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Amblyopia is a Binocular Problem

5/20/2019

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Thank you to COVD for this piece. COVD Link:
​https://covdblog.wordpress.com/2017/06/27/amblyopia-is-a-binocular-problem/

Amblyopia is defined as a visual developmental disorder that arises after selective disruption of visual input early in life.  The diagnosis of amblyopia typically focuses on the presence of a selective disruptor (the amblyogenic factors of strabismus and/or anisometropia) in young children which results in a visual disorder (reduced visual acuity) of the amblyopic eye.  Visual acuity becomes the “yardstick” by which treatment progress is measured. However, amblyopic eyes almost always have deficits in many visual functions which can also be measured, such as fixation, accommodation and eye movements, just to name a few.
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Although the clinical presentation of amblyopia focuses on one eye, it is a binocular problem.Between the presence of an amblyogenic factor (the cause) and the reduced visual function (the effect) lies the neurological process ofsuppression.  The dominant eye dominates and suppresses the amblyopic eye.  Think of big brother bullying his younger sibling, until the younger brother is cowering in the corner.**

A recent review article supports this view of amblyopia as a binocular problem by focusing on deficits in the non-amblyopic eye.  Most of these deficits are subtle and can only be measured in a laboratory, but they enhance our understanding of how amblyopia happens in a developing visual system.

The article considers possible mechanisms for deficits in the non-amblyopic eye.  Are they caused by occlusion (patching) therapy?  slowed maturation of visual functions? atypical development of the binocular cells in the brain’s cortex? or an adaptive mechanism to equate the sensitivity of the two eyes?  The authors conclude that while there isn’t enough evidence to rule out any of these mechanisms, binocular mechanisms are clearly in play.  The idea that the brain is attempting “to equate the sensitivity of the two eyes in order to mitigate the effects of amblyopia on the developing visual system” is very compelling.

What does this mean for treatment?  Traditionally, amblyopia is treated by patching the non-amblyopic eye. Let’s go back to the big brother bullying little brother paradigm. Patching essentially removes big brother from the room and sends little brother to the gym to get stronger.  But eventually, you have to take the patch off, and the amblyopic person has to learn to integrate the information from both eyes.  This requires reducing the suppression.

New binocular treatments are becoming available which separate the visual information channels to each eye and then decrease the contrast of the information being presented to the non-amblyopic eye.  At what point, will the non-amblyopic eye stop the suppression and allow the amblyopic eye to participate in a binocular view of the world?  Can big brother’s volume be turned down to a point where little brother can be heard?

This review article suggests that the amblyopic brain has already initiated this approach to treatment!  The deficits in the non-amblyopic eye are an expression of having turned down the volume from the non-amblyopic eye, or at least an attempt to do so.  The development of binocular-based treatments that follow the same approach that the amblyopic brain has already undertaken seems very promising. The evidence that amblyopia is a binocular problem requiring binocular treatment is growing. What exactly is this “binocular treatment”? Learn the answer at COVD.org!
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** Thank you to Pilar Vergara, who uses this analogy in her book,Crossed and Lazy Eyes — Myths, Misconceptions and Truth. 
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Science and Splash: “My Eyes Couldn’t Rest for a Minute”

5/9/2019

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Today’s guest blog post was written by Carrie Hall, an optometric vision therapist at Washington Vision Therapy Center in Yakima,WA and edited by Benjamin Winters, OD, FCOVD, the clinical director of that clinic.

“I’m getting annoyed. I just feel like I didn’t get a break; everywhere I looked, things were distorted. My eyes couldn’t rest for a minute unless I closed them. Even faces, I’m trying to listen to what you were saying, but you know, I wasn’t there anymore.”

Many of us who work with children who are struggling in school might find the above sentiment familiar. Familiar not in the sense that children are able to express their concerns so clearly. But familiar in that as we look at their slightly overwhelmed, slightly vacant, slightly tired-seeming faces, we know that this is exactly what they’re feeling.

