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Vision therapy update: Stella’s first progress evaluation

December 7, 2010 4 comments
toddler wearing therapeutic prism lenses during vision therapy

Vision therapy: Skills and porcupine quills! Stella's first time wearing therapeutic prism lenses.

Last night and this morning, there was a nerve-wracking build-up to Stella’s check-up, wherein her developmental optometrist would gauge how patching and vision therapy have helped Stella, or not. I’ve worked very hard (okay, harder on some days than others) during Stella’s first three months of vision therapy, sometimes pulling my hair out, often swallowing pesky doubts, and occasionally guzzling wine. She’s 27 months old now, and has been such a trooper through glasses, patching and vision therapy. She asks to do certain “eye games” and requests her patch in the morning so she can watch a video (it’s her routine, plus there’s no TV watching without a patch). But she can also be impossibly resistant in that flippant, in-your-face way common to two-year-olds. And Stella’s not the only one with a short attention span! What was I talking about? Oh yeah–this isn’t easy, folks!

I’m proud of Stella regardless, but has all our effort paid off? As we headed out to the doctor’s office, part of me was absolutely certain that yes, her progress has been hit-you-over-the-head obvious and will be decisive and documented for posterity in the history books (or at least Stella’s patient records). But, I’ll be honest. Another part floundered and secretly wondered if we’d been throwing away hundreds of dollars each month.

The verdict: Stella has made solid improvement! Stella’s amblyopic eye is getting stronger and her eyes are working together more effectively. In August, when Stella was 24 months old and had been patching for maybe three weeks, her left eye was judged to be 20/40 [edit: found out at vision therapy that it was 20/80 before patching began]. Her right, 20/20. Since then, her left eye ramped up to 20/30, and her right is still 20/20. Other positive signs: During the exam, Stella’s eyes didn’t cross like last time. She showed much clearer evidence of 3D vision and binocular vision while wearing red/green glasses. These areas still need a lot of work, but Stella’s doctor and I see her first three months of patching and vision therapy as a success.

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Vision therapy for toddlers… an exercise in patience.

September 16, 2010 53 comments
Stella, back in May, on her first day with glasses. (She was 20 months old.)

Stella, back in May, on her first day with glasses. (She was 20 months old.)

Hello! I’m Amber. Ann recently posted about Stella, my little “fashion visionary.” She honestly does love wearing that “pirate girl” onesie! Stella very recently turned two and, in addition to wearing glasses and patching three hours a day, is two weeks into vision therapy. I’d love to share our vision therapy stories and hear about your experiences, especially with vision therapy for very young kids as it seems to present unique challenges.

First, let me explain how our path led to vision therapy. Treatment for her vision issues (first, accommodative esotropia and now ambylopia) began in April in the ER at Seattle Children’s Hospital. She’d been sick with a bad cold and had lost about a pound, and that morning I thought she’d bumped her head (saw it out of the corner of my eye–I wasn’t sure about anything but the screaming). That’s when both of her eyes suddenly started crossing–severely. Her pediatrician was visibly alarmed and sent us to the ER where they ruled out serious lie-threatening problems via head CT scan and tentatively diagnosed her with “convergence spasms.” A couple weeks later, we were routed to one of Children’s Hospital’s ophthalmologists. We now realize that the illness and stress must be what brought out Stella’s latent or, at the very least, hard to detect intermittent esotropia.  I wish the ER had been aware that this was actually a rather common presentation, so Stella could’ve avoided all that radiation. Hindsight is 20/20. Unlike Stella’s left eye. Ahem.

After a very thorough exam, the ophthalmologist prescribed glasses, which have helped a lot in keeping her eyes straight. Then, at the follow-up appointment, they told us to start patching as visual acuity was decreasing in her weaker eye (her left eye has a stronger prescription which, from what I gather, means she has anisometropia). They said she may need to patch for years, but never mentioned vision therapy, I suppose because most ophthalmologists not only don’t offer it but aren’t very familiar with or approving of it. After reading Fixing My Gaze, I became dissatisfied with this approach for Stella and was excited to explore the possibility of vision therapy. Our second opinion came from a developmental optometrist who told me that Stella was too young for vision therapy. Luckily, we sought out a third opinion from a developmental optometrist who, among other seemingly innovative suggestions that differed from what we’d heard elsewhere, said Stella could begin vision therapy at this age! We now go every Wednesday morning to play “eye games.” The vision therapy guidelines they gave us initially say that most courses of vision therapy span nine to 12 months. Our journey is just beginning.

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little crossed eyes

July 13, 2008 Leave a comment

Looking back, I’ve realized that I’ve taken fewer pictures of Zoe, and shared even fewer online. I’m pretty sure that this is largely because of her crossing her eyes, I’ve been more conscious about how she looks. Not that I’m ashamed of her, but I’m feeling self-conscious about whether I should have tried to get her in earlier when I noticed her eyes crossing again.

