little four eyes

The Treat Game: Stella's baby helps find matches during vision therapy at home

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!

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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 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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Dr. Nate (of Bright Eyes News) and reader Amber both just let me know that COVD (that’s the College of Optometrists in Vision Development) is sponsoring a 30 minute web interview with neurobiologist Dr. Susan Barry entitled “School Crossings: A Neurobiologist’s View of How Our System Fails Children With Vision Problems.”    The free web interview is targeted at parents and educators and will be Thursday, August 26, at 9 pm EDT.  The interview will be recorded, but I don’t yet know whether or how it will be made available for people who are unable to attend the actual interview.  As soon as I know more, I’ll update.

From the facebook event:

Hear Dr. Susan Barry answer questions about difficult school experiences that resulted from her vision problems; how, for example, she was mislabeled as a low aptitude student and assigned to a special problems class, and what her mother did to help her child succeed. And more….. including what you can do to help your child succeed!”

Dr. Barry is the author of the book, “Fixing My Gaze” which talks about her experience growing up with strabismus, and never achieving stereoscopic vision until she started vision therapy as an adult.  The book is fascinating and her background as a neurobiologist is clear, as she explains the vision system in a very engaging and understandable matter (you can read my full review of her book).  I’m certain that the web interview will be very interesting as well.

More details: “seating is limited to the first 1,000 people to respond.  To register for this free event, go to:  www.joinawebinar.com and enter the webinar ID number, which is 547-423-251, your email address, etc.  Just follow the instructions from there.”  Again, as soon as I know more about the availability of a recorded session, I’ll let people know.

Update at the end

I mentioned in my review of Fixing My Gaze, that I had two copies of the book to give-away, so here’s the details.

If you’re not sure what the book is about, Fixing My Gaze, by Susan Barry, is an autobiographical account about the author’s experiences growing up and living most of her life stereoblind, and then later in life regaining her stereovision through vision therapy.  Barry provides a fascinating look in to how the brain works and how it is that we see, along with the interesting story of how she learned to see in three dimensions.  Check out my full review for more details.

Ok, so if you’d like to be entered in a drawing for a copy, all you need to do is leave a comment on this post. I will do the drawing on the evening of Sunday, August 23.  On that evening, I will put all the entries into a bowl, and let Zoe draw two names.  This giveaway is open to anyone, anywhere in the world.

If you’d like more chances to win, you can also do any or all of the following – each item is worth one extra entry – NOTE: you must first comment on this post to be entered:

• Print up 5 of our coloring pages and take them to your eye doctor or eye glasses shop.   Leave me a comment on this post to let me know you did that.
• Send in your child’s photo for our photo gallery to ann@shinypebble.com.  If your child is already featured in the photo gallery, just mention that in your comment.
• Write up your story of your child getting glasses, for our in the beginning… category (or if you’d prefer, you could write about a different aspect of your child and their vision), and send it to ann@shinypebble.com.  I will post these stories from time to time on the blog.  It doesn’t need to be a long story, I just think it helps everyone to hear each other’s stories.  If you’ve already written a post for Little Four Eyes, mention it in your comment.
• Join the Little Four Eyes facebook group.  Again, mention it in your comment.
• Add a Little Four Eyes badge to your blog or website, and let me know in your comment that you did that.

Update — Thank you to everyone who entered!  I wish I had enough books to give one to each of you.  Zoe helped me with the drawing tonight…

we put everyone's name in a box - with extra entries for anyone who qualified. Zoe insisted on having her name in there, too. I figured I'd just have her pull another name if her's came up.

Janet was the first name pulled

Larry was the second name

Congratulations to Janet and Larry!  I’ll email you with details.

Fixing My Gaze: a scientist’s journey into seeing in three dimensions (find it at a library | buy it from Amazon.com), is an autobiographical account by Susan Barry about her experiences growing up and living most of her life stereoblind, and then later in life regaining her stereovision through vision therapy.  While that may sound a bit dry, Barry provides a fascinating look in to how the brain works and how it is that we see, along with the interesting story of how she learned to see in three dimensions.