Believe it or not, the quote at the beginning of the story is not from a child with a vision problem, it is from a teacher who has just experienced what is like to have a vision problem.  This teacher and 3 other teachers were subjected to simulated vision problems and then given some school work to do.  The video, created by COVD member Dr. Chris Schell and Dr. Richard Maharaj captures what it is like for children that struggle with vision problems.  Even more,  they show that despite these vision problems, the teachers could easily pass a vision screening using the 20/20 Snellen acuity chart;  thereby, demonstrating how poorly we are able to catch these problems with the vision screening done in most schools.

The truth is that many of the children that we work with simply lack the capacity to voice this frustration. They have no idea that their eyes cannot “rest for a minute,” as they have never consciously experienced what that sensation would be like. They don’t know what normal vision feels like! All they know is their parents’ frowns as they peruse report cards. They know they sure do try to sit still and concentrate each time the teacher tells them to.  And they know they try so very, very hard to ignore it when their younger siblings can read the books they themselves struggle with.

It takes some contrast to truly experience how difficult it is to accomplish tasks with a visual impairment. If you weren’t born with amblyopia (a lazy eye)  or convergence insufficiency, it is nearly impossible to describe how difficult school or work can become. Just the simple task of reading becomes immensely challenging and exhausting when one’s eyes are not working together as the video so brilliantly demonstrates.

The glaring truth of how very unfair it is to try to ask a child to read with a broken visual system becomes evident in this video: we see the looks on these teachers faces as they attempt to do simple tasks, such as reading and understanding children’s books. Dr. Schell elaborates, “the look on a parent’s face when they experience a moment of double vision or blurriness in one eye and how that interferes with function is priceless. The parent “gets it” for the first time.” Just like these teachers, the parents realize that their child’s slagging performance or poor behavior is utterly logical for the situation that they have been in. They experience the unfairness of it all first-hand and finally realize that they have completely misjudged their child. Often, they are overwhelmed with guilt. They feel it is their fault for not realizing what was really going on.

The simple truth of the matter is, it’s not their fault. They didn’t know.

It only takes one creative teacher searching for how to make concepts stick to realize that fixing the vision is the answer for multitudes of her students, from now till forever. It only takes one end-of-her-rope mom, worn to the bone by late-night procrastination marathons to see this video and know how to change the course of her child’s life. And it only takes one vision therapist, or optometrist, or student, or parent, to share this video with hundreds of people who desperately need to know that they are not doomed to the state they have always lived in. That there really is another way of seeing the world.
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If you feel you or your child are struggling with a life-altering developmental vision problem, please contact a developmental optometrist near you by going to covd.org .
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Academic Difficulties and Visual Symptoms in Children with Concussion : An article review

4/29/2019

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Thank you to COVD for writing this piece. COVD
​ Link:https://covdblog.wordpress.com/2017/12/01/travelgrantspo2/

Last year, Amanda Beaudry, OD, MS  and Emily Cheng, OD received Travel Grants for the 2017 Annual Meeting with their summaries of an article on academic performance and concussion. We’ve shared it with you here, combined with new practice-relevant insights, as inspiration for this year’s applicants!

Childhood traumatic brain injury and concussions have been on the rise. While most children who suffer a concussion are recovered in 7-10 days, there is a substantial minority whose symptoms persist for longer, and this can impact their academic performance. The current standard treatment after a concussion is “cognitive rest.” The Zurich Consensus Report outlines guidelines for when it is safe to Return-to-Play in athletes who suffer from concussions, however, there are less universally-accepted guidelines for Return-to-Learn. In order to develop a Return-to-Learn protocol, it is necessary to know what symptoms are associated with academic difficulty. Studies have shown that the visual system is affected after concussion, yet vision is rarely included in Return-to-Learn protocols. The official2014 National Athletic Trainers Position Statement recommends testing smooth pursuits, nystagmus, and pupil reflex, which may be important with sports, but does not mention any convergence,accommodation, or saccade testing, which are important for academics and learning.

