A Mile of Trouble – Part 1

Regardless of which model of vision we work under, most quality Vision Therapy programs are built upon a hierarchy for development – be it visual, motor, perceptual, or some combination of the three. They all are good. We approach visual skills from the top down and from the bottom up, always adjusting to the needs of our patients.  If we were to ever cultivate a method to diagram a patient’s path through Vision Therapy, it probably would look more like a plate of spaghetti than the more familiar and discernible line graph. Not that patient’s don’t continually make upward progress, because most times they do, but sometimes in VT the shortest distance between two points is anything but a straight line.  We twist it, turn it, bend it, tweak it, swing it and flip it to help our patients improve.  It’s just how it works. One sign of a good therapist always seems to be the ability to adapt and adjust when a roadblock presents itself; ensuring that forward progress continues. When I met the incomparable and iconic Dr. Harry Wachs for the first time, he told me the only difference between him and the rest of us is ” 2 years and 9 months” (the amount of time he spent in Optometry School), he’s just had more time to learn from the challenges he’s encountered and adjust his programming accordingly.  Dr. Wachs was turning 82 that same week.

One of my longest running and certainly one of my most endearing patients has been challenging my adaptability skills in many ways.  Most patients and their families come into the office looking for help, and when it’s offered in a definitive, helpful and logical and fashion, they’re more than willing to partake in treatment. For this young man, the circumstances were quite different. His mom was born and raised in Austin and met his dad in the Middle East while serving as volunteer physician in the Peace Corps.  They fell in love and started a family, moving stateside to be near mom’s family. Dad’s culture is such that the first born son, often referred to as “the prince”, is supposed to be a model of perfection – thus the inference of royalty.  His personality is nothing short of a delight, everything you might imagine a prince to be; his grades, however, have been sorely lacking.  He has been diagnosed with a borderline spectrum disorder and when I met him, had a cargo load of visual deficiencies. He also can be a touch socially awkward around children his age.

Being a physician, his mom fully understood the therapeutic setting and was on board with our treatment plan; but dad, not so much.  The original Vision Therapy plan estimate was 48 weeks, which has now been extended.  This young man has been struggling not only with his visual skills, but academically and socially. In Vision Therapy our progress has been slow and steady, but considering he’s also a twin who was born 10 weeks prematurely and is wearing +6.00 correction for his hyperopia with three diopters of astigmatism in each eye, he’s doing alright.  Every visit begins with him lumbering down the hall with a big smile and a random –  and seemingly rhetorical – question to which he fully expects an answer. Last week’s version: Does this office have an attic?

According to dad, there is nothing wrong with his son that a little motivational speech won’t fix. We have tried and tried to help dad understand the challenges of his son, with no success.  Dad is incredibly intelligent, and after our many conversations he may conceptually understand the visual system as well as most therapists, but admitting that his son is challenged by any of it is a much different story.  His rebuttal is always the same: My son doesn’t have trouble with that.

So, what to do?


Posted on January 20, 2014, in From My Perspective.... Bookmark the permalink. 5 Comments.

  1. Have you nicely challenged Dad, visually?


  2. You bring up an interesting point, Robert. If Dad views his son as lazy, no amount of “convincing” is likely to work, other than as Karen notes trying to challenge him visually (even something as basic as taking him to the brink of clarity and diplopia while wearing prism and having him read or do a sustained visual task without a break). Obviously some Dads need to come in to the VT room and see what their child struggles with if they’re in denial. But ultimately it’s going to be mom who has to live with Dad, and as long as she’s on board we’re usually ok. Can you address the conversation when you advised mom (yet alone Dad) that VT was going to extend beyond 48 weeks?


  1. Pingback: A Mile of Trouble – Part 2 | VT Works

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