Debunking the myth of 20/20 Vision

It is time for us to retire the Snellen eye chart. After 150 years, surely we have learned there’s more to vision than 20/20 acuity! Yesterday, I mentioned to my brother (who has now decided to use his amblyopia as an excuse for not reading) that maybe he ought to get his two little girls’ vision tested. He and my sister-in-law assured me that their doctor had tested their vision and they are fine. Yep, that’s what my doctor and my optometrist also said and now I understand how UNTRUE it really is! Even if they do test other aspects of vision (which is rare) and detect a possible problem, they don’t refer patients to a developmental optometrist like they should.

Case in point: my experience last year with my regular optometrist who said “Yes, she has a little tracking problem, but she’s FINE.” (Code for “She has vision issues I don’t deal with and I don’t want to lose your business, so I recommend you just ignore it. . .” (See my blog post “It’s more in the family than I thought”) Now, I’m experiencing this yet again with my 11-year-old. I took her in last week for a regular check up and discovered that one eye was under-corrected (which I requested of my regular optometrist last year) and the other was OVER-corrected. So, either her one eye changed A LOT, or something funny is going on. Needless to say, her eyes weren’t functioning well together as a team, so Dr. Davies is going to re-evaluate Darcy this week after she has a week to adjust to the corrected prescription (through a trial pair of contacts). I talked her into trying the vision therapy program on the computer today and she didn’t last long before she told me the picture changed and she couldn’t see what she was supposed to see. Looks like she might be needing therapy too. We’ll know more in a couple of days.

41ENcLDBe4L._SX321_BO1,204,203,200_Once again, the Snellen chart (and an optometrist’s evaluation) failed to detect vision issues that are more than a little problematical. Just because we adapt well to our visual challenges doesn’t mean they don’t exist! I highly recommend that every parent and educator read Dr. David Cook’s book (Amazon link: When your child struggles: The myths of 20/20 vision (What every parent needs to know). In this 2004 publication, Dr. Cook outlines the 7 visual abilities necessary for learning:  1. accommodation (focus ability), 2. eye teaming ability, 3. eye movement ability, 4. visual perception ability (understanding what is seen), 5. eye/hand coordination ability, 6. visual imagery ability and 7. 20/20 acuity. The only one that is really tested is the last skill. It’s also the only one that’s corrected by a visit to your regular eye doctor!

Dr. Cook lists signs to watch for in each of the categories. Highly trained individuals (like your pediatrician or eye doctor) often miss the signs (and I certainly did). How much longer before we demand and facilitate the type of vision screening which will let us know how our children are REALLY seeing? Mere 20/20 (or 20/40)–without stereovision– is no longer good enough for me, so why would I accept it for ANY of my children?

What about Convergence Insufficiency?

About three weeks ago, I took my son to the optometrist for his regular eye exam. He needed new contacts and the prescription had expired. I chose to take him to my vision therapist just in case there might be other issues, but I didn’t really suspect anything.

It turns out that my 16-year-old son has a pretty serious case of convergence insufficiency. It’s basically the opposite of what I have. His eyes give up on focusing together up close and then one eye turnsdownload out. (When eyes don’t focus together properly, the brain shuts off one image in order to avoid seeing double, and that’s when the eye turns in or out to move out of the way.)

As with my daughter, I had not noticed his eye turning out and he hadn’t complained about his vision. Andrew’s eyes have been red at times, but I attributed that to a lack of sleep. However, he has always had difficulty completing his schoolwork. It has been an all-or-nothing proposition: he either does it and gets an A, or doesn’t do it and gets an F. He tends to start out the school year OK and progressively go downhill. I think he just gets tired of fighting it. I know he’s extremely bright and all the learning tests have indicated he can do the work, but he hasn’t been doing it. Since he’s not motivated to do schoolwork, he convinced himself he’s lazy! I didn’t believe it before, and I certainly don’t believe it now!

The good news is that it’s really easy to teach the eyes how to converge properly and it should only take about four months of vision therapy. I’m wondering– how much frustration could we have avoided by having this diagnosis occur about 10 years ago, before he told himself he’s lazy? Isn’t it time we really tested VISION, not just 20/20 eyesight?

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 her in my November blog post “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), by Dr. David Cook.41ENcLDBe4L._SX321_BO1,204,203,200_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.

Knowing how to see: Sapere Vedere

51pOiptURqL._SX307_BO1,204,203,200_I am inspired today by a chapter in Kevin Hall’s book Aspire: Discovering your purpose through the power of words where he introduces the words Sapere Vedere  (sah-PARE-ay veh-DARE-ay). Amazon link: This was the motto of artist/inventor Leonardo da Vinci. In his inspired way of looking at the world, da Vinci envisioned innovations that would not become reality for hundred’s of years. Sapere vedere was his secret tool: knowing how to see. For da Vinci, “believing is seeing,” not the other way around. According to Hall, “people with sapere vedere look forward as well as inward; they are capable of believing and seeing what others don’t.”

Sapere vedere combines hindsight, foresight and insight, so it’s three dimensional, just like my goal of seeing in stereo. My 3-D vision starts with hindsight: leaving the past behind while learning from it; foresight: looking ahead as I progress to my ultimate goal, and insight into the ways to arrive there. Then, as my two eyes work together as one, I achieve a single mindedness which propels me forward in my life vision.

My vision therapist told me he’s not giving up on me and we’re in this for the long haul. YES! Whatever it takes. Sapere vedere says if I can envision it, I can achieve it.