The purpose of the study “Academic Difficulty and Vision Symptoms in Children with Concussion” was to evaluate a group of children with prolonged post-concussive symptoms to determine if vision symptoms are associated with increased academic difficulty. This study retrospectively reviewed data of 1021 children who were evaluated at Children’s Hospital of Alabama between the years 2007 to 2013. The data collected on each child was reported by parents and child at the point of care and included demographic information, concussion event history, previous medical history, symptom history, and Sport Concussion Assessment Tool 2 scores (SCAT2). The date of concussive event was recorded as the “index date”. The symptom history included questions about 13 symptoms typically associated with a concussion and included a yes/no question about having academic difficulty after the concussive event. Using time since index date and symptom history, a subset of children showing 3 or more symptoms present for 10 days or more were identified as having prolonged post concussive symptoms. The primary symptom of interest was reported vision problems. The SCAT2 captures symptom severity on a 1 to 6 scale about 22 concussion-related symptoms. It also includes the severity results, Maddock’s side-line assessment, brief physical assessment, and balance assessment, The dependent variable was academic difficulty after concussive event. A higher overall SCAT2 score indicates better performance. For the symptom score, cognitive and balance subset, a higher score indicates less symptoms. For symptom severity subset, a higher score indicates worse symptoms. The subset of children identified with prolonged post concussive symptoms included 276 subjects ages 5 to 18 years old.
The most common symptoms were headaches (98%) and dizziness (70%).  Fatigue, vision abnormalities, nausea and concentration difficulty were present in 40 to 50% of the subjects. Balance problems, confusion, hearing disturbances and vomiting were less common, present in 20 to 30% of subjects.

All of the symptom variables were associated with academic difficulty except headaches. Lower symptom score and higher symptom severity scores were associated with academic difficulty. Concentration difficulty, confusion, and balance difficulty were all associated with academic difficulty. Vision and hearing were associated with doubling the odds of academic difficulty. Concentration difficulty accounts for a 21 fold increase in odds.   What was most interesting was that for those with symptoms longer than 30 days, only vision and concentration difficulty remained significant for academic problems.  This finding does make sense, since learning is highly vision-dependent and that the brain is known to have 30 areas that are dedicated to vision.   This study and previous studies suggest that visual acuity is NOT enough to identify problems related to visual dysfunction.

This study does have a few limitations. Firstly, the responses used for analysis are all based on self-report, and may or may not relate to objective findings. Also, it cannot be concluded what the direction of causation is between vision problems and academic difficulty from this study. It is possible that children with academic difficulty may have had pre-existing academic difficulty that could skew this finding.Although the American Academy of Pediatrics consensus reportlists vision as a common problem after concussion that it may interfere with Return-to-Learn, no vision specialists were included in the Return-to-Learn readiness decision-making process. This study supports the view that vision specialists should be given a greater role in assessment for Return-to-Learn, as well as in addressing any visual needs of children with concussion.
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This study makes a strong statement for the need of detailed functional vision testing in students who have sustained a mild traumatic brain injury or concussion, especially if symptoms persist longer than a few weeks.  If we can identify the cause of students’ academic struggles, then we can treat them, and we can prevent such students from experiencing unnecessary hardship and frustration in returning to the classroom. 
If your child has suffered a concussion, find a member of COVD near you for a comprehensive vision exam and get the full picture on their readiness to Return to Learn!
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Driving Again After a Traumatic Brain Injury (TBI)

4/16/2019

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Thank you to COVD for writing this piece.
COVD Link: Driving Again After a Traumatic Brain Injury (TBI)

Today’s guest blogger is Dr. Derek Tong.  Dr. Tong graduated with Honors from the Southern California College of Optometry at Marshall B. Ketchum University, where he also completed residency training in Pediatric Optometry and Vision Therapy.  He is the Clinic Director and Residency Coordinator of the Center for Vision Development Optometry in Pasadena CA.    The center focuses on working with children and adults with traumatic brain injury, strabismus, amblyopia, learning problems, and other unique vision needs. He is an Adjunct Clinical Assistant Professor of both the Southern California College of Optometry at Marshall B. Ketchum University and the Western University College of Optometry.  Professionally, he is a Trustee and past President of the San Gabriel Valley Optometric Society.  He had also served as a school board member at the Christian school near his home.  In his spare time, he enjoys travelling with his family and teaching children’s Bible lessons at his local Bible Study Fellowship.

