Saturday, January 19, 2013

Vision Therapy

Yesterday we did something that I have been wanting to do for a long time: we saw a behavoiral optometrist, also known as a vision therapist.

I can't remember when Juliana's eyes first began crossing. We don't remember seeing it when she a newborn, but then again she was very sick and didn't spend a lot of time with her eyes open. By the time she was beginning to make eye contact I was beginning to notice that her eyes looked a bit "off." Here she is when she was 3.5 months old. If you look carefully, you can see that each eye is looking in a slightly different direction:

Several months after this she had her first appointment with an opthamologist. It was a relief to hear that her eyes were healthy. The opthamologist wanted us to begin patching her eyes. We would help strengthen her eyes by patching an alternate eye each day for one or two hours.

Strengthening the eyes is well and good, but I now realize that the root problem is coordination and integration - not strength. We have actually never noticed any problem with Juliana's vision, other than the way that her eyes look. But surely it must affect her vision somehow. Other than patching or perhaps eventual surgery (a bridge that I am not sure I would ever cross), her opthamologist has no suggestions.

I needed to see someone with solutions. The problem with the eyes is really a problem with the brain. We've been re-programming her brain through occupational therapy and physical therapy. Now I needed someone to focus just on the eyes.

And so yesterday afternoon we sat down for a vision assessment. The optometrist spent some time looking at Juliana's eyes from different angles, looking through different blocks of glass, shining lights in her eyes, observing the way that she tracks a moving object. She saw the strabismus of course. I explained that it seemed like it had improved a little bit in the past few months. We used to always see it in photographs - sometimes having to delete many photographs because her crossed eyes were almost painful to look at - and now it is less obvious. Example below. I can still see the strabismus, but it is not glaringly obvious:

Overall the evaluation went very well and the optometrist had a lot of positive things to say. Juliana's eye aren't stuck in the wrong place; they drift in and out of the right places. She's not in glasses. She doesn't appear to have any visual difficulties. She doesn't misjudge distance or depth. Her skills with throwing and catching a ball are simply awesome; she is very accurate. She naturally will cross the midline of her body (read why this is important). She is crawling, which is a hugely integrating activity that is good for the brain and thus good for the eyes (read why). These are all good signs that bode well in her favor. After the assessment, the optometrist agreed with me that her right eye is in a little bit worse condition than her left (I wonder if this could possibly relate to having torticollis towards the right for so long?? I forgot to mention it).

Here's what we'll be working on for the next two months:
-Getting Juliana to look out of the corner of her right eye. Stretch the eye to the side.
-When she is focused on something up close, quickly direct her attention to something far away. This quick transition stretches the eyes.
-The optometrist said to continue with patching for the time being. When we're patching, we should be sure to play actively. Fine motor in particular is good to really encourage hand-eye coordination.
-Continue to work on crossing midline and overall integration.

After this we'll be back in to see the optometrist and see how things have improved. She will continue to give us exercises to work on at home. I'm a little daunted by the idea of getting her to "stretch" her eye on a regular basis, but otherwise I am hopeful that these exercises will not only improve the look of her eyes but will more importantly help improve this function of her brain.

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