Stella’s developmental optometrist views patching as a first step in amblyopia treatment. Patching (in our case, Magic tape over the lens of the stronger eye) boosts the acuity of the weaker eye. Stella’s lazy eye is growing stronger, and vision therapy is more and more focused on training her eyes to work together for strong binocular fusion, in an effort to encourage stereoscopy, prevent or minimize regression and provide a lasting fix.
Stella’s daily patching time now feels pretty turn-key, even though (as is my nature) I do it on the fly. She does a solid hour, at least, first thing in the morning, kicked off by some video watching. Sometimes it says on and patching is done by late morning. Sometimes patching is completed in two or three chunks. I seize opportunities strategically. If she’s engrossed with a toy that demands a ton of hand-eye coordination, I’ll throw on her patch to give her amblyopic eye a workout. We’ve got patching down! Vision therapy? Or more accurately, getting 20 to 30 solid minutes of vision therapy done at home? Still a challenge. But as her weaker eye improves, the nature of her vision therapy is changing. The latest exercises seeming to provide more improvement bang for our frustration buck. So we’re trying harder than ever.
Ever since Stella’s vision therapy progress evaluation which showed great gains, we’ve been doing a bit of what Susan Barry discusses on page 150 of Fixing My Gaze: monocular fixation in a binocular field (MFBF). This means that instead of being completely excluded via the patch, the stronger eye is merely put at a disadvantage. Her dominant eye is still able to receive and contribute visual input, allowing the eyes to work together, but the amblyopic eye is forced to do the heavy lifting. Several doctors/researchers, over several decades, have endorsed the effectiveness of this approach (Brock, Cohen and Hess for starters). Our experience with MFBF is limited but growing.
Almost every day, Stella dons a green-tinted patch over her strong eye and watches a video on our TV, the center of which is covered by a transparent red sheet. Her strong eye can’t see what’s in the red area thanks to the green tint, but it can still see what’s going on the periphery. In order to take in all the action and view the complete picture, her un-patched amblyopic eye has to pick up the slack and garner what is usually the most important part of the scene (whatever is centered, like close-ups of facial expressions, etc.). Her eyes are working together but her weaker eye has to perform at a higher level, setting the stage for binocular fusion. This work counts as patching time, so hooray for that!
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.
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.
McKenna’s surgery was 5/21 at 9:30am. We had to be there 2 hours early and the drive was an hour! So the wait was horrendous! I do not understand why we have to be there so early but anyway. My husband went in when they gave her the gas and he couldn’t talk about it for about 15 mins, he said he never wants to see her like that again (that’s why I made him do it). The surgery took about an hour, and that went by VERY fast. We went into the phase 1 recovery area and she was already fighting with a nurse, I think she woke up alone and got tangled in her IV line. She couldn’t open her eyes and focus on anything from the anesthesia and she was still groggy so the first 20 mins were the roughest. Her tears were blood and since the nasal passages and everything are connected her runny nose (from crying) was bloody as well, but that passed within a minute or so, THANK GOD! We moved to phase 2 recovery and once they took off the board and IV from her arm she calmed down because that is the thumb she sucks and she couldn’t get to it. She drank some juice and didn’t get sick so within a total of about 30mins from the end of surgery we left to come home. We brought her sunglasses which I think helped and she fell right to sleep once we got on the road. She napped again after about 20 mins at home and did well the rest of the night. She never did vomit from eating and we gave her milk for bed.
She only tried to rub her eyes when she first came out of anesthesia but I think that is because she couldn’t see correctly. Since then she has been great! Putting in the ointment is difficult and definately takes two people, but once I am done she doesn’t cry anymore. We noticed double vision for the first 2 days as she would try to pick things up. This is actually a good sign in that her eyes are trying to work together as they hadn’t before. We worked with her like “Where’s mommy’s nose” and having her pick up small objects, and it has improved dramatically. Her eyes do wander slightly to the outside now and then but for another few weeks we won’t be able to tell if they are just adjusting or if it was an over correction.
McKenna also has a Hypoplastic Cerebellum; this effects her balance and coordination; so on top of not having any depth perception her balance has been delayed so at 22 months she has still been working on walking. Since the surgery she has really been more balanced and is doing wonderfully with her practicing! She is even carrying things while she walks now which she sould never do before because she needed her arms out to balance.
So, right now we are very pleased with the surgery and look forward to her further development. I am sure she will be happy when she can play in the bath in about a week and we don’t have to put the ointment in her eyes anymore. Here is a picture the day after surgery so you can see what to expect with the redness.
Things have been going pretty well with the patch. The first two days she did not want anything to do with it, and even hit me. Then the third day she didn’t try at all to take it off, I was very surprised. I thought it was going to be a continuous battle. As long as she is kept busy she doesn’t mind at all. I set her on my lap and we read or stack things and she remains focused. The other day after I took the patch off, she held her hand infront of her eye, I think she wanted to cover it so that her left eye would straighten out. Her eye is straight when the patch is on, though I haven’t seen much improvement once it is removed. We only leave it on for an hour a day. I hope that is long enough. I wonder what dictates the different lengths of time.
As for suggestions on keeping the patch on:
Once I put it on and put her glasses on I clap and say “yaaaay” ..she smiles and claps then. I also just try to play with something that will hold her attention.. like light up toys with buttons, books, and stacking (or knocking over) things. If she gets bored, that seems to be when the glasses come off and she starts pulling at the patch.
I wanted to write up a post on the surgery – mostly writing out things that I had wanted to know before the surgery, just in case someone else is facing the prospect and is wondering what’s in store. Obviously, the surgery experience will differ for everyone, but there are certain to be commonalities. Apologies for such a long post, but I wanted to get all the details out.
Many moons ago, (or so it seems!) in September of 2007, I had an appointment for my son Braden to get his eyes checked. Although my pediatrician insisted that Braden’s eyes were NOT turning, my gut told me differently. I made an appointment with an eye doctor on my own. Sure enough, Braden’s eyes did intermittently turn in. Upon first hearing Braden’s diagnosis of Esotropia I was told that I could do surgery, however, it was only cosmetic, and would not correct his vision. We would begin with glasses, continue with eye exercises when he was older, and VIOLA- Problem Solved. Completely ignorant of the now all too familiar terms- strabismus, alternating Eso, High AC/A, convergence insufficiency, DVD, etc- and only a mom to a darn cute little boy with an eye turn- I was thrilled. Of course I’d want to avoid surgery at all costs.
I was on cloud 9 walking out of the door to the Optometrists, I could definitely deal with glasses and eye excercises. I was so happy that I had taken the initiative to go to the Doctor’s against my Pediatricians opinion.
Fast-Forward 2 months, and upon a visit to my pediatrician’s office, the Dr. who was seeing my son (not my pediatrician) stared intently at my son and asked what I was planning on doing about his eyes. I proudly told him that I had taken him, myself, to an Optometrist and what the Optometrist had told me, and watched his face scrunch in horror.
“I think you need to get a 2nd Opinion” he said “from an Ophthalmologist, if it was my grandson, he would have already had surgery”
I walked out of the pediatrician office jaded with doubt.