The US Center for Disease Control (CDC) reported that there are over 2.5 million new cases of Traumatic Brain Injury (TBI) each year.  Motor vehicle accidents (MVA) account for 14% of all TBI cases.  According to the United States National Highway Traffic Safety Administration (NHTSA), there were 5.8 million motor vehicle accidents in 2008 with a total of 1.6 million individuals injured.  Data from the US Department of Defense indicated there were over 300,000 TBI cases in the US military since 2000.

Research conducted at the State College of New York (SUNY) State College of Optometry showed that 90% of TBI patients were found to have vision dysfunctions such as binocular vision dysfunctions, oculomotor anomalies, accommodative dysfunctions, strabismus, and cranial nerve palsies.  The most common symptoms reported by the patients included loss of balance, dizziness, eyestrain with near tasks, light sensitivity, headaches, near vision blur, vertigo, and motion sickness.  These symptoms often make driving very challenging since operating a motor vehicle is a complex multi-sensory process involving integration of visual, perceptual, auditory, motor and cognitive skills.   Individuals who suffered from a TBI often feel discouraged and hopeless when going through a recovery process that seems to be slow and long.   They often notice difficulty with parking (visual spatial perception), feel unsafe with judging the distance from the other cars (depth perception), or are bothered by the sun light or reflections from the on-coming traffic (glare).  It can become very frustrating.  The good news is that current research studies have confirmed that the vision dysfunctions that occur after TBI are highly correctable through vision rehabilitation.
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Vision rehabilitation for driving may include the following treatment modalities:
1. Compensatory lenses for nearsightedness, farsightedness, and/or astigmatism to maximize clarity of central vision when reading road signs.
2. Therapeutic prisms lenses to enhance visual-spatial awareness and/or peripheral vision when driving on the freeway, the street, and during parking.
3. Tinted lenses with Ultraviolet (UV) coating to protect against the bright sunlight and the harmful light rays.
4. Anti-glare coating to minimize glare from on-coming traffic when driving at night.
5. Optometric Vision therapy to rehabilitate any vision deficiencies such as visual tracking deficiencies, binocular vision disorders, and visual-motor dysfunctions that interfere with safe operation of a motor vehicle.  An example of such a case was featured in the COVD journal (Tong & Zink, 2010)
6. Other treatment modalities as prescribed by the Optometrist who provides vision evaluation and rehabilitation for TBI patients.
Life may not be the same after a TBI, but it can still be good with the right help and support. To locate an Optometrist who provides vision rehabilitation in your area, please visit www.covd.org or www.nora.cc
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Treating amblyopia without the patch

4/1/2019

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Thank you to COVD for writing this piece. COVD
​ Link:https://covdblog.wordpress.com/2018/06/20/treating-amblyopia-without-the-patch/

During my optometry residency last year, I had the fortune of attending Dr. Sanet’s 2-day course at the COVD Annual Meeting. Recognized as a leading expert in developmental optometry, Dr. Sanet discussed the superiority of monocular fixation in a binocular field(MFBF) over patching for the treatment of amblyopia (also know as “lazy eye”). MFBF is a vision therapy technique that teaches both eyes to work together as a team, instead of blocking the stronger eye to make the “lazy eye” catch up on its own.

My time as a student and resident at SUNY had already encouraged the use of MFBF as often as I could in the middle and end stages of vision therapy, but it had never occurred to me to use it in place of patching at the beginning as Dr. Sanet suggested.  Yet the idea of promoting teamwork between the two eyes immediately made perfect sense, and I couldn’t wait to try it for myself.