Red/Green Glasses

My first vision therapy activity is simple: my doctor told me to stare at the wall while wearing red/green (3-D) glasses. images I have been wondering for the past couple of weeks what I’m supposed to be seeing. Sometimes the line of color is down the middle and sometimes the colors cross or I see bands or segments of color. Sometimes one eye or the other takes over. Red/green glasses are the choice because they don’t really mix and it’s easier to tell which eye is being used. As I’m looking at the wall, I ask myself why I’m seeing the colors the way I do, in such variety. I also like to flip my glasses around to fool my brain a little. The colors are more vivid when I switch eyes.

I had my family members put them on and describe what they see and it wasn’t particularly helpful. They described a splotchy mixture of the colors or an odd blending. My view is constantly in flux and for now that’s my normal. I had a really good therapy session today and I am very encouraged. We are working on my peripheral vision to encourage my left eye out and avoid the double vision I was starting to get by doing vision exercises on my own. I think maybe what I have done so far on my own was somewhat helpful in moving me along the pathway to stereovision, but I wonder if a more direct path would have been more advantageous.

I’m likening my choice to learning to play the piano (since I’m a piano teacher). I have been that woman who tries to teach herself to play the piano because “it can’t be that hard to figure out, right?” Meanwhile all sorts of technical issues aren’t being addressed because there is no one observing and correcting the progress and teaching the best (or easiest) techniques. (There’s also the issue of providing the best equipment). As a piano teacher I evaluate where each student is and give the specific exercises or repertoire that student needs. That’s what my vision therapist does and I’m finally the student!

This week I get to do exercises in the mirror. I have known of this idea from my study, but resisted doing it because I don’t like to look at my crooked eye. Obviously it will benefit me to get over that one quickly! Immediate feedback on what my eyes are really doing is what I need so my brain can re-wire! I’m pressing forward.

All in the Family

I’d like to see some conclusive research on the incidence of strabismus in families. I’ve read that it’s not an inherited trait and conversely that it is inherited. It appears to be inherited in my family: 4 of my five siblings (all brothers) also have it! One of my brothers also has a son with strabismus. I’m thinking more members of my family are affected, but not diagnosed.

In an informal survey, I asked my brothers how they see and they said that like me, they use both eyes, switching quickly back and forth, with one eye dominant. We have both types of esotropia in our family. One brother has infantile esotropia and underwent three surgeries as a child to visually correct it. The rest of us have accommodative esotropia, which appears between the ages of 2 and 3. Being nearsighted, I was placed in bifocals the month before I turned 3 while my brother with infantile esptropia had 20/20 vision and received patching therapy after his surgery. Another was nearsighted and has amblyopia but didn’t like being patched and didn’t have any positive results from the little treatment he received.

As far as reading goes, basically we all got really good at accommodating our monovision. I think I’ve always had some fusion close up because reading has never been a struggle for me and I am a voracious reader. My brothers are not avid readers, but did fine in school. We all have college bachelor’s degrees and 4 of us also have graduate degrees. They are not experiencing the pronounced eye turn I am, so are apparently not worried about improving their visual function.

Strabismus also makes physical activities, especially sports a challenging endeavor. I have two brothers who excelled in basketball anyway. One brother even played college basketball on the junior college level and played for years in the county recreation league, often as the league high scorer for the year on the championship team. I often wonder how he was able to accommodate so well.

I recently discovered that my youngest daughter is also strabismic. She is currently in therapy along with me. Who would have thought we would be doing mother-daughter vision therapy? That gives new meaning to the idea that it really is all in the family!

Catching my vision

There’s nothing quite a daunting as an empty computer screen, especially after nearly twenty years. I consider myself a writer. I did a bit of writing in my undergraduate college years, including music reviews for the school newspaper, and concert program notes. I wrote a 100-page thesis for my graduate degree, and promptly stopped writing. I guess you could say life got in the way, but that’s really just an excuse. It’s time to be done with excuses.

I believe passion is the key, the driving force that gets us moving in the direction we are meant to go. My life’s various passions have brought me to this point in time when I am finally ready to share my latest journey. You see, I’m strabismic and I don’t see the world like most of you. My life is mostly two-dimensional. During most of my life I didn’t think much about it. The fact that I was somewhat clumsy and bad at sports just gave me more incentive to excel in academics and music. As a young child, when I went in for my yearly eye exam, I would guess on the vision tests. It was many years before I told them I could see the music staff with one eye and the notes with the other. Then they would skip the rest of the tests, knowing I couldn’t do them. Yet, according to the opthalmologist, my vision was fine–as long as I wear glasses. I had bifocals from age 3 until I was 15 and started wearing hard contacts.

It’s been a mid-life crisis for me that in the past few years my eye turn has become more pronounced, to the point that I notice it in the mirror. Adults usually don’t say anything; they’re too polite.  But I started substitute teaching two years ago, and children are quick to notice and ask questions. So part of their elementary education now includes a little explanation about how my eyes don’t work together, but I’m doing therapy to teach them how. (My therapy has been self help for the past seventeen months, but now I’m working with a professional vision therapist.)

Since roughly one in ten people share my vision challenge, the children usually remark that someone else they know has funny eyes. And often they will also tell me that it doesn’t matter because “you’re pretty anyway.” While that may be true, the important thing for me now is to move forward in healing my sight and provide support and information for others. I’ll be posting more specifics about my vision therapy and the study that has led me to this point. Telling my story as it’s occurring is scary, but if my journey helps just one person to gain the knowledge and drive needed to heal their sight, it will be worth the sharing.