How Many Push-Ups Can YOUR Pencil Do?

Who cares?  Doesn’t matter how many pencils you have, or how many push-ups they can do.  Pencil push-ups are B.S.  They don’t do anything to help the condition they’re  “prescribed” for, which is poor convergence.  You can read the facts about how to treat poor convergence hereCI and the Private Eye has helped get the word out, so let me tell you about a teenager I just examined this afternoon who demonstrates the ongoing need for doctor and patient education on this.

Julia is a very bright 14 year old.  As a kindergartener she could read 5th grade level material.  The problem was, she hated to read.  Wouldn’t take her more than 5 minutes before she was ready to throw the book against the wall.  But she would sit and listen to others read all day long.  Five years ago, at age 9, her mother took her to an optometrist who prescribed glasses for nearsightedness.  She still hated to read.  At age 10 she returned and he upped the power in her glasses.  She still struggled with reading.

This isn’t Julia, rather it’s the poster child who represents all young children who struggle with near work despite being very bright.  No one it seems could figure out Julia’s problem.  They gave her Section 504 Accommodations in school with extra time to complete near work.  They treated her as if she were legally blind, even though she was 20/20 without glasses for desk work.  She continued get good grades though reading was still torture and homework took forever.

Julia’s mother decided to consult with an ophthalmologist to get another viewpoint.  She was told that Julia had convergence insufficiency, that her glasses needed to be made stronger, and that she should do pencil pushups to strengthen her eye muscle control.  This was at the end of 2007, and Julia found the pushups worthless.  Even though the CITT study hadn’t come out yet, Julia was smart enough to know it was a waste of time.  The ophthalmologist decided to refer Julia to a pediatric ophthalmologist, in mother’s words “one of the biggest specialists in the area”, who prescribed 10^ Base-In Prism.  Julia didn’t find that of any benefit either, so the specialist wrote an Rx for an additional 6^ Base-In Fresnel to be applied over the right lens.  No help.  Not surprising either, given that base-in prism glasses are no better than a placebo in helping children like Julia with reading problems, and you can read about it here.

So mother decided to take Julia to an optometrist last year who worked with visually impaired kids, since she was functioning with reading like she was legally blind.  Her parents had gotten her a Kindle, and she noticed that if she enlarged the print enough, reading was manageable.  The optometrist recognized that the prism  wasn’t beneficial, and wrote Julia a new prescription telling her parents that what she needed was glasses with a higher correction for astigmatism.  Sure enough Julia saw a little better far away, but reading was still torture.

Determined to get to the bottom of the problem, mother went to the top of the mountain:  Wills Eye Hospital in Philadelphia a couple of months ago.  Evidently the low vision optometrist determined that Julia had some sort of tangle of blood vessels in the retina that was probably not of concern.  Determined to leave no stone unturned, Wills conducted the following tests:  OCT, Multifocal ERG, Farnsworth 100 Color Test, Fundus Photography, Fluorescein Angiography, and a Goldmann Visual Field.  After all that they determined that Julia’s headaches when reading, print running together, skipping lines when reading, copying errors, visual fatigue and needing large print size had nothing to do with her eye health.  The only treatment they offered her was eye muscle surgery.

Julia’s mom wasn’t ready to have her daughter  operated on.  Wills told her that if the eye drift were just up close some exercises might help, but since the drift at this point was happening both far and near, surgery was the only option.  It just didn’t make sense to Julia’s mother that there wasn’t a better non-surgical alternative.  So she went to the Internet.  And that’s how she wound up in my office this afternoon.  Julia has intermittent, alternating exotropia at distance and near and the only sensory stimulus on which she fuses is a random dot stereogram.  Prism does not help her fuse.  She will be a marvelous vision therapy patient.

John G. Young, M.D. is a retired, Board Certified Psychiatrist in Boulder, CO.  He has an interesting website, Adventures in Creativity which contains the following, fascinating concept video on intermittent exotropia.  The clip is designed to make you a little uncomfortable, so be forewarned.  I apologize if it offends you.

If you’re uncomfortable now, think of how uncomfortable Julia’s mother is after finding us only through the Internet.  If this in any way motivates you to make sure that children like Julia aren’t overlooked any longer, spread this piece around.  And for good measure, here are a couple of video clips that inform rather than titillate.