Unfortunately, I had no new amblyopia patients for the remainder of my residency, and almost eight months passed before my first opportunity to try this patch-free strategy.
After discussing all the options with the eligible patient’s parent, we decided to skip the patch and give MFBF-only treatment a try. It made sense in this case to promote teamwork from the start instead of  spending time strengthening the “lazy” eye alone.  To everyone’s excitement, the results have been fantastic! 

After 2 months of treatment purely with MFBF vision therapy activities, we were able to bring a 20/80 refractive amblyope with 5.00D of anisometropia down to 20/40. Not only has the acuity drastically improved, but we’ve also developed strong global and local stereopsis (3D vision), and the patient is continuing to improve. Through MFBF activities, we took an eye that was being figuratively crushed by its prescription and helped it work with its fellow eye for the first time in this child’s life.

Since this is just a single case from my personal experience, it’s still up for debate whether treatment with MFBF vision therapy has sped up the process as opposed to patching.  Regardless, for this particular patient and parent, we were able to remove the stigma of the patch and alleviate the fear of spending multiple hours each day with sight from only one, weaker eye.  Instead, we allowed the stronger eye to serve as a guide for the weaker eye and developed teamwork right from the start.

If nothing else, I have ended up with a new trick in my toolbox, an extremely grateful parent, and a kiddo who smiles at every weekly appointment when he sees the progress he’s made.  A perfect win in my book.
The most rigid views
Will one day be overwhelmed
By the smallest change
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Dr. Matthew Roe is an Assistant Professor at the Arizona College of Optometry (Midwestern University) where he currently teaches the Pediatric Optometry and Non-Strabismus Binocular Disorders courses.  He additionally serves as a clinical preceptor in the Pediatrics, Vision Therapy, and Sports Vision clinics.  He received his degree from the State University of New York College of Optometry, and is a Fellow of the American Academy of Optometry.
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Permanently seeing double: strabismus surgery gone bad

3/14/2019

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Thank you to COVD for writing this piece. COVD Link:
https://covdblog.wordpress.com/2017/10/16/intractable-diplopia/
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Permanently seeing double: strabismus surgery gone bad

Intractable diplopia is a rare condition where double vision cannot be alleviated, except by occluding (covering) one eye.  Because it is relatively rare, the amount of literature describing its incidence, risk factors, and management is limited.  However, a  recently published article has shed a little more light on this debilitating condition.  The hope is that more knowledge will reduce its incidence, and perhaps provide guidance on effective management.

The article’s researchers reviewed ophthalmology reports of intractable diplopia in the UK over the course of one year.  Of 53 cases of intractable diplopia, 32% resulted from strabismus surgery. Another 30% had a pre-existing strabismus and other procedures or events (such as cataract surgery or a head trauma) resulted in the intractable diplopia.

“The most common event preceding the onset of intractable diplopia was strabismus surgery, accounting for almost a third of cases.”Many treatments have been tried– a second strabismus surgery, an opaque contact lens, cataract surgery, and the insertion of an opaque intraocular lens (IOL), and botulinum injections to induce a ptosis ( a droopy eyelid). Most are either ineffective or unacceptable.

With no options for effective treatment, prevention of intractable diplopia is paramount. There are other ways to help your misaligned eyes to work together, including safe, surgery-free vision therapy!
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Don’t rush to surgery, Locate a Doctor near you who can present all the options to treat your strabismus.
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Ella’s Message Part 1: Awareness Matters

3/4/2019

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Thank you to COVD for writing this piece. COVD Link:
Ella’s Message Part 1: Awareness Matters

I’m willing to bet that most of you have seen a sports game, from either physically being on the field, standing on the sideline, or watching it on TV. You also have probably witnessed players, maybe even relatives or loved ones, take blows to the head during play.  An injury like that can make observers feel powerless and afraid, especially when the decisions that follow are in the hands of someone else. However, there is one big thing that you can do before that very moment that can make all the difference in a player’s recovery–you can inform yourself about the risks and demand the same from the people in charge.

