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 here. CI 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