Is It Possible to Have A Learning Disabled Eye? Monroe “Puggy” Farmer – Part 3

We left you in Part 2 with Tonya finally getting some relief from double vision when reading, or trying to use binocular instruments, when a primary care Optometry resident at her University determined that she could benefit from some vertical prism.  But her struggles were far from over.  Tonya related during our in-office seminar to the SUNY Residents yesterday that on the Visagraph she still tests as having only a grade level equivalent reading performance of a 4th grader.

So let’s review a key concept from neuroscience that will help Tonya understand her visual function better, and in turn will illuminate how she treats patients when she embarks on her own practice of Optometry in West Virginia.  Amblyopia is a developmental visual disorder of cortical origin.  It has much less to do with the eye than it does with the brain.  As such, it is better termed a developmentally delayed or learning disabled eye, rather than “lazy eye” – as amblyopia is known in the vernacular.   But the fact that the public and even many professionals persist in referring to amblyopia as lazy eye signals that our concept of amblyopia is as outdated as the notion of referring to a learning disabled student as simply lazy.  There is much more to improving amblyopia than patching or penalizing the stronger eye to force the weak or lazy eye to become more industrious.  Just as we ultimately want to mainstream the student with learning disabilities or developmental delays as much as possible, the same imperative should be present for the individual with a developmentally disabled eye.

The key to aiding individuals like Tonya to process information when the connections between one of her eyes and the brain is relatively disabled has been termed perceptual learning.  Note that this label was coined not by behavioral optometrists, but by vision scientists and researchers publishing largely in ophthalmologic journals.  And while it may be surprising to ophthalmologists (and pediatricians) that amblyopia has an impact on reading, it is difficult to feign surprise when these connections appear in one’s  own literature.  Tonya knows, after our Residents’ seminar yesterday, why she has continued to struggle with reading.  In Part 4, we’ll finish helping Tonya build on the start she got in “remedial seeing” with Puggy in West Virginia and the Primary Care Resident at her College of Optometry.

- Leonard J. Press, O.D., FCOVD, FAAO