it feels closer…
My approach with the more challenging Vision Therapy cases always tends to be overly optimistic. While it’s true that I am always suspect of any treatment that claims it can “cure anything”, evidence shows that Vision Therapy can produce gains in more aspects than not, since vision is the overriding input. At times though, even my optimism of a successful VT campaign can be rattled, as it was the day I was handed Polly’s case report.
Polly is 22 years old. Her spherical measurement is -11.25 in both eyes with roughly 4.50 diopters of astigmatism. At the age of 20, Polly returned to her native Iran to have her 40 diopter exotropia surgically repaired. Her first exam performed by a Behavioral Optometrist happened to be in our office over a year after her surgery, and was scheduled because she was constantly seeing double following the medical intervention. Her exam findings in our office were 18 esophoric at all distances with an intermittent trope inward at both distance and near, with a constant 5 diopters of hypertropia in her right eye. Previous to visiting our office, she had been told by two local Opthamalogists that her only options for repairing her double vision were more surgery, prism in her glasses, or learn to live with it. Not surprisingly, she wasn’t satisfied with that answer, and researched Vision Therapy. By the time Polly began VT, it had been about 18 months since her surgery. 18 months of seeing double, 18 months of trying to continue college under these conditions, 18 months of being chauffeured around since she could not drive, 18 months of glasses to correct her spherical and astigmatic concerns, and 18 months of the strongest case of asthenopia I have come across.
My first meeting with Polly was painful, for both of us. She just looked horribly uncomfortable in her glasses, had a pretty definitive head tilt, was squinting both eyes almost constantly, and stated that headaches, dizziness and nausea were just part of her daily ritual. She did not make eye contact with anyone, in fact, she stared at the floor most of the time. According to her, down gaze was the only place her eyes didn’t hurt or cause her to have an immediate headache. She told me that she had been living this way for a year and a half, and since she was entering a Masters program, she wanted to give VT a try. Not to help with her academics – which despite all of this, were pretty good to my amazement – rather, her one and only goal for her VT program was more related to getting to class. She wants to drive.
Anyone optimistic that VT can be successful in helping Polly pass her driving test, please step forward. Don’t worry, I’ll wait. 🙂
During our discussion of her goals, I asked Polly to remove her glasses while we were talking. I didn’t reveal this idea to her, but I wanted to see if her symptoms of visual stress subsided at all without her specs. Glasses on or off was one intangibles of asthenopia that seemed easiest to manage for Polly, and considering her history and need to stare at the floor, I figured it was worth a try. We sat and talked for a few minutes about our VT program and what she should expect in terms of office visits, homework, and so on. Although I’m sure the world seemed incredibly blurry without her glasses on, Polly actually was looking straight ahead during the conversation. She also seemed to look upward while constructing a thought, and was attempting to establish eye contact. I deliberately stood up during the conversation and walked across the room – pretending to grab something – and Polly’s eyes followed my face. Since Polly’s glasses did not contain prism – and her constant down gaze had all but closed off her peripheral awareness – I asked if she had ever experimented with RGP’s. She said she had, but they made her feel “gross”, so she threw them out. With this, I made a mental note to ask my doctor of the possibility that Polly’s glasses were actually making her life more difficult, and if trying RGP’s again would assist with central-peripheral integration. My doctor agreed it was worth a shot.
My first activity for was Polly moving her eyes in the four main positions (up, down, left and right) and hold for each for one second, while seated. She got through one cycle, turned green, said she was about to pass out, and I assisted her to the floor where she would lay dizzy and nauseous for 10 minutes. Session over.
Our sessions continued this way for a while. As her therapist, I walked a fine line between helping her and becoming counter-productive. About 4 months into her program Polly was making great gains, despite needing to end a few sessions early after feeling sick. Her central-peripheral integration was coming along, thanks to those RGP’s, in combination with some exhaustive VT work. Her comfort level in all gazes was greatly improved, and at times she could follow a moving target without feeling ill. She still saw double intermittently, although most of her symptoms had subsided, minus the dizziness. I got brave one morning and sat her in front of some projected Quoits, which were set at zero. My idea was to have her sit still while trying to be simultaneous. Before we started, she asked if I “had a barf bucket nearby?”. She got through about 2 minutes with no problem, and her reporting led me to believe she was simultaneous. In the weeks that followed, we repeated this activity, each time hoping she could last a minute longer than the previous attempt. And yes, I was timing it.
Three Fridays ago, I met with Polly for our weekly visit. Again feeling brave, I slowly moved the Quoits three diopters into a Base Out position just to see what would happen. Polly said it hurt her eyes, but didn’t feel dizzy or nauseous and still saw clear and single, so we pushed on. After looking at the target for 3 or 4 minutes, Polly sat back in her chair and said “it feels closer”.
Suddenly, I felt dizzy! She is seeing SILO!!!!
I met with Polly this morning and again she had SILO both in convergent and divergent postures, this time for 15 minutes total. Even with this, Polly still has a long way to go. Her dizziness continues occasionally and her ranges are still pretty small, but her double vision is gone and she is comfortably seeing the world. She wears her RGP’s, makes good eye contact, is religious about doing her homework, and her mom has noticed how much her posture has changed since starting Vision Therapy. Apparently, Polly has also been criticizing her mom’s driving lately since she has a new awareness of how close the other cars are on the freeway. She has even enrolled for her driving test the first week of June.
Just another VT success story. Happy Friday!!