This blog is based on a patient of Dr Leonard Press OD FAAO FCOVD, editor of the VisionHelp blog.
Names have been changed for privacy.
There is much confusion among parents and professionals on when to seek an assessment by eye doctors experienced in children’s vision and vision therapy.
The true story below serves as an example of the benefits of including eye doctors as part of the medical team, whenever learning difficulties are present.
David’s Story
David struggled with an undiagnosed vision problem for 10 years.
By the time Dr Leonard Press saw David, a 16 year-old high school senior school, his mother reported that he had previously seen all kinds of specialists. However, none had been able to solve David’s academic challenges.
David is a very bright and diligent student, enjoying his school and academic pursuits, but somehow his grades have never matched his efforts.
His odyssey began immediately after his birth, having been born with a congenital cataract in the left eye. The cataract did not impact the vision in the left eye, like those in adults, as David still had 20/20 vision in this eye.
The decision was therefore made by David’s eye surgeons, when he was an infant, not to remove this cataract, the reason being they were only focused on the visual acuity of this eye and not how the two eyes functioned as a team.
Throughout David’s childhood the eye surgeons told his mother that his right eye was ‘perfect’ and to merely monitor the left eye frequently to make sure that the cataract was not growing and his vision was developing normally.
Even though David was diagnosed with farsightedness in the left eye, there was no discussion as to whether the two eyes were working together.
David’s visual skills were never evaluated, so there was no way to know how the two eyes were learning to work as a team and if this was impacting his school work.
Throughout primary school and most of high school, David’s work ethic at school was unfaltering. He always tried to do his best and achieve high grades, but his test scores never truly reflected his intelligence.
David Sees Dr Leonard Press
Only at the age of 16, after suffering for over 10 years, David eventually saw Dr Leonard Press. David had no history of visual treatment other than his eyeglasses, which had a slight prescription for farsightedness in his left eye.
During Dr. Press’s evaluation, David said that after reading for just a short period of time, he would experience eye strain, headaches, tiredness, and even sometimes blurry or double vision.
Dr. Press’s evaluation showed that David had considerably reduced visual skills, and that it was difficult for his eyes to function as a team.
The specific visual skill deficit that impacted the functioning of his eyes was convergence insufficiency (CI).
If CI remains undiagnosed for years, this often leads to a serious eye condition known as ‘intermittent suppression’ of the left eye. This condition causes the brain to frequently shut down or switch off the left eye, mainly when reading or working on a computer.
If left untreated, eventually the switching off of the left eye can result in a lazy eye, causing irreparable vision loss in one eye. Lazy eyes could also permanently impact the ability to read and succeed at school, college and even as an adult.
What did Dr Press do?
Convergence insufficiency meant David’s left eye was not able to turn inwards and focus clearly for reading, computer use or at any other time David needed to focus on anything close.
Dr Press changed David’s optical prescription by adding a small amount of prism for the left eye: the amount of prism prescribed was 2^ base-in.
This small alteration in the prescription reduced the eye strain and fatigue, allowing David’s two eyes to function and work as a team.
Final Word
In David’s case the many specialists that he had seen previously were initially eye specialists, but because his eyesight wasn’t seriously impairs, he was eventually referred to learning specialists. These well-meaning professionals were puzzled by the discrepancy between his intellect and learning performance, but could not find or offer a solution.
David suffered the consequences of an undiagnosed vision problem for 10 years.
Whenever David’s mother inquired about his vision, she was reassured that it had no bearing on his learning. That is, until David saw Dr Press, a specialist in children’s vision and vision therapy, and his life was changed forever.
David now loves reading and completing assignments without the added stress and fatigue.
He and looks forward to enjoying his upcoming college education.