This is the reason that #BrainInjury awareness is so critical. If coaches, parents, and players are able to recognize and respond to a suspected concussion, chances of recovery increase drastically. In addition, if observers are also better informed about concussion prevention, we can work together to decrease the numbers of these injuries in the first place.
When a player returns to the field after a head hit, like I was encouraged to during a soccer game, the risk of brain damage increases and the effects of the concussion become exacerbated. This is why players must be pulled from games immediately, even if such an injury is only suspected. The exacerbation of symptoms usually means increased confusion and disorientation–which is exactly why those who attend games need to be able to recognize and respond to a potential concussion. When I “shook off” my concussion and played through the rest of the game that night, I could barely figure out where I was–recognizing and communicating that I seriously needed medical attention was out of the question. Players rely on the people around them for their safety, and this is never more true than during a brain injury.

I played 30 more minutes of soccer after sustaining a concussion, and only once the game ended was it a concern that I may have had a concussion. If those around me had been able to recognize the risk more quickly, maybe my recovery could have taken weeks instead of years. Awareness will by no means stop concussions from happening, but it may help reduce the number of concussions and reduce those returning to the field right after they occur. It is a step in the right direction to help limit the number of concussions we see today in schools, colleges, and on professional teams.

This long road to recovery has had its fair share of up and downs. I wish my community would have known more about concussions as it would have resulted in the definite recognition of mine. This is why I am teaming up with COVD to get this information out into the world. I hope that, instead of hearing it from doctors and scientists, maybe hearing it from someone who has dealt with a concussion will drive home the truth and highlight the realities of this problem. By making those around us aware, we can get a handle on the issues surrounding concussions in sports. My hope is that this message will prevent other athletes from experiencing something like what happened to me. Please help us spread awareness about concussions by sharing this story and the following posts in this series all March long!

Have you or a loved one suffered a concussion, or any blow to the head, either on the field or off it? Don’t just shake it off–Locate a Doctor near you who can help and learn more from COVD!
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Kids who struggle with reading are likely to have undetected vision problems

2/19/2019

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Thank you to COVD for writing this piece. COVD Link:
Kids who struggle with reading are likely to have undetected vision problems

Reading is a complex process in which vision plays an important role.  The eyes must focus to make small print clear, converge to make the print single, and make accurate eye movements to the next word. A recent study by Christian et al. [i] performed by highlighted just how important these skills are to the reading process. (Read an article about the study)

Dr. Lisa Christian of the University of Waterloo (and Co-Chair of the COVD Academic Services Committee) and team examined 121 children with an IEP plan for reduced reading efficiency.  They tested refractive error, eye health, saccades (horizontal reading eye movements), accommodation (eye focusing), phorias (eye position), andvergence ranges (eye teaming).

19% of the children tested needed glasses and had not been prescribed them prior to the study.  This highlights the importance of having a comprehensive vision exam prior to starting school to ensure academic readiness.

35% of the children had an abnormal phoria, meaning their eyes were positioned further in or out than is normal.   More children had an exophoria (outward pointing eyes) than esophoria (inward pointing eyes).

46% of children had reduced convergence ability.  This means a lot of children with reduced reading ability have convergence insufficiency, or a reduced ability to turn the eyes inward when looking up-close.  Convergence insufficiency may cause headaches, double vision, or the sensation that words are moving across the page when reading.  With regards to the reading process, if a child has convergence insufficiency, their visual systems are working much harder than their peers’ to make the print appear single and clear (rather than doubled and blurry).  If a child sometimes sees double while reading, they may frequently lose their place, or see extra letters in words, which can reduce reading comprehension.

