyes together as a team.

In March we had another surprise in this regard. More about that later.