Barry had infantile strabismus (strabismus that develops before 6 months of age), and had undergone numerous strabismus surgeries as a child, leaving her eyes straight, but with no binocular vision.  Her descriptions of life without stereovision were probably the hardest parts of the book for me to read, and I expect that’s likely to be true for any parent of a child with monocular vision. I kept wanting to believe that those parts of the book were exaggerated to make for a more compelling story, and I still don’t much like dwelling or re-reading those parts.  Vision is quite a personal thing, and different people adapt differently to things like stereoblindness, so I asked my mother, who is also stereoblind, about some of Barry’s stories, and was surprised to have them confirmed, though my mother’s problems are not as severe as Barry’s despcriptions.  Like Barry did, my mom does have trouble reading signs while driving and finds it difficult to navigate in unfamiliar settings.  On pages 58 and 59, Barry recounts how her stereoblindness led to her driving difficulties.

. . .  I paid attention to the input from only one eye at a time.  I switched rapidly between the two views, which made my world unstable or jittery, particularly when looking out in the distance.  Not surprisingly, I was a pretty lousy driver. . .

“How far in the distance are you looking? he [Barry's husband] asked.

“I don’t know.  Maybe one or two car lengths ahead of me.”

“That’s what I thought,” he said.  “Try looking much further in the distance.”

But looking in the distance was unnerving.  I felt disoriented, unsure of my location in space.  I felt like the car was drifting off the road.

But the book is not just made up of Susan Barry’s story alone, and that is one of the great strengths of this book.  The author strikes a very readable, and much more interesting balance between explaining the neurobiology behind how it is that we see, how the field of vision science has developed, and anecdotes from her own life and others who have had similar experiences.

Barry shines when she is giving us the science behind our vision, particularly how it is that we see in three dimensions.  Even more intriguingly, she discusses her thoughts on how the brain can rediscover it’s binocular vision pathways in adulthood, something that had been thought to be impossible.  Her professional background, as a professor of neurobiology is so apparent in these sections.  She is clearly practiced in explaining such complex concepts in a very understandable and engaging way.  My understanding of vision is so much more enriched from reading this – her students are lucky!  Her descriptions of the history of vision science, and how we have arrived at our current understand of vision and vision treatments are similarly interesting and well-presented.  She has done her research, and leads the reader deftly through what must have been pages and pages of articles.  She specifically focuses on strabismus and amblyopia (those being the most common reasons for loss of stereovision).

The other highlight of the book are the almost lyrical, and sometimes quite funny, descriptions that she gives of her first encounters with stereovision after starting her vision therapy treatments, from page 123:

When I gained stereopsis, I felt like I was immersed in a medium more substantial than air, a medium on which tree branches, flower blossoms, and pine needles floated.  I wondered if this sense of the air was what Monet spoke about in the quote at the beginning of this chapter:  “I want the unobtainable . . .  I want to paint the air.

After reading those passages, I found myself staring more intently at the branches on trees, noticing how the leaves and twigs stood out from one another, and truly appreciating my ability to perceive the spaces between them.  This book would have been worth it just for my newfound gratitude in my sight (though I appreciated much of the rest of the book).

At times, some of the anecdotes, particularly those from other people who have had their similarly stereovision restored, read like advertising testamonials for vision therapy, which dragged the book down.  Thankfully, these sections were short, and they did serve the purpose of  making the point that her experiences are not unique.  Barry also refrains from wholesale denouncing Ophthalmology or surgery as an option for some  forms of strabismus, though she calls on them to update their assumptions about the possibilities for treatments later in life.  The most hopeful passage of the book for me is from page 151:

While the best approach may vary from patient to patient, one basic principle needs to change.  The brain may be more plastic, more responsive to treatments in infancy, but this period of high malleability does not exclude the possibility that improvements can occur later in life [emphasis mine].

I would recommend this book to any one who is interested in vision, or in stories of the wonderous ways in which the brain can adapt and change.  I would especially recommend this to parents of children with strabismus or amblyopia, as it provides well-written insights to our children’s vision.  If you are one of those parents, though, do keep in mind that some of passages may be difficult, particularly if your child has not developed binocular vision.

Full disclosure: After hearing about this book from many different sources, I ordered the book from my library to review.  When I was about two-thirds of the way through, I noticed an email offering me a free copy to review.  I responded to the email saying that I was already reading the book, but would love to have a copy to give away to my readers.  I was sent two copies to give away, and one copy to keep for myself.  I do not believe that that has colored my review of this book, but I feel it’s important to be open about these things.  Also, she thanked a couple of librarians in her acknowledgements, and as a librarian myself, I have a very soft spot for people who thank us.  That may actually have colored my review more than the free book (actually, I don’t think it did).

Book Give-away: As mentioned above, I’m be giving away two copies of Fixing My Gaze, all the details are in my give-away post.