30% of children were found to have inaccurate accommodation, or eye focusing ability. 20% of children were found to have reducedaccommodative facility, or reduced ability to adjust their focusing system.   Problems with the accommodative system can lead to blurry vision up-close, headaches, and eyestrain.   If words are sometimes blurry and sometimes clear while reading, this can lead to slow reading speed.
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These findings show that about a third of children struggling with reading have some kind of binocular vision disorder, but the good news is that many forms of binocular vision disorders can be treated with optometric vision therapy.  Early identification and treatment of these problems prepares children for success, and may save them years of struggling in school.
Learn more about diagnosing and treating binocular vision disorders at the COVD Annual Meeting in Bellvue, Washington!
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“Unlocking the 3rd Dimension”: Caleb learns to see in 3D

2/5/2019

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Thank you to COVD for writing this piece. COVD Link:
“Unlocking the 3rd Dimension”: Caleb learns to see in 3D

As a woman with Strabismus, and a mother with 2 children diagnosed with Strabismus (“eye turn” or “crossed eyes”), I understand the anxiety we all feel when our children experience any pain or deficiency. The passion we have to “fix” problems is very real! We are troubled by the “unchartered” waters that we are about to dive into. We worry about our children’s well-being, their self-esteem and our ability to give them the very best chance to succeed in life.

When Caleb was a toddler, he was diagnosed with a type of Strabismus called esotropia (crossed eyes) and amblyopia (lazy eye). We followed the usual route of consulting an eye surgeon who prescribed daily eye patching. Whilst she is a wonderful surgeon, her approach led us to believe that Caleb could only hope to achieve 3D vision if he underwent eye-muscle surgery on both his eyes as soon as possible. She explained that if his eyes were more aligned, he would stand a better chance of developing 3D vision like other children. Desperate, we dove in instantly to “fix” this problem and Caleb underwent the surgery when he was 3 years old.

The surgery did help cosmetically for a few months, but Caleb’s eyes were never 100% aligned and he never did naturally learn to see in 3D. Sadly, after a year, his eyes began not only reverting inwards again, they were also drifting UPWARDS. This is a very common side-effect of eye muscle surgery called disassociated vertical deviation (DVD). Caleb had to continue patching daily, and in fact, after the surgery, he was asked to patch for up to 6 hours a day!

On hindsight, I now realize Caleb’s strabismus was NEVER an eye muscle problem. Caleb’s eye muscles worked perfectly. His brain, however, just didn’t know how to use BOTH eyes together as a team! If your child has a speech problem, we should not rush to have tongue-muscle surgery; but instead seek the help of a developmental speech therapist first.

After Caleb’s surgery failed to keep his eyes aligned, I began researching vision therapy. I read an incredible book, Fixing My Gaze by Susan Barry, which opened up my mind to the possibilities of vision therapy for anyone with strabismus.

I studied many articles online, and contacted a developmental optometrist in the USA. Over 2 years, he patiently and compassionately answered all my questions via email. He basically gave me the courage to stop all follow-up visits to the eye surgeon, and change Caleb’s spectacles prescription to the therapeutic lenses with binasal occlusion that he recommended.

Thanks to Susan Barry’s book, I was also able to explain the wonders of 3D vision to Caleb, while helping him understand how strabismus affects his vision in practical ways. It gave him a purpose and a hope. Caleb desired 3D vision for himself. He understood what it meant to have strabismus – there was no “shielding him from the truth” – and he remained positive and confident. Our young son had absolutely no problems looking people straight in the eyes and explaining the meaning of “strabismus” to strangers at the grocer, park or lift!
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When Caleb was 7 years old, the vision therapy doctor introduced me to a colleague and fellow neuro-developmental & behavioural optometrist, one who is here in Malaysia.Caleb officially began vision therapy when he was 8 years old in 2013.