– Leonard J. Press, O.D., FCOVD, FAAO

9 thoughts on “How Many Push-Ups Can YOUR Pencil Do?

  1. Len, This is a great service you do for the public and for the profession. If we give the professions benefit of the doubt, that they are attempting to “protect” the public by not referring to a behavioral optometrist; they may be well meaning but ignorant. The result of this ignorance is that untold millions of patients are being harmed. The patient’s quality of life goes down and down. They are sentenced to a life of underperformance and pain. I am sure that all of us have experienced the patient who has spent thousands and thousands of dollars on “tests” to find out; “Your child is not doing well and there is nothing medically wrong.” If the $$ spent on unnecessary medical tests had been spent on optometric care (other than increasing minus or cylinder), the problem would have been solved. Of course, we in behavioral optometry realize that some problems are medical. I have full confidence that optometry will, as we have in the past, consult with or refer to the medical profession. Too bad this relationship in most cases is only one way.

  2. As I am not in the field, I do not understand the technical parts of these blogs. As a patient and a parent of someone with an eye condition, I can’t believe that so many people have to find out about vision therapy by the internet or through another parent. I do not understand how eye surgery can be performed without attempting the non-invasive treatment first (or before at least informing the patient/family of the option). Is there some legal loophole that allows MDs to perform eye surgery without educating patients on vision therapy? It doesn’t sound like true informed consent to me.

    I am finding it difficult to think of any other condition where it would be acceptable for a surgeon to operate without trying non-invasive treatment first (if available) or at least letting the patient know of the other treatments so that an informed decision can be made. It is also bizarre that in non-surgical cases like mine, many of us are told to do nothing and only find out about vision therapy by chance or by doing an independent search.

  3. I greatly admire Julia’s mother for not giving up and finally finding the help her daughter needs, but it shouldn’t be this hard! Binocular disorders need to be better diagnosed and their role in reading problems better understood.

    • I fully agree, Robyn. Here’s the analogy I’ve been giving for quite some time. Many years ago, there was a similar schism in the orthopedic field. If you went to a surgeon for an opinion, you were either “bad enough” to require surgery (or medication), or there was no treatment indicated. When asked about physical therapy the surgeon would say it’s unproven and a waste of time. Ultimately the two fields got together, and now you’ll find them working in whatever the best interests of the patient are. In some instances it’s surgery; in others it’s PT; in yet others it’s some combination. We’re not that enlightened yet in the eyecare field regarding vision therapy. And I guarantee you, it’s not for lack of trying on the part of the non-surgical specialists. So you’ll have to ask the surgeons why they’re still in the dark ages when it comes to VT.

    • You are correct, Sue. It shouldn’t be this hard. If an aggregate of parents go back to the doctors who told them “everything was fine” and tell them that in essence they acted unethically and/or incompetently by not diagnosing their child properly, perhaps that will have further sway. While MDs can almost be excused for this not being within their education (by and large), ODs should know better. It’s in the Clinical Practice Guidelines of the American Optometric Association.

  4. Len, Thank you for your relentless efforts to educate the public. So many of my patients have a story similar to Julia’s. So many times mothers ask me, “Why haven’t I heard of vision therapy before?” I am hoping the day will come soon that I don’t hear that question anymore. My greatest wish is to help these kids before they’ve come to believe that they’re stupid or defective.

    Keep up the great work!

  5. Len, I just had a “Julia” moment today at the office. I saw, Connor, a 4 year old boy with such severe speech and articulation problems that it was easy to mistake him for a child with severe developmental delays. Well…he has an intermittent right esotropia (inward eye turn for those non-Optometrists out there). His mother has taken him to the “big” pediatric ophthalmologists who said glasses would be a waste of money and that he needs immediate eye muscle surgery.
    Two interesting things happened – first, I figured out Connor’s speech pattern, and though tough to understand, we was basically on age level. Second, he was a +5.00 hyperope! I put some lenses on him and everything changed. Connor could even do steps unassisted for the first time. We’ll combine lenses with some vision therapy and this kid is going to do just great. The mother was so happy that she called a friend from our parking lot and insisted they bring their child in for an exam (which has already been scheduled).
    Keep up the great work with your blogs. It is worth fighting the fight – there are lots of Connors and Julias out there.
    -Rob Fox

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