Zoe a few weeks before her eye appointment

Zoe a few weeks before her eye appointment

Once we’d had the appointment and learned new she needed a new (pretty dramatically higher) prescription, it’s been even harder to see her eyes moving in, knowing (well, hoping) that if only she had her new lenses, her eyes would be straighter. I was also a bit worried that she wouldn’t like the new lenses. I know how thrown off I get when I get new glasses with a new prescription, and hers is a much bigger jump than I’ve had. I worried that all the gains we’d made in her wearing her glasses so well might be undone.

I needn’t have worried. The lenses came in on Wednesday, and Chris got them Thursday afternoon. Zoe had been sent home early from daycare for a fever, so she wasn’t feeling well to begin with, but she didn’t seem to have any problem with the new lenses. I could immediately see that her eyes looked bigger with the stronger prescription. I was worried that her eyes didn’t seem much straighter that first evening.

First evening with her new lenses

First evening with her new lenses (um, please ignore the messy kitchen)

They look straighter now, though they still are a bit crossed. We have a follow-up appointment in 2 weeks, so we’ll see how she looks then.

Second day with the new lenses

Second day with the new lenses

how did they know she needed glasses? Part II

March 16, 2008 1 comment

We were reassured after the first eye appointment, and didn’t really worry about it until around her first birthday when we noticed her eyes crossing a lot more again – specifically, it seemed that her right eye was turning in.

This time we sent digital photos to the ophthalmologist and based on the pictures, she agreed that we needed to bring her in. Before that, though, she wanted us to try patching Zoe’s left eye to strengthen her right eye for a few weeks to see if there was any improvement. She also warned us that it would not be fun or easy.

She was right, Zoe did not like having the eye patch put on. But once it was on, she was pretty much ok. I wish I knew the secret to her keeping the patch on, but in reality, she never tried to take it off. She only needed to wear it for about 4 hours each day, but that meant putting it on before daycare, and then letting the teachers know they should take it off before putting her down for her morning nap. Eventually, she got used to us putting the patch on, and I was optimistic, because she seemed to have no trouble seeing through the right eye when her left was patched, but in the end, the patching made no real difference.

At this next appointment the ophthalmologist determined that both eyes seemed to turn in at different times, and it was probably due to her being far-sighted and needing to cross her eyes to focus. She then held up lenses of varying strength in front of Z’s eyes while holding a toy nearby to see if that lens seemed to correct the crossed eyes. Since Z can’t read yet, it isn’t as important that she see closeup with crystal clarity so much as it’s important that her brain get used to her eyes working together. So, with the closest guess at a prescription in hand, we headed off to get glasses.

how did they even know she needed glasses?

March 15, 2008 3 comments

Probably the most frequently asked question I get is how we knew that Zoe needed glasses. And fair enough. Zoe’s not a big talker yet, it’s not like she could read off letters on a vision chart or anything like that.

Around nine months, we noticed that Zoe’s eyes weren’t always aligned.

(notice that even though the eyes are not perfectly aligned, the reflection from the flash is in the center of both pupils)

We mentioned it to our pediatrician at her 9-month appointment. Of course, on that day, Z’s eyes were perfectly straight, but luckily our pediatrician believed us and recommended that we contact an ophthalmologist about it. She also recommended that we bring with us pictures in which she looked cross-eyed. This was a great suggestion!

So I’ll reiterate. If you are taking your child in for an initial visit because you notice his or her eyes not lining up correctly, snap a few pictures (especially with flash) and bring them with you. That way, even if your child’s eyes are perfectly aligned that day, you can still show the doctor what you’re seeing.

At that first appointment, they used cards with a square of alternating black and white stripes to measure her vision. You know how if you look at thin black and white alternating stripes it kind of looks like they’re moving? Well that’s the concept they use with the cards. If the baby notices the square, then they assume she can differentiate between the black and white lines. They show cards with progressively thinner lines until the baby doesn’t notice them at all. They also dilated Zoe’s eyes to get a closer look. In all, I’d say Zoe liked the eye doctor visit less than any pediatrician’s visit, even one with shots.

Based on looking at her eyes while dilated, the ophthalmologist noticed that Zoe was more farsighted than normal (all babies are a bit farsighted), and she agreed with us that Zoe’s eyes weren’t always aligned, but she wasn’t too concerned and told us to keep an eye on her, and watch particularly for photos where the flash reflection in the eyes are not in the same place on both eyes. At that time, all of her pictures had the flash reflections lined up.


(an example of a picture taken a few months later of Zoe’s eyes not lined up and the flash reflection not being in the same part of the eyes).

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