A year of therapy later, Caleb woke up one morning and saw his ceiling fan looming down at him from his bed. He screamed in fright. When he finally realized that he was beginning to see in 3D, Caleb had a time of his life examining everything around him. He was in awe of how 3D vision transformed the way everything and everyone looked. For the first few weeks, Caleb’s 3D vision only lasted for a few hours in the morning. So for over 2 months, he was uniquely straddling both the 3D world in the mornings and the 2D world in the evenings. During this period, we kept a journal of all the wonders he noticed, and more of this is shared in our latest children’s storybook,“Unlocking The 3rd Dimension”.

Caleb just turned 13 years old a few days ago. It has been more than 3 years since he developed his 3D vision, and he can no longer remember or imagine life without it.
Was gaining 3D vision worth it? “YES!” exclaims Caleb, “Today, I can stand in front of you and actually see your nose sticking out of your face!”
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Building Confidence Through Vision Therapy

1/16/2019

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Today Jessica is a happy and confident teenager who enjoys sleepovers with her friends, participating in church activities, and camping with her family.  But when I first met Jessica last year, she was becoming more withdrawn, not wanting to even spend the night at her best friend’s house.  She was afraid to try new things and her self-confidence was rapidly decreasing.

Academically she was struggling.  Her mom, Patty, found Jessica was very inconsistent with her school work.  Some days it seemed she understood a concept then the next day it was as if she was learning it all over again.  She avoided reading, and noticed when she did read, the words were blurry so she often compensated by closing an eye.  She was working so hard to read, it’s no wonder she struggled with reading comprehension!

Jessica began a vision therapy program and within a number of weeks she had less resistance to reading and stopped asking, “How many more pages do I need to read?”  By the halfway point in her vision therapy program other family members and friends were starting to take notice that Jessica seemed more confident; standing taller, making better eye contact, and able to converse more naturally.

Jessica was starting to take notice too.  Everyday skills such as wiping off the table, folding laundry, cutting with scissors, and tying her shoes were easier.  She even became better and more confident steering her bike.

Patty saw an increase in her reading level, neater handwriting and spacing, and better communication from Jessica.  She was now able to express when she was frustrated with things instead of just shutting down.  Her overall body balance and coordination was improving.
By the end of her vision therapy program Jessica was well on her way to catching up in her academics.  She now had all the “ingredients” to complete her “recipe” for success – better eye teaming and tracking, improved visual perceptual skills, better integration of her senses, plus she now had the increased confidence to apply and use these skills.

Jessica’s road to success consisted of a lot of hard work as well as support and help from her family.  But the smile on her face, and the happiness and confidence that radiate from her now means all of her hard work was worth every moment!

Jessica said it best in the success story she wrote at the completion of her vision therapy program, “What kind of changes can vision therapy make in your life?”

Jessica’s Success Story
(click the link here to see her handwritten story)
“Well I really think I’ve been more confident of my handwritting and reading is way easier than before vision therapy. I used to stutter when I read but now…now I don’t stutter. It’s just so amazing how God put this change into my life. Even changing diappers and wiping down a table is easier than it was.
Vision therapy has changed my life so much. I also couldn’t steer my bike that well and now I can steer really good.  I think vision therapy has helped me so much.
Even folding laundry and unloading the dishwasher is easier because my hands use to shake while doing it.  But I don’t do that anymore. Reading, when I’m reading I can hear my silent voice, I never could before.
What kind of changes will Vision Therapy make in your life?”
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551 5th Ave, 2nd Floor
​New York, NY 10176

What Our Clients Are Saying

"Our daughter is a very good student who used to breeze through all her assignments except those requiring extensive reading. Long history or science assignments caused her great anxiety and took a long, long time to accomplish. Since she had Vision Therapy, she has been handling her reading packets easily and best of all happily. She has easily reduced her homework time to an hour! Similarly, she is a good athlete a gymnast and a swimmer who could never make any team sport requiring hand-eye coordination. She now feels comfortable pitching, and catching, and making baskets. Finally, she no longer gets car sick. Vision Therapy is the greatest." (read more...)

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Phone: 212-265-4609
E-Mail: midtownvdc@gmail.com
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