In the study of disease, often it is useful to explore the extreme in order to understand the significance of a disorder and it’s impact on human potential even when it exists in a less recognizable form.
For example, while attending optometry school the modern-day optometry student, early in their clinical training, will be presented with samples photos and video of eye conditions that depict an ocular disease with graphic exaggerations of what could be seen in clinical practice. Therefore, portraying the extreme condition helps to sensitize the future doctor to the importance of recognizing these conditions early. In this way the quality of patient care is greatly improved when the doctor is able to catch the problem early, when there is a more subtle and less obvious clinical presentation, provide the appropriate care before the problem becomes “full-blown” and thus help to provide a better future for the patients vision and quality of life.
Let’s take for example an ocular disease known as a corneal ulcer. The student doctor in training will often see many samples of eyes with extreme variations of corneal ulcer. Yet it is understood that when the condition is recognized early and the correct treatment is prescribed, the condition will unlikely erode into this exaggerated condition.
Now, if you are a regular visitor to The VisionHelp Blog you already know that vision problems, known as binocular vision problems, exist in children and adults, causing significant problems for the patient even though they may be quite capable of seeing 20/20. A fairly common binocular vision problem, known as Convergence Insufficiency occurs in 1 in 12 and can be detected by doctors early in its clinical presentation in children when the eye examination findings are not so severe and the child has not had to struggle with the effects of the condition for that long.
In the case of Convergence Insufficiency one test that is fairly easy to administer is called a Near Point of Convergence Test. In this case the doctor holds a target like a pencil tip or pen light in front of the bridge of the patient’s nose (on their midline) and moves it closer to their eyes asking them to tell when they see the object go double. The norms for this test show the diagnosis of CI can be applied when the patient reports double at 5-7 centimeters from the bridge of the nose.
However, to convey this better…let’s show an example of an extreme condition of Convergence Insufficiency as a catalyst for teaching…
While this is an example of an extreme, it is not too late for Breanna. Within a short period of time and the appropriate treatment involving office-based doctor supervised optometric vision therapy she begins to gain control and her binocular vision. Let’s take a look at Breanna this time after having completed only a portion of her prescribed treatment plan but well on her way to successful conclusion.
While at age 15 Breanna had to endure her binocular vision problem for much longer than necessary, fortunately her primary care optometrist who saw her for the first time referred her immediately. However, prior to her doctor’s referral Breanna had to endure a vision problem in spite of the fact that she had 20/20 eye sight!
As we now enter August’s National Children’s Vision and Learning Month, it is critically important that doctors, teachers and parents recognize the developmental vision problems like the binocular vision dysfunction of Convergence Insufficiency before they become the extreme. This patient-video submitted into The Visions of Hope campaign, Mackenzie says it best –20/20 Is Not Good Enough…For Me!
Dan L. Fortenbacher, O.D., FCOVD